Dr. Palap Saha is a distinguished member of technical staff at PIPRO's global enterprise architecture consulting group where he meets the government and public sector practices. Dr. Saha is the chief architect to the Andhra Pradesh State Enterprise Architecture, and Bhutan E-Governs Interoperability Framework. He worked, has cited by the United Nations, World Health Organization, U.S. Department of Defense, Open Technology Foundation, Infotech Research Group, and the Open Group, and has contributed to the World Bank A guidelines for Mongolia, Vietnam, and Bangladesh. Dr. Saha. Thank you. Am I audible at the back? Yes. Usually I'm loud enough. All right. And I must say, it's a very humbling experience for me to see how the entropy has taken off. I mean, I still remember that day when we were sitting in a room, and this used to be called Andhra Pradesh State Enterprise Architecture. That's the official name. But the label E-Pragiti has become very famous. I suppose it is almost a phenomenon now. Right? I'm very happy to hear that. I think that's Palap Saha here today. Yeah. And I'm very pleased to hear that the state is going to announce 2017 as the year of E-Pragiti. So that is great. What is very interesting as a result of E-Pragiti is that the awareness and the curiosity about Enterprise architecture has grown. That's the reason we have more than 200 people here. And I'm sure some of you may have heard about E-Pragiti already. As he said, there are a few documents already available on the portal. But E-Pragiti is actually not about the portal or not about the system. Because one of the common misconceptions about Enterprise architecture is when you build an enterprise scale application, people think that that's Enterprise architecture. So for instance, if you have an ERP which touches every part of the enterprise and the architecture of that ERP system becomes the Enterprise architecture, then that's absolutely wrong. That's not what Enterprise architecture is. Between today and tomorrow, you're going to hear many case studies. I think Mr. JS has already walked into what E-Pragiti is. And there's many more information available about that case study. And later on, I think tomorrow, second half, we have national case studies. And I've been involved, privileged to be involved in some of those engagements. So when I was asked to speak on this, I was trying to figure out what should I be presenting. Because I've been involved in the National Enterprise Architecture initiative in many countries, directly doing projects or also as advisor to multilateral institutions like the World Bank and the U.N. Because some of the developing countries' efforts are funded by multilateral agencies. So I thought let me kind of synthesize the findings that I have observed over the year and present to you as to how the overall framework of National Enterprise architecture actually plays out as the countries start adopting E-Pragiti. I think in the previous presentation, we already spoke about what are the lessons learned. So it kind of takes up from that, what are the lessons learned, what are the impediments that organizations or I would say countries face in terms of doing National Enterprise Architecture. All right, so these are some of the key questions that typically government leaders ask or should be asking. The whole idea of can we provide and deliver services in an effectively integrated manner, that's important because services are how government interacts with people and that's how it should be starting. It is not about building systems, building IT systems because I understand that most of us here do have an IT background in some way and that's not something that you need to be apologetic about. That's actually a strength because today every business is a technology business. So keeping that aside, if you really see the way governments interact and converts with the people, with the citizens, basically it is through the services. So how can we deliver services in an efficient manner? The second question that the government leaders should be asking is how do we therefore direct our resources and investments to the right services. We were analyzing the 3,000 odd services. There is actually a portal, some of you may be familiar with that. There is a portal called ITAL. It actually gives a number of services provided by each state. It's amazing that if you go through the list of services, there are about 3,000 services now. If you're online, you can actually check it out there by state and different types of services. If you analyze the services, 60% are replicated as Laura was alluding to. Every state is reinventing the wheel. And therefore for a country like ours, we shouldn't be wasting resources coming up with the same kind of services. But this is not a technical problem. This is actually more of people trying to protect their turf, not sharing information, using confidentiality as an excuse to hold back information. All of the human factors that come into play when you're talking of enterprise architectures, especially at the national level. The third question is, do we have a common platform? I think E-Precuity 4 is one example of a common platform. And I think state and even at the national level, we should be treating it as a common platform. We've not gotten to that point yet, but there are certain things that need to be taken into consideration when you come up with a common platform. For instance, we're going to use open source as an example. These are certain decisions we need to take into consideration when you're coming up with a common platform. And then a few other things, right? You know, one thing I get calls from many states and they actually tell me when you're speaking to the chief minister, he's basically talking about the cohesive 10x political value, right? Absolutely true. If you don't have the political will, the chief minister of the state doesn't have political will or who doesn't come from the prime minister, this is not going to happen, period. It is as simple as that, right? It is not about frameworks, it is not about reference architectures, it is not about notation, it is not about technology. It is all about getting the right political will and that push is extremely important because the inertia of not doing it is very, very high. Because we have been brought up in a situation where we need to be kind of almost by habit, we keep fragmented, we never think holistic, right? Earlier in the morning break, somebody was telling me, you know, and this actually came up in our, one of the national committee meetings that Jaisat was mentioning about and you know, we have colleagues from STQC here, somebody said, why aren't two departments of the government actually coordinate so that the vote didn't does not happen after the new vote is made? Right? It's a, you know, general thing which is common across all cities, all because the different departments are not interacting, they are not thinking holistically. The road lane department decides that I need to lay the road, my work is done. It doesn't matter to me if the telephone guy comes and starts digging the road, because the telephone guy is thinking, my job is to lay the road, lay the wire or whatever it is, or fix the wire. So this is something that is very important from a government leadership perspective, which kind of, you know, triggers the journey into national enterprise architecture or board of government enterprise architecture. So this is a survey done by the World Bank. It shows you what citizens are expecting from these government initiatives. India is listed there, not all the countries are listed there, but if you see the top three priority from an India-centric perspective, what the, this is citizens' expectations or what the citizens are saying is, hey government, you need to plan for the long term. I think somebody also kind of mentioned that in the question, saying that when you come up with the national enterprise architecture, it should transcend multiple elections, so to speak. Like what happens if a different political party comes into power and this is a pragmatic problem that we need to tackle at the national level. The important point is, with respect to e-government, we need to have a national aspiration, right? I'll talk about a UN survey later on. The second important priority is from an India-centric perspective is citizens are telling you, include us in the actual service design and delivery. You need to understand what services we need. Earlier he was speaking about certificates, for instance. Nearly 40% of government services are basically providing some certificates and licenses. It is not providing a service, providing a piece of paper so that it can be deposited to another government department and to deliver another service is not what government service is all about. But that is happening, that's quite rampant. We have all been experiencing that. You apply for a passport, imagine the number of documents we need. Today, of course, things have improved, but it should be even better. So these are some of the priorities, highlights from the survey and there are a few other countries mentioned here. So I'll leave the slides here so you can actually have a look. The intent here is not to go through every bullet point there. Okay, I will not go into the definition of enterprise architecture. We have seen that and what are the different building blocks of here. I think we have already been introduced to the concept of here. What I'd like to highlight here are two layers or the two blocks here, security architecture. Given that a lot of the information is going online, having a common framework for security architecture is an imperative. I suppose we have a couple of people from the Ministry of Defense here. Future wars are not going to be physical wars, they're going to be cyber wars. I think we all understand that. If a terrorist brings down the reserve back of India or the Bombay stock exchange, imagine the impact at the national level. So what I would suggest is that when we come up with a national framework, it's important that we give new importance to security architecture. I think that is kind of addressed in this conference because tomorrow we have a couple of sessions on security and cyber security. So that should be an important part. Now another thing, why I would like to highlight the security architecture is today we are all talking about cloud. How many of you know that every local cloud provider, cloud service provider is an American company? What does it do to the national security context? Ask yourself this question. I'm not saying that I'm anti-American or anything, but I'm telling you these are the questions that people ask you. Where is that data going? We all go to Gaga about all our office working on office 365 and working on the cloud, but it actually could go to a single vendor and that's something that is actually happening and people are not realizing that this is happening. Sending emails to Gmail, for instance, to government officials. That was the practice in many countries. I'm not saying that you need to keep in mind from a security perspective. I'm highlighting some of the things that actually come up, not just in India, but multiple countries. So what is government enterprise architecture? So it's a mission focused approach and a favor to galvanize the government ecosystem. So that's the official definition that we have used for equality also by transcending boundaries for designing and developing services