eHEALTH Magazine
asia’s first monthly magazine on The Enterprise of Healthcare volume
10
issue
4
April 2015
President: Dr M P Narayanan
Partner publications
Editor-in-Chief: Dr Ravi Gupta
Editorial Team Health Sr Correspondent: Anshuman Ojha education Sr Editor: Shitanshu Shekhar Shukla Project Manager: Seema Gupta governance Sr Assistant Editor: Nirmal Anshu Ranjan Sr Correspondent: Kartik Sharma, Souvik Goswami, Gautam Debroy SALES & MARKETING TEAM: Health North: Sapna Choudhary, Mobile: +91-9910998066 West: Douglas Digo Menezes, Mobile: +91-9821580403 South: Vishukumar Hichkad, Mobile: +91-9886404680 Subscription & Circulation Team Manager Subscriptions: +91-8860635832; subscription@elets.in Design Team Creative Head: Pramod Gupta Deputy Art Director: Priyankar Bhargava Sr Graphic Designer: Om Prakash Thakur Sr Web Designer: Shyam Kishore WEB DEVELOPMENT & IT INFRASTRUCTURE Team Lead – Web Development: Ishvinder Singh Sr Executive – IT Infrastructure: Zuber Ahmed Executive – Information Management: Khabirul Islam event team Manager: Gagandeep Kapani Assistant Manager: Vishesh Jaiswal administration Head Administration: Archana Jaiswal Editorial & Marketing Correspondence eHEALTH - Elets Technomedia Pvt Ltd, Stellar IT Park Office No: 7A/7B, 5th Floor, Annexe Building, C-25, Sector 62, Noida, Uttar Pradesh 201301, INDIA. Phone: +91-120-4812600 Fax: +91-120-4812660 Email: info@elets.in ehealth does not neccesarily subscribe to the views expressed in this publication. All views expressed in the magazine are those of the contributors. The magazine is not responsible or accountable for any loss incurred, directly or indirectly as a result of the information provided. ehealth is published by Elets Technomedia Pvt. Ltd in technical collaboration with Centre for Science, Development and Media Studies (CSDMS) Owner, Publisher, Printer - Dr Ravi Gupta, Printed at Vinayak Print Media D - 249, Sec-63, Noida 201 309, UP, INDIA & published from 710 Vasto Mahagun Manor, F-30, Sector - 50, Noida, UP. Editor: Dr Ravi Gupta © All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic and mechanical, including photocopy, or any information storage or retrieval system, without publisher’s permission.
ehealth.eletsonline.com | egov.eletsonline.com | digitallearning.eletsonline.com | events.eletsonline.com Send us your feedback for any of our Health news, interviews, features and articles. You can either comment on the individual webpage of a story, or drop us a mail: editorial@elets.in
4
April / 2015 ehealth.eletsonline.com
Contents
April 2015 | VOLUME - 10 | ISSUE - 04
20
X-ray Machines
Digitisation - The Shift in Trend Radiography is undergoing a major transition toward digital technology based on flat-panel detectors, with affordable offerings such as retrofit kits driving migration away from film in many cashstrapped regions
30
Microbiology Analysers & Reagents
Digital MicrobiologyThe Buzzword Microbiology as a science has expanded by leaps and bounds in the past few decades due to advancements in sophisticated instrumentation and recombinant DNA technology, which added new dimension and revealed the understanding of the subject at molecular level. Now, the latest buzz in the clinical laboratory is automated specimen processing and digital microbiology
38
Ventilators
Motorising Breathing Advancements Indian ventilators market is poised to grow at a healthy rate in the coming years as more and more hospitals and nursing homes develop specialized care
6
april / 2015 ehealth.eletsonline.com
INSIGHT The Clinical Logistics Solution
Maquet 2015. All rights reserved. • Maquet reserves the right to modify the design and specifications contained herein without prior notice.
IT solutions that deliver the right information to the right people in real time • Efficient workflows throughout the hospital • Easy access to all relevant information • Improved interdepartmental communication • Four components: Emergency, Surgical, ICU, PatientWard
Maquet | The Gold Standard
Maquet Medical India Pvt. Ltd. | II & III Floor, “Mehta Trade Centre” No.1, Shivaji Colony, Sir M V Road, Andheri (East), Mumbai – 400 099, India Phone: +91 22 40692100, Fax: +91 22 40692150, info.india@maquet.com
www.maquet.com
FOCUS
45
10 Healthcare IT Initiative
Undertaken by the UP Government
Arvind Kumar, Principal Secretary, Medical Health and Family Welfare Department, Government of Uttar Pradesh
FACE-TO-FACE
12 Keeping the Flame Alive! Dr Jagdish Prasad, Director General, Health Services, Ministry of Health and Family Welfare, Government of India
13 IT Embracing Healthcare Dr Neena Pahuja, Director General, ERNET, India
14 IT will Transform the
Future of Healthcare
Dr T Sundararaman, Executive Director, National Health Systems, Resource Centre
15 Providing Right
Environment is the Need of the Hour
Naresh Duble, Head, Healthcare and Education Vertical, Armstrong
BUYERS SPEAK
26
X-ray Rules Armamentarium of Diagnostic Imaging Dr (Col) Dinesh Kapoor, Director Radiology, Fortis Hospital
27
Interventional Radiology: A path Less Travelled
Dr Ajit Yadav, Consultant, Department of Interventional Radiology, Sir Ganga Ram Hospital
28 Increase in Demand of
Imaging Techniques
INDUSTRY SPEAK
43
Elderly Care can be Made Simple Sridharan Mani, CEO and Director, American Megatrends India Private Limited
44
NAVA: Redefining Mechanical Ventilation
Eric Noronha, Manager-Operations, TBS India Private Limited
EVENT REPORT
45
4th Annual Healthcare Leader’s Forum
16
Dr Rajat Jain and Dr Virendra Jain, Head, Department of Radio Diagnosis, Primus Super Speciality Hospital
Niranjan Kumar Ramakrishnan, Chief Information Officer, Sir Ganga Ram Hospital
34 Age of Monumental
DX-D 40: It Only Takes an Instant to Go DR
Dr Samir Pachpute, Director, ITM Institute of Health Sciences, Consultant & Quality Manager, MGM Microbiology Laboratory, MGM Medical College & Hospital
Advances in Neumovent Ventilation Technology
A Patient Centric Approach is Required
17 IT : Need of the Hour
Prof Sandeep Kumar, Director, All India Institute of Medical Sciences
18 Health Informatics: Now
More than Ever
Vivek Singh, Technical Principal, ThoughtWorks
Changes
36
‘Reagents’ Most Consumed Microbiology
Dr Anu Gupta, Associate Consultant – Microbiology, Fortis Escort Heart Institute
PRODUCT LAUNCH
58 59 60
Hb–Vario - Latest System for Diabetes Management PRODUCT SHOWCASE
61
iSpO2 Converts Smartphone into Pulse Oximeter NEWS
53 54 56 57 62
8
april / 2015 ehealth.eletsonline.com
International News National News Government Desk Hospital News Pharma Buzz
editorial
