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Pioneering the Indian digital health records stack | Eka Care
Do you remember downloading the Aarogya Setu app during the Covid-19 lockdown? The Indian government was one of the early adopters of a contact tracing app and this app was proof of India’s tech talent.
In this episode, we feature Vikalp Sahni, the man responsible for building the Aarogya Setu app in record time.
Vikalp has had a fascinating journey with a front-row view of the evolution of the Indian startup ecosystem. He was the CTO and co-founder of the travel startup Goibibo, which was eventually acquired by MakeMyTrip.
Building the Aarogya Setu app inspired him to create Eka Care, a platform for managing personal health data.
Eka Care's ambitious mission is to provide individuals with easy-to-understand line graphs, similar to tracking financial health, but for monitoring personal health metrics.
Vikalp talks about his journey of building Eka care!
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Vikalp: Hello everyone. I'm Vikalp. I'm a developer at heart, a technologist. At this moment, I'm acting as a founder, CEO of EkaCare. It's a personal health record app for patients and an electronic medical record app for doctors.
My father was a banker. He is retired now and I have studied in seven different states. Used to transfer from one state to the other state. So I have seen lots of cultures, have friends across different geographies. And basically, I'm a KV product, Kendriya Vidyalaya. And after schooling I did my engineering from NIT Silchar. I have done engineering in civil engineering. But since my 10th, 11th standard I was quite fascinated with this whole tech and computers. I was not the most studious one.
But I was quite interested in programming. And I remember my father got this 386, which was a machine that his bank was using. They wanted to upgrade their machines. And he bought me that 386 for, I think 2-3000 bucks at that point in time when I was in 10th standard. And I learned a lot on how to program, how to basically work with computers.
That's how the journey started for me. Since then I have loved the format of this creative writing to build products that can be used by multiple people. From small games that we used to do in school and colleges to actually building projects in college where I used to get gifts such as phone.
My first phone that I bought was basically a small project that I did, it's for a freelance project. One of my friend's cousin wanted a website, so that's how my journey started with programming. I wanted to build something on internet. I got placed in IBM in college.
I was not an enterprise sort of a person. So, started looking out where I can contribute.
Akshay: As in you couldn't relate to the kind of work that you were doing there, the kind of products you were working on?
Vikalp: I was programming. I used to work on C Sharp.
But I was fascinated with internet and that is how my journey also started, looking at the internet products. And incidentally my seniors, they were from Yahoo. They were doing their own startup called Bixee.com. That got acquired by Naspers MIH India.
And that's how I started my journey with IBIBO group. That's how the whole startup ecosystem and entering into it, and all of that started for me.
Akshay: So you were an employee at Bixee when it got acquired?
Vikalp: One of the guy who used to work with these founders at that point in time, they knew me well. Especially Ruben. He was one of the founder, he was earlier part of Hot Jobs Yahoo. But when they got acquired by MIH and Naspers, they wanted to build a larger team. And obviously I wanted to also participate in building internet products. That's how the whole journey started.
Akshay: What is MIH?
Vikalp: MIH was the name of Naspers Investment Vehicle at that point in time.
Akshay: And how do you spell Bixee?
Vikalp: Bixee, it was a vertical search engine. You would've seen search engines like Monster or Indeed where you search for jobs or Yahoo Hot Jobs.
This was a vertical search engine. The primary objective earlier was to do search for jobs across the various websites. But the whole technology was built in such a way that you can leverage that technology to create various vertical search engines. Like if you look at Google today, you can do an image search, you can do a video search so on and so forth.
Our believe was that there will be multiple such search engines that will solve for specific vertical needs, be it matrimony. You would be surprised to know at that point in time in 2008 when we used to build Bixee, there were close to 400 matrimony websites. And I have crawled them all and indexed them and created. And we've got patent for the technology that we have built post the acquisition and we believe that would be one of the big stories and we worked there.
Akshay: What happened to it then?
Vikalp: The thing is, it was very early days for Indian internet. 30 million Indian internet users. There are multiple products that we started. One was search, the other was social. And the idea was that we will be India's Baidu and WeChat.
That's the story that China has seen. But India was very different from a market standpoint, and China was more world setup. India has shown very different path, which is far more formidable path, which is of platforms. You see it UPI and all of that. But that was very early.
At that point in time, Indian internet population was also quite early. So, we haven't seen that kind of attraction to our product that we wanted to. And monetization also, after three years down the line, seems like we have to see how we can monetize better and that's where the whole pivot started for us.
And the pivot started from being search and social company to more of a transactions company. That is where we transformed travel.bixee product to Goibibo.com and we built a small payment gateway for Goibibo.com that we built it as an IbiboPay. So that's how the transformation happened for us, and that's why you don't see any bixee.com or ibibo.com anymore. While these were quite a fantastic products at that point in time.
Akshay: Essentially like this, out of all the vertical search sites, microsites that you were running, you saw travel as the one which was most promising to convert into transactions and decided to bet on it.
