Soumitri in 2016

Design is vehicle for change. A Design Project can be a campaign. In a furiously online world I see design projects as either a first step towards a business venture or a campaign that changes the way people think. Design innovations can change the way we deal with ageing and death. Design projects can change the way the world thinks about issues. Design projects can be about improving the lives of ordinary and marginalised people. Below are some of the areas I am currently interested in/ excited about:
  1. How to die well
  2. Ways of dealing with obesity
  3. Imagining a Future beyond Medicine
  4. Ways of Journalling Pregnancy
  5. Design for people with Locked-in syndrome
  6. Proposing a Bio-Dome (a personal diagnostic ecosystem)
  7. Design for living longer
I live and work in Melbourne. In Melbourne there is a lot of energy these days around imagining a healthy future. I engage with this energy.
  1. My design approach focuses upon proposing a future that contains preferred/ visionary products and services.
  2. I am excited by design projects that focus on the small and big challenges facing humanity.
  3. I see design projects as campaigns and so have developed, and therefore teach, the abilities required to prototype design projects within communities.
  4. My current interest is in innovations in healthcare services, where I focus upon de-medicalising and re-contextualizing normal practices to develop new traditions and artefacts in the areas of:
    1. Mental health
    2. Obesity
    3. Ageing
    4. Death
    5. Diabetes
    6. Maternal health
    7. Hearing loss
    8. (Defines the design theme or discourse)
Advertisements

Diabetes

Diabetes has been around among humans a long time. There are many people around the world who suffer from diabetes – 171 million in 2000 going up to 388 million in 2030. A lot of people work in and specialize in working in the area of diabetes: diabetes for them is a source of employment. This is one aspect of the phenomenon of diabetes and what is worrisome is that a few of these people may be keen to get diabetics become dependent upon them. A doctor may be keen to have the patient dependent upon her, a pharmaceutical company may be keen to have large populations of patients become dependent upon their drug formulation, a product manufacturer may be keen to see diabetics become dependent upon expensive technology and even the diabetics associations have their own notion of the ‘right way’. Many feel this ‘fostering of dependency’ has had a detrimental effect upon the quality of life of diabetics. Some have said that this ‘culture of dependency’ is a recent phenomenon, a fact of modern life where we have grown accustomed to giving ‘experts’ control over our body, our lives.

There exists therefore a Need (!) and something has to be done to improve the situation.

Complex problems such as Diabetes tend to be fuzzy and messy (and confronting). Often these are also contested territories dominated by experts. Designers very often have to hear disparaging comments from experts saying ‘what can YOU do’. This is also what makes this area exciting.

This project – project diabetes – is a space to work, a live project with real people and real outcomes.

A Diabetes Mentor in Your Cell Phone

» A Diabetes Mentor in Your Cell Phone – DiabetesMine: the all things diabetes blog

For most people, the cell phone is one of the only gadgets everyone understands and uses every day. There are several companies that have utilized the wide world of iPhone applications, but new-kid-on-the-diabetes-block WellDoc, a Baltimore-based company, has created a new mobile product designed for any phone, called WellDoc’s Diabetes Manager.

The WellDoc demo (which you can watch here) describes a scenario of John, a type 2 diabetic, and Dr. Smith, an endocrinologist. John has “poorly controlled diabetes,” with an A1C over 9, and only sees Dr. Smith for 15 minutes every few months. (Sound familiar?)

For the patient, the WellDoc Diabetes Manager system acts as a mobile CDE / mom:

– It reminds you when to test
– It receives blood glucose readings from a bluetooth-enabled meter or from manual input
– It analyzes the data and provides real-time feedback
– It provides a food database to prevent over treating hypoglycemia
– It asks questions about what caused low or high blood sugars and suggests areas of needed education
– It alerts when you need to retest

Disease Management for Australia

Patient centered chronic care is a difficult one to set up and negotiate in Australia – a country with universal Medicare. Disease Management here is listed within the state’s agenda – but not separately funded.

Healthways – Investor Relations – News Release

Healthways International, a wholly owned subsidiary of Healthways, Inc. (NASDAQ: HWAY), today announced a five-year agreement to offer comprehensive Health and Care SupportSM solutions to The Hospitals Contribution Fund of Australia Limited (HCF), one of the largest private health insurers in Australia with over 1 million members. Healthways has successfully entered markets on three continents in the past 12 months, continuing evidence that the health care and productivity issues faced by U.S. health plans, employers and government payers are global issues.

