A framework to Identify the root cause of the problem and solve it without creating a new problem (Imp for Healthcare/Healthtech POV)

If a factory is torn down but the rationality which produced it is left standing, then that rationality will simply produce another factory. If a revolution destroys a government, but the systematic patterns of thought that produced that government are left intact, then those patterns will repeat themselves…There’s so much talk about the system. And so little understanding.

By: Robert Pirsig, Zen and the Art of Motorcycle Maintenance

We have been working on Jile Health for the past 12 months of course, we started with a problem statement rather than a business idea or solution. Throughout the past 11 months, we have patiently worked on developing and refining solutions. As I write this, we firmly believe that what we have constructed and devised has the potential to make quality healthcare accessible and affordable for the bottom 90% of Indians.

During our journey, serendipitously, we’ve stumbled upon a framework that we’re currently employing. This framework guides us in navigating from identifying the underlying cause of an issue to devising solutions, all while ensuring that our solutions don’t inadvertently give rise to new problems.

And I believe we can use this framework across the industry, especially for Healthcare/Healthtech. Hence I am sharing here.

If we look at any problem, there would be two types of indicators

  1. Visible (Mostly Subjective but it can be Objective)
  2. Invisible (Mostly Objective but it can be Subjective)

In fact, we can create a 2X2 matrix with Visible, Invisible and Objective, Subjective

In some cases, visible indicators can be objective and invisible indicators can be subjective. We will take a look at all types of examples.

In general, we made a mistake by looking at one out of two and create a hypothesis about problems and solutions. The real magic comes out when we merge both and ask tough questions.

Let’s take an example:

Progress and Growth of Nation: There are two Invisible but Objective indicators,

  • GDP and
  • GDP per Capita.

Unfortunately, these two visible objective indicators give us no indication of the real progress of a nation on multiple fronts. For example, revenue from deforestation also gets added to the GDP, but do we want that? However, as soon as we add another opposite indicator (Visible, Subjective), we get a real sense of the Growth and Progress of a nation. In the case of the Nation’s progress, here are some Invisible, Objective indicators:

  • Wealth with the lowest throughput
  • The lowest infant-mortality
  • The greatest political freedom
  • The cleanest environment
  • The smallest gap between the rich and poor

I am sure there will be many other Visible-subjective (but measurable) data points that might indicate the progress of a nation better than Invisible-objective indicators - GDP and GDP per Capita.

The fact is every discovery of a solution or solving problems is nothing but creating a system - entirely new or renovating an old system. As Robert Pirsig said if the system is kept intact - it will produce the same output. And a system can’t be evaluated just based on one type of goal or purpose. There might be the case that a lack of infrastructure or technology could prevent us from measuring another type of indicators but that is the purpose of science and technology. The development of science and technology mostly allows us to validate many of our subjective indicators.

Let’s take another example:

There is already a thread on Discussion: Helping Women Manage Chronic Menstrual Issues - Introducing SocialBoat

Chronic Menstrual issues in women (let’s focus on PCOS (Polycystic Ovary Syndrome))

Most of the startups are tackling to solve this problem for women by looking at visible-subjective indicators

  • Irregular menstrual cycles (long or absent periods)
  • Hirsutism (excessive hair growth on face, chest, back, etc.)
  • Acne and oily skin
  • Male-pattern baldness or thinning hair
  • Weight gain or difficulty losing weight
  • Dark patches of skin (acanthosis nigricans)
  • Skin tags
  • Menstrual cycle length and regularity
  • Ovulation-related fertility issues
  • Mood swings and emotional disturbances
  • Fatigue and low energy levels

As there is so much stigma around menstrual issues and PCOS not many women open and disclose the above visible-subjective indicators. In fact, most women ignore such subjective-visible indicators considering it not a big deal.

And if anyone is designing a solution based on just one type of indicator - the solution will end up creating a new problem. As Sameer (CEO @ Rainmatter Foundation) says, we create new problems to solve old problems.

In that case, the real question is - what would be the best method to

  1. Identify the problem
  2. Solve that problem without creating a new problem

And hence we need another type of indicator, for the above example, - “invisible-objective

Health Vitals and Indicators (Invisible signs):

  • Blood glucose levels (fasting, postprandial)
  • Insulin sensitivity/resistance
  • Lipid profile (triglycerides, LDL cholesterol)
  • Blood pressure
  • Androgen levels (testosterone)
  • Hormone levels (FSH, LH, estradiol, etc.)

Micronutrients (Invisible signs):

  • Vitamin D
  • Omega-3 fatty acids
  • Iron (hemoglobin and ferritin levels)
  • Folate (vitamin B9)
  • Vitamin B12

To understand this in detail, I have created a summary:

Even, from the above, many indicators can be found in Health Records - Lab tests, EMR/EHRs, others etc. that most of us throw it considering useless.

