“We want to fold in what exists, connecting and enhancing data without discarding established practices.”

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The Libra Social Research Foundation invites all to join its open-source community through GitHub. The repository includes products and diverse building blocks, addressing interoperability in the digital healthcare ecosystem. In a conversation with OSFY’s Yashasvini Razdan, Arun Kumbhat detailed the Foundation’s vision of connecting healthcare from bottom to top, including rural areas, by standardizing data for interoperability. 

Q. What is the Libra Social Research Foundation’s contribution to open source?

A. The Libra Social Research Foundation’s GitHub repository is an open-source community inviting all to join and utilize available resources. The repository includes not only products but also diverse building blocks. It’s not just us sharing; contributors can share their work too. It’s essentially a digital solutions-focused open-source community. For example, the product Proton for primary healthcare in the public space, was built by Sampporna Swaraj Foundation and donated to the community. The entire primary healthcare solution for the public health domain is available for use, along with building blocks for different ideas and needs. Individuals can leverage these building blocks, akin to ‘Lego’ blocks, to construct their envisioned solutions.

Q. How many repositories have you created on GitHub?

A. Currently, there  are six  different  projects in  the  repository, two  which  are  very  active  and  four  which  are  not  so  active.

Q. How are  these  repositories  used  to  create  products  to  enhance  digital  health?

A. Some  people  are  building  products  using  those  repositories, like  Taurus Glocal Consulting. More  will  come as we  are  at  the  very  beginning  of  our  journey.

Q. Would  you classify the six repositories as LibraSocial’s solutions for the digital healthcare ecosystem?

A. These six repositories are the fundamental components with the potential to address the overarching issue, that is interoperability, right upto the semantic level. So, it resolves the interoperability problem, allowing you the flexibility to construct whatever you desire. Interoperability means determining the connections between various elements. For instance, if I, as a patient, come to you, and you provide a prescription and diagnosis, the digital transfer of that data should convey the same meaning to the recipient. This recipient could be an insurance company or a government program or any other stakeholder. The important aspect lies in how this data exchange happens. Ensuring that the information maintains a consistent meaning for both the sender and receiver is essential. Without this consistency, exchanging data becomes futile if it holds different interpretations for the parties involved.

Q. How can you solve this problem when the healthcare data that currently exists is not digitalised?

A. Healthcare is a unique and complex ecosystem, spanning from village clinics to ambulances, with numerous independent players. Each, from physicians to payors, from  physiotherapists to diagnostic labs and from patients to pharmacies, can benefit from digitization. Eg When implementing universal health care, hospitals must receive payment.  If a third-party payer, like an insurance company, is involved, data sharing with the insurance company is necessary. Previously reliant on pen and paper. Now even processes like blood sample collection are barcoded for traceability.

Real-time digital means are essential to transfer data efficiently. You wouldn’t want to hand over massive registers to the insurance company. To exchange data in real-time, it has to be machine-readable. This is crucial for actionable data. The challenge is achieving this interoperability to connect all data seamlessly to personal health records. Unlike other businesses, past healthcare issues impact current problems, requiring a 360-degree ecosystem. Predictive systems should consider a patient’s history for post-procedure complications and tailored advice. Health is non-fungible, distinct from money and consumer goods. We want to fold- in what exists, not to uproot but to improve the existing system, connecting and enhancing data without discarding established practices. Our intention is to connect everything.

Q. What  level  of  health  care  are  you  targeting?

A. From  the  bottom  to  the  top.

Q. When  you  say  bottom  to  the  top,  are  you  including  rural  healthcare  as well?

A. Everything, every kind of healthcare, from any practitioner. So, when you talk about rural areas, for instance, if someone wants to provide care through telemedicine to someone in a village, data is generated. If the data is standardized and can be utilized for other purposes, like sending it to a pharmacy or referring it to a specialist electronically, it should be feasible. Data comes in various types, not just numbers; it can be images, sounds, and more. Sending an MRI report digitally is also data. The challenge lies in building a software infrastructure without having the necessary hardware infrastructure in place for all of this.

The key is that you should be free to use any hardware, and yet the output of data needs to be interoperable with other hardware or software. This is the problem we are trying to solve. Standardizing the data is essential for achieving interoperability. For example, if you have equipment from X brand producing data in a specific format, and your system can convert it to a format understandable by the equipment at the other end, that’s how interoperability is achieved.

