Thank you for joining us for this very important topic that we have chosen today for our discussion which is really how telemedicine and telehealth is going to look to grow as we go forward. Today we have seen particularly with the pandemic being amidst the pandemic, there have been opportunities that have been emerging largely which were there already in the market but they were not able to find their true sort of growth. Education technology is one of them. We have seen platforms like gaming, platforms like OTT growing much bigger than they could even when there was no pandemic and another sector that we think is really a big sector that is going to emerge not just for now but also going forward. It is telemedicine or telehealth wherein this is really the digitization of the healthcare, the OPT and also some other ailments which are common and don't really require for a patient to go to a hospital or should not be going to a hospital for that kind of consultation. So we have a panelist out here, we have Saurabh, we have Kiran and we also have Rajat with us and they're going to give us how this dimension of telemedicine has been now improving and growing in different parts of the country. Of course Rajat has more sort of caught a bigger play in the tier two, tier three markets while Saurabh and Kiran they have caught play in the tier one as well as some in tier two markets. So it's going to be interesting to know where the telemedicine or telehealth has a space is going to emerge in the years going forward. So let me start with you Saurabh, interesting space to be in. We are seeing that in markets like US the telemedicine has been growing. Also from what we understood is that telemedicine is not a very new concept, it's been there for a very, very long time where doctors were consulted through digitally or through telephone as a simple medium or a tool of consultation for second opinion or for some other areas. What is your opinion on how telemedicine is likely to emerge? So it's something that we have all experienced now particularly in the pandemic and we have also realized the comfort and the convenience of having telemedicine around us as customers. What do you think is likely going forward going to be the impact of telemedicine or telehealth once the pandemic is really over or at least people are able to lose their fare of the pandemic? How are they going to use telemedicine as a tool for their medical consultations? Thank you, Ritu for having me. So the couple of points, a lot of good points that you mentioned compared to what happened in the US and what's happening across the globe. I think obviously because of the current pandemic, because of the restricted movement of people, there has been an increase in telemedicine in India and no doubt people have been trying our services and other platform services to talk to doctors. What has happened also due to the pandemic is on the supply side as well, which is the doctors. They themselves also are not that comfortable seeing many patients. Although a lot of doctors are on the front line, they are seeing COVID patients, but there are many doctors who have decided to close down their OPD either because of their own or either because they are in the containment zone and whatnot. So on the supply side, on the doctor side, we are seeing a change in behavior where doctors themselves are adopting technology. So on both demand and supply side, this has been, there has been an update. Now to your question of going forward, I think going forward, what is going to define the timeline? And of course, there is a blip which is increased. And now after once this lockdown restrictions as they are easing up, as people go out more often, there will be a slight decline in telemedicine usage. But the new normal would be higher than the previous one for sure. Now, what is going to happen going forward is that the virus is going to define the timeline. You and I cannot define the timeline as to whether telemedicine will be adopted or not. So by that, what I mean is to change user behavior, there are two things which are required, either fear or incentive. So right now it's all about fear. So users are fearful, the doctors are also scared. So I think as the restriction eases down, we are going to see how many people actually go out, how the economy picks up, and whether there's this fear still resides among both users and doctors. And we are going to see that pace of decline, obviously we are seeing today, but then it will settle at a new normal pace. So going forward, I would say the usage is going to a little bit decline as people go out more often. But nevertheless, the behavior changes already happen to some extent. So there hasn't been any incentive per se to do it, but there has been a lot of fear. But I mean, if I were to add another layer to fear and incentive, which is of convenience, you know, it's very convenient for a common ailment like let's say a cold. And I mean, today of course, it's very fearsome, you don't know what this cold is coming from. But I mean, literally, you know, when you have some very common ailments, you don't want to go to a doctor, the only reason one has been going to OPD for such ailments is because, you know, there is no other choice but to talk to a doctor. If I were to get to talk to a doctor on a phone and he would say that, okay, look, this is a virus, which is anyway going around. So just take this medicine for five days and you'll be done with it. I would really not want to go to a doctor. So my point is that do you think, you know, and any sort of disruption that has happened in the last 10 years, whether it was e-commerce, whether it was any, eventually people found the convenience factor, which really made them hook on to it. So do you think convenience, once they realize the convenience of it, they are going to be more hooked to telemedicine than they were previously? Yes, definitely. I think what you said is bang on. And what is going to, you know, sustain the new normal, which is a little less than the peak, is going to be convenience. You know, for sure, whether people would, you know, find that more and more, you know, they don't need to visit a hospital. Hospitals are sort of, you know, a catchment area as far as fear goes that you could be infected. So even hospitals are also, you know, even doctors are also suggesting to move to telemedicine. So I think convenience will play a role. Definitely that's going to happen in the long run. We all hope, you know, as provider of telemedicine platform on library, we hope that your convenience should play a bigger role in sustaining the new normal. And what changes in library have you seen particularly in the last, let's say last, I mean, start of 2020? I mean, before like the pandemic march and then after pandemic march, what kind of changes have happened on the platform? So of course, there is a surge on the user side, lots and lots of new users have come on to library and, you know, started trying out the online consultation service. But more than that, what we have also witnessed is the rise of doctors coming on to the platform.  So that I think is a huge shift in the mindset of doctors that we have witnessed. And you think doctors were the sort of the roadblock, they were the ones who were not adopting it as willfully now they have adopted it as they adopted it now.   You anyways have to take the food outside.  So it's that's behavior shift that has happened from the restaurant, which is a supply site, which is now happening from the doctor's side, is they're saying, hey, you know, why don't you consult me on library? Or why don't you consult me on this platform, right?  So, so, so that shift I think is dramatic to the extent that they are, you know, we are seeing this shift on the consumer side as well. But there's another point, you know, it's the regulations have come up. So telemedicine, even though government has been a strong proponent of telemedicine in the past, they have been using a lot of telemedicine services in the public health centers, connecting new remote towns and villages to a central doctor. But what has happened is now, Ministry of Health and Family Welfare have come out with a complete set of guidelines, which outlines very beautifully, you know, what is it that you can do, what is it that you cannot do, what is allowed, what is not allowed. And, and overall, in nutshell, the summary is that telemedicine is the way to go. And government has come, you know, all hands saying that this is the future, we support doctors with technology, they can even do a consultation on WhatsApp today, they can do consultation on platforms like Library, but that has, you know, been a tremendous push in terms of changing the mindset of doctors. Sure. Rajat, let me come to you. Now, my chart is primarily is a model which is very more readily available in tier two and three markets. And now here, of course, we still sort of been seeing overall from an overall perspective of the acceptance of technology and digitization is less than what it has been in the tier one or the metro cities of the country. Now, where do you see a bigger sort of market developing in the tier two, tier three markets for telemedicine? What opportunities are you seeing emerging over here? Are people really more now getting, and of course, you know, as Saurabh said, there has been a fear factor for which people don't want to go to their doctors and would rather have it at home. But do you see that in tier two, tier three, and also of course, you know, in any point of time, tier two, three cities are there, the hospitals are not overly jam packed, there is a good really healthy relationship between the doctor and the patient. So how do you see the models emerging, business models emerging in these markets and telemedicine? So, in tier two, tier three, you know, the bigger issue is with not just the convenience, it's the access issue. So when we talk about access, you know, you go to certain districts of the country, whether it's in Himachal or Trakhand or, you know, Eastern UP or Bihar or Jhaparkhand, you will see that in a district, you have like four MBBS doctors or three MBBS doctors across the board, like, and if you go to smaller towns, they just know MBBS or MD doctor and forget specialties overall. So there's just no concept or speciality over there. So now, like, for example, I went to one particular district, I asked, who is the doctor here? So they sit on the pass, I said, MBBS guy. So they're like, no, this is Jhola Chhatra. So MBBS guy, on Tuesdays, he goes to a clinic like that, they meet there, and they meet for three days a week. So it's not that the user is not aware that the doctor that they are going to is not qualified. But it's just that the access is an issue. Availability is an issue. And so as people become more comfortable with online solutions, people will move. So the way we look at it is that, A, this opportunity forces a lot of people to come online and experience that teleconsultation does solve their problem. So we close the loop and ask, your health outcome is positive or not? And we've seen 80, 90% there is a positive health outcome. And people are improving. And we have also looked at international studies and everything which says, 85% cases may, you will be