Apr 9, 2017

Manipal Hospitals - India’s Doctor Watson

7 min
Manipal Hospitals - India’s Doctor Watson
People fall sick, they go to see a doctor and if really ill they will be admitted to hospit...

People fall sick, they go to see a doctor and if really ill they will be admitted to hospital. It is what we are all used to, but is it the best way?

“For the past century the healthcare model has not changed,” says managing director and CEO of Manipal Hospitals Ajay Bakshi. “We are challenging that and suggesting a new model, which is that patients should be able to get a lot of information before reaching the hospital.”

A trained neurosurgeon, he has also worked in scientific research in the USA, before moving into senior management and returning to India. Today, as head of an organisation which services nearly two million patients a year, across 10 hospitals it owns and – five it manages, he is well placed to know what will make life easier for both patient and doctor.

“I understand that at the heart of the healthcare businesses is the doctor patient relationship. That has not changed for the last 1,000 years,” says Bakshi. “We are looking to improve that in several ways. Firstly, a year ago we bought Watson IBM technology. At that time we were the second hospital in the world to have it.”

Watson originated in the mid-90s when IBM built a computer system called Deep Blue, which was the first time a computer system had defeated a human at chess. IBM then took up the challenge to build a system which could master general knowledge, which it did. Healthcare providers saw the potential and between 2012 and 2014 IBM worked with partners to make Watson an expert in cancer treatment. During that experience IBM Watson read and understood nearly 15 million pieces of scientific information.

Today it reads papers and extracts intelligent information before it presents options to the doctors. Bakshi explains: “Working on a cloud based system, it reads the patient’s data in order to understand the patient and then it compares that patient with the best oncology treatment available anywhere in the world. The oncologist is given first, second and third options and what the likelihood is of that treatment working.”

In many ways it works in a similar way to the way senior doctors think and behave, so just as a senior consultant might ask a colleague his opinion, here the Watson provides that second opinion.

“It took us about six months to integrate the technology into our own IT system and we went live late October. It is a very expensive multimillion dollar technology, but we are giving it away to our patients for free. It allows an improved quality of treatment of cancer in all of our seven cancer specialist hospitals. It allows the hospital doctors to provide the same standard of care across the sector. Our thinking is that we want to provide the best cancer care in the world to our patients. Obviously there is an expectation that because our quality is better we will get more patients.”

Doctors are delighted with the quality of discussions they are having with their patients now. “It has improved the quality of care they are giving,” says Bakshi. “In addition interest is coming from abroad for people interested in getting a Watson opinion. As you can imagine there is a lot of excitement in the world around what Watson can do for a patient.”

Can we rephrase the highlighted part  as “In addition there is interest coming from people abroad who want to explore getting a Watson opinion”

Just a suggestion. The present line is also ok just that “interest” word is coming twice in one sentence


Remote access

But not all patients live near a Manipal hospital, so in addition it is available online, and this is one of several ways Manipal Hospitals is using the internet to communicate with patients.

“Patients should be able to get a lot of information before arriving at the hospital, and we have launched a product which is called healthlibrary.in which is similar to WebMD, but better. This is not used as a product in itself but is part of a broader offering for when they have a problem and want to know more,” says Bakshi.

The Manipal Hospitals app downloadable from Apple & Android App stores has the Healthlibrary already integrated into it and it enables the patient to search for his or her symptoms and learn more about it. Then, if the patient needs to make an appointment, the downloadable app can facilitate this. Following that, when patients go to the hospital they don’t have to wait in the lobby and fill out forms because all these forms are on the app and website. Bakshi compares it to checking into an airline nowadays – you don’t need to be in the airport to check in.

Manipal is ensuring that it keeps up with the younger generation, communicating with them in a way which is comfortable to them. “We have seen that the younger generation don’t want to read too much,” says Bakshi. “They would rather watch videos, so we have made nearly 400 videos of us asking doctors specific questions and them answering these questions in three to five minutes. So this might be questions like - What is the road to recovery after breast cancer surgery? What should the patient be aware of? What are the options for ovarian cancer? What are the treatment options and what are the pros and cons? These are then put on our health library website, on YouTube and are downloadable on a mobile phone. We are trying to make the library content more accessible to the modern generation which is more comfortable watching videos than reading.”