Not all invisible indicators are necessary, however, even if we take the most suitable one and match that with the visible subjective, we shall have a better chance of

  1. Identify the root cause of the problem
  2. Solve it without creating a new problem

Let’s say, we don’t have the technology to measure invisible-objective indicators that is a different case. However, if there is available technology and we can measure the invisible-objective: before even doing anything - we should be comparing both visible-subjective and invisible-objective. And at this stage LLMs (AI) create real magic. In fact, we at Jile Health believe LLMs and Health Stack will make Quality Healthcare affordable and accessible for everyone in the country.

And in this way, we will create a new system that will produce better results. And such systems will solve problems without creating new problems.

And today, we have technology available to measure invisible-objective indicators.

The above framework is also true for Mental illness, All types of NCDs, Chronic diseases etc

We think this is especially important for any Healthcare/Healthtech solution. And this is what we discovered after 11 months of work. But again, we are lucky simply because thinking to solve this problem at scale would have been almost impossible without Health Stack (ABDM)

With all the developments - Health stack, PPG, LLMs etc. - it is a good time to think of Healthcare/Healthtech solutions from a new SYSTEM POV rather than layering the old system with some renovations and paintings. :slight_smile:

Also thinking/building a new system does take a bit longer compared to layering the old system with some paintings. But in the world, there is nothing called Perennial investment except, you know where :wink:

PS: This is a part of one of my recent essays.
PS2: I am not a woman or consulted a woman before writing about the Menstrual problem, so I might made some mistakes, Please excuse that or you can correct me! :pray:


We used the above framework to discover the connection between two chronic diseases. And how the utilization of this framework and the Healthtech solution that we are building at Jile Health could have prevented Chronic Disease Costs.

This is the story of Sunanda Ji - one of Jile Health’s users.

Let’s get started…

Sunanda Ji, a 55-year-old mother of two (both under 20), with a monthly income of approximately INR 35,000, sought my advice concerning her health. She had a few medical records and had been informed by her doctor that her eyesight problems were linked to her diabetic condition, warning that without treatment, she might permanently lose her eyesight. Sunanda Ji and I live in the same apartment complex in Patna, Bihar, India. At this point, it was common knowledge among our neighbours that I work in the healthcare sector.

Consequently, I shared a link to the Jile Health app via WhatsApp and encouraged her to install it, sign up, and create an ABHA account. I requested her to attach her health records. Remarkably, Sunanda Ji had diligently maintained physical copies of her health records for many years, including prescriptions and paper-based medical bills. I wished that every Indian could safeguard their health records as meticulously as she had.

I requested Sunanda Ji to simply click all of her past medical records so I could review all and uncover the root cause of the provider statement. This is a beautiful part of the Health Stack (ABDM) a user who can use WhatsApp can also create ABHA and link their Health records. Our AI engine is not live, it will take some time therefore we reviewed all her health records on our local computer. Here are the surprising parts that we discovered through uploaded past and present Health Records

  • There was no deficiency in key health vitals and nutrients, including Vitamin A, Vitamin C, Vitamin E, Vitamin D, Omega-3 fatty acids, and zinc, which could be responsible for her eye issues.
  • Sunanda Ji is a non-smoker hence no problem with contract formation - one of the potential root causes of eye issues.
  • A normal blood pressure for the past many years - except for occasional highs.

However, blood glucose has been on the rise for the past many years. In 2019, from her body checkup report, we got to know the blood glucose (Random) was 94 mg/dL (this is in the biological range: 70 to 100 mg/dL). This is one of the mistakes most of the providers made, 94 mg/dL in 2019 was in the biological range however on the edge of pre-diabetic, no? And almost all providers in India don’t even care to nudge patients that their Blood glucose is on the edge.

And no timely, attention led to the pre-diabetic condition in 2021, and we discovered through Sunanda Ji’s diagnosis records of heart disease. The blood glucose (Random) crossed 100 mg/dL - 106 mg/dL. Here also, since the diagnosis reports were for the purpose of Heart diseases, the provider ignored the pre-diabetic condition.

According to her current eye diagnosis reports, her blood glucose (Random) is in the diabetic range - 134 mg/dL. And seems her blood glucose crossed the diabetic range last year (2022) and hence she is experiencing an eyesight issue. This diabetes leads to eyesight problems called Diabetic Retinopathy. One of the most common eye problems caused by diabetes is diabetic retinopathy. Diabetic retinopathy is a condition that damages the blood vessels in the retina, the light-sensitive tissue at the back of the eye. This can lead to blurry vision, vision loss, and even blindness.

Imagine if healthcare providers had alerted Sunanda Ji about the potential implications of her rising blood glucose levels. Technically, it would have cost nothing to diagnose the risk of Diabetic Retinopathy. Today, Sunanda Ji might not be facing the prospect of spending a substantial sum for treatment and ensuring a comfortable final phase of her life. Such an outcome would have been nearly impossible just a few years ago. However, today, we have both science and technology at our disposal to tackle this and many other healthcare problems at an affordable price for India’s bottom 90%—1.2 billion Bhartiya…

This is a small part of my recently published essay.