able to create a positive outcome by doing a teleconsultation. That's what we are seeing in our data as well. So I think what's happening is that people did not know that the Khaasi work can be done on the phone or not without a doctor. And there are two parts of it. One part is, of course, the user behavior, which is like my son's Khaasi is different from 50 and children's Khaasi. So my son's Khaasi is specialized, so it is important to show the doctor separately. And he will see the medicine separately. And the doctor says that 50 people have the same medicine. So there's that user behavior. And on the doctor's side, there's economics involved as to what he describes, what test gets done, where they get done. So there's a lot of that economics at a local level that's happening, that basically pushes for the model that exists today. But what has happened here is that a lot of users are forced to come online. A lot of doctors are forced to come online. And that has basically changed the dynamics. Now the user knows keep consultation online. So next time he has to go to a doctor, his questioning is And as an industry, it's our responsibility to make sure that that user gets an A plus experience. Consultation and the follow-up process. So we send them relevant content. We have built journeys around different diseases. All of that has been mapped out. So there are a lot of things happening. I think there's an access issue at play in our case, especially. So they are coming there anyway. But there are local incentives at play that basically stops them. There is awareness at the issue that is also there. And this particular pandemic has forced people to come online, which I think ultimately is going to help us in the long run because people will adopt the platform saying, this is all because of that. So why bother stepping out, waiting in line, going to a non-qualified doctor, paying money for medicine that may or may not work versus coming online, talking to a qualified doctor, having double assurance that the things that he's advising will actually result in a positive outcome. So I think that's what has changed. And it's a very fundamental shift that people are going to taste tele-consultation for the first time compared to even the products that we have for tier two and three are very different from tier one. So in tier one, the expectation is that people will do a voice consultation or video consultation because that's how they are trying to measure the quality of the doctor from a user perspective and different between physical and physical experience versus a video experience. Compared to our user, video consultation is not an expectation. And video consultation doesn't work because live connection, live video call doesn't work. So we give them a video upload feature. It does work for them. So I think there are just some fundamental shifts that have happened, which by the government regulation and also that has helped in the overall situation. And I don't think this is going our way now. The box has been open, Pandora box has been open. People have experienced what a higher quality consultation looks like. And they are not going to settle for anything less. So it's just more of us as an industry pushing people to experience this level of consultation across millions and millions of users. And once they experience that, they are not going to go back. Sure. Okay, let me come back to you again on another important question. But first I'll go to Kiran. Now Kiran, what I'm seeing is, so I'm going to draw parallel with another industry here. So now, health tech, and I asked this from Saurabh also, that sometimes the roadblock is in the person who has to adopt this technology. So in education technology, we realized that it was the teacher who was not as keen to adopt education technology in the classroom. And that is why the whole effort of digitizing education for children was not sort of giving the results that were expected to come. However, with this pandemic, every teacher had to go and adopt this technology, prepare classes online and do everything. So now my point is that what, how has the behavior of the doctors shifted during this particular time of the pandemic to be able to give digital technology as a solution or a digital medicine as a solution? And do you think for them, I mean, you know, once of course, doctors are enabled to be able to do it, and they are more keen on doing it, the patients would automatically shift there because they are only, it's all about a doctor-patient game at the end of the day. So do you think now doctors have shown more readiness than ever before, you know, earlier? And secondly, with doctors being now able to sort of become doctors becoming more important to the entire thing and adoption, how do you see telemedicine evolving?  Now the doctor himself wants to come. And you know, what kind of earning can the doctor expect? Do you think it's an extra strain for him or is it going to eat away his or her time from, you know, what they have been spending and they can earn on one to one? So all these things from a doctor's lens, if I have to look at the situation, if you can give us an idea of that. Sure. So let me take a step back in this scenario, right? So I'll give you an example from my past life where I was in the US managing telecommunications, right? Smartphones. And I've seen teleconsulting almost, I would say, eight years ago in the US. And I was managing a smartphone called Palm Central, which was doctor's favorite smartphone, right in the US. I mean, this was, I'm talking eight years ago, right? And we were selling like hotcakes to doctors in the US eight, nine years ago, Palm Central. And the only reason they were using it was not for consultation, only for appointments. Okay. Right. And even then, there was a huge barrier for doctors to adopt technology. This I'm talking about in a mature world. Now, if you take a couple of years fast forward, right? When we started the platform, when we started saying we want to provide teleconsultation, so our business is slightly different from Rajat's and Sorob's. So we are a B2E company, right? Business to employees company. And when we started our platform for teleconsulting, one of the main requirements was, like you rightly said, doctors, right? Now, unless there is supply, there is no, unless there is demand, there's no supply, right? In this scenario, it's like a classic gift. If I have to start an online dating website, right? Do I bring the women first or the men first? Correct. So in this scenario, I mean, what we did was we took a slightly more difficult approach where we went ahead and acquired a teleconsulting company. And today, we have doctors full-time on our payroll. So we don't outsource to doctors, right? And when we started out getting doctors full-time on our payroll, we don't judge doctors based on the number of consults. They don't get paid on number of consults. They get paid only on the quality of the consults. After every consult, they have a rating. Now, going back to what you mentioned, right? What Rajat was mentioning, it's the customer, right? For Rajat's customer, the needs are different, which is the reason why he was able to build the demand. For Solam's customer, the needs are different. He's able to build a demand specific to that customer. For our customer, the needs are completely different, right? When I'm talking about an employee, they need 24-7 support, like a nurse line. They don't care about video consultations because most of these are younger population who would like to chat more than voice or video. So when we enabled all of this, there was already an increased demand in terms of teleconsultations, but that has changed drastically, right? In the last one and a half month where we've seen almost 200-300% increase in number of consultations, primarily because of our main client, I would say, right? I know I'm going off of your question a little bit, but our main client corporates, I would say three months ago, when we went and visited teleconsultation, saying it's available 24-7, maybe as qualified doctors, they said face-to-face, right? And today, in the last one and a half month, we've signed up almost 800 companies who said, we don't want face-to-face, we want virtual consultation. So it's a complete shift in how people are thinking about this, right? I know Rome wasn't built in a day, right? So it's at least the right step is being taken in that direction, right? Where now companies like ours, all the digital health companies are starting to focus more on the demand, right? So the demand is growing, right? Where people even, like for example, even users that we knew, right? 45 years and above users we thought would never be comfortable chatting with an online doctor, but they have no other means, right? This is like, they don't have another way to do it. So this is like, this is the only way that they can chat. So the demand is changing. Now, if we are able to do a good job in that first one or two consultations that they do, then we are confident that they will come back saying, yeah, this is convenient, this is simple. And more importantly, this is super fast, then going and waiting for a simple cold or cough or because 80% of those consultations are basically for primary care, right? And now that the doctors, all the demand has gone up, right? You won't believe the number of doctors who reached out saying that, hey, is there a platform or is there a, can we use your technology to consult our patients online? In the last, I mean, a lot of doctors are reaching out, right? So, again, going back to my classic case of online dating, right, which is bringing men or women first, right? In this scenario, it's the demand. And when doctors are able to see that clients are getting used to that, and they have the convenience, doctors will automatically come to the platform.  I mean, humans are good at adapting, they will have to adapt to the new ways of consulting patients. And a very simple example in my own case, right, my pediatrician, a very, very well-known pediatrician in Hyderabad, face-to-face only. In the last one and a half month, he's done more tele-consultations than face-to-face consultations. And it was a very, very, I mean, it was a, it was a very tedious process, but he, being such a senior doctor, had adopted tele-consultation. So, I would say the demand is first, and then the doctors will definitely follow. Right. Yeah, no, I agree. You know, this brings me to another important area of concern. So, sort of, let me ask you this. You know, for doctors, you said that a lot of doctors have onboarded on the Liberate platform right now, particularly during the pandemic times. But do you really feel that in some ways, doctors feel that this will be counterproductive for them in the long run? I mean, let me give you an example of the restaurant industry. So, while every restaurant today is giving a takeaway or it is giving a delivery, but they still feel that if they continue to do this, in short run, it's okay when, you know, it's a survival game, but in the long run, if they try to do something like this, it's going to eat into their real business, which is dining in. So, now, do you feel that doctors also are going to, at some point of time, be concerned that this might actually eat into their real business, where they get the piece?  