in a coordinated, efficient and equitable manner. That's very important because when you're dealing with governments, when you're dealing with government services, it's important that the citizens are impacted. In some sense, their quality of life improves. Now, what are we looking at? I think this has already been explained. So in one picture, I'll put it, this is what governments typically tend to be. They have a very department or agency-centric, but what we're trying to do is get here. What you see here is from your current to the target while we're not removing the departments, that would be too politically sensitive to do, right? We're not removing the departments. We're trying to figure out, can we come up with a common platform or shared platforms which can integrate those different departments so that to the citizen, government appears as one? That is important. So the department administrative structure still continues to exist, but through these series of common and shared services, when I'm talking about shared services, these are business services, these are government to citizen services, government to government services, and government to business services, you get to a point where the citizen gets a feeling that I'm talking to one enterprise, the government. And the whole idea is when the citizen approaches the government department, whether it's through a portal or through a physical office, maybe in the rural area, the government does not say, sir, you have come to the wrong department. There is no wrong door, right? Now that is very easy to say, imagine the realization of it takes a lot of political will, a lot of technology and a lot of process range where you do achieve that. So this is basically in a picture, in a nutshell, what team product is also trying to achieve. In fact, that was the whole essence of the state enterprise architecture. Okay, so I was talking about the UN survey. So this is the latest survey. I don't know how many of you actually follow this. UN does a survey every two years. It's a 2016 survey. And this is a publicly available document, and there it ranks all the countries in the world in terms of their e-government maturity. And India doesn't rank very high, I think it's somewhere around 106 or 107, which is nothing to be proud of. I think one of the goals of digital India should be we should be ranked within top 20 in the next 10 years, unless we have the national aspiration it is not going to happen. Now what you see here on the left of the picture are the different maturity levels as defined in the survey. So I'm not going to go into the details. But the whole idea is can we move to a point where different government entities actually interact with one another. So that's been inter-governmental. So the collaboration is happening within the government entities to a point where you have inter-governmental, which is let's say two state governments are collaborating. Maybe it's a health issue or it's a criminal issue because criminals actually transcend different states. So can we have that? To a point where it is extra-governmental, which means that now the government is interacting with the private sector when to provide certain services. It is not necessary that every service needs to be provided in full by the government agency themselves. Finally to a point which is ubiquitous, which is where government becomes a platform. No country in the world has reached the ubiquitous, but at this point, if you Google it up, the country that is trying to get there is South Korea, which is actually seen as one of the pioneers of enterprise architecture. And that's the reason this is more than digital government. This is digital economy. Digital government is only digitizing the government's part of the country, of the nation. Digital economy is when a private sector organization, for instance, encourages cashless payment. That is digital economy. And that's what countries are trying to achieve. Can we use digital government as a trigger to build our digital economy? In the 21st century, that is how it is going to be. So I'm not going into the details of the survey, but this is something that is very essential for us to actually improve, for a country to improve its own economy, government mature. So let me now walk you through. Some of these pictures may be a little bit busy, but I think what I've done here is I've synthesized my findings to about five or six slides in terms of certain system models. So this technique was invented at the MIT School of Management. This is called systems thinking or system dynamics. And the whole idea is to understand how digital government through enterprise architecture plays out at the national level. Because it's important for you to understand what are the enablers and what are the impediments you are likely to face. Should you, in your country, or a new organization should embark on an enterprise architecture journey? So typically, now at this point, the context is government, I'm focusing on the public sector. So typically what happens is the trigger for e-government or digital government starts with propensity to build a future government. So basically if you see the vision 2029, the whole idea was can we have a long-term vision as to how the state should be directed? How the state should be moving towards a specific target? Now that leads to a certain, and that is obviously a culmination of many factors. It could be economic factors, it could be demographic factors, social factors, digital technologies, making it available, so on and so forth. But eventually what happens is when you look at future government, it becomes very complex. I think the concept of complexity has been mentioned many times. I think you understand that. So it becomes very complex. And citizens' expectations of governments are rising. I've shown you the slide on that. That leads to use of technology in terms of transformations. That's the reason you saw in the previous presentation. E-government is a framework for transformation. It's not just automating the government. Now, why do we need, you know, take-enabled transformation? Because at the citizen level, it affects corruption. And the reason I've highlighted the box there in the NOS corruption or perception is because that is one of the factors taken into consideration by the UN session. Did technology, adoption of technology in the government reduce corruption? Right? One thing that is very important from a digital government and a digital economy perspective is that we, any country, you know, any country needs to start to consume technology. The reason why we are not ranked very high in the UN survey is why we have a very big IT service industry servicing, supplying technology to other countries. We as a country, let's say, India as an example, India as a country are not very mature in consuming technology, right? Yes, there have been few, you know, impacts here and there, but as a country, we're not very high in consuming technology, and that's precisely how digital government gets triggered. You know, the idea is from a citizen perspective, this is going to reduce corruption, because one of the key points in the definition is equitable services. All right, so that becomes the trigger and you'll see some arrows there. Now, we've spoken about complexity, so there are few ways to deal with complexity. First one is enterprise architecture. I think all of you have already talked about. Gaurav was already talking about roles, because India has a multilayered government and many large countries will have a multilayered government. Therefore, it's important to understand what is the role of the central government, state government, urban, you know, local bodies, panchayats, and so on and so forth, right? And then we need to have good metrics and incentives, and that's why the whole idea of the SDG, sustainable development goals, right? So it has to impact citizen at the ground level so that his or her quality of life is improved. And obviously at this point, it's important for any government, any country to understand what are the services, what are the overlaps and redundancies between the services, which is on your left there, bullet number one, so that the difficulties the citizens are having in terms of consuming the services are removed and therefore that leads to improvement in government performance. So this is not about building IT systems. Yes, that's one of the key elements of digital government or e-government, but this is about improving government performance itself and that's why managing context is one of the key, the reason is why enterprise architecture is done. Okay? All right. Now, what happens is, let's assume that the country has already triggered some kind of a key government or a digital government. And as he rightly mentioned, the previous speaker rightly mentioned, for a country to adopt enterprise architecture, you have to get to a level of maturity of technology adoption. There are certain pay points you have to face to appreciate why enterprise architecture is required. Right? It is highly unlikely that immature organization will actually need enterprise architecture because they will not be convinced as to what the benefits are. So that is extremely important. Now what happens is as a result of the trigger of the digital economy, one thing that happens is the ICP industry goes big. So the ICP industry is on the lower end which actually becomes some way to ensure that the public sector and the private sector come together to provide some of the architecture services. And that's one of the reasons why we are doing so many industry consultative sessions, respect, let's say, within the context of each property. So basically it is taking the industry into the fold and saying that, guys, this is all about not about government alone, this is about the digital economy and therefore the industry itself moves forward. So that's the second enabler, so to speak, in terms of digital government which is at the bottom of the picture that you see here. Okay, now look at the services. This is global nothing specific to India. Look at the types of services that get impacted by digital technologies. So on your left are the services and the clusters of services that get automated first and on your right are the ones that don't get automated or they are automated last. All right, so if you can see here all the revenue generated activities for instance tax collection and all of that stuff gets automated first which is obvious, right? But once the tax is collected how that money is allocated to different schemes and social programs is something that gets automated last. So it gives you a flavor of how it happens. In fact in e-government body of knowledge, paying tax, if that is a service, paying tax is not even considered a service it's actually an obligation to be a citizen. The service is when the government comes and says let's do the road here or let's provide internet services to the local media, that's a service an obligation is something that we as citizens we have to fulfill as being part of the citizenry. Okay. Then what happens? So now it's playing out, see how it plays out. So the country has embarked so to speak on some kind of a digital government part. It has kind of brought in the industry the ICT or IALT industry into the fold. But what happens is once you're starting to come up with common platforms and you know shared services typically what happens is there is a pressure to maintain autonomy. Remember that as Bob was saying to earlier when you look at it from a holistic perspective obviously there are a lot of redundancies. Remember these services are being delivered I gave you the example of ETA if you actually go and see that. If I can't say that he did actually mention this as you mentioned but when we started we did 1200 services 1200. What they bought was 745 so that the number of the other services were eliminated because they were redundant in some sense. What typically happens is that once you start looking at it from a holistic perspective there is always an element of people trying to protect their jobs and that creates friction within the system. That will become an impediment to be digital government is going to be adopted so that's your move here on this. And the second box the yellow box is the online service index. This is another metric that is used by the USP government service. I'm highlighting this through certain metrics that are taken into consideration. And while this is important as I mentioned earlier in India we have a specially large metric we have multi-level government so we may have a national government a state or a provincial government we may have a district but we may have a city government and even at the rural areas. What is likely to happen is that these governments can belong to different political parties who will not like to talk to each other. If that is not there you can imagine why you mentioned 10x political parties.  