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News Vikram Kumar: Radical ‘High-tech Humanitarian’ Doctor   
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Boston, 1 October 2004 -- At 28, and with an MD, Ph.D. (Magna cum laude) from the Harvard-MIT Division of Health Sciences and Technology under his belt, Vikram Sheel Kumar would like to do away with hospitals. He hopes to accomplish this goal with a radical idea: empowering the patient. Kumar likes to build on his notion that healthcare can be made fun. This is why he envisions a happy world where managing a chronic disease can be fun! He believes that in a world where information technologies and medicine intersect, innovative medical care requires radical, out-of-the-box, disruptive, thinking – the kind that is changing the face of medicine.
And already, thanks to Kumar, some of the most exciting advances are happening in electronic health care – for example, by using mobile computing among the poor and the needy in India, Africa and the U.S.A.

HUMANITARIAN AWARD

That’s why Kumar, a resident physician training in clinical pathology at Boston’s Brigham and Women’s Hospital, was honored with Technology Review’s annual Technology in the Service of Humanity award Wednesday September 29th at the magazine’s Emerging Technologies Conference.

Kumar was honored for his work in developing mobile computer systems that help health workers and patients manage chronic diseases such as HIV and diabetes. He was chosen from among the TR100—a group of 100 innovators under age 35 that the magazine selected for the potential of their work to transform the world.

“We’re going to be a millionaire of a different sort,” Kumar said, accepting the award. “We’re going to try to affect the lives of a million people.” The young physician-entrepreneur was simultaneously hailed by the MIT-based Technology Review magazine today as ‘High-tech Humanitarian.’

Kumar’s belief is that mobile computing that use simple, portable computer programs can encourage people to self-monitor and to adhere to treatment regimens—one of the biggest challenges in medicine today – can actually change the face of medicine. While still in medical school, Kumar started a Boston-based company, Dimagi, to develop such tools. “The biggest dream I have is that one day we can close all the hospitals” the young physician-entrepreneur likes to say.

In association with his Ph.D. advisor, Alex Pentland, a Professor at MIT Media Laboratory, Kumar developed DiabetNet, a hand-held computer game for young diabetics.

Capitalizing on children's passion for video games, DiabetNet encourages young diabetics to keep track of their food, activity and sugar-level. With this the patient can monitor his glucose level several times a day. "The DiaBetNet project was a challenging task. It is easy to monitor glucose level for the grown-ups, but how can we do it for juveniles. Therefore, we worked on the DiaBetNet project, which facilitates youngsters to keep track of blood glucose while enjoying games,” says Kumar.

Healthcare specialists have noted that if there is one redeeming idea to come out of the hypnotic and violent world of children's video games, it is Kumar’s notion that it might be possible to give kids a medically useful obsession with a handheld game tracking their own blood sugar. Which is why he came up with a game in which children could guess not only their own insulin levels but also those of classmates or friends. After a day of monitoring the disease, a graph summarizes the patient's day, carbohydrate intake, and prior glucose data. With that data in hand, the patient guesses the blood sugar. More accurate answers earn higher scores.

Kumar hopes that one day his management systems, combined with cheap, at-home diagnostic tests that give patients up-to-the-minute data on their physical conditions, will keep people with chronic ailments from landing in the hospital. Already his PDA based systems are being used in rural India and South Africa.

Kumar explains: “My research focuses on building a class of preventive medicine using portable and wireless tools that empower patients with insight into their conditions and appropriate community support. While our current health systems are suitable for tackling acute care, patients carry the onerous burden of managing chronic conditions where healthy behavior is of essence, and regular monitoring is necessary. By giving feedback on their continually changing physiology, I am studying how patients can learn to develop accurate mental models of their conditions.”

DISSERTATION: DiaBetNet GAME

It was only last February that Kumar submitted his dissertation entitled ‘The design and testing of a personal health system to motivate adherence to intensive diabetes management’ to Harvard-MIT and, characteristically, dedicated to his young nephew Neel.