Vikalp: Many things were happening at that point in time. This was 2009 now. Flipkart was basically becoming prominent. Which means that transaction story was coming together. Yatra, Cleartrip were already a decent player and India has seen first set of their online transactions on travel.
Akshay: MakeMyTrip might have got listed by then.
Vikalp: Make my trip got listed and it was a brilliant listing. I think an Indian company going there, listing Nasdaq is a dream come true for everyone. And we basically said that, okay, this is a right thing to do.
And travel.bixee anyways had traffic, which was more of a meta search engine at that point in time. Which was an ixigo. Ixigo now does even flight bookings. This was a meta search engine and we said that it's a lowest hanging monetization opportunity. And we started getting into travel.
Akshay: How do you build a transaction layer? Do you have to go and integrate with each airline?
Vikalp: We were a little smarter there. And like any other internet startup, we first said that we will use a B2B partner and we will integrate with a B2B partner. At that point in time, it was Via where we leveraged that partnership and we said that if this entire fulfilment works for us or not.
Ashish Kashyap was the CEO and Sanjay was looking after the whole flights business. Ashish was the CEO for Ibibo Group. We all came together and we built it. Once we started seeing the early traction, and for this we wanted a payment gateway also. So we built IbiboPay, which was to facilitate the transaction.
Once we started seeing traction, we ended scaling it up and that's when my current co-founder Deepak, has also joined us from Yatra. He was looking after business side of Yatra. He joined Goibibo. So me, Sanjay, Deepak, Ashish all of us started then scaling up the Goibibo's flight business.
We started with flights and that basically from that B2B partnership. Then we ended up doing the airline partnerships as well once Deepak joined. But that was like a long journey because you have to start integrating with GDS, start integrations with individual airlines. But we started off nimble.
Akshay: And GDS is like SaaS tool, which airlines used to run their ticketing.
Vikalp: These are global distribution systems. They are distribution engine. Obviously, they have a SaaS tool as well that airlines can use. But this is like pretty early days, at that point in time when these companies have been built.
SAAS was not even a word. Amadeus, Saber, Travel Fusion all of these are large scale transaction engines that are built to distribute travel content across.
Akshay: So these are like B2B e-commerce sites. This is where a travel agent can buy tickets from an airline.
Vikalp: You are right. Earlier the travel agent used to use a terminal without a UI to actually punch in. But eventually OTAs such as Goibibo, MakeMyTrip all of them started integrating with the APIs.
Akshay: What about building the supply for the other stuff? The airline stuff while it's not easy, but it's not that hard also. What about on Goibibo where you have hotels and even homestays and all of that?
Vikalp: That is what was our claim to fame. Flights was so to say pretty sorted. But when we ended up building, we saw many other opportunities as well. And two big opportunities were bus and hotels.
Bus, we went there inorganic route. Where Ibibo Group acquired RedBus. And RedBus became part of Ibibo Group. But on the hotels, this was 2011, 12, we actually figured that India was not doing hotel bookings online. When we started, the total internet online booking would be 5-10,000 a day.
When I was leaving, we were doing close to 200,000. So, that's the opportunity that we saw. And kudos to the team and the leaders. We ended up investing in the right areas there. Two key areas were: one, to build a software for hotels so that they can distribute their content.
And we built an amazing tool. We used to call it InGoibibo. It's called InGoMMT after the merger. Then we also invested into supply, which is like a human sales team so that they can onboard these hotels onto selling inventory online. And I think that is where the whole claim to fame of Goibibo started. Hotels is where we have created a big mark in the whole travel ecosystem. That's how the whole merger and the story with MakeMyTrip also started brewing.
Akshay: InGoibibo was like a hotel ERP, where a hotel can manage its bookings.
Vikalp: Distribution system. When you say ERP, does many things. They will do housekeeping as well, they will do payrolls also, all of that.
But we were more distribution focused. There are so many people who want to book hotels online. How this booking will happen? So hotels have to come up. They have to put in their inventory, they have to put in their content, and then the booking will happen on goibibo.com, which is the B2C side.
Akshay: This is not like a pure play distribution where a hotel can go to multiple places to sell the inventory, but it's just a way for connecting their inventory to Goibibo.
Vikalp: Indeed. It was to connect their inventory to Goibibo. Then Goibibo has released APIs. People can use those APIs from Goibibo. To book hotels, you have to first have the inventory online. There was nothing online at that point in time. And that is how the whole journey for us started. At one point in time, this was 2016, it was fierce competition. And MakeMyTrip, amazing company, great founders. They also know that hotels is a big play with lots of cross margin and perishable inventory.
Akshay: Hotel margin is better than flights.
Vikalp: 100%. Flights is a low margin, but high consumer interest or a traffic acquisition channel. For example, trains. You can get consumer interest, create a good experience, so on and so forth. But the money that you would make there will be far lower than the money that you would make on hotels because there the margins are far higher.
Akshay: Because the market is unorganized. It's not a clear pricing. Like say with a train, it's very standard pricing. So not much scope for margin.