PPP for Healthier India Growing at 18 percent annually, today Indian healthcare is the one of the fastest growing industries. However, that data may not be good enough to guarantee for quality service delivery. In fact, various challenges need to be addressed for making health services more accessible, affordable, ensuring the quality of patient care. However, what apparently looks like a challenge is, in fact, a huge opportunity for the private service providers, and the Government is also playing its part in facilitating this evolution. While Universal Health Coverage (UHC) lies at the heart of the Government’s healthcare agenda, the various initiatives kicked off by the Government of India have only gone on to further strengthen UHC. Some of the recently-launched as well as proposed new initiatives, like plan to set up 20 cancer hospitals and 50 general ones; increased government focus on the secondary care, reflected in the allocation of `200 crore for 58 districts hospitals; and its determination to make India first country on the globe to have cardiac ICU unit in each of its states, etc., are examples to show how the government is trying to turnaround the way healthcare industry in the country. In this context, the State of Uttar Pradesh must find a mention here for its certain innovative steps to strengthen the healthcare delivery network. It plans to launch soon about 150 mobile medical units under the Public - Private Partnership (PPP) model under a National Mobile Medical Unit Project to widen the outreach of services to remote areas. Also, to make healthcare more accessible, the State Government is also planning to provide smartphones and tablets to Accredited Social Health Activists (ASHAs) and Auxiliary Nurse Midwives (ANMs). About 1,719 tablets and 10,252 smartphones are proposed to be distributed among the fieldlevel workers. Despite the good intention of the powers-that-be, challenges dotting the way to success threaten to derail the Government’s health agenda. An interaction with the stakeholders in the sector suggests that the solution to this uphill task rests in roping in private participation. With its limited resources and already-underpressure bandwidth, the Government alone cannot achieve the goal of ‘Healthcare for All’. For that matter, even the private sector cannot make it all by itself. So, the need of the day is that both go hand-in-hand using the PPP model. With a view to highlight the Government’s initiatives and complement its efforts, as also to identify the stumbling blocks, eHealth talked to a crosssection of people, including policymakers, decision-makers, prominent industry leaders operating in the space, hospital administrators, doctors and, of course, those availing the healthcare services. We present their views in this issue to help understand better the challenges involved and throw up possible solutions to make a healthier India.
Dr Ravi Gupta ravi.gupta@elets.in
April / 2015 ehealth.eletsonline.com
9
Focus
Healthcare IT Initiative Undertaken by the UP Government There are three major initiatives for which we are inviting public private participation: The Request for Proposal (RFP) for mSwasthya has already being floated, says Arvind Kumar, Principal Secretary, Medical Health and Family Welfare Department, Government of Uttar Pradesh.
I
nformation Technology (IT) is basically bringing in transparency in the functioning of the government and empowering the citizens to know what their entitlements are. The IT revolution, especially after the coming up of the Right to Information (RTI) Act, has made the websites more informative. The department run websites also carry details of the schemes run by them. This opened a two way communications and this is what we have also attempted in healthcare sector in Uttar Pradesh. At present, we are running various websites and trying to involve the public to tell them about their entitlements. Timely modification of these websites is also important to ensure service delivery and to engage with the stakeholders, directly giving them a clarification of their roles. One of the website that was launched recently was on the Pre-Conception and Pre-Natal Diagnostic Techniques (PCBNT) Act. This included the details of the ultrasound centres in various districts, their roles, and the registration of ultrasonologists. The aim of the website is to create public awareness and also provide them a platform through which they can inform the government about any irregularities, unregistered centres, so that appropriate action can be taken against them. While improving the system efficiency one of the key problems that the department was facing is the lack of transparency in the
10
april / 2015 ehealth.eletsonline.com
availability of the medicines in the government hospitals. To solve this, various simple solutions are available in the inventory control and procurement. One of the solutions was developed by National Informatics Centre (NIC) locally and we have been able to implement it in the first stage. All the district hospitals and the CMOs have been computerised, stock of medicine have been made available online. There was also a lack of transparency with regard to the engagement with the suppliers. The suppliers were not able to find from which districts they have received the supply orders from, and when is the payment due to them. Hospitals were not informed about the dispatch of their supply and it was also difficult for us to know if they were not delivering. Now, this entire system is under transformation as far as the medicine availability and the procurement is concerned. There are three major ini-
tiatives for which we are inviting public private participation: The Request for Proposal (RFP) for mSwasthya has already being floated. We have about 1.25 lakh ASHAs (Accredited Social Health Activists) working in Uttar Pradesh and they are supposed to be engaged with the ANMs (Auxiliary Nurse Midwife) and the medical officers. This solution ensures how a seamless data flow can be enabled from ASHAs to ANMs and then this data can be utilised by both medical officer and the higher level supervisory officers. Second initiative and subsequent participation with the private sector that we are opening is with regard to the running the mobile medical unit which is under the National Health Mission Scheme (NHMS) and we are in the process of launching about 150 mobile medical units through public-private-participation. Another initiative of the department is for the quality upgradation of the 155 district hospitals in the
Focus
state. Around 40 hospitals are picked to get National Accreditation Board for Hospitals & Healthcare (NABH) accreditation. One of the key elements is the diagnostic services available in the hospital and for these 40 hospitals we want to invite private participants. The RFP for these is under process and will be out shortly. This project is utilising the smartphone and tablets that we intend to start in few districts where ASHAs can upload data, which can be then seen by ANMs also. Both ANMs and ASHAs are the key service providers and they are supposed to maintain a number of registers. The primary problem they face is maintaining so many registers that makes them unable to extract the data if they are visiting a village. They do not know if children are due for immunisation or pregnant women are due for ANC and PNC etc. This is an initiative where we want to deliver timely and appropriate care for pregnant and lactating mothers, for immunisation of pregnant women and also to identify the malnutrition children who need supplementary nutrition. One is the beneficiary care and the other is that we are not able to capture the data generated. Even if we are able to capture it we are unable to utilise it for the managerial decisions. So we want to bridge this gap through this solution.
