THE DIGITAL HEALTH BRIDGE: MEDOPLUS’S IMPACT ON RURAL
HEALTH CARE IN INDIA
Prof. Samadrita Bhattacharyya of the Indian Institute of Management Udaipur developed this case study as the
basis for class discussion rather than to illustrate the effective or ineffective running of an organization.
It was a bright, sunny day in the summer of 2024. Koshika Sharma, the Product Head at MedoPlus, sitting in her
office in a busy locality of Lucknow, contemplated the journey of their health-tech startup, MedoPlus. She took
pride in the ways that MedoPlus, a just four-year-old company, was creating transformative impact in rural health
care, leveraging digital technologies and local people. The core value proposition of MedoPlus was to make health
care accessible and available to everyone, especially the rural population. The vision statement of the company
encapsulated the same: The Right Healthcare at the Right Time for a Healthier and Happier India. They created a
digital platform (mobile app and web-based) that connected the rural population with the nearest healthcare
providers, doctors, test laboratories, and hospitals. MedoPlus also employed local community influencers as their
enrollment executives, the MedoMITRs, who bridged the gap between the villagers and technology and made the
service available to people even without smartphones. The MedoMITRs played an important role in the company’s
ecosystem. They were local agents who had smartphones, were familiar with technology, and were often influential
or educated people of the locality. They helped the villagers who sought medical support and care navigate the
app, schedule appointments, and ensure that all medical information was properly recorded on the platform. They
were also essential in creating healthcare awareness within the community.
Koshika knew that they had created a unique value proposition for rural India in terms of access to timely healthcare
resources and relevant information. Further, the organization was creating an impact by promoting
microentrepreneurs (local health agents), ensuring an income stream for them. By the end of 2027, the
organization aimed to achieve the mission of enriching healthcare experiences and outcomes for at least one crore
healthcare seekers from rural India annually. To do so, they were planning to leverage existing and emerging
technologies, such as artificial intelligence (AI) and natural language processing, to make their digital platform more
useful to the patients as well as all other stakeholders. MedoPlus was also working on obtaining compliance from
the Ayushman Bharat Digital Mission (ABDM), with three milestones to achieve. Several challenges pertaining to
data standardization, protection, and scalability were evident.
While Koshika and her team were excited about the possibilities that their platform promised, they were also riddled
with several questions: How could MedoPlus ensure that its technology infrastructure could handle a significant
increase in users if it were to scale up across India? What would be the most effective strategies for the company
in achieving its mission? How could they create sustained value on the platform for their patients and healthcare
partners?
HEALTH-TECH TRENDS IN INDIA
Approximately 68% of India's population, or 900 million people, resided in rural areas, whereas metropolitan
regions housed 80% of the healthcare workforce and infrastructure, and their average lifespan was 5 years greater
than that of rural areas. In India, the private sector provided around 70% of the healthcare services. The average
cost of hospitalization was $450, and outpatient care was between US$9 and US$18 in 2024. In India, the doctor-
to-patient ratio was 1:1800 overall and 1:20,000 in rural regions, despite the World Health Organization’s
recommendation of a 1:1000 ratio. Additionally, people living in rural areas were often ignorant of the healthcare
options that were suited for a certain disease, and accessibility was an issue. Limited knowledge and lack of access
resulted in needless travel and medical expenses, as well as inefficient ailment management.
This prompted a rise in telemedicine adoption, which became an important instrument for closing the healthcare
gap and empowering patients, especially from rural areas. Telemedicine had made it possible for rural communities
to obtain professional medical advice remotely by removing geographical obstacles and utilizing digital platforms.
This had improved access to high-quality health care, especially in areas with sparse physical infrastructure.
Additionally, telemedicine had been essential in helping patients receive care close to home, facilitating specialist
consultations, reducing disparities in access to health care between rural and urban areas, and eventually
enhancing national health outcomes. The COVID pandemic induced a spike in demand for telepathology,
teleconsultation, teleradiology, and e-pharmacy highlighted the increasing significance of digital healthcare
solutions in India.