So, do they, I mean, that is one part of it. Do you feel that they feel that over it might be counterproductive in the long run? But in the short run, of course, it's adding to everybody's income. But also, at the same time, do you feel that hospitals are likely to get into this game themselves? You know, they might say that, okay, we also run a digital OPD and we also run a physical OPD. And you know, therefore that adds to our revenues. So, how do you think the market, I mean, you know, what is the market economics or the business model economics like for telemedicine? So, you know, there are two questions I'll answer the first question first on the doctors, the commission and other things. So, there are two kind of platforms that exist today in telemedicine. One, which is like a true platform, wherein any doctor can register, and any users can find those doctors and consult with them, right? Then there is a second kind of a platform, which is actually not a platform. But what they are is they are getting users and they are saying you can consult any of the doctors for like a specified fee, say 400 rupees a month, you can consult any doctor and they don't show the name of the doctors. So, it's like an aggregator platform. So, it's an aggregator, but it is actually not an aggregator, it is disintermediating the doctor. So, that platform is actually worse for a doctor. Even today, if I give the example of a restaurant that you talked about, similar to say a cloud kitchen, where you don't know, there is a name that pops up and you don't know that restaurant or there is no physical location to it. So, now what is happening is that platform is actually, doctors need to be really beware of that. Hey, my name is not there. I am now working as a contractual employee or as a consultant, where people are paying the fees and then I am being assigned a patient. So, that uptake in demand side, which is the user side, if there are platforms like these, doctors need to stay away. That's point number one. The second point is library is not that platform. So, in library, doctors can register. When a user pays a fee, they actually select a doctor first and then they go and pay the doctor's fee. So, selecting a doctor first means I know which doctor I want. So, we are a very neutral platform. Now, coming to the third point of the fees part. So, I can't say for other platforms, but for library, we don't eat into doctor's revenue. So, let's say the doctor's fees is 500 rupees, consultation fee. The user sees doctor fees 500. There's an internet handling fee, which is 10% of doctor fees say 50 rupees. Total is 550. So, it actually says that doctors fee 500, library fees 50, total 550, user pays 550. In fact, that money goes into a nodal account, which is a non-interest wearing account. Library doesn't earn any interest on that 550 rupees. 500 goes directly automatically to doctor's bank account and 50 goes to our bank account. So, there is no eating into commission of a doctor, per se. So, that's the first part. The second question was, if you can recall. The second question was really how will the business model evolve? Because, you know, I also feel that hospitals like Apollo. Hospitals point. So, on the hospital side, in fact, many hospitals have now adopted some kind of a platform. Either library's platform or they have come up with their own apps and web-based solutions and they are offering this OPD consultations to all their database of patients. So, it doesn't really matter whether they use library or they use their own platform or they use a third party. What they are doing is many hospitals have now adopted this technology. Now, what is going to happen in the commission and the business model of a hospital? A hospital runs on the, it doesn't run on OPD. If you ask any hospital, it doesn't run on OPD, it runs on IPD. IPD is the inpatient department. So, there is a conversion which happens from OPD to IPD. So, now, what is, you know, there are obviously conflicting theories behind it, but what could happen is that there can be a lot more OPDs that will happen because of the convenience factor that we talked about, that even for a small thing which I used to avoid the visit earlier now, I can just consult. So, there is, there can be an increase in OPDs. At the same time, there can be a decrease in OPD to IPD conversion. There could be. So, I think on the doctor side, on the hospital side, only time will tell, but given where we are today, my guess is the business should increase of a hospital because of the convenience factor that ailments which were not being taken care of earlier, now they have the opportunity to talk to a patient. And my guess is that should increase from a hospital perspective. If they are adopting a digital technology which I see a lot and a lot of hospitals have started to adopt irrespective of the size, whether it is, you know, a India wide chain or a city specific chain or even a single specialty, I'm seeing what I'm hearing from our partners at hospitals that we work with that future outlook is that it is going to increase, it is not going to decrease. Sure. Rajat, you know, I'm going to ask you this question and then we also see a lot of questions coming from our audience. We'll take those also alongside. So, you know, my point is, what are the trends you have noticed in the telemedicine in tier two and tier three cities? What kind of services are the customers taking the most? Is that profitable for the business model at large? I mean, you know, particularly that level of service, that payment points, that the price points that you're charging, does that make the model viable? Or do you think the model requires some other users, for example, you know, Saurav mentioned from OPD to IPD. So how for you this model is going to transgress to become more, you know, more of a tool where the economics works right for you. So first, I think I'll also address what Saurav was talking about the two models of teleconsultation. I think there is a fundamental problem with health and education industry. Nobody is focused on consumer. So education may be focused on the parent, the teacher, the model decides. Health care may be focused on the patient, not on the doctor. All pharma companies are focused on doctors, hospitals are focused on doctors, and subsequently, all teleconsultation platforms have come up with focus on doctor. So I actually ascribe, so, you know, they, they are platforms that are doing doctor discovery, right? Keep. And they basically go and find that and, you know, connect with them to visit offline or nowadays also do online. But our core customer has a different problem. Our core customer has a problem that he wants to talk to someone who has a ambivalence degree can provide a timely response. If you have to book an appointment, I have seen platforms where you get an appointment after like 10 hours, 14 hours, 18 hours, two days later. And in our case, we have to give the response within a 30 minute window. So ours is more built towards keeping patient in focus versus the doctor in focus. Yes, we will have much higher efficiency per doctor. So we don't need that many doctors on the platform as, you know, you would need in a marketplace, which is like, I have to have everybody on the platform. So there is going to be an impact on the doctor. There are tons of Jhola chaps, they don't need to exist. They need to go away from the business. And that will happen because of a plan. So if those doctors are afraid, they need to be afraid because Jhola chaps in our mind are not really doing value. They're basically wasting people's money. They are creating bad outcomes for the patient. And they need to go away. Right? So yes, if those doctors are afraid, they are creating noise, they need to create noise, they should be afraid because our platforms will basically reduce the money that they earn because of higher quality of service that we have provided. In terms of, you know, coming to the question that you asked us of how do the business model work. So we basically stick to what works in the behavior, tier two, tier three behavior, which is not paying the consultation for the consultation. So we don't charge anything on the consultation side, while we pay our doctors. So we pay per consultation to a doctor, we don't charge anything on the consultation side. But we do send the medicines, sell the medicines. We do the lab test. And we provide very, very limited discount. So our theory is that, hey, if we are providing A plus consultation, A plus service, then they will still buy the medicines via our platform, even when we are providing less discount compared to, you know, other medicine websites that are out there. And so far, what we are seeing is that that theory is largely true. Of course, it's not going to be true for 100%. People are going to be looking at details. But people over time, as they become comfortable with the platform, they keep coming back to the same, to the platform, talking to the platform, talking to our doctors. And they start converting on our platform. So after two consultations, after three free consultations, they get bound to, you know, convert by medicines from our platform. So we give like 5%, 10% margins, not much. But we do make sure that we follow up, we take care of the customer, provide a positive health outcome. That is our goal, that we give the customer a positive health outcome. Right. And at a unit economic level, when we look at our consultation business, very close to becoming a breakthrough, which covers the cost of teleconsultation, cost of shipment of medicines, what are the margin there is medicine, it basically starts to cover at least that business unit that provide that is directly involved with providing not the other engineering and this and that, not all of that cost, but at least coming to that point. So I think the model is there. It has taken us a couple of years to figure out, because we tried charging consumers from 9 rupees to 249 rupees, 51 rupees, 101 rupees, 49 rupees, all kinds of price points for doctors that are like the top pediatrician, top guy charging 2,000 rupees per consultation. And we subsidize it for the customer saying, and we got conversion rates like 0.07%. And we are like, yes, there is a different tier of an audience which Librecraft or other companies are attracting, but our core consumer is not going to pay for it. We have tier two, tier three markets, Homeopathy or Azureveda, maybe, is there a good opportunity? Yeah. So our way then Homeopathy, we get a lot of requests. We of course make sure that they talk to qualified BMS or BHMS doctors. They are not talking to a doctor that is a doctor because his father was a doctor, which happens a lot in tier two, tier three. So our core objective is fairly clear. And we feel that when you provide high quality service, you provide efficiency, then the low quality service providers do get washed out in any industry. And that will happen in health care as well. You cannot protect them. You should not be protecting them. But yes, for the high quality providers, you have to figure out the right unit economics so that they are earning at least at same level as they were before, or even higher than what they were doing before because they were lying with your platform. So that is something that is still discovering as we go. But the good news is that they are close to at least a unit economy level where the debt costs involved. They are coming close to that unit, that way of life. Right. Kiran, let me ask you this.  