Regarding live examples, a company called “LetsDoc” in Bangalore is making strides by utilizing open-source resources.

Q. How  do  you  keep track  of  who  is  using those repositories?

A. We don’t keep a track of who is using the repositories. So it’s just a gentleman’s agreement that if people use it, they will contribute back to the community in terms of what they have built. It’s an MPL 2.0 license, and we have no interest in keeping track.

Q. Do you  have  a  number  as to  how  many  projects  have  actually  benefited  or  projects  or  businesses  have  actually  taken  help  of  this?

A. During the development of these repositories, we ran an accelerator with 40 digital health startups. All 40 participated and benefited from it. Our focus isn’t on tracking or measuring success. These companies utilised some aspects or knowledge from the accelerator to develop their products. Two actively contributing startups are “LetsDoc with OpenHDIS” and “Sampoorna Swaraj Foundation with Photon.” Commercial gains are not our priority. The community currently has about 20 followers but is expected to grow gradually.

Q. How would you pitch the solution that the Foundation is developing to a CIO?

A. Pitching to the CIO won’t suffice; this represents a profound shift in business model, requiring engagement with the board. A CIO typically maintains existing systems but doesn’t make strategic decisions for the board. This open source digital healthcare transition involves redefining business practices, embracing digital health, and expanding the care continuum. This shift unlocks diverse business models, enabling healthcare entities to provide care remotely, without the need for extensive installations. Unlike traditional corporate systems, this approach doesn’t necessitate widespread software and hardware installations making it way more efficient in terms of TCO. Therefore, pitching to the board, not the CIO, is crucial for steering the organization towards innovative possibilities in healthcare business.

Q. Who will be the consumer of the solutions that spin off from this project?

A. It’s a huge opportunity because everyone who’s in the healthcare space is also a consumer and also a provider. If you’re a doctor, you’re also a consumer of healthcare. So every patient is a consumer of healthcare, every doctor is a consumer of healthcare, every insurance company employee is a consumer of healthcare. There is nobody who is not a consumer of healthcare. So the consumer opportunities are humongous. Healthcare is an ever evolving ecosystem.

Q. Are  there  any  alternatives  in  the  proprietary  systems  to  such  projects?

A. Internationally, tier one healthcare vendors are unaffordable for Indian providers, including the largest hospitals, pushing them out of the market. Tier two providers also struggle, leading to a rise in non-standardized mom-and-pop solutions lacking interoperability. Our solutions cater to this challenge, offering a unique approach for India and the global South. By adding a layer to existing software, even smaller solutions can become interoperable. This tailored approach is necessary in a resource-constrained environment where adopting expensive Western tier one solutions isn’t feasible. Healthcare demands retaining existing data, and our strategy involves integrating and building new solutions for seamless operation, an option not feasible with tier one or proprietary vendors.

Q. How do you disseminate this information about this project?

A. That’s exactly what we want to do by reaching out and talking to people. We want to show them that we have something they can work on to make it better and use it for themselves. If you want support from us, we will provide you the support to the extent possible with us. But go ahead and play with it, you know, build something for yourself.

Q. What are the benefits that the Foundation receives?

A. Our primary reward is the greater good. We aim to incubate and accelerate more ventures, establish academic tie-ups, and increase our capacity. Funding options include philanthropy or grants. In the future, we hope for contributions from the community benefiting from us as another potential funding source. Until then, we continue with our current approach.

Q. Why should an investor fund an open source foundation?

A. From an investor’s perspective, having access to risk-free building blocks facilitates product development. Utilizing open-source building blocks allows for crowdsourced creativity and innovation, ensuring a longer product life, and products that can evolve with the market, combating obsolescence. Red Hat serves as one example of building a massive, profitable business through leveraging open source.

Q. Who is working  behind  the  scenes  to  ensure  continuous  development  of  these  projects?

A. Us and the open-source community. You can find the team on the website, comprised of experts with decades of experience in this space—25 to 30 years each. Additionally, we have a network of experts whom we seek help from when needed. We are the ones stewarding this effort, and we aim to expand the community by establishing an open-source community, encouraging more people to participate. Our goal is to grow the community by collaborating with academia, fostering contributions from educational institutions. We simply want to increase the size of the community. We are there in the initial days, and it essentially requires widespread exposure so that people recognize the value of what we’ve done and begin using it.

