Latest / ContraMinds Podcast - Unlocking Personal Growth and Professional Excellence / Rajat Kumar Agarwal on Transforming Medical Outcomes With Knowledge Centric IT Platforms (#041)

Transcript

Rajat Kumar Agarwal on Transforming Medical Outcomes With Knowledge Centric IT Platforms (#041) · ContraMinds Podcast - Unlocking Personal Growth and Professional Excellence

• 0:00
  SPEAKER_00: We have patient monitors almost in every hospital in the country.
• 0:05
  SPEAKER_00: But you'll be shocked to know that maybe less than 1%, maybe even lesser, of them are actually networked to the system which the doctor is actually using to make decisions.
• 0:19
  SPEAKER_00: Right?
• 0:20
  SPEAKER_00: So you have so much of data being generated.
• 0:22
  SPEAKER_00: Everybody is looking at those beep, beep, beep.
• 0:25
  SPEAKER_00: But who's consuming it?
• 0:26
  SPEAKER_00: The nurse who's standing there, and if she's busy, then that data is not even coming through.
• 0:41
  SPEAKER_02: Hi Rajit.
• 0:42
  SPEAKER_02: Thanks a lot for uh accepting my invitation and uh lovely talking to you.
• 0:47
  SPEAKER_02: Welcome to Contramise.
• 0:49
  SPEAKER_00: Thank you so much, Swami.
• 0:51
  SPEAKER_00: It's I was looking forward to this.
• 0:54
  SPEAKER_02: Uh so Rajat, I uh straight away want to uh dive into the conversation where uh uh when I went through what uh you know Jagriti uh uh you know you know you know health platforms does, it just amazed me in terms of how you've gone about building it, uh, the kind of work that gets done.
• 1:15
  SPEAKER_02: So can you walk me through where did this all start?
• 1:20
  SPEAKER_02: And uh, you know, was it in college?
• 1:22
  SPEAKER_02: Was it in some kind of uh uh you know early uh engineering college passion that you guys started this?
• 1:30
  SPEAKER_02: So can you talk to me about where did all this start?
• 1:35
  SPEAKER_00: Yes, so uh, you know, uh we are all engineers, and uh engineering college is a fantastic place.
• 1:44
  SPEAKER_00: I was being I received my training in electronics and communication engineering, but our campus at MS Ramea is a very vibrant place, and we had a lot of interaction between branches, we had friends all over.
• 1:58
  SPEAKER_00: So in 2004, we came across this fantastic uh technology uh uh built upon uh Linux Apache MySQL PHP stack, which is called Drupal.
• 2:10
  SPEAKER_00: It's basically something that some people use to make websites, others use it for a variety of things.
• 2:16
  SPEAKER_00: So during our college days, we started a small organized, or there was a small organization.
• 2:22
  SPEAKER_00: I'm sorry, I don't want to say started.
• 2:25
  SPEAKER_00: Is it okay if I interrupt like this?
• 2:28
  SPEAKER_00: I just want to make sure.
• 2:30
  SPEAKER_05: Perfect.
• 2:31
  SPEAKER_05: Perfect.
• 2:32
  SPEAKER_00: Okay, so during our college days, I was part of an organization named Sankalp India Foundation, which was looking to have its own web portal, uh which was interactive.
• 2:44
  SPEAKER_00: So those were the orchid days.
• 2:46
  SPEAKER_00: The organization wanted conversation to happen, not just put things out there for people to read.
• 2:52
  SPEAKER_00: So that's when in one of the tech meets, we decided to get our hands dirty with this new tool called Drupal, and we fell in love with it.
• 3:03
  SPEAKER_00: We realized the power of being able to put up information on a at that time people didn't call it cloud, but yes, servers elsewhere, which was accessed through WWW.
• 3:15
  SPEAKER_00: And that's what got us hooked on.
• 3:17
  SPEAKER_00: A couple of years later, we graduated and we went on to serve several uh major technology firms, mostly in electronics and communication.
• 3:28
  SPEAKER_00: Nevertheless, we continued to play around with information technology and uh web-based applications, mainly for Sankal Pandya Foundation.
• 3:37
  SPEAKER_00: At one point in time, we had uh friends from healthcare approaching us and telling us how frustrated they are with the systems they had and requesting us to try and do something about it.
• 3:50
  SPEAKER_00: So that conversation moved on, and that's what eventually led to Jagriti.
• 3:55
  SPEAKER_02: So, what was uh Sankal Foundation all about?
• 3:59
  SPEAKER_02: And uh uh so where did this thing to actually uh you know start something called a Sankal Foundation and what is its connection with healthcare systems?
• 4:11
  SPEAKER_00: So uh one summer night, four engineering students decided to have a cup of tea.
• 4:19
  SPEAKER_00: The only place you get tea at that hour is actually the emergency section of the hospitals.
• 4:25
  SPEAKER_00: So they jumped off of their hospital gate and they rushed to the emergency section.
• 4:31
  SPEAKER_00: And while they were enjoying their tea, a very lean person came and literally started begging them to donate blood.
• 4:40
  SPEAKER_00: They were taken aback, they were shocked.
• 4:42
  SPEAKER_00: How can somebody be looking for blood on the streets in a city which has thousands of young people around, in a campus which has hundreds of students?
• 4:53
  SPEAKER_00: So these four young people decided to go in and donate blood immediately, but by the time they came out, the patient had not survived.
• 5:02
  SPEAKER_00: Now there could be various reasons why the patient died, but they thought it was not right for the family to be struggling to find blood on the streets.
• 5:11
  SPEAKER_00: So next morning they went to the blood bank medical officer and said, See, next time you send somebody out looking for blood, instead give them our contact number and we'll see what we can do.
• 5:23
  SPEAKER_00: This was the beginning of Sankal, and then the organization continued to serve the cause of voluntary blood donation.
• 5:30
  SPEAKER_02: So, this whole thing around uh when I look at the history of Jagriti, uh, you actually have built a blood uh management system, right?
• 5:40
  SPEAKER_02: Blood bank management system.
• 5:42
  SPEAKER_02: So, uh, what was the need for a blood bank uh management system and why was this very important in just not you know doing something by giving blood?
• 5:51
  SPEAKER_02: But why is this blood bank management system so critical to one of the aspects of how you have built the uh you know the BMT plus platform, which I'll talk about later?
• 6:02
  SPEAKER_02: But how uh why is the why was this so important?
• 6:06
  SPEAKER_00: Right.
• 6:06
  SPEAKER_00: So uh you know the central word here is quality and quality in practice.
• 6:16
  SPEAKER_00: So before we started work on e-blood banking, which was our first platform, blood banking was largely based upon papers and registers.
• 6:28
  SPEAKER_00: So the whole information set, like it used to be in every field, was totally driven by papers.
• 6:35
  SPEAKER_00: The unfortunate side of it is that it does not make use of the information which is already available with the organization to improve itself.
• 6:46
  SPEAKER_00: So you keep filling up registers, you keep filling up forms, and you have stacks of them, but how does it contribute to organizational growth?
• 6:54
  SPEAKER_00: So Sankalp as an organization had at that time actually seven platforms through which it orchestrated quality in each aspect of its work.
• 7:07
  SPEAKER_00: So the organization was using it to schedule blood donation drives, it was using it to manage emergency blood requests, it was using technology to manage funds, and the blood banks actually got extremely excited at the amount of productivity and quality increase that they could see with a small NGO using a software system built by people for their own sales.
• 7:33
  SPEAKER_00: So that's where the marriage happened.
• 7:35
  SPEAKER_00: They wanted something that would bring about transparency, accountability, and most importantly, quality.
• 7:43
  SPEAKER_00: You know, we uh each blood bag can either save a life or also cause harm.
• 7:51
  SPEAKER_00: To maximize the first and minimize the second, you need to cut down the errors which can silently happen through the long process that takes place between collection and delivery of blood.
• 8:04
  SPEAKER_00: So that's where we thought uh we can apply technology and uh improve quality of collection.
• 8:11
  SPEAKER_03: I think it's really interesting that you've uh graduated from MS Ramaya because MS Ramaya has a thriving culture of design uh over the last 10, 12 years.
• 8:21
  SPEAKER_03: So it's got an immensely popular design program.
• 8:24
  SPEAKER_03: So I I just I'm just really interested to connect those two threads and ask uh, you know, what are some lessons that you've learned uh actually marrying you know deep technical expertise with uh solving human-centric problems in something as complex and as human as healthcare?
• 8:44
  SPEAKER_00: Right.
• 8:44
  SPEAKER_00: So the first and the most important thing we learned is to keep things simple.
• 8:50
  SPEAKER_00: You know, uh we sometimes make fantastically complicated systems which promise to do enormous things, but eventually at the end of the day, you find users struggling and people struggling to prove the outcome.
• 9:04
  SPEAKER_00: So the first thing is we used to recruit young volunteers, 18, 19 years old, people who give you only a little amount of time.
• 9:13
  SPEAKER_00: Even they should feel uh interested in using this technology.
• 9:19
  SPEAKER_00: When you substitute a process with a technical process, it's not uh the the primary user, the person who's facing technology, should have not just comfort but excitement to use it.
• 9:32
  SPEAKER_00: And that comes with simplicity, that comes with keeping in mind that this persona or this person should directly and right then benefit from using something uh which people may think is complicated.