So now what we see here on the left this side here once the digital services are coming on the portal there is a chance that citizens are trying to consume those services. I mean let's assume that the question that came up was in addition to English can we provide local language support and let's assume that the answer is yes. So now even in the rural India the citizens are trying to consume services to the portal. So that improves e-participation. People the citizens are not participating in the whole cuts of digital government. And why is that worse again because e-participation is the third factor that is to take into consideration the UN Government Survey. So other than the agendas here I'm sure we can't beat it but the whole idea other than maintaining their own I would say privacy in terms of whether my department is going to share information to the other departments other than all of the other arrows and loops what you see here are positive loops. Typically what we see is those are the things that are going to push the adoption of digital government. Now this is another survey, same type of survey what it shows is satisfaction with online services. We are talking about the online service index. So what you see here is on your y-axis is how important the service is low to high and on the x-axis is the satisfaction with the service. Again on your c-plot right here the kind of services firing tax assessments or submission, applying for renewal and private licenses, applying for renewing a passport and something like that. So obviously people are generally satisfied with those kind of services because governments tend to spend a lot of money on automating those services. Because in general they have a limited generation of services. Whereas some of the more subjective type of services for instance here, lower left here you can see there are a lot of bundle of services here we actually satisfied with the government provides those services. So it gives you a sense of how services are being looked at from a citizen-centered perspective. Now, now comes the story right, we have all the plus points of digital government now what happens is a lot of people think that enterprise architecture therefore is about centralization. Everybody must follow a specific standard and once you start dictating that there are people within the government entities who will try to maintain their own job. So they will come up with their own empires whether it is technology empire, a business empire, usual the usual reason given is the way you guys are doing is not how you work. We would have to build our own thing because the whole idea is it is not invented pure simple. So if one state comes up with a reference argument which is the other state will say this cannot work for me. I can tell you what is happening in the experience what is happening in the ea, 70% of it can be replicated across any other state at the business level I am not even talking about the technology at the technology level standardization is very easy. You take it for granted it will work. Even at the business level the kinds of services that different states provide are very very similar here you go to another state they will say this is very different this is what AP has done I will not follow that for reasons. And therefore what happens is people start replicating that becomes an impediment in the overall digital government at the national level. So that becomes an impediment now. So now all the braids are coming into play. Now this is something that I would like to highlight here. Now enterprise architecture can be spoked out at different levels you can do it at the national level or at the entire organization level you can segment it out for instance I might say can I do an enterprise architecture for the entire health sector health sector across the country maybe I can do it can I do an enterprise architecture for the transportation sector as an example can I do it for the social empowerment sector so that's the segment architecture followed by solution architecture is something that we all understand quite well because that's why the solutions and the systems will come but the important point here is to maintain that hierarchy why? because as I showed you once like that we have a multi-level government many countries, large countries have a multi-level government and therefore that means to meet the deadline tomorrow after 80 is done with e-projecting and all of the systems are in place the department of health can come and tell me I want to build my own enterprise architecture as long as it is compliant with any overall e-projecting absolutely you should be able to allow that because department of health in its own right is an enterprise they should be able to do it as long as they follow the overall principles and guidelines and standard that we put in the statewide framework so federated approach is something that tends to work well when you want to balance centralization with autonomy our constitution actually gives a lot of autonomy to the states which means that for us to and we have to respect that and that's extremely important we also have to follow a centralized model and to maintain that autonomy therefore there needs to be some change in terms of the way in which some structure of shift is required okay now enterprise architecture is hard and something that is important is that therefore there has to be some embracing of federation which means that what federation means is that at the central level you define the methodology you define the frameworks you define the best practices and leave it at that don't get into the brass tacks of actually operationalizing give the states the autonomy to operationalize it as long as you qualify, as long as you comply to the big picture, you are okay because the whole idea is if you try to centralize and push everything from the central entity it is not going to work they have seen that in case of demonetization also at some point surface states start opposing it whether it is relevant or not that's a different issue states do start opposing it at certain level okay having said that you have seen this in an e-property context earlier what it provides you once you have a federated approach is something called very important in the architecture domain is called line of sight you need vertical line of sight you need horizontal line of sight and you need lateral line of sight all the three dimensions because it is possible that a person who is collecting ration was an example of that person who is collecting ration probably belongs to the you know below poverty line category of the group of citizens therefore he also qualifies for free education for his kids okay and maybe some free passes in rainways and city first corporations so what is happening is one service one rule can actually trigger multiple different sections therefore that visibility needs to be maintained and that can be maintained when you have a land hub you have IOT hub and so on and so on but the whole idea is to provide a 360 degree view from a citizen-centered perspective because the citizen is approaching the government that's all nothing more than that alright so I have spoken about the multi layers so I will not go into the details so that is the same thing so you have enterprise architecture, agency architecture and the solution architecture now I am seeing this playing out right here in India that once AP is done in other states they can be joined the bandwagon of course they don't use the word bandwagon the idea is can we become the second or third state to do a statewide enterprise architecture that is good from a national perspective because you can have all the reference architectures, frameworks and guidelines what you also need is success stories you know imagine AP is a success story after that you have two other states who are also success stories and you shared that success story with other states the remaining 26 or 25 states the critical mass is created it's almost like a big wheel the wheel starts rotating but for that you have to figure out who are those friends that you have in the organization who can actually support you in your mission and you create your alliance and alliances that's a plus point so that's the model available already now look at the top barriers for digital government nothing specific to India but this is global the top most barrier is insufficient funding okay but let's assume that money is available look at the number 2 too many competing priorities somebody is doing 6 sigma somebody is doing BPR open source, cloud, big data if all of that jargon is coming and suddenly nobody is thinking let's do that holistically somewhere it has to connect right and number 3 as I said security concerns you can digitize whatever you like in the end it actually makes you more vulnerable if you don't tackle the security aspect and that's the reason I was kind of emphasizing why security architecture is a must for any enterprise architecture framework okay so this is the full model what you see here is once you have the full system model it is at this point that countries and organizations start taking benefit of enterprise architecture this is where the value comes in remember on its own enterprise architecture is not any value you can create all of the documents and all of the models and frameworks what is important is whether it is adopted do you use enterprise architecture for decision making do you use enterprise architecture to identify which are your high priority services that's where the ROI comes alright so this is how it plays out now you must be wondering what is the value of having this model because you need to understand as from a strategic perspective when you are doing enterprise architecture for any large organization government you know whole of government even at the national level you need to understand what are the enablers and what are the inspectors I have shown you these three yellow boxes so those are the parameters that are taken into consideration in