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Taking on anemia by readdressing antenatal care in Karnataka


Keywords: Anemia, Antenatal Care, Data analysis, cloud computing, MMR and IMR


The Burden of anemia in India is a major public health issue. More than 50% women and 20% children suffer from anemia and a leading cause of 40% maternal deaths in the country.
In the state of Karnataka, 79% of maternal deaths are found to occur due to anemia Karnataka State Health system 2015, 16). Antenatal period is crucial among pregnant women, lending adequate access to prevention, care and monitoring. However, rural communities in the region face several healthcare challenges, making pregnancy a high risk one,followed by poor pregnancy outcomes.
Anemia during pregnancy is preventable, if it is picked up well in time in the antenatal period through basic blood tests and clinical examination ( ).
How we contribute: In north Karnataka where many pregnant women face significant barriers to obtaining quality antenatal care, iKure is bringing care at the door steps of the rural people.
Through app. based diagnostic device, and innovative healthcare solutions, pregnant women are identified and regularly screened and monitored by trained health workers at the convenience of their home. They take health status assessment on their mobile app. perform blood tests and clinical examinations, organize health camps and message dissemination programs.
Patients who are at high risk of developing anemia or afflicted with the disorder are monitored frequently and supported by medical team to connect with doctors virtually through telemedicine platform or hospital referral system.
To provide patients with better healthcare outcomes, iKure using data analysis technology extracts useful knowledge with respect to anemia for better decision making and management. Through various technology innovations such as cloud computing, mhealth technology and smart applications supported by WHIMS, iKure is generating multiple data sources allowing doctors and researchers to make informed clinical and behavioural decisions, improving treatment processes and detecting anemia well in advance.


The strategic antenatal care adopted by iKure provides the potential to significantly reduce the prevalence of anemia in Karnataka. In north Karnataka, with a sample size of 91 pregnant women, the insights collected in the Ist round of antenatal checkup reported 64% of the respondent with low haemoglobin count, which interestingly reduced to 57% in second round and 43% in third round checkup. Low blood pressure reduced from 24 respondents in the first round of health check up to 14 in third round. The programme is already demonstrating positive health outcomes, including raising health seeking behaviors among pregnant women who did not knew that they were at risk of developing severe anemia and other chronic ailments, increasing consumption of folic acid and iron tablets and reducing abortion rates.

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Diet Plan for good health and keeping a check on weight gain


Things NOT to consume

1. All Fried Stuff…KFC / McDonald’s / Deep Fried Items etc.

2. All soft drinks…such as Colas / Fruit Juices and fizzy drinks

3. Mutton of bigger animals… Beef/goat/pork/steaks/non b veg burgers/salami etc.

4. Frequent Fried Rice products… Biryani / Fried Rice etc.

5. Cream enriched – Dairy Derived products………. Butter / Cheese / Marmalade etc.

6. Ice Creams / Cakes / Puddings / Pastry / Confectionery Items with cream etc.


Things to be taken in moderation

1. Milk, if it is tolerated

2. Honey / Jam… applied on bread toast

3. Eggs. Two / three per week….more of the white than the yolk!

4. Maida derived products… such as parathas / egg-rolls etc. (Indianised version)

5. Excessive Indianised version of Chinese food (With MSG-Mono Sodium Gluconate

6. Spinach and other leafy green vegetables


Things recommended for frequent consumption

1. Fibre rich fruits and vegetables (Banana is calorigenic… once in a while )

2. Oat meal / Breakfast cereals / Brown bread (instead of White Bread)

3. A handful of specific Nuts like Almonds (non-roasted and Walnuts only.

4. Occasional diet of dates / apricots etc. as snacks

5. Tea in place of Coffee….. Tea without milk and sugar… green tea etc.

6. Several glasses of plain water a day… more in summer months


Lifestyle habits/practices

1. To use the staircase instead of the elevator…. as much as possible

2. At least 20 minutes of walking on every other day if not every day – swimming is the best.

3. To leave the dining table when you feel you could have eaten some more.

4. Never to take second helpings in parties… particularly oily and greasy items.

5. No junk food like fried chicken / pizza / burgers etc.

6. Wash your face with cold water before the night sleep – sometime cucumber slices around eye.

7. Avoid heavy meal at dinner and not to hit the bed directly after dinner/lunch.

8. Get up at the same time everyday.

9. Pursue any hobby on a daily basis – even for a small duration.

10. Do some household work frequently at home, which entails physical exercise.

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Integrated approach to healthcare


Never sees how rich or poor you are or neither judge you being affluent or dissolute, but when it hits, it hits equally hard to all of us- helpless, clueless and money less! In India, where the healthcare is being the most neglected for decades, and accessibility, affordability and quality underpinned with political and policy discourses, people have little hope left, as they witness the deeply rotten system within.

While the govt. is making every amendment to make quality care and treatment available at fair and affordable price, the balance between public needs with commercial aspirations has failed to bring efficiency in the system.