• 9:47
  SPEAKER_00: So keeping it simple was one of the very important lessons we learned early on.
• 9:52
  SPEAKER_00: Second thing, what we learned is uh we uh adopted this uh cloud-hosted software systems logic at a very early stage.
• 10:05
  SPEAKER_00: And that is again because we wanted information to be made available to people wherever they needed it, rather than uh people having to come and struggle to find what they need.
• 10:18
  SPEAKER_00: So we've we've been mobile first now for what 15 years, and of course, the third thing that uh is very critical is you cannot build a system today and expect it to work for a long time.
• 10:34
  SPEAKER_00: That's not how the world works.
• 10:36
  SPEAKER_00: So, whatever you build, it has to have the innate capability to take the shape and form of your work as you change rules, as you decide what you want to do, the system should adapt.
• 10:50
  SPEAKER_00: So we never really had a release system which would give you one or two or three releases only.
• 10:56
  SPEAKER_00: We we've always had systems which very quickly adapt to the changes in the real world.
• 11:02
  SPEAKER_00: Once you put these three things together, really, and this is something we learned after having gone through uh major transitions from paper to software systems, then you have users who are excited from day one and they become the people who come back saying what they need, and then everything that you are offering from technology becomes relevant and useful immediately.
• 11:27
  SPEAKER_03: Right.
• 11:27
  SPEAKER_03: That's that's super interesting because the next question I have as a follow-up is you know, SaaS is all the rage in India, FinTech is all the rage in India.
• 11:36
  SPEAKER_03: So, a question that I have is that when you look at an economy where there's a lot of talk about startups in fintech, SaaS, etc., how does building products in healthcare really differ in terms of effort, output, and success?
• 11:51
  SPEAKER_03: Because you see all the outliers being uh promoted a lot in multiple publications from SaaS and FinTech, but very rarely do you see the kind of breakthroughs that come in in the healthcare space as far as technology is concerned.
• 12:06
  SPEAKER_03: So, can you talk about what are some unspoken complexities that you have to deal with in building products in the healthcare space?
• 12:13
  SPEAKER_00: Absolutely.
• 12:14
  SPEAKER_00: So, you know, one of the highest resistance to technology adoption uh that you can see is in the healthcare setup.
• 12:23
  SPEAKER_00: One of the reasons that comes through is uh traditionally healthcare is a very sort of people expect it to be fail-safe, people expect it to be available all the time.
• 12:34
  SPEAKER_00: And I believe there's a huge mismatch uh in the thought leaders in the healthcare space and the technical space.
• 12:42
  SPEAKER_00: The two worlds seem to be looking in completely uh divergent directions.
• 12:48
  SPEAKER_00: While people talk a lot about uh the capabilities of artificial intelligence to mine things and get things done in healthcare space, if you look at fundamental things like the user interfaces which are being used in hospitals, they still seem to be coming from age-old era.
• 13:08
  SPEAKER_00: And so that's one of the major issues.
• 13:12
  SPEAKER_00: Now, why that issue?
• 13:14
  SPEAKER_00: Uh perhaps it's easier to start things and kill them in other spaces compared to healthcare.
• 13:20
  SPEAKER_00: If you start using something, there is a need to maintain that data for a long period of time because it has implications on what happens in the future.
• 13:29
  SPEAKER_00: Now, many people either don't have the comfort with their providers or they've had bad experiences where they started using something and it didn't really uh translate into a long-term gain, and that's why adoption is a major, major challenge.
• 13:47
  SPEAKER_00: People still continue to use what was working 10 years back and live with suboptimal systems rather than open up and experiment with what is fresh and new.
• 13:56
  SPEAKER_00: The third and the most important problem is you know, uh, in medicine, it is extremely important to prove outcomes.
• 14:08
  SPEAKER_00: So uh any any drug we take, any lab investigation we take, it goes through a scientific review process and it proves its worth, and that's when it is introduced to the market.
• 14:19
  SPEAKER_00: It is a more conservative space as an industry itself.
• 14:24
  SPEAKER_00: Now, what we have experienced is that a lot of technology uh that is uh being created in the space comes with a lot of promise, but very little evidence supporting it.
• 14:35
  SPEAKER_00: And there is a mismatch in terms of the scientific rigor to prove the capabilities and outcome that you're promising to the customer.
• 14:46
  SPEAKER_00: So these are all different challenges that healthcare industry faces.
• 14:51
  SPEAKER_00: Of course, uh the fourth one is I believe there is still a long way to go for our doctors to accept and realize that technology is an assistant, a very capable assistant available to them.
• 15:10
  SPEAKER_00: Even in the best of hospitals in the country, you'll find that the doctor is using the system minimally.
• 15:16
  SPEAKER_00: They mostly have a data manager or an assistant who's doing the job on the computer.
• 15:21
  SPEAKER_00: So it's a one-way traffic.
• 15:23
  SPEAKER_00: Basically, instead of paper, you are giving instructions through a data manager.
• 15:28
  SPEAKER_00: But then where is the whole benefit of that system giving you feedback and allowing you to titrate things?
• 15:35
  SPEAKER_00: So that is another challenge.
• 15:38
  SPEAKER_02: So uh Rajat, I have uh interesting follow-up questions on this.
• 15:42
  SPEAKER_02: Uh, one follow-up question I have on this is so when did this engineer become so knowledgeable about the medical profession?
• 15:52
  SPEAKER_02: That's you.
• 15:56
  SPEAKER_00: So uh I'm not sure uh uh I'll say I'm knowledgeable about the profession, but I will surely say that I'm quite enthusiastic about the profession.
• 16:06
  SPEAKER_02: No, let me let me let me let me put it this way.
• 16:09
  SPEAKER_02: Uh how did you learn this domain?
• 16:11
  SPEAKER_02: Because you are an engineer, you you started off by saying I'm an electronics engineer, and now you actually have something where you have to understand the medical domain to even do what you are saying uh what you are doing right now.
• 16:24
  SPEAKER_02: So, how did you go about picking up the knowledge in this domain?
• 16:27
  SPEAKER_02: And why do you think the importance of domain knowledge is important when you start building systems?
• 16:35
  SPEAKER_00: Right.
• 16:35
  SPEAKER_00: So in a way I was very fortunate uh to be able to see things first hand and uh absorb them in a way that the user sees them.
• 16:48
  SPEAKER_00: Uh, before we built e-blood banking, I would have got an opportunity to spend a couple of thousand hours around the people who work in blood banks, see their first-hand frustrations, and not just that, have very honest conversations with them.
• 17:09
  SPEAKER_00: So I knew at that time what are the challenges that a nurse faces, what are the challenges that a technologist faces, and what is the view of the administrator.
• 17:20
  SPEAKER_00: In fact, I also knew what are the challenges that the housekeeping faces are.
• 17:25
  SPEAKER_00: And that happened because of my relationship with Sankalp, which gave me that uh jump start to be able to closely work with people.
• 17:34
  SPEAKER_00: But the same thing when I look back, I think for every single platform that we have developed, we have consciously invested in first just being there in some of the setups while people are working, silently watching them and understanding what is happening.
• 17:52
  SPEAKER_00: And then build that relationship with them where they are able to express in a very human way uh what is their view of how things are moving around and how things could be done in a better way.
• 18:05
  SPEAKER_00: That of course is uh, I believe, uh irreplaceable.
• 18:10
  SPEAKER_00: Like I said, so at the end of the day, if your users, if each of the users who is going to interface with your system doesn't feel a wow factor on the first day of using the system, then you already have a very, very uphill task to engage one person to get somebody else excited in the organization.
• 18:34
  SPEAKER_00: And that that never lasts, that never works.
• 18:37
  SPEAKER_00: So uh, yes, investing time and energy into understanding every persona and understanding what makes them frustrated, what gives them joy, what would they like to see change, uh gives you a huge jump start.
• 18:55
  SPEAKER_02: So uh this is something that uh definitely your engineering education would not have taught you, right?
• 19:02
  SPEAKER_02: So uh so where did you pick this up?
• 19:06
  SPEAKER_00: So we often say that probably the first thing engineering taught us was problem solving.
• 19:16
  SPEAKER_00: Engineering makes us all a little more analytical and uh uh capable of looking at things in a very uh uh evidence-based way, and that's quite helpful.
• 19:28
  SPEAKER_00: So, again, you know, uh Sankalp has this very beautiful culture of reviewing everything it does.
• 19:37
  SPEAKER_00: So when people uh when even volunteers spend a day together, that day doesn't end without half an hour being spent to see what could have been done better.
• 19:47
  SPEAKER_00: It might be the most disastrous day or it might be the best day, but still people ask each other how to do things better next time.
• 19:57
  SPEAKER_00: And this process uh of course leads to a discovery of a lot of uh uh nuances about the issue, and then some people, uh, I was fortunate to be one of them, get excited about these problems, find a lot of joy in trying to see how to systematically eliminate them rather than just have a sort of a uh one-time view of people, a selected group of people respond differently to this problem.
• 20:30
  SPEAKER_00: So that that that is what hooked me into this.
• 20:35
  SPEAKER_00: So that's how the engineer started thinking more and more about the problems, and those problems happen to be healthcare and dug deeper into it.
