Gautam Rege, Co-founder, Kimaya NICU gives details of their TPN solution for NICUs, its myriad benefits, the learning experience of using it in major healthcare institutions like KEM, and more, in conversation with Lakshmipriya Nair
What was the rationale behind developing a solution for neonates?
It started off as a chance opportunity about a decade ago in 2004. During that period a friend of mine introduced me to Dr Umesh Vaidya when I made a visit to NICU where my friend’s baby was admitted. Dr Vaidya and I got talking about the need for some software for total parenteral nutrition (TPN) calculations and he actually showed me some staff members doing manual mathematical calculations to prepare a TPN feed to be given to the babies in the form of dextrose/ glucose. TPN is a process where the baby is intravenously administered feeds. For a baby, it’s not just survival that is important but also to grow healthy. Hence various nutrients like proteins (amino acids), sodium, calcium, phosphate and magnesium are critical. These nutrients need to be mixed with the dextrose solution that is administered via the intravenous drip. However, there are several constraints; if the concentration of solution is very high, the veins may dissolve and if the infusion rate, that is the speed of drip is too fast, the veins could burst, both of which could be fatal! Since these calculations were earlier done manually, it was an error prone, less accurate and a time consuming process, taking about half an hour at least for a single calculation. This is how the idea Kimaya NICU application was born. Along with the expertise of doctors at KEM, we build Kimaya TPN for these calculations to be accurate and give zero errors in the results. This small conversation with the doctor inspired us to develop a programme for the NICUs which will save these precious lives. Even though the neonatal mortality rates in India are going down, it’s still a grave reality for every hospital in the nation. The visit to the NICU few years back made us think and prompted us to provide a solution that will give another chance not only to the babies but also to their parents. It gives us an immense satisfaction that we are somewhere involved in saving lives of babies who haven’t even seen the world and are on the brink of life and death. We wrote a sample programme on a compact disc and provided it to the NICU. Within a couple of years, the doctors came back to us saying they were being asked by a lot of other hospitals for this programme. This gave us an opportunity to create a product out of the programme that we gave to the KEM initially.
How will it help streamline operations in NICUs?
We started giving this product on a CD as the Internet connectivity in India was bad and lots of hospitals lacked internet connection at that time. Recently, we have revamped the entire application and put it on the cloud as we know that the Internet connectivity is much better that what it was a few years back. This has now become a game changer for us because the doctors now require less than two seconds for TPN calculations instead of approximately 30 minutes to calculate TPN for neonates. Through this solution we have enabled the doctors to give accurate and error-free nutrition solution for the babies in NICU within a few seconds.
What is the framework for this solution? How adaptable is it in the Indian scenario?
As I have mentioned initially we started giving off this application on CD due to lack of internet connectivity and now as we have a better situation in terms of internet connectivity we revamped the application and put it on cloud. The application is built using open source technologies – the Ruby on Rails framework and MongoDB as the database. Solutions built on the Rails framework are extremely adaptable and flexible. This application is very much adaptable in the Indian scenario catering to more frequent TPN calculations and frequently changing marketing additives. We have put brand names of different nutrients marketed by pharma companies in India and whenever there is a change in market name of the nutrient that’s required to be added in the nutrient solution we make that necessary change of name in the application hence we keep it up to date.
How cost-effective is the solution?
When we distributed the application as a CD, it required a license for each machine that it was installed on. Now, since there is no installation required, doctors can start using the application immediately and can access this from multiple locations and multiple devices like laptops, desktops, tablet and even their mobile phones. Similar to how we log in to Gmail, we can log in to Kimaya NICU application using the desktop, laptops, tablets or mobile phones with Internet connectivity. The application is used as Software As A Service (SaaS) with an annual subscription. We have a freemium model for this application and the first six months of usage is free of cost. After that we charge a nominal annual fee to doctors or hospitals. This solution is also cost-effective for us as we do not need to send software updates of the CD to every doctor who has the software installed. Now, we simply update the cloud application and everyone benefits instantaneously.
The solution has been used in hospitals like KEM? What have the learning and results of it so far?
So far, this solution has given us amazing results in terms of saving lives of neonates. Neonatal mortality has reduced substantially due to various reasons and Kimaya NICU application is one of the major contributors. We have learned that accuracy and less time consumption is a factor which cannot be compromised, atleast not in the field of healthcare where every minute and second counts. The medical fraternity has appreciated the application but more crucially taken the lead in demanding improvements and suggesting upgrades. So it has been a collaborative effort.
Are you looking at upgrading this software in the near future?
IT as a field is inherently geared towards upgrades. When we are providing a solution we also take care of its upgrades on a specific frequency. Yes, we are looking to upgrade this software in the future and the new features will be a result of medical requirements and the demography of the region. If doctors need to add more basic nutrient in the neonates, yes we will definitely upgrade our application accordingly. Now also we keep on upgrading the application in terms of brand name of nutrients marketed by pharma companies. Moreover, the open framework on which this application is built undergoes regular upgrades of its own which improves functionality.
What are your other offerings for the healthcare space?
Kimaya NICU is the first of hopefully a long series of path-breaking, cutting edge applications that are going to prove crucial and critical in equipping NICUs with the best available help to help babies survive and thrive.
In addition to the critical TPN calculations, other modules are being developed like the Enteral Feeds module that calculates the amount of proteins and calories being given to the neonate from human milk, formula feeds or a mix along with Human Milk Fortifier (HMF) and Medium Chain Triglycerides (MCT) oil. This will help doctors manage enteral and parenteral feeds.
We also plan to incorporate a Discharge module that manages the discharge summary and follow up for babies that “graduate” from the NICU. The plan is to slowly evolve into a holistic NICU Management Software Suite.
lakshmipriya.nair@expressindia.com