But this can be solved, if we look at the healthcare system in totality but not in isolation and I am happy iKure has put the right step forward where it seems health as an outcome of a holistic and integrated effort. Though started at a minuscule level, iKure is looking at health in totality as against in silos. We are bringing path-breaking innovation, sustainable approaches and best players under one roof that are seamlessly integrated across and impact every levels of the larger system.

Though the clamor of the rising healthcare costs, inefficient system and highly compromised quality create havocs in one’s mind during any episode of illness, iKure serves its beneficiaries with a difference, where it not just treats illnesses but creates good health by acting in totality. This integrated approach will be the game changer in future bringing efficiency in the system to serve better and act responsibly.

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Meshing of Big Data, AI And ML in Cardiac Care Continuum


Every year 2.1 million patients die due to heart ailments in India. We have just 1 Cardiac Specialist for every 3 lakh patient. Although secondary and tertiary health care providers are engaged in doing ECGs and several other vital collections to analyze heart health conditions, but none of the existing solutions can identify high-risk cases from such reports and respond in time.

To address this gap, iKure combining Big Data, AI, and machine learning works on ECG signal anomaly detection & Patient risk model using stank ranking & deep learning that can assist cardiologists to offer preventive care much faster in the human life cycle. In association with IBM data science, iKure’s integrated platform provides seamless automation and interpretation of patient data to enable instant feedback for high-risk cases and offers high quality and cost effective continuity of cardiac care both for rural and semi-urban population.

Timely interventions can reduce the time span between critical and stable heart health conditions. However, failure of such gets magnified typically in last mile populations that constitute over 16 million cardiac patients out of total 30 million people. It has been observed that over the year from 2000 to 2015, the age-standardized rate of mortality (per 100,000 person-years) due to coronary heart diseases increased among rural men by 40% and for female it rose to 56%, whereas decline was registered among urban residents. Cardiac care in rural India is limited and inaccessible due to major shortfalls like shortage of doctors, diagnostic centers, equipped facilities, coupled with lack of awareness.

Cardiac diseases can be addressed through effective treatment plans, constant screening, and monitoring. Artificial Intelligence(AI) and Machine-learning(ML) can provide life-saving care in general and CardioVascularDiseases(CVD) specifically as high risk conditions can be identified early, impending strokes and heart attacks spotted in advance. Studies have established that AI is set to revolutionize cardiac care. This is particularly relevant in today’s context, as India is home to 16% of the global population, 25% of the world’s Coronary Heart Disease (CHD) burden, 120 million hypertensives, and a large number of individuals with Rheumatic heart disease (RHD). CVD will be the leading cause of morbidity and mortality in the country by 2020. Researchers have started meshing up Big Data with AIand machine learning algorithm to predict the anomalies quickly, cheaply and accurately without using the invasive methods.However, implementation of such advanced technology in primary healthcare delivery is still in its nascent stage in last mile communities. iKureusingAI and ML into their primary healthcare delivery, has taken cardiac care to advanced level of treatment.

The Cardiac Risk Model: The initiative is jointly done by iKure and the IBM Data +AI elite team that work on ECG signal anomaly detection and Patient risk model using stack ranking & deep learning. By leveraging iKure’s cloud based platform, it brings the power of AI with respect to patient’s clinical data stored in an AWS, MySQL data store to develop high risk pattern and can predict cardiac arrest in patients in much earlier stage.

Data is knowledge and when big Data from EKG signals coupled with a large volume of patient data from IBM cloud, cardiologists will get empowered to deal with cardiac problems through risk ranking of cardiac patients. It could also classify the EKG data as normal or with anomalies and present a prioritized list of patient cases to the call center physician for review based on potential acuteness via a cloud-based web application. It will help them to treat patients based on acuteness. In that way resources are utilized in the best possible way. Proof of concept is already developed that demonstrated that the platform can bring the power of AI to iKure’s data stored in an AWS, MySQL. The pilot project is showcased at IBM’s technology conference, Think 2019 in San Francisco. Accuracy of this model is already proved using patient clinical and demographic variables and physician feedback with the added benefits of rapid model development, publication and iteration.

Analysis of arrhythmia anomaly to predict cardiac arrest


Conclusion: The analytics help screening of vital parameters including Heart Rate monitoring, a disorder in application sequence, arrhythmias, an electric axis of heart, myocardial ischemia and infarction and cardiac rhyme diagnosis vital for the prevention of early cardiac arrest. Leveraging iKure’s integrated model together with machine learning algorithm and Artificial Intelligence will enable specialists to have a more logical approach to diagnosis and treatment of cardiac arrhythmia. The output of such effort will enhance continuity of cardiac care even in last mile communities.

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Continuity of Care in Primary Healthcare Delivery


What is Continuity of Care?

“Continuity of Care” is concerned with quality of care over time. It is the process by which the patient and his/her physician-led care team are cooperatively involved in ongoing health care management toward the shared goal of high quality and cost-effective medical care.

Continuity of care is the primary objective of family medicine and is consistent with quality patient care provided through a patient-centered medical service. The continuity of care approach helps family physicians gain their patients’ confidence. It also facilitates the family physician’s role as a cost-effective coordinator of the patient’s health services by making early recognition of problems possible. This is rooted in a long-term patient-physician partnership in which the physician knows the patient’s history from experience and can integrate new information and decisions from a whole-person perspective efficiently without extensive investigation.