Vikalp: It's a fragmentation game. How many airlines we have in the country and how many hotels we have in the country? One is that.
Second is it's very easy to distribute inventory that is not fragmented, but it's very difficult to distribute. And then you can play far more. Can I rate an airline on reviews and ratings and on seed capacity and all of that? No.
But from a hotel perspective, you can do a far more. A far better product. So that consumer would use you be it using reviews, ratings, or content. In totality, if you see that all of this is the right markers for a business model, that'll give you far more gross margins.
Akshay: So as a general lesson, if you go after a fragmented market that will always give you better margins. If you can curate and distribute in a fragmented market that would give better margins.
Vikalp: I believe fundamentally, and that's what my learning was "market fragmented, very good". But more importantly, what is the value that you are creating. If the amount of value that you are creating as a stack is high.
Like when I am selling a flight. It's basically an inventory that is being sold, which is very commoditized. But when I'm selling a hotel, there is a lot more discovery that needs to be done. Location is far more important. How do I reach that place is important. Content is important. What people are saying is important.
What kind of value you are able to add. So these two things, a fragmented market and other is the problem as such that you can add a lot of value by putting in your, be it a technology or an offline business, whatever is your model. If these two things sit together, you can command higher business value for your solution.
Akshay: Coming back to the story of the merger.
Vikalp: It was fierce competition. And eventually Deep, Rajesh, Ashish and Naspers, all of them have thought that this is a right way to not undercut each other, but actually build the ecosystem together.
That's how the whole merger story happened because the Indian market is huge and still it is underpenetrated when it comes to hotel booking online. There is a lot that we can still do. Deep keeps saying this quite a lot that, " the best is yet to come". And I fundamentally believe in Deep, the founder of MakeMyTrip that "Best is yet to come for travel in our country, especially on hotels".
It was a right thing, rather than bleeding through the nose and creating a competition, which is not on product values, but more on discounting and price value. It's better to actually merge and build the ecosystem together. So I think very smart decision by all the leaders to get to that level.
Akshay: Is there still juice in the hotel market because you have these different ways of fixing fragmentation, like OYO Rooms and Airbnb. What's your take on this hotel market?
Vikalp: India, hotels online sales is still underpenetrated. There is a lot that one can achieve.
And if I look at it, travel as an industry and hotel specifically: we have just touched the tip of an iceberg of a consumer side. There is a large corporate side business that also happens in the country, which still I believe is not organized. And MakeMyTrip is trying to do a lot of stuff there.
Many other companies are also doing. There is a lot of last-minute bookings that happens on hotels. Hotels is such a commodity that it has a perishable inventory. If the room is not booked for tonight, you're done. There is a lot of innovation that can happen in hotels be the day room.
Recently I saw on Goibibo, I was able to book a Lemon Tree in Mumbai for a day starting 9:00 AM in the morning to 6:00 PM in the evening for one fourth of the price of where I can just go for work. It's a crazy market and the amount of innovation that can happen, pure play on hotels is just immense.
Akshay: Coming back to your own journey, what happened once the mergers got done?
Vikalp: As I keep telling, I'm a lucky guy or a fortunate guy to get right people. During my tenure, I got empowered when I was building Goibibo. I got super empowered again when the merger happened and when two teams are coming together, which is Goibibo, MakeMyTrip even RedBus.
I stayed there for three years and, merged a lot of technology stack. As I said, InGoibibo eventually became InGoMMT, where a lot of optimizations have happened, also learned from each other. There's a lot of good stuff that has happened on MakeMyTrip on flights. As InGoibibo took that. So, empowered even to build new products. My journey was beautiful.
Akshay: But the group continues to run both brands separately.
Vikalp: Yes. Group sees that there is a value in both the brands because there are loyal customers to Goibibo. There's a way people see Goibibo so is with MakeMyTrip.
These are pretty large brands, more than 50 million app downloads, high monthly active users. Why would anyone want to kill anything. That's when September, 2019 I had this candid conversation that "I think it's my time to start something up new" and the whole journey to building something else started from there. But I had a great time.
Akshay: You stuck around once Covid hit? Did you leave before Covid?
Vikalp: I started discussing with Deep and Rajesh about my exit and then strategizing, but I told them that I'm not going anywhere. I'm not joining something. I just wanted to stick around till the time they want me so that everything is in a safe space.
It was like 6-8 months that I continued, did my best whatever I can do. Before Covid itself, I started researching on my ideas and discussing it with people. So my announcement of exit was in January, 2020. That's how it all happened.
Akshay: Tell me that journey of discovering the next idea.
Vikalp: While I was leaving in March 2020, I got this unique opportunity to build for the country. Me and my team delivered Aarogya Setu for Government of India.
Akshay: This was under MMT or this was like you and a team of volunteers?