In his thesis he explains: “The system comprises of an interactive, predictive game called DiaBetNet™ that patients play with themselves and others in their wireless community. Visual feedback on their physiology and variable reinforcement through scoring points on the accuracy of glucose predictions are tangible benefits provided to the patients. I developed the system as a portable device with wireless interfaces between a glucose meter and handheld device, and client and server.”

Kumar persuaded a diverse set of parties to get their technology and wireless networks to operate as one. The list includes a maker of handheld computers (Handspring), a maker of handheld glucose meters (Roche Diagnostics), a phone company (Verizon Wireless), a modem company (Novatel Wireless), and a major research center (Boston's Joslin Diabetes Center).

He then went on to design the software in C on the Palm OS as three main applications. As he explains in his thesis, “The first was a program to read data from the Pocket Compass, measure adherence to a prescribed regimen, and draw the graph for DiaBetNet when appropriate. The second was a program to transmit this data wirelessly to a server at the Media Lab. The third program sat on the server and organized the incoming data into a local database, ran a web page for patients and health care providers to have access to the data, and allowed participants remote access through their PDAs to play the network game.”

After testing the system, Kumar concludes, “the designed system with the predictive game, DiaBetNet, appears to accomplish the goal of motivating greater use of a monitoring technology. Patients using this personal health system had an increase in their frequency of monitoring, reduced occurrences of hyperglycemia, improved diabetes knowledge, and possibly optimized glycemic control.”

TECHNICAL SOLUTIONS FOR THE MASSES

“The problems that Dr. Kumar solves seem intractable,” said Technology Review editor in chief Jason Pontin. “We were excited to see someone come up with elegant, simple, cheap technical solutions that have made a huge difference to people whose lives are very, very difficult.”

One such solution is HIV Confidant, a PDA-based system being used in South Africa to encourage people to be tested for HIV/AIDS. Confidentiality is a big barrier to testing in Africa, Kumar says, because “patients don’t trust their data is secure.” Using standard encryption methods, HIV Confidant allows anonymous testing in the most remote locations. Healthcare workers can go into villages and administer HIV tests, giving patients a card with a unique ID afterwards. They return later with the results; only after the patient enters his or her ID does the data become visible. Dimagi is now working on software to help AIDS patients manage their disease by monitoring blood counts confidentially.

Kumar also helped design a mobile electronic medical record system that mobile outreach workers are using in rural India. Working with researchers at Media Lab Asia and the All India Institute of Medical Sciences, Dimagi developed the handheld software application to help standardize healthcare across villages; adoption of the software has improved data collection, scheduling of immunizations, and recording of routine demographic changes in the community. The program has a special emphasis on care for children and pregnant women. The software was designed to be easy to use by someone who has never seen a computer before, Kumar says. “The nurses trained themselves to use it inside an hour,” he adds. Healthcare workers now use the system to record and manage data from more than 70,000 patients.

In the long run, Kumar hopes his management systems will help keep people healthy. Diagnostic tests are becoming smaller and better, giving doctors unprecedented amounts of data about patients. “What we’re lacking,” Kumar says, “is ways to tie all this new technology into interaction with the patient.” Dimagi’s software is designed to do just that. And combined with cheap, easy-to-access diagnostics and computer models that predict how diseases will develop, Kumar’s programs may help patients and doctors achieve his ultimate goal: keeping people out of hospitals altogether.

FACILITATING HEALTHCARE IN INDIA

Kumar loped about the snow of NY until he was ten, learning the value of shade from his new home in Delhi. He studied in local schools and attended IIT before returning to NY to pursue operations research at Columbia University, and followed it with a joint MIT-Harvard MD/Ph.D program.

While in India, Kumar realized that what India needs are not computers, but simple handheld devices that can be used effectively. "There is huge opportunity for people willing to bet on healthcare, especially facilitating rural health. The challenge is to develop cost-effective technology solutions that relate to people and empower them. The Media Lab Asia is working on several such projects and one such is being taken up with the AIIMS in Ballabgarh," Kumar observed.

Earlier, Kumar was a Paul and Daisy Soros Fellow and an MIT Media Lab Asia Fellow. The DiaBetNet was named one of the top 10 Designs of the Decade by BusinessWorld.

francisassisi@hotmail.com

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