One of the health-tech companies, Tata 1Mg, was a leading player in the telemedicine space. It had three verticals
– physicians, laboratories, and pharmaceuticals. Through its website and mobile app, the firm allowed customers
to order both prescription and over-the-counter medications. Users could order medications for home delivery,
submit their prescriptions, and search for medications. The website guaranteed quality and authenticity while
providing access to a large inventory of medications from authorized pharmacies. In addition to medications, Tata
1mg also provided a range of healthcare products such as wellness supplements, personal hygiene products,
medical equipment, diagnostic kits, and healthcare appliances.
Another leading digital healthcare platform in India was Practo, which offered a plethora of services to its users.
Doctors in a range of specialties, including cardiology, dermatology, mental health, and gynecology, were
accessible on the digital platform. Practo users could schedule appointments with partner clinics and diagnostic
centers for wellness services, health examinations, and diagnostic tests. The online appointment scheduling, price
comparison, and review capabilities simplified the process of obtaining healthcare services for users. Similarly,
2
Chennai-based company NetMeds, another popular name in the health-tech industry was launched with the vision
to provide convenient and affordable access to their everyday medicines. The company provided unified online
and offline integration. NetMeds was one of India’s leading online pharmacies, providing a convenient platform for
users to order prescription and over-the-counter medicines, healthcare products, wellness items, and medical
devices.1
However, telemedicine or e-pharmacies alone were not the solution to healthcare accessibility issues in India.
Digital solutions alone could not address all the issues because healthcare providers could not treat many ailments
remotely via online or telephonic consultation, and a significant portion of the rural population still lacked access
to smartphones and the Internet.2 There existed a market for digital platforms that helped the patients in their entire
ailment management journey.
MedoPlus forged its niche in the growing, yet competitive market of health-tech companies. It differentiated itself
from the existing players by being a one-stop solution for a patient’s entire healthcare journey, starting from doctor’s
appointment booking, lab testing, accessing medicines, to follow-up visits. It also offered its services exclusively
to the rural population to bridge the gap between demand and supply of healthcare resources.
MEDOPLUS – AN INTEGRATED HEALTHCARE MANAGEMENT PLATFORM
In October 2020, Dr. Prakash Bakshi, Co-Founder and CEO; Neeraj Chandra, Co-Founder and COO; and Shekhar
Yerramilli, Co-Founder, founded MedoPlus Services Pvt Ltd (MedoPlus), a healthcare technology startup.
MedoPlus was headquartered in Lucknow, Uttar Pradesh, India. The appalling condition of healthcare in rural
areas deeply affected the founders of MedoPlus, which led them to conduct an in-depth study in more than 500
villages throughout seven states in India. They found that people often postponed treatments, and health issues
grew worse due to a lack of knowledge about disease symptoms, restricted access to licensed healthcare
practitioners, excessive healthcare expenditure, and challenges in receiving the right care.
The vision of the company was to provide ‘the right health care at the right time for a healthier and happier India’.
To guarantee that a rural patient could access any healthcare needs, MedoPlus onboarded qualified physicians,
diagnostic labs, and hospitals from district level up to state capital level on its digital platform that were accessible
through both mobile application and website.
1Onsurity, “Top 10 Revolutionary HealthTech Startups in India”, [Link]
2 2023, “MedoPlus in partnership with Sa-Dhan: A faster way to find and finance healthcare”,
[Link]
[Link]
3
MedoPlus was essentially an integrated healthcare management platform that was multi-sided in nature (see
Exhibit 1). On one side, it had healthcare consumers, i.e., the patients who needed access to the right kind of
healthcare resources and providers. Users of the platform could easily register, arrange for testing and health
check-ups, and buy prescription drugs. The other side of the platform comprised the healthcare providers –
hospitals, test laboratories, private practitioners, and pharmacies. As the third side of the platform, MedoPlus
employed the MedoMITRs, a network of local health agents (see Exhibit 2). With the addition of MedoMITR, or
enrollment executives, MedoPlus specifically targeted non-tech savvy people in rural areas and made navigating
the platform features simple.
The MedoPlus platform introduced an auto-referral feature that ensured convenience for the patients. This feature
automated the process of referring patients to specialists, relevant healthcare providers, and test labs based on
their medical needs. Based on factors such as specialization, location, availability, and insurance coverage, the
auto-referral system in MedoPlus would match patients with the most appropriate healthcare provider. The platform
could automatically generate referral letters, share patient records, and schedule appointments with the preferred
provider. Patients could receive notifications about the referral, with details about the specialist, appointment
options, and what to expect next.