Vikalp: It was volunteers, but obviously volunteers were all part of Goibibo and MakeMyTrip team. It started off also with a very small POC that happened in my cabin, where one of my senior VP Raul, he came up with this thought that, "okay, let's do the contact tracing". I remember he came up with this advertisement from a newspaper in Kerala, which says that, these are the specific areas. If you have been to any of these areas at this point in time, please come and visit the public healthcare centre. We will test you for Covid because a Covid patient was all there. Now, look at it, doing it at a scale of million people you cannot. And it's not possible to contact trace.
That's when we started dabbling around on this idea of building something. There are a couple of developers who just got collected. They wanted to build something to solve a problem. And I think our thesis was very simple. Whatever we knew on technology, can we put together like a hack around it so that we can trace the contacts and we can help.
And that was a talk of the town. Covid was all there. That was in the month of March. Raul, a couple of my developers at Goibibo, android, backend, we all came together. We delivered a small product and Deep Karla, our CEO-founder MakeMyTrip, he liked it.
He shared it with NITI Aayog. They also loved it. And then after a lot of rigorous tests and trials, and I will give it to the government on the amount of help and the overall focus that they had put in, making sure that we are building a robust product, not only from scale perspective, but on the privacy and security as well.
After many interviews with NIC team, METI, where they not only grilled us on technology, but also on integrity. Finally they said that, okay, let's build for the country. And I think the need was such that they also wanted a team coming together and solve for it as a pure volunteer.
Not associated with companies as such. For me, the fortunate thing was I was anyways out. But MakeMyTrip, Goibibo they sponsored these engineers and kudos to Deep and Rajesh and everyone there to sponsor these. Then we built it for the next 3-4 months along with NIC, Government of India, METI and everyone.
That actually changed my perspective from corporate travel or a travel product to health. And that's just to answer your question of how I ended up being here where I am.
Akshay: When you build a product for the government who wants the IP for it and where is it hosted? Is it hosted on a government server?
Vikalp: Everything is government. We are just volunteer developers who are developing for the country.
And along with developers from NIC, which is National Informatics Center, they now run future of Aarogya Setu. It was more like an open-source contribution and actually the product is open sourced. But the running of it, the scaling of it, everything happens on the infrastructure, which is owned by government. It has nothing to do with the private parties.
Akshay: Did you face any sort of backlash? I remember there was some sort of privacy backlash about it. Did you personally face any of it?
Vikalp: Personally why would anyone attack individual?
But if you look at it, anything that government does, you will have naysayers and you will have people who will say good about it. What I realized is many of the naysayers work on partial knowledge. They don't understand the entire architecture or the complexity of the things that are basically being done and delivered.
So you would see a lot of these backlashes. What I fundamentally loved about the whole project is: there was no ulterior motive anywhere. The only motive was to deliver a service that can help a person who in a remote location, is 60+ and suffering from Covid and actually need help.
Be it a very simple mental help, as someone can go ahead and talk to them. Apart from that, letting people know that you should quarantine or you should not quarantine. So it was very earnest attempt and that is why we as a team also work like mercenaries at that point in time to make sure that we solve for it.
Akshay: How did contact tracing work in it? That was the core objective.
Vikalp: Contact tracing is all about, let's say if I'm sitting with you across the table. There are two key markers that can be leveraged from your device. One is location which is GPS and second is Bluetooth. Now the core fundamental of Aarogya Setu was: this information is private, and if this information is private, they should remain with users.
Hence, the contact tracing capability that Aarogya Setu has built was all completely local. One thing is: works without internet, and second is it never sends any data to backend. So it basically tracks the Bluetooth proximity of other devices that are hosting Aarogya Setu app. And all of these devices are anonymous device.
No one knows who is it. These devices were nothing but a code. So your code will be ABCD, mine could be PQRS, and there is a contact book that gets created locally on device that ABCD and PQRS have come in contact and vice versa for this period of time. And it's a local information stored locally not being sent to any of the backend services. That's how the whole contact tracing works.
Akshay: How would I know that I've been exposed? Let's say there is ABC, which I met with. And after 3-4 days, he is positive. And on his app, he updates it.
Vikalp: Yeah, that's how it happens when he updates that, he is positive. Now we know that he is positive, which means that PQRS is positive. We send a broadcast wherever in the local contact book. Again, this happens locally on the device. Wherever you see PQRS as a contact that has happened, you basically mark it bases the model to red or yellow or orange.
Akshay: How does that algorithm work of which colour to assign? Like duration of exposure.
Vikalp: It's a very scientific thing which is basically being done by ICMR. The thing is, if I'm going by let's say a car, and I stop at a signal, and then there was another person on that signal. Now Bluetooth can actually put that person in a risk section. But then the duration was very low.
If the duration is low, the person is at a very low risk. And these specifics are being delivered to us by very senior scientists. We actually develop algorithms to make them execute at that scale.
Akshay: Does this rely on self-reporting? I have to report, I'm positive. That's like a loophole there. If people are not updating on their app that, they're positive.
Vikalp: It does rely on self-reporting and people generally would update on what exactly. And there's a lot of emphasis around people.