Key features of mSwasthya to empower field level workers As of know ANMs and ASHAs if they have any issues and want to discuss any problem they do not have any platform available. So this basically will be a solution where they can get an online resolution of their queries and also address queries of the beneficiaries. There will be an on demand audio and video training also of the ASHAs and ANMs through this solution. The beneficiaries can then get mobile alerts, will be able to schedule and plan their activities, and will be in a better position to monitor
which are the ANMs who basically are delivery, kind of interactions with the beneficiaries etc and will be able to track the outcomes of various schemes also. ASHAs and ANMs will be provided with smartphones and tablets. The private provider is supposed to bring in these with the entire solution. About 1,719 tablets and 10,252 Smartphones are to be provided to the field level workers. If the pilot project in the five districts becomes operational and successful it will be escalated to rest of the 75 districts. The problem faced by the department at present is that even if ASHA is able to deliver service she is not able to get her incentive on
services through a mobile vehicle. This will not only be providing the diagnostic services but also some of the key service delivery needs to be ensured. These 150 medical units are to be pumped into 40 districts, which are high priority districts and the districts that are affected by the Japanese encephalitis, acute encephalitis syndrome cases. So minimum of five blocks are required to be picked up in each districts and these services are going to be run by the engagement of a private partner, who is required to bring in not only the mobile units but services as well. He is also required to provide HR and diagnostic facilities.
About 1,719 tablets and 10,252 Smartphones are to be provided to the field level workers. If the pilot project in the five districts becomes operational and successful it will be escalated to rest of the 75 districts time. This solution will also be able to ensure that the ASHA is getting her incentive on time, in case not the supervisory officers and the higher level officer will be able to track. Similarly, we can track the incentives that are due to the beneficiaries. The system integrator will be appointed for the time period of three years. He is then required to provide the software and hardware of the solution also, the training and handholding of the field level workers as they will not be able to know how to feed the data, how to utilise the Smartphone etc. The operation and maintenance of the system should also be looked after for the entire three years. So, this is a complete package which the service provider is required to provide us.
National mobile medical unit project
All the diagnostic facilities and the data generated by these 150 mobile medical units would require an IT solution, the GPS tracking for mobile vehicles, so that the scheduling, planning and diversion of these vehicles can be undertaken accordingly. This is the third project with regard to diagnostic labs and we are doing it with collaboration with World Bank. Tele-diagnostics is one of the areas of key applications of the IT we want to make use of it. There is a dearth of radiologist and the experts in the department and by utilising expertise available with the private partners we want this gap in healthcare service to get bridged. The model for diagnostics for the Below Poverty Line (BPL) patients the entire cost will be taken by the government and for the Above Poverty Line (APL) the cost will be taken care by the users itself.
The objective is to provide outreach
april / 2015 ehealth.eletsonline.com
11
Face-to-face
Keeping the Flame Alive! The corporates should wake up. They must build infrastructure for poor people and contribute atleast 15 percent of their benefit to them, tells Dr Jagdish Prasad, Director General, Health Services, Ministry of Health and Family Welfare, Government of India to Elets News Network.