• 20:45
  SPEAKER_03: So I'm I'm curious to know, did you study uh you know in the early days how uh products that are designed by American, European, or Japanese companies uh in the healthcare sector solving specific problems?
• 21:00
  SPEAKER_03: Did you did you have a look at that and what did it inform you?
• 21:03
  SPEAKER_03: What were your takeaways from it?
• 21:06
  SPEAKER_00: Uh so I never studied any of it.
• 21:12
  SPEAKER_00: And I got to understand that there are things you can study to do all of this much later uh when we had our products out, and when in fact we had some uh gurus, I must say.
• 21:26
  SPEAKER_00: Uh so we uh I was very fortunate to work with uh one, Dr.
• 21:30
  SPEAKER_00: Lawrence Faulkner.
• 21:32
  SPEAKER_00: So he's a trained doctor, but I think he was born to be an engineer.
• 21:38
  SPEAKER_00: And I happened to work with Mr.
• 21:40
  SPEAKER_00: Arend Prasad, who's again a thought leader.
• 21:43
  SPEAKER_00: So these people, uh gurus who came in at a much later stage, really, uh, are the ones who uh uh opened up the world in the sense uh tell us what other people are doing, and then we could look back at our systems and see where we had reached.
• 21:59
  SPEAKER_00: But Till then we were growing very organically.
• 22:03
  SPEAKER_00: The interesting part, in fact, is that we realized that a lot of uh best practices and the right rules kind of things were organically built into our products just because that was the best way to approach that problem.
• 22:21
  SPEAKER_00: So we would have failed, learned, uh read something uh possibly on a mobile phone or in a net cafe at that time.
• 22:30
  SPEAKER_00: But uh yes, uh I we didn't formally study that or receive any training.
• 22:36
  SPEAKER_03: So uh so that's that's really interesting because when you went uh I think when you move ahead you start seeing similar products that come into the space and stuff like that.
• 22:45
  SPEAKER_03: So my follow-up to that question would be when you consider doing when you consider designing product solutions uh in the healthcare space for India, for example, how does that solution differ from when you are designing it, say for example, an American market?
• 23:04
  SPEAKER_03: What are the constraints uh that you have to work with in an Indian context to vis a vis the uh or versus the cont the constraints or the no constraint or the unconstraint uh uh effort that you might have to put in to build a product uh for a Western market or something?
• 23:21
  SPEAKER_03: What are the differences?
• 23:23
  SPEAKER_00: Right.
• 23:24
  SPEAKER_00: So um let's start with the Indian market.
• 23:27
  SPEAKER_00: The principal problem that I see in India, uh, of course, the opportunity sides are numerous, but the principal problem here is that uh I believe not many people are able to really uh uh assess the value of a software system, right?
• 23:46
  SPEAKER_00: So there's one system and there'll be another copy in any uh shortest possible time, and people make decisions purely on the cost of the product.
• 23:56
  SPEAKER_00: There's very little investment into what it actually changes on the ground.
• 24:01
  SPEAKER_00: And uh a vast majority of health tech decisions in our country are really made for the administration, not for the doctors, not for the nurses, and mostly not even for the patient.
• 24:21
  SPEAKER_00: So they are essentially reporting and feeding tools to top-level management, not really systems which can change the experience of delivery in a fundamental way.
• 24:32
  SPEAKER_00: So those are the two uh major challenges that we see in the Indian market.
• 24:37
  SPEAKER_00: In the Western market, you if you leave US and you look at all the other spaces, they are again living in stone age when it comes to health tech.
• 24:53
  SPEAKER_00: So we we visited several different countries to assess what kind of technology are they using and what are the capabilities, and we were shocked.
• 25:04
  SPEAKER_00: We had frustrated doctors, frustrated nurses, each one of them very, very enthusiastic about moving forward, but working with systems which uh in 2020 we had a hospital which was working on a HIS which was deployed in 2001.
• 25:22
  SPEAKER_00: Zero mobile capabilities, you can access data only from within the institution, and it comes with so many restrictions that at the end of the day, any of the innovations are basically ruled out.
• 25:36
  SPEAKER_00: People are just letting things continue the way they are.
• 25:39
  SPEAKER_00: US, of course, is fundamentally different.
• 25:42
  SPEAKER_00: That's the market which where uh all the innovation in health IT is happening and adoption is very, very quick.
• 25:50
  SPEAKER_00: And really, that's the space where you have to really put value on the table to be able to move forward.
• 25:56
  SPEAKER_02: So uh you talked about uh Lawrence, Dr.
• 25:59
  SPEAKER_02: Lawrence Faulkner, right?
• 26:01
  SPEAKER_02: Uh, where you said here is a doctor who could have as well been an engineer.
• 26:07
  SPEAKER_02: And at some point in time, you talked about uh, you know, uh really managing quality.
• 26:13
  SPEAKER_02: Uh so walk me through uh what was the learning when you started working with uh Dr.
• 26:20
  SPEAKER_02: Lawrence Faulkner and how did you incorporate that learning into many of the uh system design principles that you started putting?
• 26:29
  SPEAKER_02: Because what I really know is BMT Plus is probably one of the world's first uh you know systems to manage uh thalissemia.
• 26:40
  SPEAKER_02: And the fact that what did you learn there and how did you then make it user-centric?
• 26:47
  SPEAKER_00: So uh Dr.
• 26:51
  SPEAKER_00: Lawrence Faulkner happened to be attending a wedding in Madurai, and for which he was crossing Bangalore, and he had a flight the next morning, so he was staying in a hotel in uh next to the airport, and uh somebody introduced us to him, saying, There's a doctor from Italy who knows a lot about thalassemia.
• 27:11
  SPEAKER_00: You guys speak about thalassemia, why don't you go and meet him?
• 27:15
  SPEAKER_00: So uh that dinner conversation is what we call now love at first sight.
• 27:22
  SPEAKER_00: He liked us, we liked him, and he decided to come to one of our daycares.
• 27:27
  SPEAKER_00: Now, this daycare was in a government hospital with a lot of restrictions and limitations, as you can imagine.
• 27:34
  SPEAKER_00: Nevertheless, this daycare center was using high health tech to deliver very basic treatment.
• 27:42
  SPEAKER_00: So, all that it was doing is crunching data on patients' past history to decide what should be the next treatment steps.
• 27:50
  SPEAKER_00: When Dr.
• 27:51
  SPEAKER_00: Faulkner looked at it, he had the big ideas in mind and he started conversing with us.
• 27:59
  SPEAKER_00: Bone marrow transplantation is one of the most critical medical procedures, unlike a surgery which lasts for a couple of hours.
• 28:12
  SPEAKER_00: Here, there is a life at risk for several weeks.
• 28:16
  SPEAKER_00: The patient is immunocompromised compromised, and for a long period of time, you have to look and anticipate a lot of problems and try and avoid them.
• 28:27
  SPEAKER_00: So he is the global specialist for transplantation in thalassemias, and at that time he was very keen to bring this first world procedure to countries like ours.
• 28:42
  SPEAKER_00: Of course, we already had some transplantation centers working, but for thalassemia at that point in time, still many patients were actually traveling to Europe to get a transplant, and that was because of cost, it was because of outcomes, several different factors.
• 28:59
  SPEAKER_00: So the principles that he made us understand was that the outcome does not necessarily depend upon how qualified and competent your doctor is, the outcome depends upon those hundreds and thousands of small transactions that happen with the patient on a daily basis.
• 29:25
  SPEAKER_00: Every single time a drug is delivered to a BMT patient, if that drug is not delivered right, the patient can get infected with an antibiotic resistant bug and die.
• 29:39
  SPEAKER_00: So he switched the table around from when we think of complicated procedures, high-end stuff, we think about experts.
• 29:46
  SPEAKER_00: He switched the table around and really drove the idea that it is really the entire care mapping which really matters.
• 29:56
  SPEAKER_00: And having seen this system being used in a daycare, he inspired us and guided us into working on BMT Plus.
• 30:06
  SPEAKER_00: How BMT Plus differs when it comes to treatment planning is that first of all, even with the initial few organizations where we work, we were able to create a clinic which was practically paper-free.
• 30:24
  SPEAKER_00: He loves to joke that the only place where a paper belongs in a bone marrow transplant unit is probably the toilet.
• 30:35
  SPEAKER_00: So uh now what happens when you make the system completely electronic, when the housekeeping nurse and the doctor, everybody is using an electronic system.
• 30:46
  SPEAKER_00: So immediately there's transparency, immediately there's enhanced communication, but most importantly, each role, each role has a stake in the outcome.
• 30:59
  SPEAKER_00: So BMT Plus was designed not for the sophisticated procedure to be done.
• 31:05
  SPEAKER_00: It was designed to make sure that hydration is well managed while the patient is inside the hospital, that each drug is being taken care of well, that the nurses are able to make sure that in a busy shift, when there are so many things to do, they are getting assistance in prioritizing what matters over the other things.
• 31:27
  SPEAKER_00: The housekeeping is able to understand what is the priority for the day if I have a patient who has a very infectious condition on the floor.
• 31:37
  SPEAKER_00: So it was a completely different approach, ground upwards, ensuring that every single component of care finds its rightful place on the technology space.