We used to send push notifications to them. We used to send a lot of these things to encourage people to report. And for example, in many cases when it's a government mandated things, if we get an information that a particular phone number is a positive, then we leverage that information also because many a cases you won't self-report, but you would go to a PHC and the PHC will report on your behalf.
Because you're talking about people who got covid, you might want to give them care. There are multiple such models where the whole contact tracing effort was useful.
Akshay: And how does GPS help in this?
Vikalp: GPS was of very less use, to be honest. Bluetooth is the right thing to do.
Akshay: How did this lead to EkaCare? Tell me about the birth of EkaCare.
Vikalp: I got transformed from travel to health, suddenly. After this, I thought that there are very simple things and if you look at it: my family, my father is diabetic. And I realized that he basically takes this needle every week once, and he puts that value into a piece of paper in a diary.
Then I started looking at other use cases as well. If you want to find a date today in 5-kilometer radius, it's super easy. You'll swipe left, swipe right. There are many apps, you might get a date. A person like you, charming as well.
But God forbid if you want a B+ blood or an O+ blood, what would you do? You would basically send a mail to your HR or put a WhatsApp status or a Twitter. It's so strange, that such an important thing is not digital. And many stories you have.
My sister got Thalassemia minor as a diagnosis once she got pregnant. And in India, we basically are giving more weightage to that before getting married you look at people's Janam Patri and all those kinds of things. But incidentally, if both parents are Thalassemia minor, there could be a complication to the kid.
And nobody knew about this. Individually also, if you are a Thal minor, and if you continuously pop in iron tablet, you might end up getting stones in your gallbladder because your body is not comfortable in digesting iron the way the other bodies are.
And she never got to know about it because no one looked at three reports together. Every time after six months used to visit a doctor. Doctor says okay, haemoglobin-iron low, let's have these tablets, and then you're done. All of these started coming to my mind when I was doing this whole journey around health and Aarogya Setu.
I said that fundamentally without a longitudinal record, you are shooting in dark. Then you are basically just leaving it to the fate that let's give this medicine. If something works, great! If nothing works, then we'll change the medicine.
There was a nice presentation that an endocrinologist gave in one of these conferences that we follow. Any non-data driven approach is basically shooting in the dark to get the right outcome. And if you look at it, I'm not sure how you store your medical records.
If I ask you a very simple question, how your TSH or thyroid hormone moves over a period of last 3-4 years, you definitely have reports, but you cannot give that answer. And we expect poor doctors to actually go ahead and read through those documents to give you the right outcome while you and I look at the revenue numbers then a nice graph.
It's a pretty strained setup, and I said that this needs to be solved. So that's how the birth of EkaCare happened. And we fundamentally believe that this is how the world will evolve over a period of time.
Akshay: I like that term you used of a longitudinal record. So longitudinal record means like time with an axis.
Vikalp: Longitudinal record is like, I have done my CBC in last 5 years, at least 6 times. Some doctor have prescribed, sometime I did a regular self-health checkup. Now, these are point in time transaction. At that time, what was your body? But if your body says that your cholesterol is high in the last five years, every time your diagnosis will change, your way of approaching a particular problem will change.
Because your body is such that it has an inherent tendency of creating that particular marker. And your outcome and your medication and everything will basically depend upon that. So that's how the longitudinal records work. So you go away from these looking at a human body at that point in time to looking at a human body, how it has behaved over the period of time.
Akshay: So essentially what you wanted to build was like a single source of truth, which has all the data about your health markers.
Vikalp: Absolutely. It's so, imperative today. If you look at my father, my mother, I have EkaCare, I have all of their records in EkaCare, and I feel in peace because I can go to a doctor and I can say that, here is the last eight years records.
And you can now see that all of these vitals have been moved like this over the eight years. So we have built technology that cannot only store these medical records, but parse and process that information to create these insights for doctors and patients. That's where I will be also at peace that okay, doctors have seen all the information and now the outcome is far more data driven rather than more experiment.
Akshay: Tell me about the first version of the product you built. That 0 to 1 journey. Once you had the idea, then how did you execute?
Vikalp: We are a one-and-a-half-year-old startup. The product was out in the market in the month of May, June 2021. So we basically are in that 0 to 1 journey.
I think one of the product that we started off with is EMR. This information that you are creating as a user, how would a doctor get that information? So we fundamentally said that there are two things that we have to solve, one for doctors where they can look at this information, they can generate prescriptions, they can manage their appointments.
And also for us: doctors, not for hospitals. We are very specific to doctors for their clinic, for their staff and themselves. There are these doctors that have started coming in, they started using us. And this product has started seeing a lot of success on prescription and appointments.
Akshay: So it's like a free to use product for them.
Vikalp: If you look at it, we don't see this as SaaS tool, but there is a small fee that we take.
Akshay: What kind of fee?
Vikalp: There are many doctors. They pay us 1000 bucks. It's a yearly subscription.
Akshay: Which in a way, it ensures seriousness. If you give it free, then people may not use it also because you don't value what you get for free.