A
s we have less number of doctors, the Government of India has lots of things to do. We have eight lakhs ayurvedic doctors who are well qualified. Doctors are concentrating on cities and not on rural areas, the reason being no proper infrastructure. We are producing nearly 54,000 doctors every year. At the same time, we are producing ayurvedic doctors, who are half the number, and whom the government is utilising. Since years, we have been fighting many diseases such as cholera, leprosy, etc. However, with the National Rural Health Mission (NRHM) being started in 2005, the focus has been shifted and the concentration is on reproductory and child health. With this programme, the infant mortality rate has come down. More than 5000 ambulances have been provided just to carry out the patients from the village to the place where delivery can be done. The working of these ambulances can be witnessed in Tamil Nadu, West Bengal. It is working well in both the northern and the southern states. We have nine lakh Ashas at the moment, who are working at the village level. They have been provided with the facilities for immunisation, and maternity check up for women. We are now trying to concentrate on the secondary care of the hospital. The Government of India has given nearly `200 crore for 58 districts wherever the district hospitals are there. Recently, the Health Ministry has put up the health portal system, which anybody can visit, see and get
12
april / 2015 ehealth.eletsonline.com
the information. There is a great use of electronic media in healthcare because at the moment, we are the largest country with 1.2 billion population and in 2025, it is going to be 1.4 billion. Thus, the cost of the business of healthcare will be growing up. At present, 70 percent revenue comes from the private sector and 30 percent from the government setups. However, the government has to spend more money in the public health sector. Another project by the Government of India is to make 20 cancer hospitals and 50 hospitals, which will be having a nucleus of the cancer treatment. Diabeties and Hypertension are tremendously high in the country. About 50 hospitals for cancer nucleus treatment require an amount of `50 crore. We observed that the non communicable diseases are causing more problems than the communicable ones because 53 to 58 percent people are dying with non communicable diseases. India is the first country in the whole world, which will be having a cardiac ICU in each of its state. We are providing funds to the states for
the same. At present, the public health sector is in a very bad state. Non-public health sector is drastic. Thus, the government has decided to open institutes like AIIMS in other states too. One of the programmmes started by the Government of India is Pradhan Mantri Swasthya Suraksha Yojana (PMSSY), under which the government is paying up to `120 crore to every medical college that can upgrade their speciality to treat the tertiary care patients in their medical college. Equipment and building constructions are included in it. So far, we have covered 38 colleges in the country and we are planning to cover more. The politicians who are heading the states need to concentrate on the healthcare because health is a totally neglected subject. In few villages too, e-health has started. 800 villages have been taken in UP and Bihar recently. Sitting in Delhi, doctors are treating the patients in villages. There are people who ask the patients’ history and they then communicate with the doctor. Integrated Digi Surveillance Programme is one of the important parameters in the e-health domain. Although we have lots of obstacles in our way, but both the public and the private sectors have to join hands to achieve the best in healthcare. Not only the government, but everyone has to take the responsibility, the corporate sector too. The corporates should wake up. They must build infrastructure for poor people and contribute atleast 15 percent of their benefit to the poor people.
Face-to-face
IT Embracing Healthcare Dr. Neena Pahuja, Director General, ERNET, India talks about how IT is embracing the healthcare sector and how summits like Healthcare Leaders’ Forum aid industry leaders in working for future possibilities. In an interview with Elets News Network, she discuss about the challenges and adoption of IT in healthcare. Do you see the adoption of IT a challenge in healthcare sector? Absolutely! Before joining government I was part of a corporate hospital and as a CIO, I have worked with the doctors and I have seen that it is actually challenging for the doctors. The doctors haven’t been groomed although they are the best doctors in the country. Although most of the doctors are technologically savvy but when it comes to their typing on data on health records they are not comfortable. I think what we need to do is to possibly take education to the next level.
What is the future of adoption of IT technology in healthcare? There is a huge plan in terms of digital India and in terms of connectivity but it is going to take time. As far as Digital India initiative, ministries are also looking at innovative ways of how we could do this connectivity in a faster and a affordable way. We need to start working on changing the reality of bandwidth. We are taking connectivity to North-East, to Andaman-Nicobar and naturally to the remote areas of India. We are looking at technology how to make it stable when it rains as connectivity stops working. So we are taking a special initiative from the Ministry where we are looking at how we could have stable connectivity in the areas where there is heavy rainfall. But it cannot happen in a day, the execution of the plans will take time.
How does Healthcare Leaders’ Forum serve as a platform for sharing knowledge among the industry stalwarts? My association with eHealth is six years old and I have been a part of e-Health conferences from quite a long time. I think the conference brings in what is happening and what is the future roadmap that’s what e-Health focuses on. The forum is taking care of industry trend, government plans, and how can people collaborate. We are making a beginning but I think it is also important to keep an eye on future while we create the complete platform otherwise we will be left behind. The number of hospitals that we are creating, number of AIIMS that we are creating, the number of medical colleges we are creating, we will not be able to create the capacity that we need today actually..
April / 2015 ehealth.eletsonline.com
13
Face-to-face
IT will Transform the Future of Healthcare IT and Healthcare go hand in hand and IT has a bright future in healthcare industry as they are well integrated in the business processes, tells Dr T. Sundararaman, Executive Director, National Health Systems, Resource Centre to Elets News Network. cess, it should not appear as a separate additional layer on top of it. Nowadays everything that happens - a nurse does in a sub-centre or a doctor does in Primary Healthcare Centre (PHCs) is left untouched but now they have an additional task of after they finish the day’s work to enter all the data in and that data goes up into a black hole from, which they get a feedback. So it is an additional burden without any commensurate gains. There has to be a system where there is a less effort with a profound profit. A good example of this is banking. Similarly, the model should be followed in healthcare to provide better quality to the users and that is where we will see the adoption of IT in the sector.
What is the future of IT adoption in healthcare? The healthcare IT industry is going to grow and IT will be much more integrated. In fact some of the best systems where IT is best used, you do not refer to it as IT at all. Today IT is well integrated in all the business processes and it is an achievement. In healthcare one will never have only IT achievement, it is the system that makes an achievement. IT will be used exponentially but it will transform the way healthcare is done and healthcare will also transform the way IT is done.
How can Healthcare Leaders’ Forum help in sharing knowledge among the industry?
What challenges do you see in of adoption of IT in the healthcare industry? and how do you think these can be overcomed? IT should be integrated into the heart of the business pro-
14
April / 2015 ehealth.eletsonline.com
It helps industry people to get a sense of what are the requirements and challenges that government is facing, what is the nature of development so that they can be more responding to that. Some of the issues that we see are the overall legal and policy framework that is needed for e-Health to grow. How does the government play stewardship role and how does the industry wants the government to play stewardship role and how does the government fulfill its own IT needs for healthcare, these interfaces are all very important for industry to understand.
