When patches pulsate like heart-beats – how Narayana Hrudayalaya runs them?

From Paytm-isation of healthcare to telemedicine, to AI to security, to robotic surgeries – the veins of IT and arteries of heart-care are meeting at more points than they ever did. Let’s see where have all the clots gone?

An interesting report from the Enterprise Strategy Group (ESG) revealed that, on an average, organisations are running 25 to 49 security tools from up to 10 different vendors. That’s some sprawl.

Also, as 451 Research reveals, 40 percent of organisations seem to be so taxed that they are unable to act upon at least a quarter of their security alerts. That’s some fatigue.

Plus, there are no brakes on the rampant rise of the volume of published Common Vulnerabilities and Exposures (CVEs) (As many as 18,000 per year for 2017 to 2020). That’s some struggle.

The scenario gets even more complicated when we consider that a lot of these flaws stay open, with a long remediation time and with a lot of room for exploitation. Many flaws get exploited silently and do not leave much room for correction once the damage goes deep.

This is not a pleasant task. It’s like taking regular tests and smears to just stay away from the surgery room. But, Ramu Manjunath, Core Infrastructure Lead, Narayana Hrudayalaya, takes it seriously and handles it cleverly. Leaving the stitches open for even the tiniest spot can have dire consequences, and he knows that well.

In this interview, he tells us exactly why, and how, patch management is not just some post-operative task but a major pre-emptive job at this heart-care institution. He also lets us in the special future-dashboard room and gives a peek on how advanced, easy and relevant technology is going to get in the near future.

Yes, soon enough there will be more people, beyond the god-old pharmacist, who can actually decipher a doctor’s prescription. Soon enough, there would be robots doing heart operations. Soon enough we would have more citizen doctors. Let’s find out how. Get the scrub.

DQ: What went into the recent patch management endeavour? What is its significance?

Ramu Manjunath: With as many as 45 units, including hospitals and clinics across the country, and an office in Ireland, Narayana Hrudayalaya Limited is one of India's premier healthcare providers. Having taken several IT initiatives, almost 95 percent of our infrastructure is hosted on cloud. Around 125 engineers work round-the-clock to ensure Narayana's IT operations run smoothly and efficiently.

We used ManageEngine that helped Narayana Hrudayalaya update over 5,000 end points in less than a week’s time. We did this as we were facing problems with one of the most critical processes overseen by IT teams - Patch Management. Updating 5,000 endpoints was a herculean task and a time-consuming affair. It took engineers up to a month to patch all the endpoints manually, and ensure they were up-to-date.

DQ: How well did it go and how much has it helped?

Ramu Manjunath: Quite smooth! Patch management was a difficult task earlier as there are so many devices and constraints of bandwidth, with a serious need for uptime. Doing it in office hours was a no-no. In Metros, we could still avail 24/7 staff presence to schedule this update in non-work hours but doing it in remote locations was difficult.

We could only install the patches during non-business hours, and it took away time from our human resources, that could have been better utilised for other purposes. We have been using Desktop Central, ManageEngine's unified endpoint management solution, to boost our patch management lifecycle. The company is now able to complete the process in less than a week's time and without any human interface.

DQ: How tricky can this area get with so much sprawl, CVEs, confusion and attack-aggression going around?

Ramu Manjunath: Different roll-outs and updates on Windows products happen time to time. We do it on priority areas first – some main components and after 15 days when the main ones have been addressed well, the same patch is rolled out for extensive production. To do this over 5000 components can be challenging and band-width-consuming, but, we can now update and trouble-shoot easily.

As to CVEs, we have an in-built database that will verify which systems are up to date and which are not. So only those products that lack action would be attended to. There is no need for unnecessary downloading of everything.

DQ: Is speed vs. coverage a difficult tug-of-war?

Ramu Manjunath: This solution allows us upstream and downstream modes. So we can configure everything well upstream and then spread it downstream to solution servers. All products and updates can be replicated well downstream. This is done on non-work hours and helps us utilize idle bandwidth too.

DQ: Tell us something about your cloud infrastructure. Is it easy to handle two different platforms?

Ramu Manjunath: We have Azure in India and a smaller set-up (AWS) for Ireland. It is not difficult to manage the two. We also have app-monitoring tools that have been set as per products, users, stakeholders (engineers) and uptime needs. Now, we have SMS-based alerts for critical service availability updates too.

DQ: Can the idea of citizen-doctors be less fantasy and more pragmatic anytime soon? Specially, after some recent controversies on banning third-tier degrees in medicine that were (purportedly) intended to extend the outreach of heart-care awareness?

Ramu Manjunath: The idea is quite possible. The biggest game-changer, here, would be technology. This is important when we look at the low rates of doctor-population density in India. Yes, there is this shortfall of doctors. So what is the solution? The answer can come from AI and software. Example – the errors of written prescriptions can easily be solved with electronic modes. The government should create a core backbone of interconnection and interoperability of medical records – something like core banking.

DQ: You mean Paytm-isation of records?

Ramu Manjunath: Most people carry medical records in hard form even now. What if all the hospitals are interconnected on this so that one patient can get treatment in a fast and smooth way without worrying about the documents. What if these records were easily portable on one’s mobile phone? So if something goes wrong, or an accident happens, the speed of treatment is not compromised for lack of records. Maintaining data on a mobile can be done in better ways, I hope.

DQ: Players like Apollo have already started with Robotic surgeries. What’s your take here – is too early for technology to get in here? What new challenges does the space of Cardiac Care face?

Ramu Manjunath: It’s about time. In the coming days, we also aim to use AI for various operations and treatments. AI can help one see eye retina and help in quick detection. With these technologies, preventive care will get a lot of speed.

The challenges, of course, continue. We try our best at Narayana Hrudayalaya to bring in knowledge for end users.

Like, giving medical tools with instructions of use to 9th standard students. They are trained on how to check their families, neighbours and friends for signs of any issue well in time. People with heart issues can be detected soon. Plus, the kids get conversant with medical terms.

DQ: You feel more AI would be used in this realm ahead?

Ramu Manjunath: Why not? Down the road, AI and machine learning would be deployed a lot. AI can help with faster second opinions and save doctors’ time.

DQ: What is more urgent here – telemedicine or tele-emergency?

Ramu Manjunath: Telemedicine. As it needs a lot of travel time and critical cases. If technology can treat people instead of them having to reach hospitals, then it would be a better scenario. It can be done by using video-conferencing or integrated tech collaborations for immediate doctor assistance.

DQ: Patches done! So, what next would you be eyeing in technology adoption?

Ramu Manjunath: We are going ahead with a third-party assessment tool as well, for Windows and beyond. It scans the entire system and finds out vulnerabilities. We can patch everything connected with Microsoft and third-party products too.

• Pratima H