Vikalp: You are right. And how the model from revenue and all of that pans out, we are too early on that journey. This is something that we are right now discussing and figuring out. What fundamentally we want is to digitize this so that we can have a far better outcomes over a period of time.
Akshay: This is like the InGoibibo approach. You want both parties to use it. The doctor product is a way for doctors to kind of start using it and there would be a patient product so that it really adds value.
Vikalp: But very different from hotel. If you look at it from our team's perspective, we work for doctors far more because eventually that is where the outcome will be driven. We make sure that whatever we do we have an outright trust with doctors. For example, we don't do things like I would've done at Goibibo.
If there is a hotel that comes in, you as a buyer of a hotel, you want to stay in multiple hotels. Sometime you'll experience this, but as a patient, you want to go to a same doctor all the time. I would like to go only to 2-3 doctors.
I don't want to experiment with multiple doctors. We remain true to that fact that we build a solution where we create a health journey for patient, but we don't end up becoming a discovery tool for doctors. We basically connect them with one doctor and they have a long-term journey with that doctor, and the same doctor will now be able to give a better outcome because of longitudinal journey and being able to communicate to you, because there is an EMR side of story, there is a patient side of story, which was very different. We don't do reviews and ratings.
We don't believe in things such as: if you don't give a doctor all kinds of information, you won't get the right kind of an outcome. And then you rating that doctor is not the right thing. Like in case of hotels, it is very easy. Same room, same clean linen. Doctor is very different.
From outside it looks the same, but the way we operate is very different from what we have learned.
Akshay: So essentially, you're a product for doctors. It just so happens that patients are also on the product, but your core focus area is doctors. Empowering them.
Vikalp: Our core focus area is to provide for better outcome. The better outcome cannot happen without both the parties in the ecosystem. That's why for us, patient and doctors both are important and it's a play where we have to do a lot of hard work because we practically are building two products. So be it. There are ways in which industries are solved and health is very different.
Akshay: Your patient acquisition is not happening directly, but is happening via a doctor, essentially the doctor creates a patient account every time a patient comes to him. The doctor would share some link to book an appointment and the patient, when he's booking the appointment, then he would create his record there.
Vikalp: Both ways. Today we have 5 million plus app downloads, without doing marketing. These are not the number of prescriptions that has created on Eka. Why that happens is because people do care for their health. We believe that people care for their health.
People download EkaCare app. They start their process of uploading their medical record, not only by scanning and storing it, but also by syncing their Gmail account. And because of our technology and all Google has given us, we are the only healthcare company where Google has given us the access to discover through the mailbox because we use right kind of a tech privacy, security enabled.
After a lot of security assessments, we got that approval. People are coming and they are storing their medical record. I think if you haven't stored your medical records yet with EkaCare, you are losing on better outcome whenever you need it. We have seen a lot of organic traction there. It's not only the doctor acquisition, there's a lot of organic acquisition that happens.
Akshay: So one kind of patient is somebody like me who has mostly paper records and wants to digitize them, have it available on an app. He would download scan. And through Gmail integration it'll automatically import if I get a mail from Lal Path Labs, it'll recognize this is a report and it'll import it. So I will get a longitudinal record of my medical markers on the app and probably there would be some sort of recommendations based on how you see that moving and some sort of algorithmic recommendations.
Vikalp: On the first part, there are very ways and from patient side we see it two ways. One is your health record that's get generated from healthcare provider. Which means that your medical record, you can scan and upload. We have a functionality where you can WhatsApp your medical report to our WhatsApp number, and it'll go into your account.
We have a feature such as if you don't want to share your Gmail account with us, you can forward to your firstname.lastname@example.org. We have created an email address for each one of our customers, so the records will come to you. The app also has profiles so that you can segregate them into your family's individual record so that these records are not muddled with each other. But apart from that, your health is not only about the document that you got from your providers.
And I shared with you many ways to integrate that. Your health is also how you are feeling today. For example, if I'm a female, I should definitely record my menstrual cycle's history because that's one question that will be asked every time you go to a gynaecologist. If you are a diabetic patient, you have to record your diabetes values inside the app.
That is not coming in from any document. Many people in India use Apple watch or any other things for their heart rate monitoring, we have baked it into the app itself. You can put a finger on the camera and we'll give you a heart rate which is as accurate as your Apple Watch. And this is a data that you want to generate for yourself.
Today, I am having a migraine attack. Tomorrow, I had an asthma, so all of these things also patient generate on EkaCare.
Akshay: Do you also integrate with smartwatches?
Vikalp: That's also in the plans that: we will integrate with all kinds of devices. So all of this information becomes your health marker.
We integrate with ABHA, which is the health ID and Ayushman Bharat Health Account. That's governments initiative very similar to UPI, where this entire ecosystem will get digitized. So that's how we get all of this information. And then we store it. Consumers can go ahead and by consent share this information to their doctors.
Akshay: How does a doctor use it to manage his practice?