Face-to-face
Providing Right Environment is the Need of the Hour We may be 50 years behind from US or Australia in terms of the healthcare delivery system but we can match those standards in our system in no time, says Naresh Duble, Head, Healthcare and Education Vertical, Armstrong to Elets News Network. Why there is lack of adoption of IT in Healthcare? IT in healthcare is having their own challenges and technology and adopters don’t go hand in hand. It is really difficult to make the community of healthcare learn about the usage of technology as they are mostly under pressure all the time. We need to give them time and space to learn. When you work in busy environment it is difficult to learn technology. Place should be properly fit for the purpose to perform the job. IT is important which enhance the efficiency but people efficiency is far more important aspects to think about. Providing right environment in healthcare is the need of an hour. AIIMS body has really helped this new healthcare facility guideline has included sound and acoustics as a parameter in their guiding system which is very welcome state and aligned by six other countries. We have requisite intelligence, now we have to work across state governments and national governments to really benchmark ourselves and move closer to the global standards around sound and technology and healthcare building facilities. We really help in facilitation of adoption of sound technology, which is doable.
done in line with global standards. We may be 50 years behind from US or Australia in terms of the healthcare delivery system but in no time we can match those standards in our system. We are progressing very well and it is a very positive stage for healthcare.
How did you see Healthcare Leaders’ Forum a platform for the Healthcare stalwarts?
What is the scope of solution providers in the healthcare industry especially after Union Budget 2015? Finally we are increasing the allocation for education and health in our budget. We are nowhere near global standards, we need to do a lot more and it’s a first welcome stage that we have taken. So all the new facilities, which are coming now, like we are working with AIIMS new facilities, we are working with West Bengal State Government for 25 treasury hospitals coming up across the smaller cities, we are working with mother and care hospitals in Bhubaneswar, Bangalore and Kerala with state government. So as allocation gets in, the new facility get build, they can be
e-Health is a leading platform where technology being discussed in healthcare. We talk about technology, efficiency, productivity, progressiveness, and using our resources well. Armstrong acoustical solutions are at hub of sound, which can deliver in healthcare. When you are doing a new facility or augmenting an existing facility, it is important to keep human at center of our change and modification. So when you really design a healthcare with proper sound, doctor can talk to a patient in a privacy, which is due needed for treatment. No amount of technology takes care because sound always affects us. So, yes we need a better technology, better people to run the technology, we need to make the product and that’s why this platform makes huge sense to talk to the industry leaders about use of proper designing in healthcare.
April / 2015 ehealth.eletsonline.com
15
Face-to-face
A Patient Centric Approach is Required Niranjan Kumar Ramakrishnan, Chief Information Officer, Sir Ganga Ram Hospital speaks to Elets News Network on the sidelines of the HLF Summit. How have been IT services helping in supply chain management for Healthcare sector? Majority of our revenue as well as expenses go into medicines and medical equipment and everyday transactions happen at the hospital level. So these are the two major cost components for hospitals. In this case CRM really helps the hospitals to streamline their procurement process, elementary process and atleast 10-15 percent of cost can be managed by installing proper technology.
What are the solutions Sir Ganga Ram Hospital has deployed to manage cost? Sir Ganga Ram Hospital is the earlier adopter of technology and has bagged couple of awards for being a technology oriented hospital. Most of our doctors use the employment system through mobile app. Very recent development is that we are the very few hospitals in India to have end-to-end procurement solutions where more than 100 manufacturers participate and more than 12,000 medicine plants were handled through complete eprocurement solution. We are also developing doctors’ dash boards and we are among very few hospitals in India who are making cashless cards for patients, which was introduced in dialysis department.
What challenges do you seein the adoption of technology among the healthcare industry?
16
April / 2015 ehealth.eletsonline.com
The adoption of technology to share and store the information will take lot of time. For greater adoption, there should be an incentive, motive or return on investment and there should be real transfer benefits to be realized while start using the system. So wherever they thought and believe that the data has to be entered so that helps them in day today activities hospitals normally start using it. In the clinical aspect the challenges are there as there are more patients and less medical staff, and doctors cannot spend more time in entering the data of each patient. I think we should show them the real benefit of using the technology and what happens if they enter the data, show them the benefit of analytical data, the moment you start demonstrating that part adoption will start increase.
What can be done to make healthcare more patient centric? Hospitals should ensure that a complete lifecycle of a patient kept as a primary automation process, not the typical purchase process. The approach of patient centric system is not developed though we keep talking about innovations. So patient centric health system is not strictly followed or implemented and IT should really support that aspect. Whatever technology we tried to introduce normally is in the interest of the hospital or the administration, then comes to the doctors and last to the patients, which is the reality. But this should be followed in the reverse order. So I think if we start following patient centric system the healthcare industry will change.
Face-to-face
IT: Need of the Hour
Prof Sandeep Kumar, Director, All India Institute of Medical Sciences, Bhopal, in conversation with Elets News Network shares how medical professionals creates non-threatening system to make end-users or end providers feel comfortable with the software. According to you what’s more need to be done in healthcare sector? Most importantly from the government side, the government has a desire, keeps on instructing itself to use 4-7 percent of the GDP but government is unable to spend 1.2 percent of the GDP on healthcare because the process of spending money is a very labyrinthine process. When I have been with the government there’s money in the government but to spend that money, and see that the user is benefitted or the provider is satisfied is a challenge. IT may come in a way to be able to make up this gap where government is unable to process of tendering, process of purchasing in the government are extremely complex.
What is your opinion about the adoption of IT in healthcare?
Does healthcare personnel have readily adopted IT technology?
There is no healthcare without IT. There are areas where IT is involved in a big way like instrumentation, systems IT in terms of hospital management, HR management, accounts management, OPD crowd management, OPD registration management, off site OPD registration, off site doctors registration, follow up and now with swipe card technology, village management, pregnancy management, assisted living, video assisted living, telemedicine, outreach through IT, GPRS system, taking pregnant women on your radar. Nowadays doctor are equipped with more IT tools.