The platform employed electronic payment methods such as Razorpay3 and UPI4. With [Link] for the backend,
Angular for the frontend, and MongoDB for the database, MedoPlus was designed for robustness and scale. For
every step, there was an OTP authentication process that guarantees safe transactions and the patient’s consent.
The app reduced clinic waiting times to less than 30 minutes and maintained digital medical records for future
reference.
BUSINESS MODEL
MedoPlus also made money from commissions and revenue sharing with its healthcare partners. It did not charge
the patients anything. The patients had to pay the doctor’s fee, the laboratory charges, and for the medications, as
and when they availed of any service. MedoPlus did not charge any transaction fee. It charged commissions from
the healthcare providers and pharmacies. For example, if the doctor had charged Rs. 100 ($1 = Rs. 83.5 in 2024)
for an appointment made through the platform, MedoPlus took a cut from it. Further, the agents or MedoMITRs
were given money from the earnings. The health agents worked on a commission and earned service-based
money. MedoPlus used its app to facilitate payment for a transaction. A patient could directly pay the healthcare
providers through the app or website when booking a doctor’s and lab appointments and buying medications. If
3 With its portfolio of products, Razorpay was the only payments system in India that enabled companies to receive, process,
and distribute payments.
4 The National Payments Corporation of India created the Unified Payments Interface, also known as UPI, as an instantaneous
payment system and protocol in 2016.
4
the agent was booking an appointment on behalf of the patient, he or she collected the payment from the patient
and transferred the digital payment through the platform.
MEDOMITR – A UNIQUE PROPOSITION OF MEDOPLUS
500 million people in rural India lack the digital skills needed to navigate healthcare apps. Our primary approach is
an ‘assisted model’ where we build a network of ‘trusted’ local village entrepreneurs (MedoMITR) to guide villagers
in their healthcare journey.5
- Neeraj Chandra, Co-Founder and COO, March 22, 2024
A network of local health agents known as MedoMITRs, or enrollment executives, was the backbone of
MedoPlus's operations. Speaking about MedoMITR, Koshika stated:
MedoMITR goes to patient’s place many times. The patients also come, and they do a video consultation.
The motive is to tell what is my health issue? I don't know if I have sinus problem. What I know is my head
is hurting. So, the patient is going to app, the way it is made is so that the focus is on selection of a
symptom. We focus more on symptom. We train our agents to identify the symptoms, to understand the
issue. If its blood pressure, ask a question accordingly based on symptoms. So based on the symptoms,
the app shows the list of doctors who are mapped to those symptoms.”
MedoMITRs helped patients use the MedoPlus platform. Through this combined digital and physical approach, it
helped villagers get treatment from reliable medical providers at affordable prices, as fast and as near as possible.
Their main role was to talk to villagers, try to identify their health issues, any health concerns in their families, and
then direct them to the right healthcare providers. MedoMITRs also provided health awareness programs on the
ground and organized health camps. Since smartphone penetration and technology literacy were still low in rural
India, the health agents played an important role in helping the villagers. Koshika elaborated the process:
For example, you are the patient. I am the agent. The patients will tell the symptoms, and the algorithms
will tell the problems, the agents will check list of doctors that are suited for the problems and who are
closer [regionally]. So say, in the next 2 Kilometres (km) you have this doctor, in 6 Kilometres you have
this doctor. Now, [if] you choose to go to doctor, appointment is booked on behalf of the patient by a
health agent, having said that even individual users, like you and me, we can login into the app and book
appointments. So MedoMITR is not a showstopper, he/she is just an enabler. That is what in a crux we
do. And in the process, all the medical data gets captured such as medicine prescriptions, lab reports get
captured here. All these data were visible to the doctor. Anything that the doctor does is visible to the
patient in terms of any prescription. Any lab report is visible, hospitalisations details, discharge summaries
5 Bukhtiyarm, Idrees (2024), “MedoPlus App: Driving healthcare to doorsteps of Uttar Pradesh villagers”,
[Link]
5
are also visible to in patient’s repository. So, for example, I go to see the doctor based on the consent
that I give, you can see what all question I have chosen. And if I go to another doctor, that doctor can also
see what the prescription was given.