Vikalp: There is an EMR tool: Electronic Medical Record System. We call it internally Doctor's tool. Let's say you visit a doctor today. Doctors basically can have two ways of providing you with care.
One is: they first take down your phone number and registration detail on a piece of paper, or there are people who can use a digital tool. We come there as a digital tool where as soon as you walk into the clinic or you phone, your information gets added so that you can now schedule further appointments.
You can do changes, you can do follow up, you'll get notifications that this is the time when you should come in. So that's one problem that we solve.
First is this appointments journey, where when a user is coming in, be it a walk in or on a phone, or does it on online, we have an online presence, digital presence for doctors where you can take an appointment. Once you do that, and once you visit a doctor. Doctor can do two things. One is they can write a prescription on a piece of paper, or they can write this prescription on a digital tool, which is EkaCare.
And when a doctor is creating this prescription on EkaCare be it the medication, your symptoms, your history, all of that information becomes part of your medical history, your prescription, your longitudinal journey. And when a doctor basically hits the send button the information gets delivered to the patient be it on WhatsApp or wherever.
Now it's patient’s prerogative. Whether he wants to use EkaCare as their channel of keeping medical records or not. And there are many who choose not to, many who has not been exposed to. That's how the whole ecosystem works on the doctor's side. Now, what happens is if Akshay or Vikalp goes back again to the same doctor and you haven't used, or I haven't used EkaCare on the patient's side, the doctor can still search for that phone number, that person and see what was the prescription that I have created last, when he visited last, what was the diagnosis.
And that fundamentally saves a lot of time especially for the doctors who see a lot of patients in a day. There you don't have to ask questions that are like what happened last time, and so on and so forth. Your outcome can be far more driven with empirical data that you have collected last time.
Akshay: For patients who don't download the EkaCare when a doctor hit sent, they get what? An email or something like with the prescription?
Vikalp: They get SMS, WhatsApp prescription.
Akshay: Do you also then have a pharmacy integration?
Vikalp: As I said we see there are a couple of things that everyone asks me why you don't have. Pharmacy, why you don't have labs, why you don't have doctor discovery. Eka is not about providing insights.
The question that you asked, I uploaded a medical report and I'll give insight, Eka will not do that. Eka is an information company. For me "I don't know"," how can I treat you?"," I know this is you", and that is very important. So if you look at it from that perspective, I cannot tell you that, "Hey, you should visit an endocrinologist". That is your doctor to tell and refer. What I can show you is your thyroid is always up and borderline, and what does thyroid mean. That is where we come in and we dread this very carefully. We are a technology company. We are not a healthcare provider. Hospitals are healthcare providers. Clinics are healthcare providers. We are a facilitator for a better outcome by leveraging the technology. And that is where we don't end up sending you a notification that go for a blood test or a B3 and then start monetizing it. Or I will give you a discount of 30% in these medicines and so on and so forth.
That happens elsewhere, and that's why we don't have pharmacy or labs the way it happens across the board.
Akshay: What would that look like when you work with your doctors?
Vikalp: For example, if doctors are prescribing medicine or doctors are prescribing a lab, how can we facilitate a transaction there so that a doctor and patient are doing conversations and rather than patient going ahead and scouting for discounts, it's basically between the doctor that what would be the right kind of a test and where you should go.
I'll give you another example how it happens in the US. When you create a prescription, doctor asks you which pharmacy you want to get your medicines from. And then doctor just presses a button and then the prescriptions gets delivered there, and then there is a pharmacy next door who will basically facilitate that transaction, which is a behaviour. That is a right behaviour, rather than saying, okay, don't take this medicine, take another medicine, which is a substitute.
Akshay: Yeah! In almost like 50% of prescriptions, I end up buying a substitute because the chemist doesn't stock what the doctor wrote.
Vikalp: You end up buying a different medicine, even in the lab test. You go to the doctors with a specific lab test, and then doctors would be like, "oh my God, what is it?"
It's not what I have prescribed. The thing is this is so not transparent and so not non digitized. If there is a tool that can come in to actually make this a journey that is transparent, have doctors at the centre of it and patients get the right kind of a benefit out of it.
Now the thing is, my question to this industry is generally when you go to a doctor, you pay him 400, 500 rupees as a consultation fee. But when you go to a lab you basically pay them 1000 rupees for a CBC or 800 rupees for an x-ray. The cost of that x-ray is not even 10 rupees.
The cost of that CBC is not even 200 rupees. It's just a device where you have to put some chemicals or a camera that is kept in a dark place. And if you tell today that let's pay 1000 rupees to the doctor as a consultation fee and pay less to the x-ray and the lab.
The doctors will have a lower footfall. And that's why they create these clinics where they actually are able to leverage a lot of these revenue potentials and so on and so forth. And it's very hard. The idea of a doctor is not to basically run a business.
The idea is to provide for the best outcome for that patient and get the data collected from the various other sources. But in this industry, incentives are misaligned. And we don't want to enter into a situation where we muddle.
Akshay: You would be taking away the doctor's revenue if you start doing pharmacy and diagnostics.