The Indian healthcare industry lacks information as not even 20 percent of health personnel are using information technology. Although there is awareness of IT for healthcare but the adoption or usage of IT in day today work is missing. I think the hardware is there, software are also brilliant, Indians have proven record of being excellent computer savvy, we have knowledge of English. We as mangers have to create nonthreatening system where the people who are the end-users or end providers feel comfortable with the software and the software is configured onsite to the need of the end-user or end-provider and the systems are badly managed.
Please share your experience of Healthcare Leaders’ Forum? I am establishing from last three years primary, secondary, tertiary care medical institutions, which is an apex institution of national importance both in healthcare and delivering medical education, teaching, training and research. I am always open to technologies that are adaptable and there are people here from cross section of society with whom the interaction on technology is welcomed. I am getting more knowledgeable and this conference has been able to bring more intellectual people on one platform to discuss the future roadmap of the healthcare sector.
april / 2015 ehealth.eletsonline.com
17
Face-to-face
Health Informatics: Now More than Ever Our focus is on expanding access to and improving quality of healthcare in low resource settings, says Vivek Singh, Technical Principal, ThoughtWorks.
T
houghtWorks Global Health partners with organisations that work to advance the cause of equity in health in the social and government sectors and that operate at all levels of the health system. A dedicated team of physicians, public health specialists, and technologists supports these clients through 34 offices worldwide. Our focus is on improving the quality of healthcare and expanding access to this care in low resource settings. We deliver technol-
18
April / 2015 ehealth.eletsonline.com
ogy solutions, tools, consulting and open source expertise to help clients empower workers in the field, deliver high quality facility-based care, and leverage system scale to improve outcomes. We work in more than 30 countries with 3000 employees, providing technology services to enterprises and startups. We have been present in India for the last 13 years. However, beyond delivering services to Corporates, we believe that we have a responsibility towards
Face-to-face
are not easily available. There have been great stories in Kerala and Tamilnadu, but there are still vast parts of the country which suffer from lack of access. We notice that solutions to these problems are coming in from organisations like JSS. Apart from just technical support to these doctors, NGOs and others who are working to alleviate social injustice in the country, ThoughtWorks has decided to work with them and use our skills to build solutions on the ground. Some people might be skeptical about using technology in such settings. But this can be a really powerful tool. The technology is being deployed on the field where the real work happens. This can really empower the people on the ground. The data that this technology enables us with, helps us really figure out what the problems are that need to be focussed on. However, this is not easy. People need to understand and appreciate the use of this technology to ensure that the data collected is accurate. We also find that in a lot of situations, it is hard to convince doctors to start using this technology. The true value that technology provides can be unlocked only when we build solutions on the ground. We need
society, which goes beyond creating employment and paying taxes. Social and economic justice is at the core of ThoughtWorks. We live in an unequal world and we cannot turn our eyes away from that reality. Many people face problems of hunger and lack of access to medical facilities. We believe that technology can help solve these problems. We have partnered with Jan Swasthya Sahyog (JSS) in Bilaspur, Chhattisgarh. JSS is a voluntary, non-profit, registered society of health professionals running a lowcost health program in the rural areas of Chhattisgarh. For over 14 years, they have been providing healthcare services through a community health program in a rural health centre, which includes a 55-bed hospital. They operate village outreach centres in three other villages that are not easily accessible. The team at JSS researches ways to minimize the cost of healthcare in these settings and works to influence policy makers. They also advocate for the poor in various areas of public health. Patients at JSS typically wait one full week to see a doctor– in spite of the outpatient department accommodating 300 patient visits per day, including emergency cases. Evidently, we are in a society where the access to healthcare is difficult. Some of these places that need most help are so remote that even phone connections
Beyond delivering services to corporates, we have a responsibility towards society, which goes beyond creating employment and paying taxes to visit these places and learn about real life problems from organisations like Jan Swasthya Sahyog. By doing so, we can experience and understand problems from people first hand and deploy solutions that they trust and make them better at what they do. At ThoughtWorks, we do not create proprietary software, but build software using open source. Our goal is to create software that can be used by everybody to benefit Public Health. For instance, we are creating a suite of Public Health Systems, which includes solutions like shared health records. So, if a patient from a village in Tamil Nadu comes to the tertiary care or secondary care hospital, their health records are maintained on the system and can be used to treat them. However, we find that insufficient funds alone are not the issue when it comes to building such software. It is also a shortage of skills. Large technology companies which have the skill and money at their disposal should use this advantage that they have to create meaningful and empowering solutions.
April / 2015 ehealth.eletsonline.com
19
X-ray Machines
Digitisation
The Shift in Trend
Radiography is undergoing a major transition toward digital technology based on flat-panel detectors, with affordable offerings such as retrofit kits driving migration away from film in many cash-strapped regions, writes Anshuman Ojha of Elets News Network.
X
ray machines and their use in a variety of fields, for glancing through the insides of solid substances, began in the last decade of the 19th century. As the true nature of these rays and the length of their applications was being studied by a number of industries, their first true use begun when physicists started using them for studying the structure
20
April / 2015 ehealth.eletsonline.com
of atoms and crystals and medical doctors started using them for diagnosing and treating diseases. The healthcare segment, an important end-user of x-ray machines and the major revenue generator of the global x-ray systems market led to demands of nearly 575,000 x-ray machines in 2014. This demand is estimated to grow at a moderate
CAGR of nearly 5.2 percent in the next 3-4 years and reach 700,000 by 2018. General radiography is undergoing a major transition toward digital radiography (DR) technology based on flat-panel detectors (FPD), with affordable offerings such as retrofit kits driving migration away from film in many cash-strapped regions. While shipments of FPD and retrofit flat-
Moving UP!