Waiting on prescriptions can be a time-consuming business – with a 20-25 minute wait at the pharmacy not unheard of. Manipal Hospitals now sends these directly to the pharmacist so that they are ready when the person walks in the door. The patient is also emailed the prescription, should they want to take the prescription to a pharmacy nearer to their home.

Content that it is improving the patient doctor relationships, Manipal is moving forward with the idea of enabling patients to have video consultations with doctors once they have had an initial consultation. Taking into account that sometimes patients do not need to be seen physically by a doctor - he or she just needs to organize blood tests or discuss how he or she (comment: just to maintain consistency in language)is feeling - all of this can be achieved on a video chat, which the doctor gets paid for. This should go live in the next couple of months.

Everything is going to plan, with Bakshi finding that his background makes him ideally placed to liaise with doctors. He says: “Our doctors are very excited about these innovations. If you go to any other country the biggest challenge of implementing technology in healthcare is that doctors resist it. By virtue of me being a neurosurgeon, as well as a CEO, I understand the doctors very well and I am able to carry them along and get them excited about it. This I think is a big success of our organization, because if doctors don’t like it you can’t make it work.”


Our engagement with Intersystems on a Unified Healthcare Information System :

In current days, it is no longer an option for a major hospital group not to have a HealthCare Information Systems that it relies on for running the Clinical and Revenue Cycle work streams. Operating at a paper light or paperless environment has been proven in so many studies that it improves the quality of care, reduces adverse event and enhances the efficiency of a hospital.  TrakCare Hosptial Information System (HIS) has been at the leading edge in delivering these benefits to Manipal Hospitals. 

TrakCare’s comprehensive clinical, administrative, and departmental modules share a single data repository and have a common user interface. Data entered once is immediately available to all authorized care providers, enriching the patient record with each interaction.

Manipal Hospitals wanted a strategic HIT partner like InterSystems that can align with the long term digital hospital journey that Manipal has set. Manipal has looked for such partner based on the below strategic imperatives.


  • A global leader with geographical presence that aligns with Manipal footprint. TrakCare has been ranked best in KLAS globally for the past two years.
  • An HIS that has deep clinical best practice that can enable our clinicians to make informed decisions. TrakCare has a product design that incorporates clinical best practices & decision support system.
  • An HIS that acts in a hospital as a single source of truth not only in one hospital but enterprise wide. TrakCare has been used in mega deployments in country & statewide around the globe.
  • A reliable long-term partner that we started our journey with ten years ago and is part of our future journey as well.
  • Manipal’s own experience was very good with Trakcare HIS over the last 9-10 years.


Manipal has recently signed an enterprise wide agreement with Intersystems to deploy TrakCare HIS in all its hospitals. 

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Jun 13, 2021

How healthcare can safeguard itself against cyberthreats

Jonathan Miles
6 min
Jonathan Miles, Head of Strategic Intelligence and Security Research at Mimecast, tells us how the healthcare sector can protect itself from attacks

One of the most fundamental lessons from the COVID crisis is that health should always be a priority.  In a similar fashion to the human body that frequently fights off viruses and foreign invaders that intend to cause it harm, the sector itself is now a prime target for another type of external threat: cyberattacks.

The figures speak for themselves: between December and January this year, hospitals in the UK were at 89% capacity, with 7,000 fewer available beds than there usually are. As the pandemic increased pressure on hospitals, clinics, and research facilities to create a treatment for patients globally, it has left the sector exposed to hackers who, like a virus, have been targeting it relentlessly and evolving their tactics. 

From patient records being held ransom, to fake emails claiming to originate from the UN WHO, the NHS, or vaccine centres, through to attacks on the cold supply chain to find out the secret formula of the COVID vaccine, the healthcare industry is facing constant cyberattacks and struggling to cope. This threat is unlikely to go away anytime soon – and as such, the industry needs to take a proactive, preventative stance to stay safe in a dynamic digital world. 

Going digital 

The responsive nature of healthcare – particularly of hospitals – means that efficiency is crucial to the industry’s standard operations. To support this, the sector has been embracing technological advancements that can improve the quality of work, enabling staff to meet pressing deadlines, and enhancing patient care. For example, the industry has been digitising records and improving its ways of working through digital means over the past few years. 