Vikalp: In plain simple terms, "yes" we don't want to do it. Are there a better way of making sure that every party in the ecosystem is within the realm, it's a win-win for all. So that's where we would basically work in and we are very clear with that specific philosophy and thought process.
Akshay: So your target audience for the doctor product is just clinics and in small practitioners.
Vikalp: Anyone, non-hospitals, nursing homes. We don't solve for beds. We don't solve for inpatients. We don't solve for services where you need to do housekeeping and so on and so forth. We solve for outpatients; we solve for appointments.
Akshay: If the vision is to have seamless exchange of medical records, how would you make that happen when patients are going to hospitals? If I as a patient have all my history on EkaCare and I'm going to a hospital, how would you enable that doctor to access?
Vikalp: So two things that are happening in the ecosystem. One is when I mentioned that if a doctor has their own pharmacy, has their own clinic, lab. It's seamlessly integrated. Because now the report is getting generated at the clinic itself and that adds a lot of value for doctor.
That's why he would recommend. That's why all the hospital recommends that go to my lab, which is there itself. So that is solved to some extent when you are going to the same doctor, same hospital. But that doesn't happen. You go to a different doctor at times or a different hospital.
So what is happening in the ecosystem is, I'm not sure if you have heard about this, which is called ABDM: Ayushman Bharat Digital Mission, which is coming up with a concept of health ID where your medical records are linked to a health ID. When you go to a hospital you have to show your health ID, which is nothing, but your name@NDHM or tomorrow Eka and so on and so forth, which is like a UPI.
Now, all the records will get digitally associated and if you use EkaCare as a PHR app, which is your personal health record app, all this information get digitally assigned to you. I'll give you a small experiment. I don't know if you have taken your booster dose or not.
Download EkaCare app, create your health ID. And we've created more than 2.7 million health IDs now. And you go to the CoWin and you use the same phone number, same demographic information to get your booster dose. You will get your certificate onto EkaCare app digitally.
You don't have to do anything for that. So that's the way the ecosystem is shaping up. And we are giving a big push to that ecosystem along with government so that this entire medical record sharing stuff can happen seamlessly.
Akshay: So you're like the Google Pay layer basically of UPI.
Vikalp: We would like to be the PHR app, which is very equivalent to Phone Pay or Google Pay on the consumer side.
Akshay: Are there other competitors in this space yet?
Vikalp: People have started doing it. I think Paytm have started creating health IDs. They are, I think after us, so we have created some 2.7 million health IDs.
They have done some 250k health IDs, they are decent when it comes to the numbers. There is ABDM app or a ABHA app where from overall numbers perspective, they would be the top. I think we are the top in terms of the private players. And I'm sure there will be tons of more. There's an interoperable play, you can do a UPI on True caller as well, and ICICI bank app as well, and Google Pay, Phone Pay, BHIM also. So it's all about execution.
Akshay: How would the data flow in. Every time you go to a diagnostics lab you give them your ID or they would ask for your ID. It would become mandatory for them to add, like the government would make it mandatory, the diagnostic labs have to upload this data to ABHA ID.
Vikalp: Mandatory is not the right word. There was a news article that AIIMS will go completely digital using the ABHA rails from 1st of January 2023.
Like UPI, anything that has a clear value for both sides, be it a business or be it a consumer. That'll take its own flight as soon as the whole platform is ready and it has got right kind of a transparent understanding.
Akshay: What are the incentives for hospitals to go onto ABHA rails?
Hospitals, diagnostic labs, people who generate the data, what are the incentives for them?
Vikalp: How will you give an outcome. One is generate data. Let's say you go to a hospital like Manipal and you want to now get yourself treated for an ailment.
You go to the doctor. Doctor would want to see your records. How would he see the records? He will then again ask you for your ID. As soon as you give the ID, you will get a consent on a EkaCare app that Manipal Hospital Whitefield is requesting for these last three documents of yours.
And when you say approve then the doctor will get that information digitally so that he can look at it and give you the right sort of outcome. So it's both ways. Any system that works both ways will definitely have its own flywheel working.
Akshay: The ABHA data includes prescriptions also? Or only diagnostics.
Vikalp: Everything, including even discharge summaries to any kind of notes that you want to share advices.
Akshay: Is it similar to a team of volunteers like yourself who are building that?
Vikalp: It's a pretty fantastic and thought through setup. I think ABHA or the Health ID or this blueprint of the entire health exchange was written like 3-4 years ago by ISPIRIT.
This is basically that team. Post covid, obviously every single government started thinking a lot about health and that is a fundamental difference that I see when we look at India versus China. India said that we are a platform nation. We will build platforms such as Aadhaar, such as UPI, and we will build Indian companies on top of it.
While China said that "I wall the whole thing". So we are far more thoughtful, far more long-term sustainable in that sense. And ABDM, ABHA is one such platform that I'm super excited about and I wish that soon it'll reach the same level of adoption as Aadhaar and UPI.
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