the UNE government so if you were to design an enterprise architecture framework we have to understand that we need to do well in that service as I said we need to act in aspiration okay so this is the entire model right the model is probably not readable but the picture is actually very clear with the projector which is not very clear now what you do here is from this model you can identify what are the things to be done to push the adoption of enterprise architecture I told you right any journey transformation journey is a mix of enablers and individuals impediments plus points, minus points your journey will be successful as long as the combined impact of enablers is more than the combined impact of impediments it's as simple as that no matter what you do realistically you cannot get rid of the inhibitors what you can do at best is minimize their impact on the overall implementation even in AP all of those inhibitors actually exist impediments so that was precisely what I was trying to come to you will have to face all of these things if you were to do enterprise architecture it's a mix, it's actually a journey it's almost like it's a balance of things that can help you and balance of things that will stop you so what you're seeing here is through the synthesis of multiple case studies there are certain interventions that have been brought in for you to drive the adoption of enterprise architecture for the state level and also at the national level how do we use enterprise architecture four different ways one way to use enterprise architecture is to support strategies so you have the grand vision vision 2029 and use enterprise architecture to realize that's right that's one way of using enterprise architecture the other way is to use enterprise architecture to manage your portfolio you have 72 projects so what you do is in multiple environments that have been brought in typically there are multiple initiatives that are derived out of your architecture you can manage it as a portfolio you know what portfolio is you manage your portfolio so that you can manage your risk somebody had a question on risk that is not equal in risk some are more some are less can you manage it from a portfolio perspective usually the whole idea of portfolio is financial it's economic third is you can use enterprise architecture to support your projects individual projects to support your vendors and the fourth way of using enterprise architecture is to guide your solution delivery I'm building a system and I have common usable services directly and use those services and assemble my system so there are many ways architecture can be used and this is important because if your blueprint is not being used in any part of the organization then you are finished your blueprint may be a beautiful document it has to be used it has to be put to use somebody has to use it so there are various ways of using enterprise architecture basically to highlight the fact that it should be adopted to get the out of it okay so OECD is the organization for economic cooperation and development there are obviously principles engage research and open up governments to maintain public trust so trust and corruption we have spoken about that adopt cohesive approaches to deliver awareness to governments and strengthen government capability to ensure return on ICD investors so if you go into a single framework this is what governments need from a digital government perspective having an architecture is important driving governance is equally important that's the second layer then you have the different segments of architecture so to speak so there's a performance part there's a business part there's a information application technology but not all governments think that once they are done with the enterprise architecture that is not going to happen because there are many other supporting activities that need to be tackled so for instance governments of IT service delivery performance, IT risk management security is spoken about security insurance, investment management, open data these are all the things that are important so those third layer boxes are equally important then you have certain enablers procurement management, the real government procures information technology systems is equally important change management project management, communication so on and so forth so what I am trying to tell you here is on this slide enterprise architecture no doubt is an important element success factor but there are many other things that need to be put in place to have a full digital government framework people ask me how we build the architecture why did we succeed I said we've not taken care of the other things plus the impediments that we need to develop I think there is a methodology here which is very similar so what we are doing is here I will show you how the light so this is the light but there are only 5 phases here on your left so these are the 5 phases currently it is still working progress but I am showing you what is currently working progress so on your left there are 5 phases they have simplified it number promise, direction and your strategy, your vision that's your vision 20 to 29 as an example and there are multiple steps of direction and vision so that what you see there and the outcome of that is your architecture scope and vision this is here so that's the milestone that you get from phase 1 the second layer there is business architecture the entire layer is the different steps of business architecture I will skip the steps but the direction is once the strategy and the vision is set we need to define the businesses in case of government it should be services products in service prioritization, rationalization we want to eliminate certain services we want to re-engineer certain services so on and so forth so that's the second layer and the output of that is business architecture that's your second policy on your left the third is blueprint which is where once you know the business now you need to come up with the data the application, the technology and the spirit combine all of this together there is one document called the architecture blueprint that's your third policy on the right having the blueprint is not enough you need money right, you saw the money every country needs money right so the fourth layer is investments you have to identify those architecture initiatives and figure out what are you going to invest the money in you know you may have 72 projects why do we focus only on the four projects there will be some thinking around that you need to prioritize that's your fourth layer and the idea here and the output from there is the roadmap now the government has come up with the roadmap it needs to put in place procurement okay vendors have to come in and probably build those you know implement those initiatives that's your fifth layer and that's your outcome which is your transformation outcome those are the five key outcomes that we're looking from an E-9 perspective that's all how do we address every aspect of architecture the first layer is why second layer second layer is what third layer is how fourth layer is when and with what timeline and resources and fifth layer is how well that's it five fundamental questions that are getting answered through the process so this should be available sometime in England I'm assuming it will go to be so this is actually a maturity model I'll state the maturity part of it because actually no state needs to face most states even the most advanced state is probably between phase three and four because the idea is not to let the blueprint the idea is to use it for certain decision making so that's where phase four and then phase five is taking benefit of it so you're not yet anywhere close to phase one and most states are actually in phase one so they go to phase zero okay this is fine some benefits so I also did a survey we did a survey in collaboration with the UN I'm going to show you some data here so there are certain benefits listed there and there are certain parameters criteria of enterprise architecture you can see how the countries actually rank up and I was talking about South Korea many of the things in fact of the seven in four they are completely institutionalized it means they have reached phase five okay so in other countries you know Australia, Jordan, New Zealand so Australia, New Zealand as well because New Zealand is actually institutionalized in two areas and localizing they could have a mature enterprise architecture but that's not government but it may be for one department as an example so that's localize but it gives you an idea of what is happening across the world in terms of enterprise architecture okay and the reason why I'm showing you this is some in fact all of these countries some of the major countries like South Korea Australia and New Zealand they rank very high in the human circle so there is a reason there is a direct impact if a country has adopted enterprise architecture it is directly on which to be matured in the world units are more or less but clear by now there is limited awareness most countries, most states don't know what kind of enterprise architecture is so that has been built up governance becomes the biggest issue because you know every department every ministry is trying to protect themselves there is no sharing of information some of that has been made there is no concept of integrated approaches as I said we kind of think fragmented maybe it's cultural or whatever it is right lack of connection to national priorities right nothing specific to any country but the whole idea is going to link it to certain goals which are more visionary in that sense right so that's important most ICP funding is actually very agency centric and in many cases especially in India what I've seen is very vendor ICP funding is very vendor CIOs are not a common position in the government in India there is no concept of a government CIO so it continues for five years let me qualify that so I hope you know what that means because from a dictionary perspective it's important and then of course one thing that happens is given that it becomes very IT centric it does not get the amount of visibility when I say it I mean enterprise architecture does not get the amount of visibility and attention it requires right for me the best place to talk about enterprise architecture would be with the planning commission really kind of because you have the five year plan somebody has to implement it that's where enterprise architecture comes so that's the execution of the strategy so that's the strategy for the country you have five year plans and then you have the execution of it so it's important that and certain countries have achieved that one of the reasons why South Korea is successful is because it is driven by their department of government administration okay I think more or less done so this is something that I've already covered I would like to finish my session this is my last slide one thing that you have to remember especially the government sector