But you know, I know that in case of a doctor that is always in at least in the mind of a tier one, and I'm sure not just in tier one, tier two, tier three, the doctor is very critical to the whole thing. So there is always a certain doctor by the certain name I want to meet for a certain ailment. And you know, his time is always valuable. He's always a busy doctor. Now, how do you meet that need of the customer in telemedicine, you know, where if he wants to only meet with that customer, and I mean, both sort of when Kiran can really take it up Kiran can start that, you know, how do you sort of address that situation of the customer where he says I want to meet that doctor and I'm happy to pay XYZ for it for telemedicine. Let me let me start. And then sort of you are more closer to this than I am right from be a consumer point of view. So our focus is very simple. Right. I mean, we're not going to make 100% of the customers happy. Right. And as a product guy, you can't make every customer out there happy when you're building a product, right, you're building for a certain segment. And you know, you'll leave out a certain segment out, right. And no matter what kind of a tech, what kind of an incentive, what kind of a motivation that you provide that superstar or rockstar doctor, he or she will always be late. Right. Because they're always running back to back. Yeah, or they will end up having an assistant consult for all of this. Right. So rather than breaking our head on trying to solve for a problem which is there for 20% of those population, right. Why our focus is to solve for the 80% of the population where there is primary care issues, right.  Right. So, so we're not trying to solve for all of those corner cases. We're trying to solve for 70% right now, which is because the market going back to your earlier question, right. India, I mean, this is this is the sounds cliche, right, which is healthcare infrastructure, the supply of this healthcare infrastructure and the demand is, there's a huge gap, right. Now, even if with teleconsultation, with all the tech platforms, every startup out there, even if they're providing teleconsultations, the market is so freaking huge. Right. Right. That there is, there is enough for everybody. Right. If you look at an average Indian, right. I mean, if you look at from a consultation, I'll just give you one small stat from our own point of view, right. A person consults at least twice in six months. This is not including the follow ups, not including the dependence. Right. So if you look at it, the population we haven't even penetrated. I mean, even we haven't crossed even the early digits of those numbers, right. So the market is big enough where I, I don't think we should focus on trying to solve those complex problems rather than trying to solve for 80% of the problems, which would help ease up the infrastructure for those specialists to focus on. Because if I'm an endocrinologist out of 100 consultations of 80% of those could be sold online by someone else, my time is better spent on those cases. Right. So I don't know what, what's your take on it? No, I think, you know, you're right. The, the, the, the issue is that there are two kind of users who, who know a particular doctor, like what you said that I want to consult with only this doctor versus say I want to consult with, I mean, I'm okay with any, any doctor. So, so I think as long as you, you know, the, the role of a platform is as long as you have all kinds of doctors there on the platform, the user has the choice. Now that choice can be met or choice cannot be met. So for example, you want to talk to say doctor, you know, Naresh Trehan of Medanta, the Medicity, then of course there are only, you know, X number of ways or very like maybe like one or two ways that you can talk to him. Right. So if you are very, very particular about a particular doctor, which is, which a lot of many, you know, patients would want to have their opinion, then I think it's a, it boils down to that single individual as to how accessible he is, you know, how many working hours he has and within that certain time, he can see only X number of patients. So, so I think the, as you rightly said, the role of technology per se is very limited in that use case.  That, that cannot happen. But what can happen is, if we can multiply doctor's presence using technology. So for example, if, if a particular doctor is staying out of Delhi, he's sitting out of Delhi, he can consult a patient across India. So, so, so I think multiply the doctor's presence across various geographies is possible, not necessarily within the same, you know, time space. Sure. Okay. So I'm now going to take, I've been getting lots of questions from audience. I'm going to also involve them. So let me start with Ismail Sayed. Can we give him the audio please? Shalini, if you can pass on the audio to Ismail. Hi there everyone. Can you all hear me? Yes. I'm calling from Dhaka.  So I believe I asked a lot of questions. I'm sure time is really short. So let me just boil it down to three. I think one for each of you guys. Let me just go right into it. My interest is, will telemedicine tort laws related to privacy similar to HIPAA in America, would it be more lenient by 2021? What are your predictions? Question number two, what are the core concepts of continuity of care beyond the initial telemedicine session that you guys would think is a value proposition? And I think the last question probably really important, especially from my point of view, from the Indian context, why do you think doctors are only stakeholders in health startups instead of key shareholders like C-suite positions, meaning core decision makers in healthcare business? So that's it from my side. Thank you. So let's start with you. So I think I'll take the, you know, on the data privacy side, the whole, as of now, there aren't much guidelines, but almost all technology companies in India, they follow the Information Technology Act. And as per that, there are a lot of data privacy guidelines and regulations that exist. So as a platform, we follow and comply with the Information Technology Act. HIPAA, per se, is not applicable in India right now, but we try to follow the best practices and ensure other digital healthcare platforms would also follow the best practices if, you know, left to them right now. So as of now, there is no central government regulation, but I think the new telemedicine guidelines, it talks a lot about data privacy as well. There's a complete section on that as well, how data privacy and insecurity needs to be maintained. So as platforms who understand the data privacy across not just in India, but you know, outside, so in Europe, you have GDPR in US, you have HIPAA.  And that's what, you know, I can say on the data privacy side, to your question on whether it will be a little bit relaxed by 2021, I don't think so that laws will be a little bit relaxed. I think laws are going to become more stringent and stringent. And there will be, you know, I, it's, it might be no wonder, I wouldn't wonder if there's a separate data privacy guideline only for telemedicine, which is a sub part of the complete telemedicine that has been launched. There is a detailed guideline on that as well. I think it's going to get stricter and stricter as the access to telemedicine opens up. I'll leave the rest to the other guys. Rajat, you want to take up some question? Sure. So I can take on the continuity and the shareholder side. So a quick comment on the shareholder, I think it's just the way the doctor education happens. They, over time, you know, become very, very risk averse and very, very specialized. So, so when businesses are set up around it, they're usually not part of it. And that's why they are not shareholders in such efforts. Although that has changed over the last two years, quite a bit. So a lot of people have been seeing a lot of companies, at least in India, that have been formed by the doctor. So that has changed. I think that's there. And I think it's for the better over time. We think it will change much more because they have more domain knowledge compared to other people coming out and building on it. On the continuity of care side, I think, you know, there was a discussion of hospitals doing telemedicine earlier, telemedicine earlier. A lot of, a large part of the reason why hospitals before pandemic started doing telemedicine was the continuity of care, which is post-op, you know, the linkages break and the doctor is unable to capture revenue from the patient in terms of medicine, lab tests, et cetera, especially when you have, you know, bypass surgery or anything. So they started a lot of hospitals started or adopted teleconsultation to take care of that continuity of care kind of a model and capture that revenue. But in case of teleconsultation, it's a much more simple and more straightforward process and has higher impact, of course, because you, when you think of it, you know, pretty much that 12, 13 diseases, which are large, 80, 90% of the chronic diseases was whether it's PCOD, whether it's diabetes, heart-related stuff, a bunch of issues. And there are lifestyle changes that are associated with each of them. So if you can egg them on and what we have done in our platform is basically once we identify based on his reading pattern, based on his consultation pattern that, hey, the person suffers from X, then we basically start sending them that content that will improve his life and lifestyle and reduce the chances of that episode happening again. And also start, we have started cracking certain metrics so that person can feed in glucose levels, et cetera, et cetera, so that we can start creating more custom advice versus trying to do a generic advice flow. I think continuity of care will be an important part overall from our telemedicine platform perspective. And it's actually much more easier for companies like us to do versus for doctors to do because they just don't have the bandwidth for it. Sure. Kiran, you want to add something? Yeah, so just on the doctors or stakeholders, right, Esmael, I think that's a great question primarily because I'm not a doctor by education, right? But I'm running a healthcare technology company, right? So completely cognizant of our capabilities and what we can, what we cannot. So one of the things that we did very early on is to get domain experts, right? I mean, as stakeholders. So within our company, we have almost three senior doctors. I mean, cardiologists who are stakeholders, there's Dr. Varaprasad, who is again a senior doctor, one of the vaccination companies. And at a C level, we have something, we have a new, a different role called chief medical officer, right? So every little code that goes into the platform, every little decision, every little product that we do has to be signed off by the chief medical officer, right? Because at the end of the day, a bunch of engineers cannot actually cater to