Agfa HealthCare India Pvt. Ltd. Technosoft Knowledge Gateway, 2nd Floor, B-14, Road No-1, Wagle Industrial Estate, Thane (West)- 400 604 Email for enquiries: sales.india@agfa.com Mumbai 022-40642900
New Delhi 011-41510858
Kolkata 033-22820745
Chennai 044-42125263
DR benefits, for any budget. With the DX-D Retrofit upgrade solution, you can do more with what you already have. DX-D Retrofit is affordable and delivers all the benefits of DR – such as premium DR image quality, improved workflow and faster exam speed – while maximizing your existing imaging investment. You can choose among a range of detectors for all needs and budgets – including state-of-the-art Csl detectors. With its fast, non-invasive and risk-free installation, easy servicing, cassette-less workflow and seamless integration, DX-D Retrofit will take you UP to the future of direct radiography.
Learn about Agfa HealthCare at www.agfahealthcare.com
X-ray Machines
panel detector DR systems produced an estimated 17 percent of annual general radiography shipments in 2014, that figure is expected to reach 25 percent in 2017.
Indian market The Indian X-ray machines industry is growing steadily owing to the growing popularity of the digital segment. DR systems are emerging as one of the fastest growing segments as they tend to offer higher resolution due to flat-panel detectors. The DR-based X-ray systems market is likely to see a compound annual growth rate (CAGR) of nine percent in the coming six years. This is, reportedly, the highest CAGR, which can be attributed to high patient throughput rates, low radiation risks, and excellent image quality of HF X-rays. Currently, the Indian X-ray machines market is dominated by analog models. Even computed radiography (CR) has brought in many changes to its earlier version, in terms of number of plates, method of image reading and producing, erasing older images. Direct DRs have improved the workflow efficiency like never before.
Though costlier acceptance of DR is showing high growth rate especially by government and corporate healthcare providers as they confirm to its better output and return on investment (RoI) justified. The usage of digital models is increasing as people are becoming aware of newer technology and their perceptions are changing. The mammography market is already dominated by flat-panel detector-based full-field digital mammography systems, led by adoption in mature regions. Purchasing in emerging regions is relatively low, however, with not much demand for breast screening, and few healthcare providers are able to purchase the costly equipment.
The DR-based X-ray systems market is likely to see a compound annual growth rate (CAGR) of nine percent in the coming six years.
Interventional and mobile C-arm systems sales are benefitting from a growing trend toward minimally invasive surgery. Advanced systems with digital technology and advanced navigation software are driving growth in mobile C-arm x-ray, while interventional x-ray is already dominated by digital technology and is being spurred on by new installations of hybrid operating rooms that combine multiple imaging modalities and full surgical equipment in one room. Furthermore, hospitals are becoming more receptive to new procedures like transcatheter aortic valve implantation (TAVI) as an alternative to open-heart surgery. These procedures are performed using high-end mobile C-arm systems with flat-panel detector technology. Lack of government support for indigenous manufacturing, cost of duties on components, availability of technology (DR, CR systems) at local level, regulatory issues including AERB certification for indigenous manufacturing are some of the challenges faced by both vendors and buyers.
Global market Driven by continued digitization of x-ray machines and increasing healthcare investments in emerging regions, the global market for x-ray machines is expected to reach US$12 billion by 2017, according to IMS Research. The global x-ray machines market significantly benefits from the rising pool of geriatric population across the globe. Old-age naturally leads to a number of chronic diseases and many issues related with the health of bones, leading to increased necessity of x-ray scans. The introduction of technologically advanced x-ray machines has also led to increased demand from sophisticated applications. Economic development in the AsiaPacific regions, backed by a huge
22
April / 2015 ehealth.eletsonline.com
X-ray Machines
patient base, has increased demand for a variety of x-ray machines from private and government hospitals. The market is, however, limited by a certain extent due to factors such as implementation of regulations such as Affordable Care Act and Patient Protection Act in certain countries, and low rate of adoption of digital radiography systems in the market. Past trends of the global x-ray machines market indicate that alongside the factor of technologically advanced products, the factor of image quality is an important buying criterion as it relates directly with the quality of diagnosis. Price is an important factor to be considered in the price sensitive Chinese market of x-ray machines. Furthermore, developing countries from East and West Europe, having recently been through an economic depression, also place high importance upon the price factor of x-ray machines. The market is also observing a shift in buying pattern – buyers are moving towards mobile x-ray machines from conventional x-ray machines. Increased adoption of
picture archiving and communication systems (PACS) in the European and American healthcare industries, as well as government-led reformations in healthcare facilities in developing countries represent the chief positive trends in the market in the current scenario. The large patient pool and a rapid rise in prevalence of target diseases and the rising volume of globe’s geriatric population are also significantly adding to demands of x-ray machines on a global front.
Technology advancements Recent advances in imaging technology - like CT scans, MRIs, PET scans, X-ray and other techniques -- have had a huge impact on the diagnosis and treatment of disease. Advances in imaging over the last five years have revolutionized almost every aspect of medicine. More detailed imaging is allowing doctors to see things in new ways. Imaging can provide early and more accurate diagnoses. In some cases, it might even lead to better and more successful treatment.
Digital imaging Digital radiology is not a new concept,
but in the past decade, it has become cheaper, more common and more flexible. As computers and their networks have evolved, so has digital imaging. Several advancements in digital imaging have helped to reinvent traditional methods, such as the X-ray. For example, wireless and mobile X-ray systems allow health care practitioners to examine a patient at their bedside, when he or she can’t be moved to the radiology room. Remote viewing systems enable practitioners to look at images outside of the imaging center’s picture archive and communication system. It also gives patients access to their images through the Internet.
Magnetic particle imaging MPI (not to be confused with myocardial perfusion imaging, a radiology method for the heart) is a new medical imaging technology that maps superparamagnetic iron oxide nanoparticles that are injected into the blood stream. The first proof-of-principle study of this method was published in 2005. MPI’s main advantages are that it’s more detailed than traditional imaging techniques, and it does not use any radiation. It produces images quickly, in comparison to other radiation-free techniques such as MRI, which is also more expensive. These advancements in medical technology are available in health care settings today. Researchers at universities and companies are investigating other emerging technologies that could make their way into the hospital setting in the next few years. The upcoming decade may bring even more interesting advancements. This makes it an exciting time to become a radiology technician and learn to apply some of these and other technologies.