Welcome back to part two of our TechCrunch Disrupt series of episodes for Building Tomorrow. I'm your host, Paul Matzko, and today we're talking about all things related to health innovation at this year's conference. Now after drones and autonomous vehicles, I would say that medical devices were the single largest category of exhibitors on Startup Alley. I'm gonna play you an interview with a startup that's producing a new kind of hearing aid that can do, well, as you'll hear, it sounds like it can do pretty much anything. I'm sitting with Dr. Dave Fabry, who's the CIO of Starkey Hearing Technologies. We're gonna talk about their new product, the Livio AI, which is a hearing aid, but much more. Welcome. Thank you for taking the time to talk to me, Dr. Fabry. Thank you very much. It's my pleasure. So this is a hearing aid that I think doesn't do justice to what this device does. So it's going to improve people with hearing loss. It's designed to help them hear what's going on around them, but maybe describe some of the more innovative elements of this device. Yeah, I mean, I'm an audiologist. My background is my 35th year in the profession. I've worked on industry and on the clinical side, and what we're particularly... What I've spent 35 years doing is trying to persuade people to address the fact that they have hearing loss and consider wearing hearing aids. In many cases, that path to hearing health is one that's delayed by seven to ten years. This product, Livio AI, is directed to try to raise... You can either try to do a number of things to address stigma associated with hearing loss. You can try to make them smaller and cosmetically appealing, and we think we've done that with the package of this. It's a good-looking small device. You didn't even know I was wearing it. But you can also do it by amping up the technology. Hearing aids, as we traditionally think of them, are stand-alone devices that are designed to amplify sound to compensate for a person's hearing loss. About four years ago, we were among the first to introduce a device that was connected directly between a smartphone and the hearing aid without an intermediary device. So we were able to stream crystal clear audio, whether it was phone calls, whether it was Siri, navigation. Any app with any audio at all could be streamed directly from the phone to the hearing aids, making it a connected device. Livio AI is the next generation on our journey as a company to move it into a multi-purpose, multi-function device. As you said, some of the things... First, we have to begin with the state of the art hearing aid to compensate for hearing loss, and that's always going to be our expectation. We're 50 years in the business. The next thing that we're interested in doing is adding features that will be of interest to people like myself. I'm a baby boomer. My parents were concerned about things, health conditions such as cancer and cardiovascular disease. Hearing loss was sort of an afterthought. It's really a disability in that many people, the older you get, the more likely you are to have a hearing loss. By the age 70, you've got about a 50-50 chance of having some measurable hearing loss. And yet, many times when people go to see their primary care doctor, they'll say, well, all your hearing is normal for your age.  It's assumed that you're just going to have to deal with it. We say now that the data show a couple of important things that lead into why we developed this product. First of all, that we know that many cardiologists will say that the ear in the aging individual is a good overall indication of cardiovascular health. The blood supply that goes to the ears and the eyes is very small, and when you start to have blockage or risk of stroke and things like that, any cardiovascular condition, the blood supply to the ears and the eyes are often the first to go. And that's why they show up in collaboration, in correlation, rather, with cardiovascular disease. So one of the things that we've looked at is the increase in obesity in the U.S. Physical activity is declining. So with that also comes conditions like diabetes, it's elevated risk when you're overweight. Cardiovascular disease, as I said, and hearing loss are correlated. So the first thing we did in this product, we put in a motion sensor that many people might be familiar with if they wear a Fitbit or an Apple Watch or some activity tracker, and we've incorporated that in the app directly on our product as a score that can be monitored every day. There are three components that may look familiar to you. Step count, we're setting 10,000 steps a day, which in general serves as the default for most fitness trackers. We also want to encourage people to be physically active by doing exercise, a brisk walk or more. This motion sensor in the hearing aid can track the steps that you take every day and whether you're exercising. And then the final thing is just simply moving around every hour for even just a few minutes. It's good for joints, it's good for muscle, and so that part of the physical side of the equation is something that can be monitored directly in the instrument instead of having to have a secondary device, a separate device. If they're already wearing their hearing aids and we know that they're physically active, we can record a score from zero to 100 every day. That's the first time it's been introduced in a hearing aid directly. We're coupled also to Apple Health, but the nice thing is I have a dog. My dog likes to go for walks. I can just take my hearing aids. I can go for a walk. I can leave the phone behind. When I come back and range of the phone, it'll couple and it'll update the steps. So I have no step regret. Every step gets counted. That's important. It's important. Yes. Everyone counts. And then the other part, so the fitness, you know, first time in a hearing aid that we're incorporating this motion sensor that can track steps, exercise and movement, but then the brain function is really in response to research that has shown that untreated hearing loss in the aging population is correlated with cognitive decline. We know that people who previously, if they didn't have hearing loss earlier in life, they were active, vibrant, socially active, that as they start to have some difficulty, like the noise here at TechCrunch, they start pulling back. It can lead to, and data have shown that it leads to social isolation, even depression, and ultimately cognitive decline. Now I'm not here to say that hearing aids will prevent dementia, but we know that the longer people wait after being diagnosed with the hearing loss to doing something about it, the greater the risk for actually expediting that cognitive decline. And so what we've done is we've built in the other side of this Thrive score, the Wellness score in the app that can be viewed and monitored by the end user, by the patient, is first use. We know that the more people use their hearing aids that compensate for hearing loss, the better they're going to do.  They're all feeding input into that, and so the brain is where the hearing occurs.  The second element that we're talking about is social engagement. We employ AI and machine learning in this hearing aid to constantly monitor every environment where the person is, and what it can determine is, is it a quiet or noisy environment? Is there speech present? Are they streaming a phone call or watching a television program? The most important stimulus that most of us hear on a daily basis is what? Speech, the human voice. We can monitor that and log that when a person is around and engaged in conversation with other humans. We'll total those up and give a point total each day for the engagement that they have. And then the final piece is what we call active listening. In this case, we want them to wear their hearing aids, talk to other people, and get out in the world. Wear their hearing aids everywhere they go. Wear them when they're at tech crunch, when they're in challenging environments. Wear them when they go to a restaurant, a gym, because two things. One is they'll begin to see how much better they're going to do in those situations. And then it also allows the hearing aids to be optimized by their professional or even to a degree within the app by themselves. They have some capability of customizing the function to their liking. But most people still... Rather than having to go... Yeah, they can adjust it so that it can operate pretty automatically the majority of the time. But that in turn... We also have incorporated a telehealth feature in here that we're calling Hearing Care Anywhere. If I'm at a difficult listening situation like this, I can actually initiate a request that goes to the cloud and that my professional will notice that they receive a request that says, I'm at tech crunch and I'm having trouble hearing male voices. They can in turn send an adjusted setting without me needing to go always back into the clinic for adjustment. We're trying to make it convenient for the professional and the clinician by enabling this telehealth which we think is a large part of the future because even though people can adjust themselves, most feel most confident in the hands of the professional. The other thing that we're really quite excited about in this case and first again for the hearing aid market is real-time translation. So my wife and I were just in Paris last week and my high school French can only take me so far. That's right. So... And so what we do is we incorporate a real-time translation feature in here that can go both ways. I found it very useful two ways. One is if I'm in a situation where you're a native French speaker, you want to speak to me and I want to be able to understand it. There are lots of translation type products on the market, but what this does is if you speak French into this, it will translate into English the language that I understand acoustically to my ears amplified for my hearing loss. So it's discreet and only I hear the translated sound. The other way that I found it quite useful to polish up on my high school French similar to some of the other language training programs is that if I just switch the direction so I go French to English, then if I say, you know, where's the bathroom? And then it will go, where's the bathroom? And it'll give me a pronunciation guide acoustically, discreetly. And then I can use it to coach myself to improve. But we're really excited about that and we've had terrific response from the translation. Does it use like a Google Trans... It's using a number of different AI services that we're putting in and embedding with that. We can translate 27 languages right now. We really don't want to hitch our wagon to one or the other, but we want to be able to take advantage of that machine learning, of that AI as those improvements continue to work. We'll develop our own and collaborate with others. That's really exciting. So, I mean, we've got... You've got a translator in your ear. You've got a fitness tracker in your ear. A health, a mental and cardiovascular health medical device in your ear. Something else I saw on the product list was geotagged adjustments. Yeah. I thought that was actually cool. Yeah, and that was what I kind of showed you in the sense like here. I could go in here. I can use the GPS that's embedded in the phone so that I could tag this location and so that when I return to this situation, it will remember the settings that I made. Another feature that is quite useful that also uses that geotagging is one we call Find My Hearing Aids. This will show that my hearing aids are connected to the phone and exactly where we are right now in the Moscone Center and even kind of a divining rod that shows how close the devices are to the phone if I happen to leave them behind. So inevitably, those times when you think you forgot them at home but they're actually in your pocket, now you'll know. Exactly. In my mind, yeah, I'm working on that cognitive