• 31:50
  SPEAKER_00: And thereby you first strengthen the base and then move upwards to the degree that immediately in front of you, you are able to go from seeing the ins and outs, how much of P somebody has made a couple of hours back, to be able to do outcome analysis.
• 32:10
  SPEAKER_00: That whole spectrum from bottom to top is something that uh we built as part of one single platform available through any internet available, any internet-enabled device.
• 32:23
  SPEAKER_00: That that's what was uh a very unique experience uh and where his uh his drive and his uh understanding of what actually mattered helped us design a system which actually then went on to solve problems for a large number of organizations.
• 32:46
  SPEAKER_03: Yeah, so I'm gonna ask you a very, very basic question.
• 32:50
  SPEAKER_03: And uh my very basic question is this what is a system?
• 32:54
  SPEAKER_03: Because we've been talking about system this, system that, etc.
• 32:57
  SPEAKER_03: etc.
• 32:58
  SPEAKER_03: But if we had to break it down to its absolute basics, what is a system?
• 33:04
  SPEAKER_00: Right.
• 33:05
  SPEAKER_00: So uh when I'm saying system, I'm actually referring to a cloud-hosted application.
• 33:12
  SPEAKER_00: This is a uh like we have SaaS models, there's a software available on the cloud.
• 33:18
  SPEAKER_00: Each person, part of the organization, has their username and password to log into it.
• 33:24
  SPEAKER_00: But the difference in the system that we are talking about is it is a system which is designed to be a platform rather to than a monolith.
• 33:34
  SPEAKER_00: For example, yeah, let me.
• 33:36
  SPEAKER_03: I'm sorry, really, I'm really sorry for interrupting you.
• 33:38
  SPEAKER_03: But the reason I asked this is because uh I think a large swath of uh what we understand as the technical capabilities of what a system is, is very different from what we understand as a system.
• 33:52
  SPEAKER_03: Because on one end, you have the platform, then you have a person, or you have the healthcare provider, then you have the administrator.
• 34:00
  SPEAKER_03: So when you take all of that into account, so can you talk a little bit about how you visualize a system in terms of not just the product and the solution, but in terms of the entire ecosystem of people, stakeholders, services, care, progress in a certain sense?
• 34:18
  SPEAKER_03: Can you just encompass that in terms of what a system?
• 34:21
  SPEAKER_00: Let me try to do that.
• 34:22
  SPEAKER_00: I'll speak a little and then let's see if we are getting what we're looking for.
• 34:26
  SPEAKER_00: Yeah, so you know, uh, we often look at care delivery in bits and pieces.
• 34:32
  SPEAKER_00: But what we try to look at is something called knowledge management.
• 34:38
  SPEAKER_00: So the any organization will accumulate data, it'll have people working, it'll have processes that it has, and all these things should come together to create knowledge, and then that knowledge should feed back into the organization and drive its growth.
• 34:53
  SPEAKER_00: Unfortunately, most of the time these things get looked into in silos.
• 35:00
  SPEAKER_00: So you have a data collection system and a team, and then there are processors, and then there are people who make decisions, all of them are segregated.
• 35:09
  SPEAKER_00: And like we discussed, so we don't really account for all the people who are involved at different levels.
• 35:16
  SPEAKER_00: Many times uh we build systems with uh IT first priorities rather than procedure first priorities.
• 35:24
  SPEAKER_00: So when we look at system, we really see it like this: there's a working clinic, there are doctors, there are nurses, there are papers, and they are all doing their stuff.
• 35:34
  SPEAKER_00: Now, when you are looking at bringing transformation, you have to ask what is the biggest problem to solve for these people?
• 35:43
  SPEAKER_00: What is it that matters to them?
• 35:46
  SPEAKER_00: And then try and figure out how do you move about it.
• 35:50
  SPEAKER_00: In our case, what we put in place is a very, very agile cloud-hosted application, which is put in place, and then each one of the personas, each one of the user groups, their priorities, their concerns, their interests are taken into account to build what they need out of this place.
• 36:17
  SPEAKER_00: One thing that happens throughout this process is that we try and make sure that each piece of data which is being collected from all these.
• 36:28
  SPEAKER_00: So I'll give you a typical example.
• 36:30
  SPEAKER_00: We have patient monitors almost in every hospital in the country.
• 36:36
  SPEAKER_00: But you'll be shocked to know that maybe less than 1%, maybe even lesser, of them are actually networked to the system which the doctor is actually using to make decisions.
• 36:50
  SPEAKER_00: Right?
• 36:50
  SPEAKER_00: So you have so much of data being generated, everybody is looking at those beep, beep, beep.
• 36:55
  SPEAKER_00: But who's consuming it?
• 36:57
  SPEAKER_00: The nurse who's standing there, and if she's busy, then that data is not even coming through.
• 37:02
  SPEAKER_00: So while we work on the personas as we interact with people, we ensure that the data that is being collected either through people or through other modes, directly from equipment, from a service provider who's providing you services, from an access controller into your unit.
• 37:21
  SPEAKER_00: So all this data is being collected and structured in a way which then can be used to improve services.
• 37:28
  SPEAKER_03: Understood.
• 37:29
  SPEAKER_03: Understood.
• 37:30
  SPEAKER_03: So I think it's super interesting when we use the term knowledge management.
• 37:34
  SPEAKER_03: I think it's super interesting because my follow-up question to that is having worked with so many stakeholders across the system, uh, in your experience, how does a how does a doctor view data?
• 37:46
  SPEAKER_03: I'm I'm asking this very specifically because, for example, I watch a lot of sports.
• 37:52
  SPEAKER_03: Okay, so the new trend in sports is after a match, the athlete or the sportsman uh is actually given a packet of performance analytics.
• 38:02
  SPEAKER_03: Okay, so post-match they'll say how much they ran, what was their heart rate, etc.
• 38:07
  SPEAKER_03: etc.
• 38:08
  SPEAKER_03: They have their entire stats.
• 38:09
  SPEAKER_03: So when the game was at a certain pitch, what was their uh heart rate at that, and then when they are not running very fast and the game is in their control, or they have 80-90% possession of the ball, how was their formation, etc.
• 38:22
  SPEAKER_03: etc.
• 38:22
  SPEAKER_03: in the context of the team, in the context of their individual performance, etc.
• 38:27
  SPEAKER_03: So there's data within data, there's stats within stats.
• 38:30
  SPEAKER_03: So they get to analyze their performance at a very deep level.
• 38:33
  SPEAKER_03: So, how do you visualize the future where doctors have access to that kind of data?
• 38:38
  SPEAKER_03: And when they have access to that kind of data, uh, how will they interact with it?
• 38:42
  SPEAKER_03: Is a question I have.
• 38:45
  SPEAKER_00: Right.
• 38:46
  SPEAKER_00: So healthcare is very different.
• 38:49
  SPEAKER_00: I believe the person delivering food to your doorstep has more analytics around his actions than a doctor in any of the reputed hospitals in our country.
• 39:00
  SPEAKER_00: And that's that's really a sad reality.
• 39:04
  SPEAKER_00: So uh there are two sides.
• 39:07
  SPEAKER_00: Unfortunately, uh the only real time where most people would look at data is when they are trying to summarize something to present to their colleagues.
• 39:18
  SPEAKER_00: Never as really part of their day-to-day work, never really as a review of the previous day's outcomes or whatever is happening around them.
• 39:28
  SPEAKER_00: So we've we've built a healthcare model uh where which um I should uh maybe speak a little about how aviation changed.
• 39:37
  SPEAKER_00: So aviation at one point in time used to be led by superheroes, and those superheroes could never make mistakes.
• 39:46
  SPEAKER_00: These were the pilots, the big bosses in the room.
• 39:50
  SPEAKER_00: And then we had terrible crashes.
• 39:55
  SPEAKER_00: Fortunately in healthcare, we uh sorry, fortunately in aviation, they did a very, very good job at reviewing what went good and what did not go good.
• 40:05
  SPEAKER_00: And I believe they call it cockpit resource management today.
• 40:08
  SPEAKER_00: One of the lessons they learned is that everybody can make mistakes.
• 40:12
  SPEAKER_00: Everybody has a role to play to get good outcomes.
• 40:17
  SPEAKER_00: Let me just ask: so when you think of a good hospital, do you think about the nurses?
• 40:25
  SPEAKER_00: General answer is we never think about the nurses, we never think about the housekeeping, we never think about the maintenance engineer who's ensuring that distilled water is being supplied and good quality oxygen is being supplied.
• 40:37
  SPEAKER_00: We choose healthcare only based upon the doctors.
• 40:42
  SPEAKER_00: This model makes the doctor a superhuman beyond review, and a person who cannot be uh sort of uh participating in things like uh review of actions.
• 41:01
  SPEAKER_00: And of course, uh the other reality is that our doctors are extremely busy, they are overloaded with work.
• 41:09
  SPEAKER_00: One of the differences that I see between West and in India is that uh there is more silent time available for the doctors where they have to think and produce scientific output.
• 41:23
  SPEAKER_00: Here it's all about clinic to clinic, clinic to clinic, and there's no real time for review either.
• 41:29
  SPEAKER_00: So we are we are really underutilizing in a even in an arena like healthcare, which is such a critical application, we are underutilizing data in a manner which is unbelievable in any other industry today.