Q. How  do  you  audit  and  check  the  contributions  that  come  from the community?

A. We don’t intervene; we just leave it to them. What I meant is, if they’ve derived benefits, they can contribute something back. There is an MPL 2.0 license under which these resources are available. It’s free, and they don’t have to pay anything for it. However, they can share back what they have developed if they choose to.

Q. Why are you using an MPL 2.0 license?

A. It provides the right degree of freedom. MPL 2.0 imposes one of the least amount of restrictions on people wanting to use an open-source resource.

Q. Is  there  any reviewer  sitting  to  verify  the  bugs?

A. It’s a continuous, iterative process that happens between us and the community members and whoever is using it. Anyone who uses it and finds a problem either discovers a fix and shares it with us or informs us about the issue, and we fix it. It’s a collaborative effort between us, forming a large cooperative group of friends.

Q. How  do  you  manage  conflicts  that  arise  between  the two  maintainers?

A. Currently a small community, it’s poised to grow through bug reports and fixes. Users report bugs, share solutions, and community members collaboratively address them. It’s a voluntary, collaborative effort; no one owns or controls the community. We, as volunteers, don’t claim ownership.

Q. How  do  you  incentivize  this  community  to  participate?

A. We, the initiators, have a missionary purpose, while community members aim for its sustenance and growth to enhance their products. This creates a virtuous cycle, aligning interests. If you profit from the community-built solutions, supporting it is a natural incentive, benefiting from a pool of creative individuals offering innovative ideas at no significant cost.

Q. Do you have a platform where the community members meet, interact, and discuss the  project?

A. At the moment, there is no physical contact; it’s always through the community itself, phone, and email. But as the community grows, we will have to find solutions to what will work best, and at each stage of size, I think the solutions will change and evolve. So, we will have to find methods as we go along that work for the larger community. As the size grows, we will have to find answers to those.

Q. Is  there  any  issue  tracking  procedure defined  for  LibraSocial?

A. As I said, we are still in the early stage of setting these up, documentation, and procedures. We’re doing that, I mean, at the moment, it’s all quite informal, but we’re in the process of applying our heads to it, taking opinions from the other community members, sort of defining best practices on what will be the best way to do this. It is collaborative, right? It’s not a business, no one owns it, it’s collaborative, so it will run very democratically and whatever people advise, whatever  is  the  best  solution  that  comes  out,  will  be  adopted.

Q. And  are  there  any  sort  of  specific  areas  that  the  community  is  currently  focusing  on?

A. Our top community priority is the Health Delivery Information System (HDIS), specifically designed for the smallest clinics or hospitals ie the Bottom of the Pyramid. We’ve established an MVP (minimum viable product), and it is well rounded in the core areas of OPD, Telemedicine, Pharmacy and Lab. . Our primary focus is on completing this crucial initiative. Once achieved, community members are encouraged to pursue additional projects of their choice. We firmly believe that this effort will have a significant impact, addressing the challenge of limited data availability. OpenHDIS aims to enable even the smallest healthcare establishments to collect and share data in an interoperable manner. Unlike larger institutions that can afford various systems, the real issue lies in underserved areas where there is either no existing system or an inability to afford expensive, non-standardized proprietary systems. This is the problem OpenHDIS aims to solve. In addition Photon has all the ready building blocks for digitalization primary healthcare in the public space.

Q. How can a new contributor join this community?

A. Simply visit GitHub, explore available resources, and feel free to reach out to us for anything you’d like to pursue. Joining our community is open to everyone, and you can participate in any capacity – even as an observer. Whether or not you actively use the platform, you’re welcome to join, interact with us, and engage with the community.

Q. As  a  community  leader,  how  do  you  view  India’s contribution  to  open  source?

A. Honestly speaking, we are in the very early days of realizing the importance of open source as a country, because we don’t have very many open source communities here. The potential of open source is enormous, and we’re only at the tip of an iceberg at the moment in this country.

Q. India has a large presence in the software domain.So why do you say we are still at the tip of the iceberg?

A. Considering the history of Indian IT, we’ve predominantly served as providers of IT services, mainly to foreign entities or governments. The leading IT names in India today are primarily service providers, with only a few known for creating software products. However, we’re now approaching an economic point where we need our own solutions, marking a shift from a focus on services for foreign exchange to a necessity for solutions. Traditionally, success was measured by headcount, but in the product domain, it’s about users. We’re moving from being solely service providers to a combination of service providers and product creators, leveraging a substantial domestic and international market presence with an improved understanding of global markets.

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