This shift is critical to offer high quality patient care; yet, it also means the sector has become more dependent on IT, which can come with a risk if cybersecurity processes employed are deemed as inadequate. 

Without the correct security measures in place, the desired efficiency gains realised, can be easily lost in a heartbeat. Simply put, an elementary glitch in the system can have a tremendous ripple effect on many areas, from accessing patient records and conducting scans, to maintaining physical security and protecting the intellectual property of experimental treatment development.

To prevent this, healthcare organisations need to ensure they’re considering cybersecurity as part of their overall digital transformation strategy – and setting the right foundations to create a culture where safety goes hand in hand with patient care. 

Strengthening defences

Before implementing cybersecurity process, healthcare organisations need to assess the potential risks they face. Depending on how much confidential data the trust has, where it is stored, who has access to it and via which means, the cybersecurity strategy and associated solutions will change. 

It’s fair to say that a medical device start-up where all employees have a corporate-sanctioned laptop and access data via a VPN will have radically different needs to a large hospital with hundreds of frontline workers connecting to the hospital’s Wi-Fi using their personal device. 

These requirements will pale by comparison to a global pharmaceutical giant with offices in multiple locations, a large R&D department researching new treatments for complex diseases and a fully integrated supply chain. Considering the existing setup and what the organisations is looking to achieve with its digital transformation strategy will therefore have an immediate impact on the cybersecurity strategy.

Despite this, there are fundamentals that any organisation should implement: 
Review and test your back-up policy to ensure it is thorough and sufficient – By checking that the organisation’s back-up is running smoothly, IT teams can limit any risks of disruption in the midst of an incident and of losing data permanently.

In our recent State of Email Security report, we found that six out of ten organisations have been victims of ransomware in 2020. As a result, afflicted organisations have lost an average of six days to downtime. One third of organisations even admitted that they failed to get their data back, despite paying the ransom. In the healthcare industry, this could mean losing valuable patient records or data related to new treatments – two areas the sector cannot afford to be cavalier about.

Conduct due diligence across the organisation’s supply chain – Healthcare organisations should review their ways of working with partners, providers and regulatory institutions they work with in order to prevent any weak link in their cybersecurity chain. Without this due diligence, organisations leave themselves exposed to the risks of third party-led incidents. 

Roll out mandatory cybersecurity awareness training - Healthcare organisations shouldn’t neglect the training and awareness of their entire staff – including frontline workers who may not access the corporate network on a regular basis. According to our State of Email Security report, only one fifth of organisations carry out ongoing cyber awareness training.

This suggests it is not widely considered as a fundamental part of most organisations cyber-resilience strategy, despite the fact many employees rely on their organisation’s corporate network to work. By providing systematic training, healthcare organisations can help workers at all levels better understand the current cyberthreats they face, how they could impact their organisation, the role they play in defending the networks, and develop consistent, good cybersecurity hygiene habits to limit the risks of incidents. 
Consider a degree of separation – Information and Operational Technology (IT and OT) networks should be separated.

Although mutually supported and reliance on each other, employees shouldn’t be accessing one via the other. This should be complemented by a considered tried and tested contingency and resiliency plan that allows crucial services to function unabated should there be a compromise. Similarly, admin terminals should not have internet access to afford a degree of hardening and protection for these critical accounts.

As the sector becomes a common target for fraudulent and malicious activity, putting cybersecurity at the core of the organisation’s operations is critical. It will help limit the risks of disruption due to cyberattacks, reduce time spent by the cybersecurity team to resolve easily avoidable errors, and ensure that institutions can deliver patient care, safe in the knowledge that their networks are safe.  

Fighting future threats

With technology continuing to change the face of healthcare, the surface area and vectors available for attacks by malicious actors is constantly increasing. With the introduction of apps, networked monitoring devices, and a need for communication, the attack vector is ever expanding, a trend that needs to be monitored and secured against.

To prevent any damage to patients, staff, or the organisation they are responsible for, healthcare leaders must put security front and centre of their digital transformation strategy. Only then can the sector harness the full benefits of technology. Doing this should include implementing cybersecurity awareness training to challenge misconceptions around security, encourage conversation, and to ensure employee knowledge of the security basics and threats faced. 

This ultimately allows healthcare organisations to do what they do best: provide the highest standard of patient care, safe in the knowledge that their operations, patients, and data are safe.

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