Through the agreement, Healthways will provide proactive support to HCF members with chronic conditions to help slow the progression of their illness. All HCF members will have access to a comprehensive suite of Internet-based health and wellness resources, including customized health information, health risk assessments, health coaching and online, personal health records. Services will focus on prevention, education, behavior change and evidence-based medicine to drive adherence to proven standards of care, medications and physician care plans.

“This collaboration with Healthways allows HCF to implement best-in-class preventive and care management strategies that will keep our healthy members healthy, while improving health and reducing complications for those members with chronic conditions,” said Terry Smith, HCF Chief Executive Officer.

Also:

A report issued by the Australian Institute of Health and Welfare further confirms that chronic diseases are a major health concern in Australia, placing great burden on individuals, communities and the health industry. More than one-fifth of hospital stays are due to common chronic disease, and $11 billion in national health expenditures are attributed to chronic disease.2

Diabetes and Interaction Design

I saw charmr (you can say Charmr on youtube to watch the video) by Adaptive Path and was quite intrigued. I have students doing similar projects. This is ‘gadgets that help’.

I am in diabetes for a different reason – I want to change health outcomes for the, say, 40 million Indians and further 40 million chinese. In India and China health outcomes are really bad and amputation is routine. So I have been developing an alternative service model – alternative to the government’s health service model – that marginalizes the doctor and makes a nurse practitioner the primary carer. Then both India and China spend very little money on health care – so the model is user pays. In this sits the need for technology that has very low operating costs. This is the technology agenda.

I describe the above just to check – is anyone interested in this project?

Strengthening the national diabetes care services by enhancing the capacity of health care providers

Capacity Development project. What is the ‘care model’ that the health care providers will be trained in? If this is clinical practice – how does the diabetic benefit – and therefore how will the ‘care’ model be assessed?

India Diabetes Research Foundation :: IDRF-WDF Project

PROJECT TITLE
Strengthening the national diabetes care services by enhancing the capacity of health care providers.

PROJECT PERIOD
From 1st July 2007 to December 2011

GOALS AND OBJECTIVES OF PROJECT

Goal: Strengthening the national diabetes care services by enhancing the capacity of service providers – doctors, health educators and other paramedical field staff.

Objectives:
To plan and conduct training workshops for Doctors, Health Educators, and Paramedical personnel from the project states. The participants include staff from Government, NGO and private medical systems.

To support the project states technically in strengthening their diabetes service delivery through trained man power.

To motivate the participants to establish a network of Diabetes Prevention and Management Centers starting with rural areas.

To raise the awareness of all the stakeholders including Policymakers, Health Managers, NGO and general population on prevention of diabetes and its complications.

This may dissipate focused effort on diabetes which is a big problem for India

Rs1,620 crore pilot project to curb diabetes, heart diseases launched – Economy and Politics – livemint.com

One health activist said the government was trying to pack too much into the programme. A. Ramachandran, president of India Diabetes Research Foundation, called the Rs1,650 crore budget “a drop in the ocean”.

“The government has also diluted the programme by clubbing three diseases together. This may dissipate focused effort on diabetes which is a big problem for India,” he said, adding the US, UK and Australia had dedicated national diabetes programmes.

Rs1,620 crore pilot project to curb diabetes, heart diseases launched

Rs1,620 crore pilot project to curb diabetes, heart diseases launched – Economy and Politics – livemint.com

New Delhi: In the first initiative of its kind, the Indian government
has started a programme to prevent as well as map the extent of
diabetes, cardiovascular diseases and stroke—chronic ailments that
could cause life expectancy in the country to fall and have economic
implications as well.

Launched on a pilot basis in seven states—Assam, Punjab, Rajasthan, Karnataka, Tamil Nadu, Kerala and Andhra Pradesh—for the first year, a budget of Rs1,620.5 crore has been allotted for the national programme to check these diseases in the five-year plan to fiscal 2012.
“This marks the transition from focusing largely on the Big Three (HIV, tuberculosis and malaria) to Big Five (diabetes, cardiovascular diseases, stroke, cancer and chronic lung diseases),” Union minister for health and family welfare Anbumani Ramadoss said at an event to launch the programme. Experts in his ministry feared “life expectancy in India could actually fall” on account of these diseases, he added.
According to the World Health Organization, the “Big Five” accounted for 53%, or 5.47 million, of the total deaths in India. K. Srinath Reddy, president of the Public Health Foundation of India, estimates the country could lose 18 million man years in 2030 on account of the ailments, double the number lost in 2000.
“Educational interventions that target behavioural change are important, but not sufficient. They need to be buttressed by policy interventions,” said Reddy.