MedoMITRs were aware of the unique requirements and difficulties that the communities faced. They established
rapport and trust, which made access to healthcare services easier. They guided users through the MedoPlus app,
showing them how to order medications, schedule appointments, and access digital health information. Their
direction guaranteed that people who were not tech savvy could also use the site. MedoMITRs offered
individualized support, making sure that the patient's particular medical requirements were satisfied. They helped
patients understand medical instructions, reminded patients about drug schedules, and followed up on visits. By
serving as advocates, they made sure that the community's needs and voices were heard. By sending MedoPlus
feedback, they assisted in enhancing and modifying services to better meet the needs of the rural populace.
They improved community health by educating the public about preventive healthcare measures like
immunizations, good hygiene habits, and routine checkups. MedoMITR could promptly deploy resources in an
emergency, link patients to urgent care facilities, and administer critical first aid while they waited for more qualified
medical assistance. MedoMITR monitored the patients' progress, offered follow-up support, and promoted
continuous communication with doctors to guarantee that patients continue their treatment.
To find prospective health agents, a field team visited key opinion leaders in the villages, such as the local Pradhan,
school principals and teachers, self-help groups, etc. The opinion leaders helped select the health agents based
on criteria such as attitude, confidence and ability to connect with people. Other important criteria were owning
smartphones, being technology literate, and typically owning or having access to a place where people could meet.
Health agents could operate from their houses or common village points and common service centers such as
Panchayat Bhavan.
At MedoPlus, once health agents were registered, they underwent a training program for 360 hours. The training
program was approved by the Healthcare Sector Skilled Council, which was an undertaking of the National Skill
Development Corporation and was funded by the Confederation of Indian Industries. The training program involved
healthcare technology training, soft skills training, and training related to entrepreneurship. Once they completed
the training, they could go out to the field and work and get on-the-job training as well. So, the entire program was
a combination of classroom, online, and on-the-job training.
MANAGEMENT OF DIGITAL HEALTH RECORDS
MedoPlus captured a variety of data that mapped a patient’s healthcare journey. Data sources were all three sides
of the platform – patients, healthcare providers, and MedoMITRs. The data that were captured on the MedoPlus
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application during the registration process were both optional and mandatory. Mandatory data were limited, such
as the patient’s age, gender, symptoms, etc. An example of optional data would be data related to insurance.
MedoPlus had partnered with public and private hospitals that were accepting Ayushman Bharat Pradhan Mantri
Jan Arogya Yojana, or PM-JAY insurance6. The app captured data related to the patient’s blood group, past
medical history, type of present medical ailments, or symptoms such as headaches, cold, or body aches. Data
related to lab tests in the past and present could be captured and stored.
The healthcare providers could also enter patient-related data. For example, a doctor would enter the symptoms
of the problem and the diagnosis. The doctors then photographed the prescriptions and uploaded them on the app,
or they could manually enter the prescription on the app. Further, the diagnostic centers could also upload lab
reports. Also, hospitals and health centers uploaded hospitalization summaries.
Patients themselves could directly enter their data by logging in to the app using their own login credentials. If
agents had to enter a patient’s data, they would enter the app using their own login credentials, and they would
get to see a different screen. From that screen, the agents had to find the patient from the patient database.
Koshika explained how MedoMITRs entered data on behalf of the patients:
Once the Agent has located the patient, the app will show all the data related to the patient, the app for
the agent and the patients is the same after the initial few steps. The appointments are only booked by
the agents after the consent of the patient, the health agent after locating the patients account will book
an appointment by selecting the doctor’s icon on the app, which would be according to the issue
mentioned by the patient, example, headache or stomach ache, once the agent selects the book an
appointment tab, an OTP would be sent to the patient to confirm the booking, Even to view the medical
records of the patient and OTP is required. The OTP would be sent to the patient’s registered mobile
number.
The patient’s mobile number was required to create an account on the application, which helped in OTP
authentication and consent sharing. This authentication process was used for multiple actions such as booking
and canceling appointments, rescheduling appointments, and payments. Hence, the patients got to know how
much money they were paying, and for what purpose.
