AI widens scope for IT exports

A lot of the most critical healthcare software used in the United States, from insurance, medical records,  analytics, billings to general operations are made in Nepal.

Coding is outsourced to IT companies in Nepal because it is cheap, and there is a large pool of coders with 15,000 graduates entering the job market every year. 

Churn is low, and programming remains a desirable career, with people able to work remotely for high pay with little investment, often even without a degree.

Indeed, building US healthcare software holds up the growing Nepali IT industry which last year exported software worth $900 million, nearly as much as Nepal earns from tourism every year.

IT exports have a long history, starting from when Rudra Pandey co-founded D2Hawkeye, which pioneered healthcare analytics. The company is now Verisk Health.  

There are over 15 technology companies that specialise in medical software, operating mostly as subsidiaries of US companies, but some are also ‘vendors’ that are completely Nepali-owned.

One such company is TechKraft, which builds software for clients across the world in healthcare, but also in finance. Its Executive Director Santosh Koirala says: “A big advantage Nepal has in making US healthcare software is simply how long it has been involved in it. This has created many domain experts, and new programmers here are technically excellent as well.” 

The trust and skills that companies and individuals have built up is also how TechKraft gets clients, referrals and business, and they have to strictly ensure data security and privacy protection.

“This is personal information about people’s insurance, their visits to the hospital, their diseases. Any breaches could lead to expensive lawsuits,” says Koirala. 

While it is much easier for subsidiary companies to keep data within their systems, vendors must put in place multiple layers of physical and cybersecurity to convince clients to work with them. They must work in what is called a ‘cleanroom’: a controlled environment where teams can work on sensitive data without compromising security or privacy. 

Laptops and even pen and paper cannot leave the workplace, and all employees must pass training in globally recognised information security standards.

AI is transforming processing of healthcare data, and companies like TechKraft have integrated it in everything they do. Agentic AI is designed for a high level of autonomy, and can handle booking, rescheduling, and reminders for patient visits, detect anomalies in medical imagery, analyse patient data to create custom treatment plans, predict outcomes, even catch medical fraud. 

AI also helps programmers at TechKraft write better code, faster. “AI has had a huge impact on our workflow, it is faster and more efficient,” says Koirala, ”but since it makes things so much easier, it may become harder to find business.” 

It also means that a project may require only four engineers skilled with AI instead of say, ten. The remaining six are out of a job.

Another Nepali company, Wiseyak, also works on a host of AI healthcare products. One is software that can diagnose diabetic retinopathy and pneumonia at least as well as the best doctors. Another is AI-EMR algorithms that can analyse patient data to provide insights and recommendations. 

“We help doctors by building powerful tools, and not replace them.” says co-founder and CEO of Wiseyak Suresh Manandhar, who has been studying and working with AI for 40 years, long before it became a part of everyday life. 

Wiseyak now wants to make software that can be used in Nepal’s hospitals to diagnose various diseases. For retinopathy, an AI is trained on publicly available datasets of retinal scans. 

The model can then learn to detect a range of symptoms such as microaneurysms in the eye, ‘cotton wool’, and macular degeneration. It can then make a diagnosis based on the quantity and size of the anomalies it detects. 

“AI can be fine tuned by feeding it retinal scans of Nepalis,” says Manandhar who admits to difficulties because medical records in Nepal are still paper-based and not digital, and few hospitals want to retool. “The government should  invest and build momentum to adopt these technologies.” 

Santosh Koirala of TechKraft is also president of Nepal Association for Software and IT Services Companies (NAS-IT), a group that focuses on policy and advocacy with the government. He is optimistic about gradual progress in lobbying efforts. 

“The government is slowly getting it,” he told us. “Removing limits to Foreign Direct Investment and allowing Nepali companies to have offices abroad are big steps in the right direction.” 

NAS-IT also advises universities on the development of courses to keep students up to date with the latest developments in AI, as well as pushing for data insurance to make clients less reluctant to work with Nepali companies.

Both Koirala and Manandhar are optimistic about the general direction Nepal’s IT sector is going in, and can build on.

 “There is a lot of potential which is being recognised quite quickly,” says Koirala. “We know the technology now, and we know how things are done at a global level. The next step is for Nepal to start making products that can be used widely across the world.” 

IT products for application within Nepal are now designed in Nepal itself, and software companies such as eSewa were ahead of their time in the region.

Manandhar is also bullish: “There is no limit to how helpful AI can be for Nepal. Trained, super-specialised doctors are scarce, so AI can be a substitute and make them three, four times more efficient.”