If They Build a Medical Home, Will the Docs Come?

Disease Management Care Blog: If They Build a Medical Home, Will the Docs Come?

Among its many admittedly good qualities, the patient centered medical home (PCMH) has been lauded as the means to resuscitate, re-engineer or revive primary care. The Disease Management Blog asks: assuming the PMCH has plenty of merit by itself, what does it have to do with the rescuing primary care?

Putting a number on India’s diabetics

This is the number of diabetics in India – at 6% of the population. This is a figure I dispute – as it starts with 49 million as an estimate. Thats low for an asian country with a genetic predisposition towards Diabetes. The stats for USA say 9% of the population.

Putting a number on India’s diabetics

September 23, 2005 17:59 IST
Last Updated: September 23, 2005 19:16 IST

The facts are startling.

Out of the 100 crore people in India, 70 crore are above the age of 20. Out of the 21 crore urban population, 2.52 crore have diabetes but 8.4 million are undiagnosed.

About 12 to 15 percent of the urban population above the age of 20 has diabetes but it remains undiagnosed.

Out of a population of 49 crore in rural India, 9.8 million have diabetes but 4.9 million are undiagnosed. That is, about 2 to 6 percent of the rural population is diabetic.

But 30 percent of the diabetics in urban India and 60 percent of those suffering from diabetes in rural India are undiagnosed.

On the whole, out of a total of 3.5 crore diabetics in India, 1.33 crore go undiagnosed.

Diabetes in India

So its now the BBC – that is saying it. 10% or more of Indians have diabetes. A third or less are detected.

1. WHO says in the thirty millions. Out of a world population of 177 million.

2. With these new figures we are looking at 100 to 150 million diabetics.

If I were to take the 5$ per day subsidy (in Australia) as a ball park figure to arrive at the Health Care costs of an individual living with Diabetes we get the figure of 500 million per day.  Will the public health system provide a subsidy – to pick up the cost of testing strips? Either totally or partially.

Overall the state spends very little on health in India – so the individual diabetic has to spend 70% for the testing strips. This brings us to 350million $ (Australian) as the total spend from the diabetics in India. In reality of course this expenditure is not really incurred.Tags:

Powered by Qumana

BBC NEWS | South Asia | India battles diabetes ‘epidemic’

Diabetes in India

Vodpod videos no longer available.

more about “BBC NEWS | South Asia | India battles…“, posted with vodpod

India battles diabetes ‘epidemic’

BBC NEWS | South Asia | India battles diabetes ‘epidemic’

By Adam Mynott, BBC News, Chennai, India

The latest figures for the prevalence of diabetes are two years old and by common medical consent hopelessly out of date.

It is estimated that up to three million people die from the disease every year, and over a quarter of a billion people are affected.

Both figures are likely to be very short of the mark.

World Diabetes Day is on 14 November and all over the planet events are taking place to draw attention to the threat of what is described as an epidemic that is out of control.

Already it kills more people than HIV/Aids and the prognosis is grim.

Patient at eye clinic
Doctors do not understand why Indians have a high rate of diabetes

India is the nation with most diabetics.

Officially there are 41 million Indians with the disease, but in Chennai, Tamil Nadu as many as 15% of the population suffer.

Elsewhere in the vast country, doctors report diabetes rates of between 9% and 14%.

So, even taking the lower of the two marks, it is clear that India, with its population of 1.1 billion, has upwards of 100 million diabetics and that figure is growing every year.

Jeremy Yuille Explores IxD Education at Adaptive Path

I am very curious about Adaptive path – especially their work -‘charmr’ – on diabetes. I needed to see this about Jeremy – to jog me to speak to him.

Jeremy Yuille Explores IxD Education at Adaptive Path | jamin.org

Adaptive Path recently hosted a brown bag lunch with Jeremy Yuille regarding interaction design education. I skirted up from my Nokia office a few blocks away to take advantage of AP’s open invitation. It took me a while to realize that Jeremy is on the IxDA board, and that I had met him at the IxDA conference last February during a discussion about future IxDA conferences.

Jeremy is also Program Manager at ACID, Digital Media Coordinator at Royal Melbourne Institute of Technology Communication Design, Interaction Designer at overt.creation, according to LinkedIn. And he is working on a PhD in design, which was the impetus for coming to AP to talk about interaction design. To paraphrase, he wanted to talk to industry stakeholders before making claims about interaction design as an academic.