One of the main challenges the platform faced was the lack of standardization of medical data. As the data
frequently originated from multiple sources and had various terminologies and formats, it lacked consistency. In
some cases, there was missing data. These made it extremely difficult to efficiently process, aggregate, and
6 Ayushman Bharat PM-JAY is the largest health assurance scheme in the world, which aims at providing a health cover of
Rs. 5 lakh per family per year for secondary and tertiary care hospitalization to over 12 crore poor and vulnerable families
(approximately 55 crore beneficiaries) that form the bottom 40% of the Indian population.
7
analyze the data. Prescription data, for example, were provided in various formats – structured forms, scanned
photos, or natural language, each of which required a particular approach of data processing and integration.
Koshika noted that “Medical data should be interoperable based on patient’s consent. There should also be a
standard set of medical data maintenance. The true challenge in managing medical data lies not just in its volume,
but in its inherent variability and the need for precise standardization”. Addressing these problems required robust
data management strategies, including standardization protocols and advanced data processing technologies.
IMPACT
MedoPlus was adding value to society in two ways: first, it was providing an integrated healthcare management
system to the rural population in India. Second, it was creating livelihoods for several women and men in the
villages, thus nurturing local entrepreneurs. Villagers in the districts of Lucknow, Barabanki, Raebareli, Sitapur,
and Hardoi in Uttar Pradesh, India were able to schedule appointments with licensed healthcare practitioners from
the comfort of their homes by using the MedoPlus app. As of March 2024, MedoPlus had registered 2.7 lakh
villagers. Dr. Bakshi, the Co-founder and CEO of the company stated:
The app allows villagers to book appointments with qualified doctors, diagnostic labs, and hospitals in the
villages. Patients can consult specialists both in-person and digitally. This has helped villagers in reducing
the waiting time at clinics from hours to less than 30 minutes. Moreover, all medical records are
maintained digitally which are mapped to a unique patient ID for any future reference and better decision-
making by healthcare providers. The in-built algorithm guides less aware patients to the appropriate
specialist. All the financial transactions are done digitally through the platform.
Neeraj Chandra, the COO further stressed the impact of the company:
We have brought on board more than 500 healthcare providers, transformed over 350 villagers into micro-
entrepreneurs as MedoMITR, with 70% of them being women. We have successfully completed 90,000
patient incidents and conducted over 1,200 health camps. Sixty per cent of our direct beneficiaries are
either poor or very poor and 46% of our direct beneficiaries are rural women.” Shekhar stated that around
150-200 patient appointments were booked on an everyday basis through our App. “Through our platform,
patients seeking healthcare under the Ayushman Bharat scheme can also book hospitalisation
appointment.
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The Swiss Re Foundation recognized MedoPlus for their impactful work in health care. Among 350 companies
from across the world, MedoPlus was the only Asian company to rank in the top three at the competition that took
place in Zurich, Switzerland. The company was also a finalist at the ‘TiE Lumis’ awards during ‘TiEcon Delhi 2024’.7
WAY FORWARD
As of mid-2024, MedoPlus was working on obtaining compliance with the Ayushman Bharat Digital Mission. See
Exhibit 4 for details on ABDM. There were three milestones that the startup needed to achieve to get compliance.
The first milestone stated that patients should be able to create an Ayushman Bharat Health Account (ABHA). All
the healthcare providers, doctors, and local agents should also have this account. The government was promoting
the maintenance of digital medical records through ABHA.
The second milestone was regarding data standardization, i.e., the information that was being captured by the
healthcare providers and shared on the MedoPlus platform should be saved in a standardized format. The aim
was interoperability. Koshika mentioned, “For example, if Apollo hospital was putting something, and tomorrow if
the patient goes to Fortis Hospital, they should be able to see the same medical history in the same language and
format. Therefore, they are saying there should be a standard set of data maintenance in the backend somewhere”.
The third milestone was regarding making the medical data interoperable based on patient’s consent. Patients
facilitated the exchange of data between healthcare providers.
By the summer of 2024, MedoPlus had already completed the first milestone, and was working on the second
milestone as per the government rules. After two milestones, they could apply for a review.