• 41:45
  SPEAKER_00: Sports, of course, goes to extreme, but I wish we were doing even 1% of that, even 1%.
• 41:52
  SPEAKER_00: That that that I would think of it as a great day when we reach that level.
• 41:58
  SPEAKER_00: Understood.
• 42:00
  SPEAKER_00: And nevertheless, you know, uh our biggest challenge is bringing about an organizational transformation where gradually from this very low-tech situation we move into a situation where uh like I share sorry, like I shared with you, most doctors would prefer to have a data manager to make notes on the system.
• 42:25
  SPEAKER_00: And most of us still receive a prescription which is handwritten.
• 42:30
  SPEAKER_00: We often joke about the handwriting, but we never question why can't it simply be typed out and given in a manner that people will understand.
• 42:39
  SPEAKER_00: Right?
• 42:39
  SPEAKER_00: So there's a long way to go to get uh healthcare data analyzed and processed the way it gets done in several other industries.
• 42:50
  SPEAKER_00: The catch there is really to uh empower all the other roles and ensure that uh we create systems and processes which will look at analysis and fail.
• 43:07
  SPEAKER_00: Sorry, let me say uh one more distinguishing thing.
• 43:10
  SPEAKER_00: When somebody fails in sports, the implications generally are not as gruesome as in healthcare.
• 43:19
  SPEAKER_00: When somebody fails to deliver a parcel, the implications of that are not as bad as when you goof up in a clinical setup.
• 43:29
  SPEAKER_00: So it takes a lot more courage and a lot more strength to actually be able to review things and find the root cause and accept it.
• 43:41
  SPEAKER_00: You might have seen issues like violence against doctors.
• 43:45
  SPEAKER_00: Why can't the doctor make a mistake?
• 43:48
  SPEAKER_00: After all, it's a human working somewhere.
• 43:51
  SPEAKER_00: But we have picturized uh we still think of uh many people would say still think of doctors as gods where any mistake of This is almost looked at like a crime.
• 44:02
  SPEAKER_00: So then we are actually creating a society where the culture of hiding things and not bringing things out would take precedence over open conversations and people feeling comfortable in saying, sorry, I made a mistake.
• 44:20
  SPEAKER_00: So that's the other very distinguishing factor about healthcare, which prevents people from adopting systems which could actually help in a very major way.
• 44:34
  SPEAKER_02: Brilliant explanation of how you know how it's different from whatever Vignesh was talking about.
• 44:41
  SPEAKER_02: But tell me, Rajat, to do what you are saying, it requires a certain transformation of habits, right?
• 44:49
  SPEAKER_02: So if I'm a housekeeping person, I normally don't record whatever is being done.
• 44:55
  SPEAKER_02: If I'm a nurse, I don't record it.
• 44:57
  SPEAKER_02: If I'm somebody else, I don't record it.
• 45:00
  SPEAKER_02: So so clearly uh what I know of your system is it's probably the most complicated uh, you know, match that you do with all the data that you get, right?
• 45:12
  SPEAKER_02: So somewhere I was talking to somebody and then they said, you know, you almost uh do a uh you know HL type match with the blood that comes in, and that's the kind of sophistication you have built with ML AI in your systems and things like that.
• 45:26
  SPEAKER_02: But let me first go back and then say to get this data, there's a certain amount of habit change that's required, okay?
• 45:33
  SPEAKER_02: And that habit change then has to be simple enough for me to capture this data for giving insights.
• 45:39
  SPEAKER_02: So, how do you kind of do that?
• 45:42
  SPEAKER_02: And uh, you know, it's such a difficult change that you are uh uh you know you are actually pursuing, right?
• 45:49
  SPEAKER_00: Let me tell you a story about one of our customers.
• 45:53
  SPEAKER_00: So, if if one had to put all the hospitals in the country uh ranked as per the number of errors they make in a procedure, probably this hospital would be the worst because they record more than 1,000 errors a year in their clinical facility.
• 46:18
  SPEAKER_00: The interesting thing is more than 90% of these errors are self-reported.
• 46:26
  SPEAKER_00: So this is not somebody else identifying and reporting.
• 46:30
  SPEAKER_00: So, how how do we bring about this change?
• 46:33
  SPEAKER_00: First changes make things easy for the person to do.
• 46:38
  SPEAKER_00: So we never have a situation where somebody would be asked to duplicate things, copy from one screen to the other.
• 46:46
  SPEAKER_00: I'll give you a simple example.
• 46:48
  SPEAKER_00: If a lab report is out and the values are there, then there should be no need for somebody to copy them on a piece of paper and organize them for somebody else to be able to see.
• 46:59
  SPEAKER_00: But that's how things are happening in our situation.
• 47:02
  SPEAKER_00: So, what we do is we provide contextual personas.
• 47:06
  SPEAKER_00: The nurse gets the screen the way she likes it.
• 47:10
  SPEAKER_00: The same data is available to the next person the way they like it, the pharmacist the way they like it, the doctor the way they like it, and the housekeeping the way they enjoy it.
• 47:23
  SPEAKER_00: In fact, we had one of our centers where a housekeeping person had the highest compliance to checklists.
• 47:35
  SPEAKER_00: And he enjoyed it because it was the first time that really he his ticking of that sheet was making a difference.
• 47:45
  SPEAKER_00: You go to any of uh toilets, any washrooms, you find those sheets stuck up there.
• 47:50
  SPEAKER_00: Who cares and who bothers?
• 47:52
  SPEAKER_00: But this person knows that it matters.
• 47:56
  SPEAKER_00: So, how how this uh helps is so number one, you empower people and you make things very contextualized to them.
• 48:02
  SPEAKER_00: Second thing is you make it a little more difficult for them to make mistakes by giving them just in time feedback, by giving them alerts, by giving them messages.
• 48:14
  SPEAKER_00: So somebody puts in a value which doesn't make sense.
• 48:17
  SPEAKER_00: Either you can bring it up at the time of clinical review, or you can let the person know, are you sure you want to do this?
• 48:24
  SPEAKER_00: It seems unlikely that this is the case.
• 48:27
  SPEAKER_00: So when you put just in time feedback for user actions, then your data quality is automatically improved.
• 48:37
  SPEAKER_00: And the person is automatically engaged because now he knows this is not just another place to document things, this is helping me do my work better.
• 48:47
  SPEAKER_00: So we use a lot of alerts, we use a lot of highlighting, very subtle things, on-screen things, which help people make sure that whatever they are putting in is more meaningful, more contextual.
• 48:59
  SPEAKER_00: We help them plan their work, schedule their work.
• 49:03
  SPEAKER_00: This is one of the most difficult things in a situation like a hospital.
• 49:06
  SPEAKER_00: There are five patients, three monitors are beeping, twenty instructions are there for next two hours.
• 49:13
  SPEAKER_00: For the system, if all the data is available, it is very easy to really put out a priority list.
• 49:21
  SPEAKER_00: Not really to judge the person and instruct them, but to give them a view that these are the possible things that you might want to look at first and then move to the others.
• 49:31
  SPEAKER_00: So you realize that first of all, you have to get the system to talk to its user in a way that both of them are enjoying.
• 49:39
  SPEAKER_00: So one of the biggest joys I have is that most people who see our system for the first time fall in love with it.
• 49:51
  SPEAKER_00: Especially the nurses, especially the ones whose voice is never heard.
• 49:56
  SPEAKER_00: And this is because then they are part of the game.
• 49:59
  SPEAKER_00: The second thing is that we encourage, of course, uh it goes without saying that in a critical situation, transparency is what will definitely help improve outcomes.
• 50:14
  SPEAKER_00: A computer system becomes a policing system if the management takes the approach to penalize.
• 50:23
  SPEAKER_00: And this is one of the major organizational changes which comes when people take the digitization journey.
• 50:31
  SPEAKER_00: We actually engage in comprehensive program management for our customers.
• 50:38
  SPEAKER_00: You can't just take a software system, give it to an organization which was working on a completely different manner, and expect those subtle human realities to change by themselves.
• 50:50
  SPEAKER_00: So we undertake a process going into several months where all these roles understand these subtle things to keep in mind when things are going to suddenly become so transparent, when all the data is suddenly going to become so available.
• 51:06
  SPEAKER_00: And one of the very crucial changes we encourage is non-punitive approach, especially when people come up by themselves to report problems.
• 51:20
  SPEAKER_00: A good design system will help you discover errors.
• 51:24
  SPEAKER_00: If you can encourage your users to the degree that they feel protected enough to say, my God, I've made this mistake, I don't know whether I can fix it on my own.
• 51:35
  SPEAKER_00: But I want everybody in the team to know so that at least the further damage control can be done.
• 51:42
  SPEAKER_00: So incident reporting for this customer worked so well that I started with that they are filing 1,000 reports.
• 51:51
  SPEAKER_00: And this is all people filing by themselves, meeting every week, discussing what went wrong.
• 51:57
  SPEAKER_00: Now it changes from blame to careful scrutiny of the process, and that's where you come across those very beautiful, subtle issues within the system that are preventing people from doing what they should be doing, that are coming in the way of proper healthcare delivery.
• 52:22
  SPEAKER_00: When conversation moves to that level, you have people who are engaged to the degree that they start receiving joy in saying that no, I make mistakes, but I also fix them.