Smart DNA

Smart DNA: Programming the Molecule of Life for Work and Play: Scientific American

  • DNA molecules can act as elementary logic gates analogous to the silicon-based gates of ordinary computers. Short strands of DNA serve as the gates’ inputs and outputs.
  • Ultimately, such gates could serve as dissolved “doctors”—sensing molecules such as markers on cells and jointly choosing how to respond.
  • Automata built from these DNA gates demonstrate the system’s computational abilities by playing an unbeatable game of tic-tac-toe.

Logic gates made of DNA could one day operate in your bloodstream, collectively making medical decisions and taking action. For now, they play a mean game of in vitro tic-tac-toe

Smart Insulin: It Knows What You’ve Been Eating

» Smart Insulin: It Knows What You’ve Been Eating – DiabetesMine: diabetes, life, health, community

Imagine: Smart Insulin that could sense high glucose levels and automatically dispense insulin on demand. “As your glucose levels drop off, the drug stabilizes, trapping insulin until the next glucose spike.” WOW! So it knows if you’ve been bad or good and just jumps right in there to correct your BG like a healthy pancreas?!

You are kidding me, right? Weeeelll, not according to Todd Zion, founder and CEO of SmartCells, a privately held company based in Beverly, MA, that is developing such a self-regulating drug. It would be injected just once a day, using the same needles currently used for conventional insulin.

Two weeks ago, the company announced an agreement with the JDRF that includes $1 million in first-year funding to support preclinical safety and efficacy testing. “The partnership is structured to support milestone-based funding through proof-of-concept human clinical trials.” WOW.

As a reader noted in a recent email, “This sounds like the best news in diabetes in over a decade.” In longer than that, I might argue!

True Confessions of a Good Diabetic

» True Confessions of a Good Diabetic – DiabetesMine: diabetes, life, health, community

I read other PWD’s blogs, and they always seem like they have it so together. But then again, when fellow diabetics meet me in person, they seem to think I have it all figured out, too. Closer to the truth is probably that we’re all just taking it day by day. And man, do I stray sometimes:

Sometimes I don’t test for HOURS after I eat. I just lose track of time. Or I can’t be bothered stopping whatever all-important thing I’m doing to get the out the gear and do what I know I should.

Designed to deliver insulin to the hepatocyte cells in the liver

» More Diabetes Innovations: GluMetrics & DiaSome – DiabetesMine: diabetes, life, health, community

DiaSome Pharmaceuticals, located in Conshohoken, PA, is developing a “proprietary nanotechnology cell-receptor targeting system” designed to deliver insulin to the hepatocyte cells in the liver via both oral and injectable drug routes. According to their documentation, “the site-specific targetting of insulin essentially restores ‘normal physiology’ to the liver, allowing for improved glucose regulation in diabetic patients.”

DiaSome’s calls its system HDV-Insulin: “a nano-sized carrier for all commercially available insulins.”

Their main product at the moment is an oral version (Oral HDV-Insulin), which is a low-dose, short-acting insulin delivered in a pill or capsule form for use in Type 2 diabetics. At only 20-50 nanometers, the particles are small enough to “cross membrane barriers” in the body, and “avoid enzymatic degradation.”

Whoa, that’s small! Keep in mind that a nanometer is one-billionth of a meter — or about one-billionth of a yard, or 25 millionths of an inch. This is approaching the size of an atom, and 3-10 atoms end-to-end are about one nanometer long!

So how fast is this tiny technology coming to market?

A Tale of Two Diabetics

Disease Management Care Blog: A Tale of Two Diabetics

Meet Homer. His appetite for doughnuts and aluminum wrapped carbonated carbohydrate-rich beverages has finally caught up with him. His doctor has told him that he’s overweight and has diabetes mellitus. An oaf he may be, but he’s a lovable well-meaning oaf who does his best to follow his doctor’s advice most of the time. He’s been told by his doctor about the role of diet, exercise, medications and regular follow-up. He remembers little of it.

Homer’s neighbor Ned hasn’t been immune from exposure to Fatland either. A victim of one too many yummylicious Church suppers, his waist line has also reached critical mass. He is very attentaroonie to the need for blood glucose control, has bought a meter and is already thinking of giving that eye professional he saw just last month a call to see if there was any sign of a new word he learned on line i.e., ‘retinopathy.’ He’s been told by his doctor about the role of diet, exercise, medications and regular follow-up. He’s tried to remember what he’s been told. He remembers little of it.