the health tech, right? To your question, absolutely. Doctors are important and we look for them to actually give us clearance on everything that we do, right? And from a continuity of care point of view, continuity of care can only come if the medicine is personalized, right? And today, if a 36 year old with a family of diabetes who smokes or may not smoke and is taking less than 2000 steps per day, right? My follow up is completely different from everybody on this panel, right? So everybody's medical footprint is different. And that can only be achieved if we are being able to track the data continuously, normalize it. And more importantly, if we are able to provide personalized recommendations, only then there is interest for people to come back and use it by way of which you collect more information by way of which you personalize it more, right? So that continuity of care comes in a little later before you build the trust of the user to come to the platform first. Right. The next question is from Deepak Kriplani. Can we give him the audio please? Is Deepak online? Okay. So his question is really, as a doctor, my patients have my phone number and I am already, okay, this question is not complete. I think the question kind of broke into the other line. As a doctor, my patients have my phone number and I'm already doing telemedicine. How would liberate help me further? Yeah, so that's actually for sort of. Yeah, I think, you know, if you read the fine print of a telemedicine guideline, there are a lot of things that a doctor needs to get protected from. So for example, the complete communication history, the prescription history, if a patient says something and you say something else. So from a medical legal perspective, elaborate really protects you because whether it's a text consultation, which is like a WhatsApp style communication or it's an audio call, which is like talking to a phone or it's an audio call, all of these three are recorded and stored for the doctor to refer at any point of time in the future. So from a medical legal perspective, it is very important as per telemedicine guideline doctor is responsible. The telemedicine consultation, which is say an audio video or a text is equal to an in person consultation. So the laws that govern in person consultation for a doctor are actually equally applicable to a telemedicine. So it's very important that as a doctor you protect, you are protected from a medical legal perspective. The second aspect, you know, which library helps is basically managing the patient queue.  There is no start and there is no close. And what is going to happen on library, a platform will give you an opportunity that, okay, you have a 15 minute window or a 30 minute window where a patient can consult with you. And that's the consultation that gets over. There is a closure to it. There is a prescription attached to it. So the whole workflow of a doctor is mapped online using technology. The third part is with regards to the payment. So as doctors adopt a lot more technology and a lot more, you know, patients online, what is going to happen to your finances? How are you going to manage, you know, how much fees you got if there is a payment gateway that you're using yourself, sending a link on Paytm, some guy, you know, some user is comfortable not with Paytm but say with Google Pay or some other platform online, you know, platform to receive money, you'll have to keep track of everything what is going to happen in across. So what library does it aggregates everything at one platform, irrespective of user can pay through Paytm, credit card, debit card, net banking, Google Pay, phone pay, any platform they can pay. But as a doctor, you receive your consolidated money in your own bank account. There is an online system of leisure which says, okay, this particular patient, this was the name, this was the date, this is the amount and everything. There's compliance with regards to TDS that we do as well. So we have the pan number of your doctor. We, you know, ensure that your forms that you live in, the TDS, you can see online by logging to the TDS site, the government site that your TDS has been paid and things like that. So, you know, practically from three perspectives, the library can be helpful. One is from a medical legal perspective. Second is through the whole patient user experience perspective. And third is with regards to the finances. Sure. Thanks. We have the third question from Prashant Chaudhary. Is he around? Can we pass on the audio to him? Yeah, can you hear me? Yes, we can hear you. So, basically, it's related to how do you see consumer adaptation of AI-based telemedicine apps in the future? So basically, considering government has released that AI-based apps can not counsel the patient or give medicine to the patient, but they can assist the doctor. But how do you see the future that how AI can, you know, be helpful in that? Or the adaptation, the consumer will be willing to take a medicine or take anything from, you know, the AI-based app. Are you addressing this question to anyone in particular? No, it's open. So, anybody can. Kiran, you want to take it up? Sure. So, when I say, when you say AI, right, Prashant, this is already happening across multiple platforms, right? And, for example, that you can care, right? When you actually reach out to a doctor, doctor already has a summary of every information that they need. So, there is no history taking again and again with the doctors. They already have a summary, a cheat sheet kind of an approach which is a combination of your past medical information, combination of your activity, combination of your risk, combination of your past prescriptions, lab results. So, they already have a cheat sheet which is based on an AI engine where they just look at it and say, okay, this is the benchmark of the customer who's actually reaching out to me and they're able to consult better from there on, right? Now, there are further AI bots that are being built in wherein the initial few discussions, right, like the backup work happens on a bot and then gets bifurcated to different doctors based on the request or a query or the primary concern, right? So, that is already happening across multiple platforms, right? The critical AI that is needed now is while we only have limited doctors, those limited doctors already were stretched in an offline world, they are now coming to online and in an online world, they only have limited time because they also have to manage offline once the lockdown ends and all of that. How can you make the consultation more efficient, right? Instead of taking five minutes, can they start off immediately because they have the entire cheat sheet, because they have all the data concerned? That is where most of the companies are focusing, that is where we focus, to make, to help the doctor consult much faster instead of taking five minutes, taking history again back over and over. Sure. The next question is from Jagannatha Venkatarameya, can we pass on the microphone, please? Okay, his question is that telemedicine is a great womb for 50 years of space age. SHINE Project at International Space University, Strasburg, is one of the best base hub, based new normal for health surveillance disaster management. I don't see the question really, I see this is a point that is made. Hello. Are you online, Jagannatha? Yes, madame, yes madame, thank you. At the outset, my greetings to all the distinguished panelists. Thank you. I have raised a few focused points. That is when I am going through this healthcare system, being a public health engineer from IIT Kharagpur way back in 1982, my quick response would be if today the entrepreneurs, especially those who are stakeholders in telemedicine, if you look at the indigenous knowledge and indigenous medical practices, I think there is a well of a difference that can be made. That is a small, small, it need not be always globally like I mentioned in my question about a SHINE project under International Space University 2011, where they use a space platform to do the surveillance. But this COVID thing has given us an opportunity to go to surveillance level at the district level. Way back in 2000, I remember in the Indian Social Science Congress, telemedicine was a focus. So you have to hurry up a bit. I am concluding. I would like to look forward for taking clue from the best practices in the disaster management and pandemic situations and come out with some sort of a community empowered telemedicine options. That will be the new normal. It is going to give an enormous opportunity, you see, rather than going for the medical security approach. I hope you get my point. The security approach is going to be a self-defeat to me in the new normal. This is my understanding. Thank you very much. Who can take this up? Rajat, you want to take it up? Yeah, sure. So I think we were not really, as an industry, I don't think we were really prepared for taking on a public health emergency that has happened now. And there are a number of efforts that are going on, starting with COVID and others, that are basically trying to take on as a public health emergency and figure out what solutions companies like us, other entrepreneurs, can put together to provide it. And one is where they have basically facilitated teleconsultation for roughly 50,000 calls a day. I think the project is called Step 1. So I think there are efforts underway, clearly at very, very initial phases. And you have to agree that the situation has changed pretty much overnight for the industry. Where, on one end, we were being questioned whether teleconsultation is even legal. And there was a lot of pushback from doctors and consumers for very skeptical investors who are not very sure whether they want to invest in the money or not. They were all taking these risky bets. To suddenly, you have a government that has approved it, customers who wanted doctors who are agreeable to it. And then there's a pandemic on hands. So a lot of things are happening. I think next three, four months, we'll have a better infrastructure in place to handle something subsequently, something that will happen subsequently, because not at this scale, but at least local, regional endemics continue to happen, whether it's malaria or whether it's some other infectious disease that has happened in India. So I think we'll be better prepared in the next few months than what we have been for at least this eventuality. So yes, there are projects that are going on. Hopefully, we'll have more things in play in next couple of months that will allow us to be better suited or better prepared for handling what's going to come in next one or two years during this pandemic. Sure. We have one final question coming from Ankita before we conclude. You know, there is one question I've seen repeatedly that is coming up is on data protection of the patient. I mean, what are your views on it?  I mean, what kind of data privacy laws do we have in place right now? So, you know, as I said, the data privacy laws for any, you know, online company is governed by Information Technology Act. There are certain data governing policies which are there as part of the telemedicine guidelines as well. So there are the tools that I know. Ultimately, what I can say is the patient's data, data of the patient is patient's data and nobody else's data. And as of now, there is no interoperability between one platform to another.  