crime. We also have gesture control, that motion sensor, so I can tap the side of the hearing instrument and enable streaming from a remote microphone or from a TV device. Very natural user interface without having to fumble for the controls. Great, yeah. One last piece here. I know a lot of our listeners are going to be millennials, Gen Z, Gen X. So they're not thinking about the hearing aid functionality of this. So they should be because, again, like I said, 50-50 by the time you're 70. So it's going to come for us too inevitably. Right. Do you see a future, maybe this is not specifically for the Livio or for Starkey, but do you see a future in which some kind of hearing aid-style device or really just headphones that does a lot of the same functionality, is something that we all just wear all day long, whether or not we have hearing loss? Well, and I think it's a very important question you raised because right now there's a stigma associated with hearing loss and hearing aids and only about 30% of the people with measurable hearing loss actually wear hearing aids. What I'm finding with the Baby Boom generation, like myself, is I'm less stigmatized by hearing loss and hearing aids, but I have higher expectations that they'll meet my needs or exceed my expectations. I think this device is a first step towards that and to your point, I've been wearing these devices even with very minimal hearing loss for about the last three months. No one even knows that I'm wearing them and if they do and I explain what they do, they say, how do I get them? I don't even have a hearing loss and I want to get them. The issue that I see, think about the way, and I'm old enough, I'm a lot older than you, computers. We used to have the entry point into the computer was through the keyboard, then we had the mouse. Now we have touch display. Now we have voice. Think about Siri, Alexa. Think about all of the aging population and the fact that they may have some hearing loss but want to use that front end natural user interface of a voice. That's where we think the big opportunity is, is that it's the entry point into the worldwide web into the CPU of the computer, into your phone, and that, we think, has a lot of appeal not only for people with hearing loss but for everybody. Yeah, well, wonderful. Thank you for taking the time to talk to me. Thanks very much. I appreciate it and good luck with the rest of your tech crunch. Thank you. As it so happens, news recently broke that Starkey will have two major competitors soon. Apple and Google have announced that they are forming partnerships with other hearing aid companies. Now if you think about it, those AirPods that Apple likes to promote, it's a pretty good foundation for something that sits in your ear and amplifies sound, which at the end of the day is what a hearing aid is. The question is whether companies that make headphones can develop the medical device aspect more quickly than the medical device makers can develop the multifunction stuff. So it'll be an exciting race, but the fact that there are so many entrants into this space goes to show you that the hearing aid sitting in your ear that is kind of the future of wearable tech. Our next startup interview isn't about making a medical device, but they are innovating how we, or more accurately our pets, will get their medicine in the future. Listen in. I'm sitting here with Arun Girder, who's the CEO and co-founder of Pinpoint Pharma. Now Arun, you have a medical device designed to allow the, maybe I should say manufacturer, but the mixing of pharmaceutical compounds for animals, for pets. Is that right? Sort of. We don't think of ourselves as a medical device. We are primarily a compounding pharmacy for veterinarians, except that we are a 21st century compounding pharmacy. We make custom medicine for pets on demand. What's different about us is that we have a proprietary printing technology that is much more efficient, much more precise and much more rapid than traditional compounding pharmacies which largely do things by hand. And that's actually been an issue for pharmaceutical companies, or pharmacies, I should say, that are focused on compounding for humans, prescription drugs for humans, a scarcity of compounding pharmacies, especially in underserved and rural areas. Is the same thing been true on the pet side, that a pharmacy that's willing to do on-site compounding for pet prescriptions? I cannot speak about the human side because we are specifically focused on pet medicines. We find that the missing need is not so much rural or geography based. It is across the entire nation in that many veterinarians are deeply aware that different pets need different kinds of medicines. For example, you have different species, even within the same species you have different body masses, and veterinarians are used to dosing. They are trained to dose in milligrams per kilogram of body weight. But the fineness needed to distinguish between an 8-pound cat and a 12-pound cat, or even a 40-pound dog and an 80-pound dog, often that gets rounded to the nearest available off-the-shelf product. And in that sense, a veterinarian is familiar with the need to do custom dosing, but many times they are not able to get the service they ideally should have. And that's where we believe that we can step in. So is that a function of, you know, the difference between an 8-pound and 12-pound cat is half as much, again, body mass, whereas, you know, for a human being precision is important, but the difference between a 200 and a 202-pound human is relatively slight as a percentage of total body mass. Partly, partly. But speaking a little bit about humans, because we did speak with a lot of doctors, pharmacists, nurses, and other people. So far we've interviewed close to 250 people to get an idea of where the problems are. On the human side, it's not just a function of body mass. It's also about, for example, a newborn. A neonatal medicine is extremely different from normal adult medicine. So they need far tinier doses. A nurse once told me that the stomach capacity of a newborn human is about 7 milliliters. So if you are off by 0.1 ml, it can make a fairly big difference in that that's the entire stomach capacity. So how do you dose appropriately? How do you do that? Same thing with older people, geriatric medicine. If someone has partial organ failure or metabolism issues, they are going to process medicines differently. Now, having said all that, these are all things we learned when we spoke with the 200-plus people that I mentioned across the entire ecosystem. But we have chosen to focus on pet medicine because that's where we believe that there's a cleaner market. There's also a more knowledgeable population that's already familiar with custom medicine based on body mass and individual factors. We'll get to that cleaner comment here in a minute. But I'm pushing us ahead of ourselves. First, how does this system actually work? So like, walk me through on the ground level, there's a pharmacy that is working with you guys. I come in asking for a particular medicine that needs to be customized to me. How does that process then look? We are catering straight to veterinarians, so I'll tell you how the process works. From the veterinarians. It's like, let's say you take your pet to the veterinarian, they decide this is the medicine, this specific pet ought to have. It can be, let's say that you have a 12-pound cat. It's a slightly heavier than average cat. Now, your veterinarian is going to use their knowledge to figure out how much medicine this cat needs in what form, whether it's oral or not. And if it is oral, what flavor, and those things can all be customized. There is as much variation across pets as a taste variation across humans. What works for one pet doesn't work for another. The veterinarian then goes to our website and places an order. They say make this medicine in this many milligrams per dose. This many doses in this product form, whether it's oral or not. And if it's oral, it can be any, pretty much any form. Whether it's liquid, solid, chewable, all that. If it's skin absorbable, they specify that. And we pretty much print that medicine. What our technology does, it's kind of like an inkjet printer for medicine. It's how a regular inkjet takes liquid ink and puts it on blank paper. That's your final product. We take liquid medicine and put it on blank substrate. So the substrates are just inert carriers. But the medicine is added to the substrate in perfect concordance with what the specific patient needs. That's where the thing comes. And we, once we print it, which is a pretty rapid process, we just ship it straight to the client. That would be the pet owner in this case. So that's how it works. So it doesn't even, it can then at that point, it doesn't have to go to the veterinarian's office first, and then to the patient, it can go straight to the patient. Yes. We did offer the choice to veterinarians that we can ship it to you and you can give it to the patient or however they wanted to do it. But they expressed a preference for shipping it straight to the client. That way the client does not have to make two trips to the veterinarian's office. Convenience. Is that something that can be done? I mean, you can order it one day and by the next business day have it expressed, shipped to you? Or what's the time frame for that? It depends on how far away they are from us. We can print it pretty much right away in that the speed of what our process does, we can very easily make more than one dose per second, depending on the volume of medicine in each dose. It's analogous to how if you're printing monochrome, like this text, it comes out pretty rapidly out of the printer. But if you're printing something graphics heavy it comes out a bit more slowly. So it depends a little bit on how much medicine is in each dose, all that. But we can print it right away and we can ship it same day so that the client can get it anywhere from overnight to two days out. That is kind of what our business model is. Now with this with prescription printing like this did you have a background on the printing side or on the medical side? What was the background that brought you and made you kind of interested in this in this field? My background is in chemical engineering. I'm a PhD in chemical engineering that's been quite a while ago but my entire professional career I have spent in pharmaceutical production at both at the largest scale like half a million tablets an hour as well as what we are doing in the custom medicine and things in between in about 50,000 tablets an hour that kind of scale. It's not really so much about my background as we just found where the need was and I personally decided to apply my engineering background to where we believe the problems were. We collaborated with pharmacists we have collaborated with medical doctors on the human side as well as veterinarians so that's it's an interdisciplinary effort all in. I mean I think it's need to see these different fields coming together I mean you've got the printing tech you have the need for chemical engineering and dosing which obviously needs medical side and I think it's a neat confluence of fields. This I think is a good time to talk about the animal human side and my understanding is that it's actually would be no more complicated to print you know pharmaceutical drugs for humans so it's not a degree of difficulty of technical difficulty question to do with the messiness of our health insurance system and