Who is going to have the better outcome – Ned or Homer?

What system of care for rural communities?

Systems of Care – and a argument for the design of a new (public) health care system needs to be made – for a focus upon the BOP.

Disease Management Care Blog: The DMCB’s Principles for Healthcare Reform

Chronic illness is a significant source of health care’s cost increases. Imperfect options to slow the rate of increase and achieve greater value include, but are not limited to, disease management, the chronic care model, pay for performance, consumer incentives, decision support, patient registries and electronic records. Combinations work better than any single option.

Health insurance is necessary but not sufficient to assure adequate access to health care. Options to increase participation in health insurance include requiring coverage (play or pay), lowering premium expense by control of cost (see above) plus, over the short term, value-based insurance designs and plans that trade lower premiums for increased out of pocket expenses. Serious consideration should be given to insurance options that protect against financial ruin, not meeting mandates. Increased participation in health insurance is likely to increase utilization of health care.

Stop talking waste, start talking value. Start with assessing how to maximize the effectiveness of studying comparative effectiveness. Assessment of technologies will need to consider their potential of additive growth vs. substitutive value.

Primary care is of sufficient value by itself to warrant increased payment without any need to concoct rationales such as pay for performance or extra payment for patient centered medical homes.

Research funding must be focused on improving systems of care outside Academic Medical Centers or Integrated Delivery Systems. Some funding should be discarded in favor of Prizes. Registries of data from publically funded research should be deidentified and open sourced on-line for data analysis.

The worksite and community are the better locations to provide wellness and prevention programs, not the health care system.

The public schools and community are a better location to provide obesity prevention and management, not the health care system.

Disease Management

Disease management (health) – Wikipedia, the free encyclopedia

Disease management is the concept of reducing healthcare costs and/or improving quality of life for individuals with chronic disease conditions by preventing or minimizing the effects of a disease, usually a chronic condition, through integrative care. It is also often known as: demand management, health management programs, or disease self-management.

Medical Management Model


BCG Health Care Publications

As medical costs continue to rise, health care insurers are taking a fresh look at medical management to contain costs. With today’s approaches more sophisticated, insurers and their health plans must make carefully balanced strategic choices to derive competitive advantage by enhancing their capabilities in this area. In this report, BCG reviews the various medical management strategies that different plans are adopting and the critical issues that will determine success or failure for the health plans placing those bets.

Boston Consulting Group

Boston Consulting Group

Monitoring Glycemic Control in India

The Lifescan glucometer is sold by Johnson and Johnson in India. I am not sure if this particular model is sold in India.

(Can someone tell me what it costs at a pharmacy in India? And is there a scheme to get subsidized glucometers and strips?)


The Context of the Srrvice Design for India is captured in this quote from Diabetes India dot Com. Therefore the problem/service proposition can be stated as: Develop a service to enable a Diabetic in India to achieve glycemic control economically.

Diabetes India – Diabetes-Monitoring glycemic control

Presently, self monitoring of the blood glucose levels, along with 12 weekly ghb estimations would seem to be the ideal method to monitor blood glucose control in patients.

But this may not be feasible, or economically viable, for many patients.

Diabetes Service Model

I have made two maps to illustrate the Service Model for Diabetes Care. One is the OVERVIEW – picture of the parts of the service, namely the service system (registration, subscription etc), the care system and the product system and the other is the ‘functions’ or the list of expertise that are included in the service.

(Click on images to enlarge)

Overview of the service system

Overview of the service system

Functions of the service

Functions of the service

The task now is to model a user-pays service enterprise that is defned as a product service system. The model then can be located in different contexts ( developed country urban to developing country remote area) to derive a suite of service and product offerings. The model thus becomes a foundation/ a platform for defining product ideas. The term product here refers to both hard material objects and soft interactive experiences.

Diabetes Service

I imagine system for the individual diabetic – much like the mobile phone – that arrives at the home. Is accessed from the home, the person of the diabetic, at a price similar to that of mobile phone provision – Rs. 25 for a lifetime of access to a service. The service – set up with a profile – periodically in consultation with the health care provider reminds and gathers data from the diabetic. To generate data the diabetic accesses some hardware that is communally owned – a BGL reader which send the data back to the hand held device ( phone with added features?). The handheld talks to the server – intermittently – and data is exchanged.