Although, you know, some groups are working to come up with the interoperability and coming up with the standard of data. But the privacy of the data is still in the hands of the patient and the doctor. So you as a patient are giving access, and you are uploading it on a particular platform. And that platform is, you know, the other side, doctor is also using. So I think it is good to right now see what data protection laws in the terms and conditions, you know, of course, users don't have that much time to go through and, you know, read the TNC, we are, you know, mentally, sort of trained to just say, okay, while signing up, I agree to the term integration and privacy policy, right? So, so I think that is something that we as users are not trained.  And this is good for everyone, because the fact that as an ecosystem, if everyone takes care of the data privacy, it exudes or infuses greater confidence among the system, which ultimately benefits the whole health ecosystem. So, so there is actually incentives that are aligned to protect the data of the user. And its system is sort of self regulated in that sense. So just one point I would like to add that, right? So when you talk about data privacy, right, as sort of mentioned, I'm sure, Rajat, all of us are super serious and super sensitive about data privacy, because at the end of the day, we are digital health companies, and we are governed by the IT, right? And then there's ISO 27000 certification and all of that, right? Now, the questions that are being asked is specific to digital health companies. I would turn around and say, have has the consumer ever asked that question to a hospital? So if you if you walk into any hospital today, I mean, I'll give you an example of a couple of hospitals I walked in, where they have a storeroom of all the records, right? And it's unlocked, it's open, right? And most of these hospitals don't even have an IT or a security person, right? CSO, what I call IT security contact person, right? They don't have any of those limitations, right? So when we are talking about data privacy, it's, yeah, I mean, we are held to a higher standard and we will support it and we will actually stand by it. But it's important to turn around and ask those questions to the existing systems which are like nowhere closer to what where we are. I agree. I have gone to hospitals without even a single computer in the entire hospital and they're like hundred bedded hospitals. And also, you know, the concept of privacy as such is a very tier one concept, right? It's a concept for the audience who is speaking and who is hearing this webinar. So because we go to YouTube and our doctor is giving a little talk on pregnancy and other issues.  And I don't know what to say to her that I have already had sex with him. I'm like, first thing is don't comment on YouTube, right? And that's the base. So the concept of privacy is not there. People think online hain to privacy head. And so I think even if you look back or even if you look today to rural levels, rural areas, tier three, it's still one room houses and the whole concept of privacy, we of course take care of patients, data, only doctor and patient can see that data. There's no way anybody else has access to that data. But I'm just saying the concept of privacy, our consumers are also not that mature in terms of demanding for that privacy. And the government has other reasons for it. But ultimately, I think it's going to go to the right direction. It's just that as an industry, we are very far away from there. Or as an ecosystem, users, doctors, everyone. Yeah, but there's certainly a need to enhance it because that's what the customer would not want to be anonymous. That's the patient would really not want his entire medical history out there with everybody. So there are a couple of regulations that are coming in. One is the telemedicine guidelines that came out to protect the individual's data privacy. Then there is another guidelines that is being formed in terms of data privacy, which is specific to all the digital health companies in terms of what information can be shared, what information cannot be shared. And then when we are talking about data privacy, there are two sides of it. There is what we call personal identifiable information. Kiran, Kiran phone number, Kiran mail ID. If I remove these three areas, any data that can relate to our medical information into a separate storage and encrypted, then this anonymized information is useless. What is really important is to protect that personal identifiable information that actually says, okay, this record relates to Kiran. So those level of security beefing up is already being done for most of the companies. Sure. I see that Ankita is here. Ankita, would you want to ask your question? Sure. Thank you first of all everyone for sharing your valuable perspectives with regard to Nepal laws and all the security data. But I still would like to understand from you that how you are preparing your platform to manage scales, keeping in mind patient confidentiality and privacy laws. And apart from this, are you thinking of involving any third party for security for securing data? And if yes, then how do you think of tracking or auditing the compliance? So I'll just answer this quickly. And then let me fellow panellists. So Ankita from Ekincare point of view, right? So we do get audited every quarter by an independent consultant. So we are ISO 27001 certified as we deal with large corporates and tons of privacy information. So there is an independent body that audits us, provides us a report every quarter. And every year there is another audit that happens. And every client that we work with from Fortune 500 companies too, they also audit us pretty much. We are going through an audit pretty much every week or every other week. Sure. Saurabh, you want to answer this? I think this is what, you know, there's nothing new to add. What I talked earlier about data privacy and security. Sure. Rajit? Yeah. So all the data, you know, everything is encrypted with keys and etc. So it's not that anybody can see the data between what is happening between patient and the doctor. We haven't yet gone through the audit process as such. I think it will be useful to go through that. But as a process, in terms of scale, you know, for technology, products like ours, they have been built to scale. And to just give you an idea, we basically get roughly 20 million visitors a month on a platform. We do roughly 300,000 considerations a month. We get another 130 million on our video content across YouTube, Facebook, TikTok, etc. And we power a lot of widgets across media websites as well, which are providing COVID tracker and other frackers kind of thing. So the tech and product are already built for substantial scale, whether if there's any Hindi user in India within six months, he would have seen my chart at least two times. So it's already built for fairly substantial scale. And I think, of course, as the government guidelines come out, saying, we need to do this, we need to do that, we will make sure that happens. Okay, thank you. Just one last question, especially for Karan. So I understand EkinCare does share a large and good amount of data with corporates. So how do you send this data? I believe it can't be sent on Excel. So do you have an interoperability connection with CL7 or is it something else I would like to do? So on the back end with the corporates, there is a separate dashboard that every corporate sees with respect to the population data, what I call population data. So within that population data, all the PII information is stripped out. PII, I mean, personal identifiable information is stripped out and only the anonymized population level insights are provided to the companies in terms of their population. And all this is going back and forth over an encrypted line, what we call HTTPS, very secure line. Sure. So with this, I'm going to have to conclude it. We're already upshot the time, but thank you so much. I think it was a very riveting conversation. We've had our attendees still asking questions, but you know, we're so this entire conversation is Facebook live. And if you have more questions, please put it there. I would request, I'm sure our panelists are very busy. But if you get a few minutes, kindly put in some answers from to the industry people, it's still a new field. And, you know, I would say people have a lot of inquisitiveness about it. But my few takeaways from the conversation we've had so far is that this is certainly telemedicine is here to stay. And it is something that is going to be only growing going forward. Because today, I mean, I think not just for the fear of COVID, but also for the reasons of convenience, for the reasons of incentivization, as Saurabh had said, it's going to be much easier for me to get my regular ailments done from through telemedicine instead of actually going all the way and visiting a doctor and then waiting in the OPD for him or her to address me. Secondly, of course, data privacy, as we've discussed it, is going to be very, very important. We have seen cyber hacking and we have seen lots of lose data, looseness and data protection, which needs to be addressed by the platforms themselves to make sure that the customer, the patient is covered. And I think thirdly, going forward, we have right now from what the panelists have shared, there have been some streams where there have been more telemedicine streams like common cold or common ailments or dermatology. But going forward, you know, one would see a lot more rise in what the patients go for telemedicine for. And I think it going forward, only platforms are going to enrich themselves by adding more doctor force and everybody so that the telemedicine can become a easier tool. And I think lastly, I would say it's the doctors who themselves have made the change to the entire ecosystem. They are now forthcoming and ready to be part of this digital or the virtual healthcare sort of advisory. And therefore, this platform is likely to increase. You know, once the doctor comes in, his customer is about to come in, they're not going to go anywhere. So this, which means that really the whole telemedicine structure, whether it's in big cities or small cities, it's only going to grow in this sector, which we probably first time talked about. I mean, an entrepreneur, we probably, you know, talked about it as a subject for the very first time. But I think the more discussions, you know, I see that the panelists and delegates telling me that we should have more discussions on this subject. So going forward, we'll probably have more such discussions. Thank you, Saurabh, Rajat, Kiran for joining us today. And in reaching this, please join us on these are our Facebook pages and also our other social pages on Instagram, Twitter, LinkedIn, please join us over here and ask your questions. In case you have more questions, in case you have more sectors, you would like us to cover at entrepreneur, we'll be very happy to bring them forward. Thank you very much, everybody for joining us today. Thank you. Thank you.