[The above is a lightly edited version of the definition of Continuity of Care from the American Academy of Family Physicians (“AAFP”) website.]

Continuity of care has several dimensions:

  • Relationship continuity: continuous caring relationship with a clinician
  • Management continuity: continuity and consistency of clinical management, including care planning, and any necessary co-ordination of care required by the patient
  • Information continuity: providing and sharing information regarding the patient across all care providers

Management continuity is relevant whenever a patient is receiving care from more than one clinician or healthcare provider. It concerns the processes involved in co-ordinating, integrating and personalising care to deliver a high-quality service. The General Physician’s (GPs) clinical responsibility as coordinator of care for patients includes helping patients to understand and plan their treatment, navigate unfamiliar services successfully and remain engaged with their care. Good relationship continuity can contribute substantially to achieving this. Having one principal care provider with a holistic view of the patient is central to patients’ experiences of good management continuity and provides a sense of security and confidence about the future.


Benefits of Continuity of Care

Continuity of care approach has significant benefits and will result in better care at a lower cost over a period of time. Some of the specific benefits include:

  • Increased trust in the doctor-patient relationship
  • Reduces fragmentation of care and improves patient safety (by reduction of medical errors), quality of care and outcomes in a cost-effective way
  • Enables early recognition of healthcare problems without extensive investigations and unnecessary medication
  • Reduces “collusion of anonymity” when “patient is passed from one specialist to another with nobody taking complete responsibility for the patient
  • Better accuracy of the patient’s medical records
  • Reduction in unplanned hospital admissions
  • Reduction in the use of emergency department
  • Better adherence to medical advice, especially regarding long-term prevention and wellness
  • Empowers patients to take greater ownership for managing their health
  • Reduction in secondary care (medical care provided by a specialist or a facility upon referral by a primary care physician)
  • Improvement in treatment of chronic condition and quality of life of patients
  • Ensures information continuity; patients dislike having to repeat their story to different clinicians
  • Improvement in patient satisfaction

Use of Technology in Continuity of Care
Technology is a major enabler towards ensuring continuity of care. Some of the key technology elements that are widely used for this purpose are:

  • Electronic Health/Medical Record (EHR/EMR): EHR/EMR is vital for maintaining information continuity across various care providers.
  • Continuity of Care Document (CCD): CCD fosters interoperability of clinical data by allowing physicians to send electronic medical information to other providers without loss of meaning, thereby ensuring better patient care.
  • Tele-Medicine: Virtual patient-doctor consultations through tele-medicine platforms will facilitate relationship continuity and enable a physician to provide care to patients remotely.
  • Home Care Medical Devices & Wearables: Data from medical devices and wearables enables the healthcare providers to remotely monitor patients and take timely and proactive action for improved care delivery.


Challenges in Continuity of Care

While there are significant benefits of the continuity of care approach, there are a few challenges that we need to recognize.

  • Relationship continuity is dependant on having access to a particular physician when required. Patients with an urgent problem are often prepared to trade off waiting to see a physician with whom they have a good relationship in favour of an unknown physician.
  • In several cases, patients are willing to sacrifice “continuity of care” and are acceptable to consult with a doctor other than their usual GP. These include:

1. Patients with acute problems (like a chest infection), don’t really care which doctor they see. They are looking for someone who can see them in a timely fashion and will treat them.
2. Need specialised care from another member of the team
3. Wish to discuss a problem they find embarrassing to discuss with their regular doctor
4. Chose to consult a GP of the same gender

  • There are studies to suggest that a fresh start with a new doctor might open new diagnostic perspectives.
  • Seeing the same doctor might not guarantee a good relationship.
  • Patient-doctor relationship continuity might encourage collusion (for e.g., wrongfully getting a sickness certification)
  • Continuity of care can decrease communication if doctor or patient assumes they know (or are known by) the other so well that new issues are not introduced or discussed.


“Continuity of Care” does not necessarily mean that the patient will consult with the same doctor each time. This might not be possible. In such cases, we will need to ensure continuity using technology and services of other clinicians in the network. When it comes to continuity, the patients are really looking for the following:

  • They do not have to repeat details of their history and condition each time they meet a new clinician
  • They are not repeatedly handed over from one clinician to another and no one seems to be responsible
  • They are not subjected to unnecessary medication and investigations
  • They do not fall between the cracks as they transition from one treatment setting to another
  • They do not receive conflicting opinions from different clinicians

We need to ensure that the patient does not experience the above.

However, we should endeavour to provide “Continuity of Care” through the same doctor during an “episode of care” (healthcare services for a specific medical problem, condition or illness) for each patient.

At iKure, “Continuity of Care” is a key focus area and our primary healthcare delivery model is built around this theme. For us, continuity of care involves integrating patient care in his home with our Clinic services through the following:

  • our network of Hub & Spoke clinics
  • regular health intervention programs in the community
  • trained frontline health workers for last mile connectivity
  • our proprietary population health management system
  • integration with medical devices and wearables
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