regulatory approval can you walk us through that? Partly yes we had a variety of conversations with people across the ecosystem as I mentioned and from a technological perspective there's nothing preventing us from printing custom medicine for humans. The issue was that I had mentioned earlier that the animal side was a lot cleaner and what we found was on the animal side people who are paying for the service are the pet owners and they are also the people who directly visualize or witness the problem it is very closed and localized in that sense whereas on the human side for example we have great benefits in the precision of our medicine in that we can get submilligram level dosing which is currently completely unheard of so this can easily benefit neonatal care or geriatric care or people who are using things like warfarin where the difference between 2mg and 3mg is the difference between therapeutic and overdose one will land you in the ER things like narrow therapeutic there's a variety of drugs there's a variety of patients for whom our sort of high precision printing process will really benefit however the patient we found is the beneficiary the doctor has to do something slightly differently in that veterinarians are extremely used to doing things on a milligram per kilogram basis on the human side the guidelines are not milligram per kilogram that often many times it would say something like adults take 20mg children below 12 take 10mg it is already discretized in that sense the third thing is on the human side the majority of the time it's the insurance company that pays for the medicine and it was not clear what their incentive was so the payer was different the person writing the prescription has to do something different and the beneficiary doesn't pay just sees the effects without having to do anything it was a very complicated system on the human side with the sales cycles being very long and protracted so we decided as a start up we are not going to mess around with that we are always open to dealing with human medicine as a different vertical in the future but we chose to focus all our attention on pet medicine because there the problem was much more well defined people already knew that they were not getting the exact fineness of the dosing that they needed plus there was a huge huge problem on the veterinary side in terms of patient compliance this is something that humans can for example swallow a bitter pill literally you can kind of just grin and bear it your cat spit it out first of all if your cat is small or if your dog is a smaller thing you often have to buy something off the shelf and you have to subdivide it into four pieces two pieces four pieces you might be doing that by hand not all tablets are pre-grooved and you might not get the same amount in each quarter of a pill you might get only three pills the fourth might crumble into powder you try to give this to a cat and now it claws you and doesn't want to take medicine because it's a cat it might take it but then it spits it out so now you are scratched and bleeding the cat has patted its medicine out there is this white foaming mess on the floor and you don't even know whether you gave the right dose to start with on the animal side therefore there was a lot of pain in getting animals to voluntarily take medicine so we believe that customized medicine there it's not just about the dosing levels it's about if we can make something that the cat voluntarily wants to take it will really simplify the lives of pet owners everywhere now does this mean using a different substrate that's more appealing tastes better to the animal it's a variety of things I did mention pharmacists had told us that tastes vary from individual animals as much as it varies with humans so they do not have the knowledge ahead of time to make something that will appeal to all cats but we have the ability to tune the flavor to the individual animal we also have the ability to tune the carrier form for example it can be a solid that the cat takes by mouth but if the cat absolutely is recalcitrant on that we can put it in another form depending whatever the veterinarian do we will do it unless it's something we do not question the veterinarian we completely trust the veterinarian on how much medicine this cat needs the only reason we might push back is if something just doesn't make any physical sense to us we might say hey did you confuse milligrams with grams or something order of magnitude but other than that we trust the veterinarian to know what they're doing so in theory a veterinarian could say this is the sort of thing where they could ask the owner of the pet and say what's a flavor your pet looks they like to tune the flavor they like chicken flavor they find out they put in the order make this tune the flavored and make it make it a liquid form so they can use an eyedropper to administer or something because that's how the owner says the we can use data like that these little sample packs of flavors that we can distribute to veterinarians ahead of time and they can let's say there are about 5 to 10 different flavors you can feed it to a cat or leave them all in front of the cat see which one it takes after smelling it and we just pick that flavor that's great yeah there are many ways to do this there are many different ways but the vision is that if a cat will voluntarily take medicine our COO for example is a veterinarian by background and her cat has given her trouble with going behind the couch and spitting things out but her cat is also very telling the difference between a treat and a medicine just from the sound so it can either come running to you expecting a treat or it can run and go and hide in the closet so the vision is that if medicine can be made in a form that it simplifies the pet owner's lives considerably it's about 10 to 15 minutes of struggling with the pet is now gone that's something we believe is worth it yeah anyone who's any pet owner I think especially someone who owns an intelligent cat would appreciate not having to fight to get something down their gullet that they don't want now on a cost comparison how would this process compare if the drug is going to have a different price point so we have to speak in generalities here but do you anticipate this costing more than the current prescription system where do you come out in the price point there are two comparisons to make here one is custom medicine versus off the shelf in general custom medicine is more expensive simply because you need the labor to do things by hand however we believe now we are not comparing ourselves off the shelf medicine we are comparing ourselves with other existing custom medicine and there we believe that since our process is a lot more rapid we can turn things around more quickly the economy of doing things more rapidly we can pass on to the customer to start with we are cost comparable with existing compounding pharmacies but we believe that as we scale up in future the price savings can be passed on to the customer that makes sense you are competing for a different segment of the market you are not competing against the generic off the shelf that is great to hear then we can take it back as I am listening to this and I own the pet so I appreciate the pet angle trying to get my greyhound trying to get my greyhound to swallow a pill involves pill pockets and coaxing again you have to believe that it is a treat and not a medicine so I appreciate the animal side but part of me keeps thinking this would be really nice on the human side too right the ability to customize the medicine to make it a better fit I mean it is better for you medically if it is exactly calculated to your weight and to your particular situation it is it is more convenient more pleasant of an experience if you can adapt it so it is not the giant pill if you are someone who has a swallowing issue I mean there are people like that who have medical swallowing issues like part of me keeps thinking it is striking to me that in a sense our pets will have this advanced production technology before their owners will that just is very striking to me so on the human side what would need to change before you guys really seriously considered expanding into a human pharmaceutical space that it is an interesting question we right now the situation with the human medicine was not clear that is why we focused on the animal side I would say a variety of things first is there are some doctors specializing in certain things for example pediatricians neonatologists geriatric medicine certain disease combinations like if a person has let's say an endocrine disease and cancer like diabetes and cancer they might be seeing an endocrinologist and an oncologist but the drug interactions may or may not be on each other's radar it is often the nurse or the pharmacist who becomes the final point of contact and they have to figure out which of these things are going to interact there is already some knowledge that custom medicine is needed but the tradition seems to be that on the human side they start out at the baseline of some medicine you then go back to the doctor in about 4 to 6 weeks and they look at whether you have had too many side effects or not enough therapeutic effect they adjust the dose it is either high or low depending on what happened another 4 to 6 weeks later they might adjust the dose again so it might take you about 3 months to hit your steady state and the adjusting the dose would be something like subdivide a pill which in many cases is not good because pills can be coated or it might be take 2 or take them more often all kinds of discreet ways to do it that we believe can be changed up front because this is not something we do in house at pinpoint but we are aware of many people in the field for example take your liver function test your blood draw or plasma draw or just your genetic factors or your doctor can use your entire medical history use their judgment to say this is how much you need the issue there is they might be able to calculate you need 7.35 milligrams or whatever the number is but you are torn between a 5 and a 10 so even if they can calculate it there is no mechanism right now to efficiently make what you need other than existing compounding pharmacies most of which is currently still done by hand so that is one thing that needs to change is that doctors and people writing prescriptions would need to become more used to writing things on a continuum rather than discreet levels on the insurance company side if let's say that the doctor needs to do a blood draw before they prescribe this custom amount it is not clear right now who is covering the cost of that blood test the blood test can be very rapid it can be done right while you wait in the doctor's office it usually takes no more than half an hour from what I have read in the literature by people who have come up with tests like these again it's not something pinpoint does directly however there was stymie about who would pay for that and this is not something a pre-prescription blood test is not currently covered or is not familiar to many insurance companies that sort of education we believe might need to happen all these things are completely bypassed on the veterinary side simply because they do milligrams per kilogram basis right out of the gate so they are extremely used to it well hopefully as medical community writ large sees this working on the animal side and this I'm convinced becomes a dominant way of doing compounding prescriptions for animals they'll start to make changes on the health insurance on the medical on the human medical side that makes it possible to port this over to human medicine so Arun thank you for your time, thank you for explaining what pinpoint pharma does I think our listeners will enjoy hearing about this and I'll put a link in the show notes to your website so they can look at you in more detail thank you for having me I'll admit that when I first heard that this technology which promises more accurate drug dosages at a lower cost was going to improve the lives of our pets and not people first I got a little disappointed it shows how life saving and life improving technology is being delayed for humans because the health insurance system is so tangled and messed up but I'm glad the companies like pinpoint pharma are finding ways of rolling out this technology anyways even if it means that pups will have better pills than their people do now I suppose our sign off is more fitting than usual today as always until next week be well building tomorrow is produced by test terrible if you enjoy our show please rate review and subscribe to us on iTunes or wherever you get your podcasts to learn about building tomorrow or to discover other great podcasts visit us on the web at libertarianism.org