post game. Michael Grady, Sarah Kustak, Frank Isola, Game 1 in the books, and the next get to victory, 1-15, 1-07, immediate reaction right now. Kuz, I'll start with you. What's your thoughts on this game? Let's talk about some resiliency out of the gates, losing James Harden, and the way this team came together. Kevin Durant and Kyrie Irving immediately were making big buckets, but this was a complete, complete team effort. There was a balance of beautiful basketball, a lot of grit, game-winning plays that you saw, whether it was getting on the floor, blocks, rebounding, taking care of the basketball, an excellent amount of cutting and just offensively the way in which we saw the chemistry take place of all of these players come together. It was just really a beautiful thing to watch. Yeah, how are the nets going to handle adversity? Well, we got a chance to see it. 43 seconds into the game. James Harden goes out and to think, now you expect Kevin Durant and Kyrie Irving to play like this, and Kyrie Irving is playing at a level he hasn't played at since he won a championship with Cleveland. Kevin Durant is always great. But how about the performance of a guy, Mike James, who comes off the bench, you do not game plan if you're Steve Nash expecting Mike James to play 30 minutes. Somebody has to make up those minutes for James Harden. Mike James had 12 points, Chris Middleton had 13. I thought to think that Mike James began the year in Russia and Blake Griffin began the year in Purgatory in Detroit. And the fact that they're playing big time minutes in the fourth quarter. This was about Kyrie Irving and Kevin Durant. Make no mistake about it. But those roleplayers, wow. Wow. You can't really can't say that enough, especially headed into the game. Bruce Brown began the season on the bench. Good call. No question. And Mike James, I don't know how many minutes he played in that Boston series came into tonight, not expecting to see much action. And then boom, James Harden, as you mentioned, goes out 43 seconds into the game. And Mike James plays 30 minutes. Cool. So real quick on Harden. I feel, you know, you certainly feel for Harden. You know how badly, you know how badly he wants this and that leave the game 43 seconds in was really devastating. It's it was just so hard to see. I think all of our stomachs dropped. And of course, we'll still wait and anticipate until we hear more news about it. However, you know, for James Harden and how much he is meant to this team, what he has done in terms of orchestration, the multiple setbacks he's had with this hamstring injury. You don't want to speculate and jump ahead.  But my goodness, did his teammates come together and put on quite a performance, given the fact that he was absent? Yeah, it's going to be a major concern in the short term. Obviously they survived. We don't know how long he's going to be out if he's going to be out at all. And you know, James Harden, go to basketballreference.com. It's a great website. Go look at games played. He does not miss games. No. And he missed that stretch this season with the hamstring injury. That's legitimate. So that's going to be the concern because James Arn just doesn't walk up the court. The guy loves to play basketball. So that is going to be a concern. I still believe and to Sarah's point, let's not go crazy here. But I do believe if you couldn't play, they still have enough to win with. That's how good Kevin Durant and Kyrie Irving are. Took them a little bit to kind of get their footing. First quarter was a little bit uneven. They trailed by two second quarter. They got rolling. But really in the third quarter was when things took a turn for the better for the Brooklyn Nets, a 24 11 run in that third quarter. Coons we


This study investigated the effects of cisplatin on rats over a period of three days. It found that cisplatin caused significant damage to the kidneys and liver, with symptoms becoming more pronounced over time. Cisplatin also affected several biomarkers, including blood urea nitrogen, creatinine, and serum nitrites, which all increased over time. Additionally, it was noted that cisplatin decreased the levels of alkaline phosphatase and alanine aminotransferase, but increased the levels of aspartate aminotransferase. This suggests that cisplatin has a negative effect on the liver and kidneys, and can cause serious damage if administered too soon or for too long. This article was authored by Zara Pazeski, Atusa Kasravi, Mina Nakiai, and others.


First of all, Magna Sights, I'd like to introduce myself. I'm Batman. Second of all, I don't believe a word of what this article says. It's too close to April Fool's, and it's probably a prank being pulled by none other than the Joker.  All right, I have been fooled and tricked and led to believe over and over and over by Warren Brothers and all these damn rumors about when the trail for Batman V Superman is coming out.  You know what I mean? Just make her the best thing in the world and keep playing around. But let's get into this article. Like I said, I don't believe it. As far as I'm concerned, it's a rumor. Ain't nothing confirmed. I don't believe it. This is one of the only ones that I'm really not gonna have too much fun speculating with, because it had hurt too many rumors. But let's get into this. So, it says, ever since Warner Brothers announced it's a man of steel followup, Batman V Superman, Dawn of Justice, I've been waiting to see a trailer. Obviously, those at Comic Con last year got to see a tiny bit of footage from the film, but Warner Brothers never officially released it. So most people have yet to see anything, which brings me to today's update. After speaking with a few sources, I'm happy to report that the first Batman V Superman trailer is on the cusp of being released. I'm told it's absolutely attached to all copies of Mad Max Fury Road, I believe. Which is an obvious place for it to debut, seeing as how Mad Max is Warner Brothers' first big movie of the summer. What I've heard is that Warner isn't sure it wants to release the trailer, while Avengers Age of Ultron is destroying records and driving all social traffic during the end of April and early May. If they wait until the weekend Mad Max opens on May 15th, Avengers will have already been out for two weeks, and they can take over the conversation at the time. When everyone is ready to talk about Batman and Superman, the bottom line is we will absolutely have seen the first Batman V Superman trailer by May 15th. I don't believe it yet. While some of you might be saying they should release the trailer now, throw caution to the wind, the science behind marketing is much trickier than simply releasing something when it's ready. When you're building the campaign to a hugely expensive movie that has to open to massive amounts of money and kick open the doors to future DC movies, you need everything to be perfect. You need to make sure everyone is talking about your trailer and by extension your movie. If you release the trailer during the surge in Avengers Age of Ultron interest, which will also have the new Star Wars The Force Awakens trailer on it, you run the risk of people comparing your footage to Star Wars and Avengers or getting lost in a crowded conversation. That's true. Even if your trailer is jaw dropping and you think you've got the goods, why risk it? I think Warner Brothers is making the smart play here with the way they're unveiling the Batman V Superman trailer. Go with Mad Max, get a bit of breathing room between Batman V Superman and Disney's big guns, take over the conversation and own the middle of May all to yourself. Of course, things change all the time in Hollywood so it's possible the Batman V Superman trailer could end up getting released before Avengers Age of Ultron. So Warner Brothers can be the first, but no matter when the trailer actually gets unveiled in the coming weeks, if you see Mad Max Fury Road in a theater, you will also get to see some footage from what's sure to be one of 2016's biggest films and I cannot wait. I absolutely love Zack Snyder's A Man of Steel. I love the way he grounded Superman in the real world only finding his smile when he discovered who he really was. I loved the amazing iconic score of Hans Zimmer. I loved the opening scenes on Krypton which felt like a real place and was everything. The Green Lantern movie should have been. And I loved the entire cast which was made up of great eclectic actors who each brought their A game. If Man of Steel is ever on cable or playing in the background and hooked, it's just one of those movies that has its teeth in me. That was the first ever Superman did to me. Anytime it's on TV, I stop to watch it. I'm hoping Batman V Superman Dawn of Justice has the same effect when it opens in theaters March 25th, 2016. Yeah, so like I said, Batman doesn't believe a word of what this article says. Tomorrow's April 1st, April Fool's Joker Day. I don't believe it, Magna Scythe. So, tell me down below in the comments section, do you believe it? Do you not believe it? Do you think this is true confirmed information? Okay, I personally, I'm just waiting.  Y'all done played with my emotions too much. I'm a bitter, battered woman that's ready to leave WB. Although you know I'm coming back to you when you release it.  I'm gonna be at the theater. When Ben and Henry gets it in. You get what I'm saying?  Okay, what's gonna happen is one of my Magna Scythe WB. One of my Magna Scythe is going to post a comment, hey, I just saw a man, Max Drew, bro. It's in there, Tyrone, it's in there. Then I'm gonna go see it. Or I'm gonna wait for y'all to post it and I'm gonna do my reaction. Then I'm gonna go see it because then my first reaction to be in the theater and the Magna Scythe won't get to see me react to such epicness. So, if you enjoyed my video, hit the like button. If you did not, hit the like button and subscribe. One million subscribers. I'll go wear hockey pants.