• 52:37
  SPEAKER_00: And I am involved in keeping our patients safer.
• 52:42
  SPEAKER_00: We were very fortunate that several of our customers have actually undergone this transformation to the degree that now entering data is never a push.
• 52:54
  SPEAKER_00: They don't like it any other way.
• 53:00
  SPEAKER_00: Just to share one very important thing.
• 53:07
  SPEAKER_00: Our most complicated program, which is taking care of tertiary care, wherever it gets installed, we never really suggest that data managers are bringing brought in.
• 53:22
  SPEAKER_00: And you know, the fundamental thing is if the primary user is not benefiting from what the system is doing immediately, then probably everything is for the sake of reports.
• 53:34
  SPEAKER_00: I can't even think of one of our users who is actually using a data manager to key in all the information that we are receiving.
• 53:42
  SPEAKER_00: So, Vignesh, sorry, one thing that I go wrong with is uh yeah, I when I start speaking, I'm not even sure what the original question was.
• 53:50
  SPEAKER_00: So please keep no no no.
• 53:54
  SPEAKER_03: No, I think it's super interesting because I think it takes the conversation in a lot of interesting ways.
• 53:58
  SPEAKER_03: Yeah.
• 53:58
  SPEAKER_03: So I think I think I think the term knowledge management is super interesting.
• 54:04
  SPEAKER_03: So can you talk a little bit more, like if you add your primer to a to say a 10-year-old or a let's say an early college going student about what is a knowledge, about what knowledge management is.
• 54:16
  SPEAKER_03: How would you walk someone through it?
• 54:20
  SPEAKER_02: And and to and to add to what Vignash is saying, I want you to actually talk about knowledge management.
• 54:26
  SPEAKER_02: And I in fact read about your program management.
• 54:30
  SPEAKER_02: So, therefore, to me, uh, you know, I want to really uh talk I want you to talk about both because program management is very casually used many a time.
• 54:39
  SPEAKER_02: So, therefore, uh it's important for you to talk about knowledge management and program management, right?
• 54:46
  SPEAKER_00: Right.
• 54:47
  SPEAKER_00: Uh so uh, you know, uh one of the simplest questions to ask for any organization is do my people have whatever they need to do their work available to them with least possible bureaucracy?
• 55:09
  SPEAKER_00: So you know, uh we we accumulate data, we talk about big data, we we have so many different sources by which we are collecting information.
• 55:19
  SPEAKER_00: However, when a person is trying to do their own work, are they in a position to make the best use of whatever is available in their organization to do a better job?
• 55:35
  SPEAKER_00: Now, this simple problem of not having access to right data, right information when needed, and uh for whoever it is needed is a very major problem that we've grown into once we started digitizing things.
• 55:58
  SPEAKER_00: So we built silos that there are so many protection layers and so many things that at the end of the day, many organizations struggle to make sense of the volume and complexity of their own accumulated data.
• 56:13
  SPEAKER_00: The approach of knowledge management really says uh in my mind, I'm sorry, so I'll just share what it means to me.
• 56:23
  SPEAKER_00: So um, it means organizing these various components in a way that of course there is good data governance, and yet people are able to get the insights and contribute to problem solving across the board.
• 56:44
  SPEAKER_00: No departments, no bureaucracy, no silos, and this can beautifully be achieved using software control.
• 56:56
  SPEAKER_00: Software allows you the kind of flexibility that traditional systems would never offer.
• 57:04
  SPEAKER_00: So you can have six different places where you house your data for technical reasons, but you can also have microservices interacting with those different data warehouses and retrieving only what is needed for every single persona and every single involved person.
• 57:23
  SPEAKER_00: So when you start connecting all these individual silos of data in a meaningful manner, and for each persona, for each role, start figuring out how do I empower this person to act better and how do I leverage all that we have gathered so far to strengthen this one person.
• 57:44
  SPEAKER_00: That is when you are thinking of a knowledge management-based approach.
• 57:53
  SPEAKER_00: So that's that's my take on it.
• 57:55
  SPEAKER_00: So I don't know if it makes any sense.
• 58:01
  SPEAKER_02: Yeah, Vignish, you asked that question.
• 58:04
  SPEAKER_03: No, no, I think it does make sense, but it's just also that I will I will say that if you were even talking about knowledge management systems from say a college goer, like of almost a faculty member to a student perspective, I think sometimes even most members of the faculty they have something called formal knowledge management, but the ability to update it, the ability to revisit past knowledge, the ability to dissipate it accurately, correctly, in terms of actual, you know, uh pedagogical uh taking the right pedagogical steps to uh deliver the impact that it has to create for the student.
• 58:42
  SPEAKER_03: I think that's it's it's almost like it's a two-sided ecosystem where you have the knowledge in place, you have one party giving it and then you have another party receiving it.
• 58:52
  SPEAKER_03: So, how how do how does a dynamic of this sort of an interaction play?
• 58:57
  SPEAKER_00: Let me give you an example of a bone marrow transplantation setup where a new patient has come in and the doctor has been told that this person wants to undergo a bone marrow transplant.
• 59:09
  SPEAKER_00: We have a lot of children who have thalassemia, a blood disorder where they would have received years of treatment in various different centers before they come for bone marrow transplantation.
• 59:21
  SPEAKER_00: Typically, any center would start with, tell me what is your past history and show me your paper files and let's move forward from here.
• 59:30
  SPEAKER_00: That is a typical anyway when you go to any new hospital, that's how the journey starts.
• 59:36
  SPEAKER_00: What if, what if the nurse could actually press a button and get a summary of the treatment which this patient has received over the last so many years at their home center?
• 59:52
  SPEAKER_00: What if all the blood products given to this patient and every single time this patient had a reaction?
• 59:58
  SPEAKER_00: And if this patient had a major health event, what if all this information with proper authorization, only after proper sort of only when you are placed to receive this information correctly, was made available to you at the click of a button?
• 1:00:17
  SPEAKER_00: So that's what actually today our systems are doing.
• 1:00:21
  SPEAKER_00: When a new patient comes in from a clinic which has a data sharing agreement of a reasonable type in place, they are able to make sure that without having to call 10 people to figure out what has been done in the past and then make sense of it using mails and WhatsApps and whatnot, or rely upon the patient to describe every single trouble they had, you could actually use that other part of information residing in some other server somewhere else in a very meaningful way to ensure that the context is set for what is happening next.
• 1:00:55
  SPEAKER_00: In fact, I'll share with you one more interesting thing.
• 1:00:58
  SPEAKER_00: How many times does it so happen that when you go for a lab investigation, does the lab ask what has happened to you?
• 1:01:11
  SPEAKER_00: So it's it's it may sound unusual, but for good laboratory analysis to happen, the laboratory needs to know the clinical context.
• 1:01:21
  SPEAKER_00: Now the clinician doesn't always have the time to provide that context to the lab.
• 1:01:28
  SPEAKER_00: That lab may not be inside your hospital, that may be an outsourced lab.
• 1:01:32
  SPEAKER_00: So Jagriti has built a labs platform which automatically pulls in the relevant components of information from the patient's charts and makes it available to the lab.
• 1:01:46
  SPEAKER_00: Something which otherwise would have taken a number of calls to figure out, which automatically improves the quality of the report and the outcome which the sending hospital would have looked forward to.
• 1:02:00
  SPEAKER_00: I'm just giving you these small examples on how these silos can be broken, and data can so the lab benefited from getting proper information about the patient, the doctor benefited from getting a more accurate report from the lab, and the winner is the patient who gets faster diagnostics done.
• 1:02:22
  SPEAKER_00: This is just one example, really.
• 1:02:24
  SPEAKER_00: You know what has transformed the capabilities of IT today is microservices.
• 1:02:32
  SPEAKER_00: The ability to control at a very granular level how a huge diversity of providers and systems can be harmonized.
• 1:02:45
  SPEAKER_00: And I like to use the word platform.
• 1:02:47
  SPEAKER_00: So Jagriti Inno Health platforms, the choice of that word platforms is a very deliberate one.
• 1:02:54
  SPEAKER_00: We don't build monolithic systems, and the first thing that our systems do is learn to talk to any other system.
• 1:03:03
  SPEAKER_00: So in the transplant, one of the transplantation units where we are involved, the fingerprint access, the blood pressure which is being monitored, the temperature monitors, all of them are networked to the system.
• 1:03:21
  SPEAKER_00: And these are not very expensive, sophisticated pieces of equipment purchased for this purpose.
• 1:03:26
  SPEAKER_00: These are your regular devices.
• 1:03:29
  SPEAKER_00: Only thing is now people are coming up with microservices, and you can always have systems talk to each other.
• 1:03:35
  SPEAKER_00: So once you enable this kind of data flow across systems, then achieving what we say is a knowledge management approach where people so going back to the example that you took, if a student was able to use a couple of keywords to figure out what has been done on this topic in my college ever in the past.
• 1:04:01
  SPEAKER_00: So, can can do we have any any any institution where for I want to know how many people failed at this project?
• 1:04:07
  SPEAKER_00: Can I just put in a keyword and find out?
• 1:04:11
  SPEAKER_00: Why should it be so difficult?
• 1:04:13
  SPEAKER_00: I don't want to know who failed.