I am amazed by the one who formed the earth and made no way For a lost and broken world and yet he saved us Who was calling out to crucify the sun On a wooden cross he said for even you that saved us


What's up everybody, Jason here for jasperyscasebrakes.com, five training camp mixture spots being given away here guys with this 2021 rookies and stars football one box serial break number four. And again guys first we'll do the break, we'll randomize the customer names, teams, distribute the hits out, they'll randomize the original customer names and the top five out of the thirty two will get spots in the training camp mixture. Number five is in the store guys, that's the last filler to unlock the break guys. Also this is a promo break so we'll copy and paste the names into the list right now and you guys will have chances to win some good amount of money, $5,000 in break credit if we sell all the breaks in the category by Tuesday. Excuse me, let's go dice roll in and let's do the break first, five and one six times, one, two, three, four, five, six, five one six, six, Tommy, Donna, Stephen, Kendrick, six, one, two, three, four, five, six, six times, Pittsburgh Steelers down to the Rams. Now again stick to what you got, it's a quick little serial box which is basically just like a pack of like fifteen cards so no trades, pleasure teams there, really quickly so you guys can see them. Now let's switch scenes and do the quick serial box break. The Andaman Marino Crusade, Trey Lance, Trey Lance, we got an Ian Book Airborne and a Crusade Jerry Rice, Trey Lance did have a good pre-season debut this year, oh yesterday, it went nice like seventy plus year touchdown pass, alright so there you go guys, a couple of Niners there and those 49ers cards will be going to Jose. Now let's switch scenes guys and let's do the main giveaway, here we go, top five get in, roll it and it's a one and a three for four times, remember top five get in after four times, one, two, three, four, boom, five times or four times sorry, top five, get in guys, so just missing out is Aaron Miller, sorry buddy, let's see if you're in the top five though, I know you did get a couple spots, Joshua Jones you're in, Tommy, Joshua, Steve and Steve, there you go, alright so top five aren't in, so there you go guys, that was it there so again guys, top five get in, so let me paste your guys names here and again guys we are just one filler away guys, before I go let me copy and paste the names here, sorry Aaron, you were close though man, maybe next time though you know, I have never heard that but that's actually a good way to put it man, it's like man always the bridesmaid, never the bride, alright so from you guys here down it is twenty twenty one, we'll go rookies and rookies and stars, one box, serial number four, so there you go guys you guys are all in there now, so appreciate it guys, again next fillers on the website, all spots in last one and then I'll get to sell two full spots and then we can break that tonight guys, appreciate it everybody, Jaspy's casebrace.com


What's up everybody, Jason here for JasperCaseBricks.com. Last filler here, guys, even with the last 10 spots in hip-rate football with this 2022 Prism 5-pack retail break number 34. So first, guys, we do the break, randomize the customer names, teams, distribute the hits out. At the end, we'll have a new dice roller, new list, and randomize them, top 10 get into the hip-rate break. Let's roll one and a five, six, seven times, one, two, three, four, five, six, or one of six, seven times, sorry. TJ down to Tristan, two, three, four, five, six, seven. Colts down to the Cardinals. All right, now stick to what you got, of course, because it is just a quick little couple of retail packs. Let me show you your team right there. And here are the five packs, here we go. Keelan Cole, J.K. Dobbins. How about that? About a little nicely centered too. J.K. Len Hurts, rookie silver. Damn, and who has my Eagles? Nester, look at that, dude. I did that easy place for the spot. Probably a couple of them, actually. That is awesome, dude. Very nice hit. Nicely centered, definitely greatable. Take a look at that, man, when you get it. Nice, all right, now let's switch scenes. And again, top 10, get a chance. Roll, three and two, five times, good luck. One, two, three, four, five. Five times, five, five, top 10. Rosario, Dan, Nester, Kayam, Gregory, Jason, Nester, Patrick, Nester, and Steve Birch. There you go, top 10. Boom, so appreciate it, guys. Coming up next is the break of toe.


Hey, this is Brett with Summit Automotive in Fond du Lac, Wisconsin, your destination for new and used Jeep and Jeep Grand Cherokees. Today we are checking out a brand new 2020 Jeep Grand Cherokee Altitude in red velvet pearl coat. This is based off the Laredo package and we'll go around it so you can see it from all the different light angles and then we'll get up close and go into the specific options on this Jeep. This one comes with the 3.6L Pentastar V6 motor and is paired up with the 8-speed automatic transmission. It gets you 25 miles per gallon on the Highway 18 City and an average of 21 miles per gallon. So this is based off the Laredo package and then the Altitude is an upgrade to that package. The first thing you'll notice is the 20-inch painted alloy rims part of the Altitude package and it has Bridgestone Duler 26550R20 tires and it's got a kind of a highway tread on there. Red velvet pearl coat, really a good looking color. Has the premium lighting group so you get the HID by Xenon headlamps, the LED running lights and the LED fog lamps as well as LED tail lamps.  The gloss black Jeep logo. You also get the blacked out Grand Cherokee lettering on the side. Color matched painted mirrors, this one has the enter and go system and we'll take a quick look at the original buyer's guide here, definitely feel free to pause the video to check out every option that comes with this package. You can see that you get the navigation system part of this package and there's your premium lighting group which is a 795 option and it comes standard with the ProTech One package which gives you your backup camera blind spot monitoring and parking sensors. Three year 36 bumper to bumper and five year 60 powertrain. What I love about the Grand Cherokees is the five star safety rating overall, four and five for front, five for side and four for rollover. There's your miles per gallon and we'll continue on with the walk around here.  Has the power lift gate, back storage area is very clean, you get a full size spare tire and jack tools, got a little storage bin on that side and on that side some hooks for grocery bags and those seats do go down nice and flat for extra storage. Press that button it'll come down after three beeps, really a good looking color. Has the blind spot monitoring, the heated mirrors that's part of your ProTech One, the enter and go system so you have the doors locked, you just have to put your hand in the door and watch that unlock for me, just does it automatically if I got the keys on me.  As you hop inside the vehicle here you can see that this one has the seven inch LCD display, also part of that altitude package, outside temp and compass display and the digital spinometer and you can change those corners to whatever you want displayed in there whether it's miles per gallon or miles to empty, you can change that. Has your cruise controls on the right, Bluetooth and information center controls on the left and on the back of the steering wheel are your audio controls. You get the 8.4 4C touchscreen radio which gives you the factory navigation system, AMFM and Sirius XM radio capabilities but being the 4C you also get Android Auto and Apple CarPlay capabilities where you can project your screen from your cell phone to the screen up there so if you had like Waze or Google Maps you could display that up there instead of using the factory navigation.  Down here you get two USBs, an aux jack and a 12 volt power point. You get your 8 speed automatic transmission with the mechanical shifter and you do get remote start on this key fob as well as the power gate button.  Up here you have your home link buttons for garage doors, security systems and lighting systems as well as your map lights and you do get SOS and assist in that mirror part of that 8.4 with the navigation system. We'll take a quick look at the back seats and then we'll do a final walk around. So these back seats are not heated in the altitude package, you do get the latch child safety system and they do fold down for extra storage. You can see how nice and flat that that goes, it's almost completely flat just a little bit of an angle to it but it's really nice if you've got a whole bunch of extra stuff easy to put down and get up.  Does have the capitalist fuel fill which is a really nice feature if you've never used that. I highly recommend it, try to get it on all my vehicles. And we'll do one more final walk around here, I would personally like to thank you for checking out the video today and we do a lot of walk arounds on our new stuff so that you can see the new model years coming out and what's new and hopefully learn a little bit about each vehicle. And in this vehicle particularly that you can see it and get a really good idea of what you're going to be dealing with when you get to the store and I'd like to thank you for checking the video and if you'd like to check out more HD videos you can go to youtube.com slash summit auto remember to like subscribe and share on this video and all the videos that you see there. And check us out for all of our vehicles online www.summitauto.com full pictures and descriptions of every single vehicle from two locations all at summitauto.com and like I said remember to like subscribe and share in fact in a second you will see a link to subscribe to our YouTube channel on your left a link to more new Jeep videos like this one on your right. If you have not been to our website on the bottom link to this vehicle on our website click those check us out and we're super excited to be offering the 2020 Jeep Grand Cherokee especially the Laredo with the altitude package and the LED premium lighting group thanks for checking out the video.