MedoPlus was also exploring a number of innovative technological solutions that would help them achieve the
scale without overburdening the state healthcare system. The company was partnering with technology companies
and piloting various AI-driven solutions. For example, MedoPlus was working on an AI-based solution, where if a
patient coughed into the app, it would detect the underlying cause, whether the patient had asthma or tuberculosis,
with reasonable accuracy. The technology was still in the pilot stage, and MedoPlus assessed whether the patients
and the doctors were comfortable using it. Similarly for cataract, they were piloting AI-driven solutions that would
detect cataract simply by taking a photo of the patient’s eyes. These technological solutions on the app would
essentially offer directional assessment of the problem, which could be done at the MedoMITR level. This would
help in a preliminary level of screening that would ease the burden on the healthcare providers and offer scalability.
These developments had several implications for the company. To achieve their mission of onboarding at least
one crore healthcare seekers from rural India by December 2027, the platform had to ensure sustained value
7Bukhtiyarm, Idrees(2024), “MedoPlus App: Driving healthcare to doorsteps of Uttar Pradesh villagers”,
[Link]
9
creation for all its sides. The network effects were pivotal for the platform to remain attractive to the patients as
well as the healthcare providers.
However, MedoPlus had to ensure robust technology infrastructure to handle the significant increase in user base.
The company had to tackle the data quality and standardization challenges for ABDM compliance it was aiming
for. This indicated the necessity for technological solutions as well as management of data at the source or people
level. Also, to implement the AI-based directional assessments or the first level of screening at the MedoMITR
level, the health agents required proper training. Finally, since medical records contained sensitive information, the
platform had to ensure proper privacy policies and security measures for data protection and OTP-based consent
sharing, especially regarding data interoperability. Koshika was fully aware of the challenges but was also hopeful
about the possibilities that technologies offered.
EXHIBITS
Exhibit 1
MedoPlus – A Multi-sided Digital Platform for Healthcare Services
Healthcare
providers
(Hospitals,
Doctors,
Diagnostic centers,
Pharmacies, Health
centers)
MedoMITRs
Patients
(Local health
(Rural population MedoPlus agents)
of India)
Source: Created by the author
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Exhibit 2
MedoPlus Healthcare Provider Partners
Source: “MedoPlus”, [Link]
11
Exhibit 3
MedoPlus MedoMITR Interface
Source: “MedoPlus MedoMITR”, [Link]
EXHIBIT 4
Ayushman Bharat Digital Mission
The Indian government's Ayushman Bharat Digital Mission (ABDM) was aimed to transform healthcare delivery
by using connectivity and technology. Using ICT, it developed a "citizen-centric" approach, establishing a digital
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health ecosystem to improve the effectiveness, efficiency, and transparency of the health services. Both public
and private health services would be available to the people, and medical professionals would have better
access to patient medical histories to provide better care. As part of the mission, people were advised to create
a health ID to standardize the process of identification of an individual across healthcare providers. The system
gathered basic information about an individual, such as contact data, family/relationship information, location,
and demographics, in order to issue UHIDs (Universal Health IDs). The ABHA (Ayushman Bharat Health
Account) Number will be used for the purposes of uniquely identifying persons, authenticating them, and
threading their health records (only with the informed consent of the patient) across multiple systems and
stakeholders.
Ayushman Bharat Health Accounts (ABHA)
As a crucial part of the ABDM, Ayushman Bharat Health Accounts (ABHA), a 14-digit unique number made it
easy to share and access medical records online. An individual's entire medical history could be linked together
with the 14-digit ABHA number. It facilitated communication with accredited healthcare professionals and
streamlined the retrieval and exchange of lab results, medications, and electronic health data. The use of digital
tools enhanced transparency and accountability, reducing the potential for fraud and inefficiencies, and ensuring
a more trustworthy healthcare system. The benefits of ABHA were substantial. It offered a unified platform for
all patients’ health records, eliminating the need for physical documents and preventing the loss of important
information. The system facilitated hassle-free access to healthcare services, with streamlined sign-ups for
Personal Health Records (PHR) applications and improved patient convenience. Moreover, ABHA generated
valuable data insights, aiding in evidence-based decision-making and better policy formulation.
Source: [Link] and “PIB Delhi (2024), “Explainer on Ayushman Bharat Health Accounts (ABHA)”,
[Link]
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