• 1:04:14
  SPEAKER_00: I just want to know what failed.
• 1:04:16
  SPEAKER_00: If I know that, I'll make better decisions.
• 1:04:20
  SPEAKER_00: So, knowledge management is really a philosophy which you implement through software systems that we are very passionate about.
• 1:04:29
  SPEAKER_00: Now, let's talk about program management.
• 1:04:32
  SPEAKER_00: You know, there are three components to any place systems, people, and processes.
• 1:04:39
  SPEAKER_00: And a fine balance being maintained between these three, particularly when there is change happening, is absolutely critical.
• 1:04:49
  SPEAKER_00: One of the problems that a lot of us uh uh suffer, because uh one of the causes of a lot of pain is because we try to jump too far at once.
• 1:05:06
  SPEAKER_00: Right?
• 1:05:07
  SPEAKER_00: So I want to bring in agility.
• 1:05:10
  SPEAKER_00: So when you try to drive in a change, it's not just the system that can change, it's not just that notice or an email which can be sent out to people expecting them to change their behavior.
• 1:05:24
  SPEAKER_00: It has to be done at a much more subtle level to ensure that there is less anxiety, more reliability, and uh honestly more fun.
• 1:05:36
  SPEAKER_00: So program management is nothing but doing that back end work properly to ensure any changes, any uh interaction between the systems, people, and processes are beautifully orchestrated to create harmony.
• 1:05:58
  SPEAKER_00: So, like I said, we are So we are a software company.
• 1:06:03
  SPEAKER_00: We shouldn't probably talk about non-punitive approach being taken when it comes to discovery of errors.
• 1:06:10
  SPEAKER_00: But if you don't do that, then there will be resistance to using electronic platforms.
• 1:06:16
  SPEAKER_00: It is so closely interlinked.
• 1:06:18
  SPEAKER_00: If your platform is going to find more errors, then suddenly you cannot have negativity in the organization as if today, since the time the software has come, there is more problem.
• 1:06:32
  SPEAKER_00: The problems are happening.
• 1:06:33
  SPEAKER_00: Now you are discovering them.
• 1:06:35
  SPEAKER_00: And you are discovering them faster.
• 1:06:38
  SPEAKER_00: So it needs you to prepare the organization to be able to absorb this change and deal with the changes that come together with it.
• 1:06:48
  SPEAKER_00: So that's very, very critical.
• 1:06:51
  SPEAKER_00: So we are now moving as an organization, Jagriti is moving away from just program management and deliberately putting in two more words in there.
• 1:07:01
  SPEAKER_00: Human-centric program management.
• 1:07:05
  SPEAKER_00: Ensuring that the first goal is to make sure that the humans involved feel like winners.
• 1:07:12
  SPEAKER_00: And then you chase your business goal, then you chase everything else that follows.
• 1:07:15
  SPEAKER_00: But first, it's the users.
• 1:07:17
  SPEAKER_02: So Rajit, one thing that really uh you know uh intrigues me, okay, is where do you find the engineers to do this kind of work?
• 1:07:33
  SPEAKER_00: So so yeah, uh, so I mean it's really difficult to find uh people who uh you know one of the one of the most important things about giving out a good product to your users is making sure that you don't let them down.
• 1:08:00
  SPEAKER_00: Unless your engineers understand at a very fundamental level what are they building and how does it uh impact the user, there is such a big mismatch between expectations and delivery.
• 1:08:18
  SPEAKER_00: Absolutely, that uh it is the customers who are at the suffering end of the game, and then there's a lot of bitterness.
• 1:08:26
  SPEAKER_02: Yeah.
• 1:08:28
  SPEAKER_00: We have always chosen the approach of having the people with right mindset first than people with the right skill set as the top priority.
• 1:08:42
  SPEAKER_00: I'd rather have an engineer who has the patience and the appreciation for what they are building than an engineer who's fantastic at code but who doesn't really want to get involved in the use cases.
• 1:08:59
  SPEAKER_02: Yeah, absolutely.
• 1:09:02
  SPEAKER_00: And finding people, of course, uh uh it's it's so difficult in today's environment where everybody wants to be on top of the game as quickly as possible, as soon as possible.
• 1:09:18
  SPEAKER_00: Finding people who really want to invest in uh building expertise, really getting to a level where uh they can on a personal level make a difference.
• 1:09:32
  SPEAKER_00: Yeah, that's that's that's such a such a major challenge.
• 1:09:36
  SPEAKER_02: So, how do you how do you go about uh therefore uh recruiting them?
• 1:09:41
  SPEAKER_02: How do you go about grooming them?
• 1:09:43
  SPEAKER_02: Because they get influenced by the environment, right?
• 1:09:46
  SPEAKER_02: Because you know, my my classmate got this increase, my uh, you know, uh batchmate became this, you know, uh, you know, my roommate uh you know has this uh promotion.
• 1:10:01
  SPEAKER_02: So uh it requires a very deep conviction with what you're doing.
• 1:10:05
  SPEAKER_02: So from whatever I've been listening to you for the last you know one hour, I think a lot of conviction comes first, competence comes next, and uh you know commitment to do it come what may come with it, and that is a very different uh build that is needed, right?
• 1:10:29
  SPEAKER_02: And how do you get that?
• 1:10:32
  SPEAKER_00: Absolutely, uh you're very right in pointing out the requirements for the kind of work that we do.
• 1:10:40
  SPEAKER_00: Uh so you know, uh, like you said, when there is so much of uh peer pressure and so many things happening around people, uh we are not immune to it.
• 1:10:52
  SPEAKER_00: We suffer from the same problems that anybody else does.
• 1:10:55
  SPEAKER_00: However, we have a big advantage, and that advantage is that as an organization, we are very careful about what we do and what environment we maintain internally.
• 1:11:08
  SPEAKER_00: So while there is this one side of things where people are attracted, there are there are those very few who are actually looking for a little different space which gives them that joy, that kick, that purpose, and who may not really be able to find that easily.
• 1:11:27
  SPEAKER_00: So we guard our values first.
• 1:11:31
  SPEAKER_00: We don't make decisions to drive growth as much as we value our value set.
• 1:11:39
  SPEAKER_00: We we make sure that as an organization we are always doing the right thing.
• 1:11:45
  SPEAKER_00: That's that's not easy.
• 1:11:49
  SPEAKER_00: We have uh in the past often resisted temptation to grow fast at the cost of compromising these essential requirements of the team.
• 1:12:01
  SPEAKER_00: You always have these people who see what you're doing like it, and then who want to give you a booster to go to the next orbit.
• 1:12:11
  SPEAKER_00: But then if you don't feel that their value system aligns with yours, uh there's a tough call to make.
• 1:12:18
  SPEAKER_00: And we are fortunate that uh team Jagriti doesn't have to think twice across the board to on what is the direction ahead of us.
• 1:12:28
  SPEAKER_00: What this does, of course, is uh create that safe space for some people to find their life purpose in a very permanent way, so it's very much more difficult to bring in a new team member and get them absorbed.
• 1:12:44
  SPEAKER_00: Many people would leave us in the first year of work or not even join us because of the way we are structured.
• 1:12:51
  SPEAKER_00: But it is also true that many people would find their life goals and life purposes so beautifully aligned with what they do that work becomes fun and uh the relationship that you have with your team, with your product, with your customers, that becomes enriching.
• 1:13:17
  SPEAKER_02: So absolutely, but uh, how do you balance that with the life ambitions of that person, right?
• 1:13:22
  SPEAKER_02: Because you know, I'm an young graduate, I come out, you know, I get married, I need a house, uh, so there are certain uh you know uh money requirements, economic requirements that I have.
• 1:13:35
  SPEAKER_02: Uh so balancing it starts, in my opinion.
• 1:13:38
  SPEAKER_02: Uh, would you agree with me?
• 1:13:40
  SPEAKER_02: Uh, having run an organization like this, uh, I presume you have done it now for almost 15, 17 years, right?
• 1:13:47
  SPEAKER_02: Uh uh, I think if the purpose is not aligned, uh, then what happens is that anything that is monetary or economic, always there is a gap.
• 1:13:57
  SPEAKER_02: And uh, and I think the most important thing is when your purpose aligns, then the gap between the rest of the stuff that I need as an uh employee or as I need a as a part of the organization, uh, that tends to match, and it's that's the most critical uh aspect of engagement, involvement, and uh uh you know, I would say retention.
• 1:14:24
  SPEAKER_02: What do you say?
• 1:14:26
  SPEAKER_00: Completely agree with you.
• 1:14:28
  SPEAKER_00: I often use this uh sort of uh little uh example of how people want to earn more and then use that money to do more to be happy.
• 1:14:43
  SPEAKER_00: While there are people who are extremely happy doing what they do in terms of their work.
• 1:14:51
  SPEAKER_00: So uh all of us need to have a reasonable life, that's a duty we owe to ourselves and our family.
• 1:15:01
  SPEAKER_00: But it is also true that there is uh no real limit to how much one can earn in terms of monetary compensation alone.
• 1:15:13
  SPEAKER_00: So when you have your at least a part of your purpose aligned with your organization, and when you have a sense of comfort with your colleagues, if you are able to find these two things, you are in a very, very lucky place.
• 1:15:33
  SPEAKER_00: You are in a very fortunate space.