Now, more than 1,200 civilians have been killed in the respective Democratic Republic of Kengou, provinces of Ituri and North Kivo so far this year. Millions of people now need humanitarian aid in the Eastern region, the UN Refugee Agency said on Friday. Democratic Republic of Kengou authorities declared a state of siege in May. It's an exceptional measure aimed at ending the reign of terror by armed groups operating in the region, most notably the Allied Democratic Forces ADF, a group linked to the so-called Islamic State. The UN High Commissioner for Refugees, UNHCR, and its partners recorded more than 1,200 civilian deaths and 1,100 rapes this year of them. That in the two most affected provinces of North Kivo and Ituri, UN Refugee Agency confirms. The UN agency also highlighted the need for a steep increase in humanitarian funding for the area.


Thank you for the invitation to present at this meeting. I'd like to talk today about the fact that we have lots of data and, in fact, increasingly amounts of data, and this poses some questions, so I ask one of those questions, now what? About a year ago, one of our board members handed around a report from EY into the data that is held by the National Health Service in the UK. One of the comments they made was that medicine is no longer being just supported by data, but that clinical science and data science are very closely related and, in fact, now data is driving change. They also put a value on the NHS data and said that the 55 million patient records are worth several billion pounds to a commercial organisation. So that instigated a bit of internal reflection at our institute here in Perth, Western Australia. We have 120 staff members, 35 audiologists and 15 clinics around our state and the numbers are growing. We have an implant program that has 2,000 clients. Our database over the last 20 years has grown to include data from over 30,000 clients and about 10,000 appointments per year are added to our database. We manage that data on something that we call EOSuite, which is built on a commercial product called NetSuite. NetSuite looks after the finance, the stock, the HR. What we've built on is a patient management system, which we call EOSuite, which handles the case notes, calendars, reporting, and so we have contact through EOSuite to our funders and our suppliers. We can also communicate to our patients and our referrers. Alongside that sits the NOAA platform, which is used to communicate to instruments and to devices, and we do have a link into our NetSuite, which I'll get back to shortly. So in terms of the challenges, I want to discuss a few of these and perhaps you have encountered these as well and have some solutions already in place or have some ideas and I want to use this as a platform to start or continue some discussions on these. Firstly, it's floors and ceilings. We all need a floor and we all need a ceiling over our head. But in terms of our data, these provide challenges. And of course, when we see the audiograms of implant candidates, we see lots of limits to the instrumentation and they can't record any other data beyond those limits as shown there by those arrows. On the right there, you can see one of our studies on speech data. This is on CUNY data from our implant patients from preoperative through to 12 months. And if we use a 100% score as a cutoff, we can see that at 12 months, about 30% reach a ceiling score. And one could even consider 95% as a ceiling score in which case half of our patients reach the ceiling at 12 months. We've since been involved with a study across three large clinics internationally. And when we looked at the data, we found that about a quarter of the records across the three data sets were affected by either ceiling or floor effects. So what do we do? I don't imagine as much we can do about audiometry. In terms of speech, audiometry, speech perception testing, certainly we should be using adaptive tests such as the azibaya or the noise test. When it comes to analysis, if you look through the literature, we can see that people have imputed values for ceiling scores. And they've done things like adding 5 dB, 10 dB, 20 dB, or in another instance, just set it at 125 dB. Now, it certainly isn't correct. And it's also not correct to ignore those scores. We can see an instance of people interpolating to get immediate values, which I guess is fair enough. The potential solution is for us just to classify these data in terms of severity, the type of audiogram or outcome we see or the change in classification. The next challenge that we've been confronted with is accessing data in proprietary databases. We know that NOAA is used to communicate to instruments and hearing aids. And we have Cochrane Plant fitting software, hearing aid fitting software. Now, in terms of NOAA, there is a part of that, which is public. So you can look up an XML file and you can identify and extract the ID, the date, the name, the audiogram, thresholds, transducers that have been used. But there's a lot of data that is encrypted by the manufacturers. And in essence, we can get one-on-one access, but to sit down and transcribe all these data is not a job that we should be doing. So it looks like we have to work hand-in-hand with the manufacturers to extract that data on, say, hearing aid fitting and data logging. Or we have to get hold of some APIs. But once again, we certainly need the help of the manufacturers because they've encrypted that data and they can only get that access if we give them permission because, in effect, it is our data. The third challenge that we've been confronted with is the linking of the records of clients that are on different databases. And there I want to go back to the example of NetSuite and NOAA. Over time, we've noticed that clients are not being recorded similarly in both databases. We don't have a platform for common IDs. And even if we did, it is prone to error and and audiologists or administrators not paying attention. And so we see multiple records for clients. We see mismatches between names and errors in names and dates of birth. A Susan can be a Susan can be Susan, one database and Sue and another database that can be misspellings in names. We see dates of birth that are being transposed, being born on the third or the sixth or the sixth of the third. One of the tools that I've used is available from the Centre for Disease Control and Prevention. They've got a program called Link Plus. And as you can see there in the example, I've used it to link the first and last names out of the NOAA database with the first and last names out of our ESuite database. And it uses a statistical approach to matching these names and therefore can identify when things are slightly misspelled, when dates have been transposed, or even where names have been shortened or slightly changed, a Joe and a Joseph, a Sue and a Susan. And then of course we've got limitations in the available data and I've given some examples there. We have inconsistent definitions and classifications. If you look through the literature, people have used three frequency average, four frequency average, better year, worse year, the WHO and the global burden of diseases group and different definitions. And it's good that they've now unified their classifications. There are inconsistent and non-existent definitions of etiology and disease states. For example, we recently did a study on hyperacusis and there is no standard definition for hyperacusis. Also in the case of implant registers, there are no formal definitions for etiology, which makes analysis quite tricky, particularly across platform studies. What we've also come across, and I'll get back to that shortly, is there are insufficient and inadequate measures, particularly for outcome measures. And finally, of course, we should acknowledge also that we are an international community, but we will have our own languages and therefore comparing speech perception tests across languages is a bit tricky. This was illustrated by a study that we've done with three centres around the world, contributed a large amount of copper implant data and we had a series of predictors, as you can see there on the left, and our outcome measure was the word recognition at four months. When we applied standard regression analysis models to these data, we found that we could predict the outcome with a certainty of about 12%, which compares similarly to what other people have reported in the past, in terms of... They've reported predicting when they actually have about 20%. We then applied some machine learning algorithms to our data and while we found that machine learning improves the performance of the models, beyond the linear models, the gains were pretty modest. And we also showed that they were unlikely to be improved even if we had more data. The only way it could be improved is if we had better quality data and different types of data, which highlights that we need to standardise our data collecting in terms of definitions and we need to also improve the quality or the number of both predictor variables and perhaps also outcome variables. And of course, we can all recognise that just a word recognition score is not the best outcome measure. I want to quickly finally make a couple of points on statistics. I think we really do need to make good use of our statistical colleagues. I just want to use as an example the IOIHA, which many of you may be familiar with as an outcome measure for hearing aid use. It has been misused quite a lot, even by senior people in recent years. And I just want to draw your attention to where the neutral point in each of these questions are. Question one, it's at the beginning. Question two, it's in the middle. Question seven, it's at the second point. And what we found is that people have applied a number to each of these points on their scale, added them up and then looked at a total score, which on the surface is really not appropriate. And thankfully, somebody has drawn attention to it. An article has recently appeared in the International Journal of Audiology, where the case is made that we really need to revise the way we analyse this data. And as I said, we really do need to make use of our statisticians. And finally, I want to just mention the whole aspect of ethics in using client data. And we've been confronted with that recently, when and how is client clinical data available for researchers? In Australia, the Privacy Act says that data collected can only be used for the reason that it has been collected, and therefore for use as a managed and hearing loss of somebody and not for somebody to research project. We have instances where our clinicians are also researchers, and it's very difficult for them to have one hat on one day and another hat on the other day. The whole topic of de-identification also needs some attention, just removing the name is not strictly de-identification. And finally, who really owns the data? Certainly, clinics collect that. But particularly if some commercial gain is made, how do we communicate and how do we acknowledge the contributions that patients, our clients make to this output? Thank you very much for your attention. I'm looking forward to in the near future, us gathering face to face rather than remotely and particularly would like to welcome you to come to Perth, Western Australia.