• 1:15:36
  SPEAKER_02: So uh so Rajat uh, as you now uh look back, uh there's a lot of satisfaction with what you have built.
• 1:15:44
  SPEAKER_02: Uh, how do you see the future of Jagriti?
• 1:15:47
  SPEAKER_02: And uh how do you see this panning out?
• 1:15:50
  SPEAKER_02: Because I don't see many organizations when I go and look at what you do, uh you are you have a uh you know uh way in which you publish white papers, okay.
• 1:16:03
  SPEAKER_02: Very, very western method of actually sharing uh knowledge, uh contributing to the uh you know to the industry that you belong, okay, making it open access.
• 1:16:15
  SPEAKER_02: Lots of things that you do there, uh, which is really what I think has taken you till where you are today.
• 1:16:22
  SPEAKER_02: But there will be a larger uh you know roadmap.
• 1:16:26
  SPEAKER_02: How do you see and what do you think are the most important steps to build that uh you know dream, if I were to call it or an aspiration?
• 1:16:35
  SPEAKER_02: So, what are the core components that you believe?
• 1:16:38
  SPEAKER_02: Uh as you said, you guard your values, but yet you need growth and you you need progress.
• 1:16:43
  SPEAKER_02: Let me not use the word growth, but let's say progress.
• 1:16:46
  SPEAKER_02: Uh, so what components would you use or what engines would you use to grow it?
• 1:16:52
  SPEAKER_00: So I I am reminded of actually a situation about uh 17 years back where in a college canteen uh I happened to be interacting with a friend who used to write a blog for the first time and who asked a similar question.
• 1:17:11
  SPEAKER_00: And uh uh if I remember correctly, the answer I gave her is that you have to persist.
• 1:17:20
  SPEAKER_00: When you know you're doing the right thing, you have to persist.
• 1:17:25
  SPEAKER_00: One of the beauties, and I really appreciate uh the guidance we got.
• 1:17:32
  SPEAKER_00: Uh one of the beauties of the way we structured ourselves was to be rational and evidence-driven in terms of what we do.
• 1:17:43
  SPEAKER_00: Like you said, we publish, we share outcome, and we do it through open access channels.
• 1:17:52
  SPEAKER_00: Because we truly believe that before we can make a claim about what we do, we have to prove it and prove it in the most robust manner.
• 1:18:03
  SPEAKER_00: When that happens, when you are assured that your actions are actually translating into real-world benefit, and when your team and your organization is oriented towards ensuring uh constant improvement, so producing more of this every single day, then it is always only a matter of time.
• 1:18:36
  SPEAKER_00: So if you are in the right direction, if you're doing the right thing with the right intent, and you're doing it uh with a lot of energy, enthusiasm, and putting the right resources in there, then adoption follows.
• 1:18:50
  SPEAKER_00: It is also true that uh the battleground that we've chosen are very, very lofty.
• 1:18:57
  SPEAKER_00: So for software to improve survival of a patient by 10% is a very big deal.
• 1:19:07
  SPEAKER_00: So if you take up a challenge like that and you really want to succeed in that, it will take time for people first to believe that this is even possible.
• 1:19:17
  SPEAKER_00: And that is where a large part of our system still resides.
• 1:19:23
  SPEAKER_00: But what we are experiencing as an organization year on year is that the more you persist, that acceptance come uh starts building in, naturally starts building in.
• 1:19:38
  SPEAKER_00: So, yeah, I guess persistence is the word brilliant.
• 1:19:43
  SPEAKER_02: So, uh, so on that note, uh Rajat, uh, I want to just uh jump into some quick uh quick fire questions and uh would like your immediate response.
• 1:19:53
  SPEAKER_02: So, my first question is uh, what does success mean to you?
• 1:19:57
  SPEAKER_02: Happiness.
• 1:19:59
  SPEAKER_02: Good, okay, and what would be the advice that you would give to an 18-year-old in a university today?
• 1:20:07
  SPEAKER_00: Continue to searching for what excites you, do what you love to do.
• 1:20:12
  SPEAKER_00: You will have all the opportunity to make money, money will follow, but don't don't uh always choose uh what gets you excited.
• 1:20:23
  SPEAKER_02: Brilliant.
• 1:20:24
  SPEAKER_02: Uh, what is one piece of advice that you got uh which you believe uh has held you in good stead for so many years?
• 1:20:35
  SPEAKER_00: I've always been told to do the right thing no matter what the outcome is.
• 1:20:42
  SPEAKER_00: I've been told to accept uh failure, I've been told to accept negativity, I've been advised by my father to accept anything that comes in the way.
• 1:20:54
  SPEAKER_00: But uh do the right thing, and then uh he's always uh encouraged me not to bother about consequences.
• 1:21:05
  SPEAKER_02: Very nice.
• 1:21:06
  SPEAKER_02: Uh what's one uh piece of uh you know uh belief that you have, which many people really don't agree with you?
• 1:21:20
  SPEAKER_00: I don't think uh people agree with me on process.
• 1:21:31
  SPEAKER_00: I am a person who likes to uh uh to set up and follow processes and continue to enhance them, but that process is uh which is slow, boring, whatever it is.
• 1:21:42
  SPEAKER_00: I'm a big believer, don't find manies.
• 1:21:46
  SPEAKER_02: So tell me a couple of books that have influenced you and your life and what you do.
• 1:21:52
  SPEAKER_00: The autobiography of a Yogi Viki was of course one of them.
• 1:21:57
  SPEAKER_02: Okay.
• 1:21:58
  SPEAKER_00: Checklist Manifesto is a beautiful book to read.
• 1:22:02
  SPEAKER_00: Okay, and uh uh there's a very interesting book called The Red Market.
• 1:22:09
  SPEAKER_02: The Red Market?
• 1:22:11
  SPEAKER_00: Yes, uh it talks about uh how uh human organ trade has really happened across the world and it gives you a context into uh what is happening around.
• 1:22:23
  SPEAKER_00: So that's another very interesting book.
• 1:22:26
  SPEAKER_02: Uh if you were to invite uh three or four people for a dream dinner from whom you would like to listen, learn, who would those three or four people be?
• 1:22:40
  SPEAKER_00: I'd like to invite Shirley Bagatsingh.
• 1:22:45
  SPEAKER_00: I'd like to invite Subashindra Bos.
• 1:22:49
  SPEAKER_00: I missed having met Dr.
• 1:22:51
  SPEAKER_00: Kalam.
• 1:22:52
  SPEAKER_00: Okay, I would have loved to uh and perhaps I would have liked to speak to Chaitanya Mahaprabhu.
• 1:23:06
  SPEAKER_02: Okay, interesting.
• 1:23:09
  SPEAKER_02: Thanks, uh thanks Rajat.
• 1:23:11
  SPEAKER_02: Uh it was an absorbing conversation.
• 1:23:15
  SPEAKER_02: Uh I think uh there were parts in the conversation as you were speaking.
• 1:23:21
  SPEAKER_02: Uh it really touched some of the deep beliefs that uh you know that I had.
• 1:23:27
  SPEAKER_02: At the same time, uh some tough decisions that you need to take if you have to do the right things.
• 1:23:33
  SPEAKER_02: Uh it was fantastic and uh thanks a lot for your time.
• 1:23:37
  SPEAKER_02: Really appreciate the time and uh the kind of work that you are doing uh really amazes me.
• 1:23:45
  SPEAKER_02: And uh I'm happy that uh you know, whatever little that I can do to enhance and value add to your thinking, uh, I would be happy and thanks a lot for spending time.
• 1:23:58
  SPEAKER_00: Thank you so much.
• 1:23:59
  SPEAKER_00: It's uh uh I'm sure you can uh you know the best reward that uh I have got in my life is uh uh having conversations with people.
• 1:24:19
  SPEAKER_00: Uh uh with so I I've got a lot of uh value in my life uh from people who I would like to say are like gurus who give and I get and I don't even know whether I deserve what I get and I can never pay for it.
• 1:24:40
  SPEAKER_00: So that that is something that is so beautiful uh component of what we do, and like I said, I'm not even sure uh for a great platform that you are building in terms of contramines whether I even deserve.
• 1:24:58
  SPEAKER_00: But thank you for being patient listening me out and setting this up.
• 1:25:07
  SPEAKER_00: Uh it's a very valuable thing.
• 1:25:11
  SPEAKER_02: Thanks, thanks, Rijat.
• 1:25:12
  SPEAKER_02: Thanks for your time.
• 1:25:13
  SPEAKER_02: Thanks for listening to this episode.
• 1:25:16
  SPEAKER_02: For selected links and detailed show notes, visit www.contramines.com slash blog.
• 1:25:24
  SPEAKER_02: Follow contraminds on social media and let us know who you would like to see next on the podcast.
• 1:25:30
  SPEAKER_02: If you're listening to Contraminds on Apple Podcasts, do share your comments and give us a rating.
• 1:25:35
  SPEAKER_02: We are keen to know what you're thinking.
• 1:25:37
  SPEAKER_02: Contraminds is also on YouTube.
• 1:25:40
  SPEAKER_02: If you are listening to the podcast on YouTube, hit the subscribe button and stay up to date on all our releases.
• 1:25:47
  SPEAKER_02: Thanks for listening and stay safe.