CRT vs LCD Nowadays majority of radiology monitors are LCD and they have
24
April / 2015 ehealth.eletsonline.com
X-ray Machines
many advantages over the older CRT monitors. The LCD screens are much thinner and lighter than their predecessors, and are more adjustable to fit the workspace. Because the screen is not curved, there is less light reflection and distortion artifacts have been eliminated. These monitors also take up less overall space, which can be a huge benefit in some reading stations, and they are more environmentally friendly. The LCD monitors use less power and monitor disposal is easier because the lights do not contain mercury. Some of the earlier complaints about LCD monitors have been addressed as the technology improved. For example, the refresh rate is now much better than when the monitors were first introduced. And complaints about difficulty viewing angles have diminished. Outside sources of lighting are needed for LCD monitors as they do not emit light on their own. To accommodate this, backlighting (light behind the screen) is used. Originally, the monitors used cold cathode fluorescent lamps (CCFLs) for the backlighting, with a diffuser that spreads the light across the display. Most displays now use lightemitting diodes (LEDs). Often, LEDs are incorrectly referred to as a type of screen that is different from LCD technology. In reality, the screen type is LCD and the LED is the lighting system. There are many advantages to LED lighting, such as a higher contrast ratio, and improved color accuracy. The LED lighting also adds consistency to the images. How images are viewed on the screens has changed significantly over the past decade as well. It used to be the norm for radiologists to have to move between workstations if they were comparing images, but now the trend is to double the size (at least) of the screen. The radiologists do not want separate displays, but rather, one big wide screen.
Color versus Grayscale As with pixel choice, the decision regarding color or monochrome monitors depends largely on the monitor’s use. There is one 5 MP color monitor on the market right now, but, it is expensive. For the most part, 5 MP monitors for mammography are monochrome but it is not as simple as buying a 5 MP monitor and just using it for all applications. A 5 MP grayscale monitor does not give you the flexibility to view some of the computer assisted diagnostics when you are using color to look at things like ultrasounds where you see color representing blood flow. It has been observed that customers are choosing 3 MP color and 5 MP grayscale for mammography. These advancements in medical technology are available in healthcare settings today. Researchers at universities and companies are investigating other emerging technologies that could make their way into the hospital setting in the next few years. The upcoming decade may bring even more interesting advancements.
Drivers & challenges With growth in the number of hospitals and diagnostic centers, demand for x-ray machines will
keep rising Increasing incidence of injuries is an important reason for growth in the x-ray market Increasing prevalence of osteoporosis will boost the growth in the x-ray market Demand for x-ray systems are likely to increase due to the technological advancements Convenience associated with CR and DR will drive the x-ray machines market Emission of harmful radiations cause many people to avoid x-ray scans Low standard of after sales services negatively affects the market especially in smaller cities and towns Digital units are however priced higher than analog ones which have been traditionally present in the market. Due to growing target population, the market offers huge prospects for players to grow and serve the market in a lucrative way The current challenge for most of the private/corporate set-up is how to do away with films cost burden. CD publisher, pen-drive storage systems, and image digitizers are few solutions catching up with these healthcare providers
April / 2015 ehealth.eletsonline.com
25
Buyers Speak
X-ray Rules Armamentarium of Diagnostic Imaging
S
pectacular progress has been made and continues to be made in the field of radiology. Introduction of new imaging modalities and constant improvements in the available modalities has outpaced most other advances in healthcare. Nowadays, there are computed radiography (CRs) and digital radiography (DRs), computed tomography in its multi-slice form, DSA PET, SPECT, and MRI but can we do away with Xray machines. In any size of healthcare institution, in any role that institution plans to play, primary, secondary or tertiary radiology forms an integral part and stands out as backbone of diagnostics. Therefore more development is required in technology to get faster and better results. In our own scenario in India there has been multifold rise in the X-ray equipment market as elsewhere in the world. Digitisation has revolutionised the way X-rays were produced and viewed. Credit goes to the digital images and development in PACs and fast speed of data transfers images can be almost seen as soon as they are acquired wherever the radiologist or the consultant desires across the globe. The digital X-ray market is booming in India. Referring physicians literally demand to see images in digital formats considering the ease and convenience of viewing. DR systems though expensive are fast catching on but CR thrives even in the smallest of clinics. Digital imaging provides rapid and convenient flow of diagnostic information. Images are available within
26
april / 2015 ehealth.eletsonline.com
Dr (Col) Dinesh Kapoor, Director Radiology, Fortis Hospital, Noida
seconds and can be beamed across the continents using the technologies available either web based or even on hand held devices such as mobiles and tablets. WhatsApp and other social sites are a great boon to humanity in this regard. Not only the quality of imaging is better, it also helps plan appropriate exposures to reduce the radiation dose. However, the cost and maintenance of such systems is a deterrent considering the economy requirements. Paying capacity of our general population is less than the developed nations. Also not many can afford insurance, nor is there a social security system. Hence, penetration of this technology is slow in rural belts and even in II and III tier towns. Multiple factors are to be considered. There are areas where even adequate power back up is not available. Overall growth in healthcare spending does augur well but once again budget
allocation has not been adequate. Both government and private players need to come together to address these issues and help bring costs down to affordable levels. Vendors must also ensure proper maintenance and supply backup so that the centres in far flung areas do not suffer long downtimes due to equipment or supply failure. There has been a paradigm shift with gradual replacement of film based systems to DR systems and improved viewing displays combined with state of art workstations. However, both government and corporate apathy on loosening their purse strings the radiologist has to make do with whatever is provided. Various hospitals that I have had opportunity to work will not invest in very high-end conventional radiology systems and more so in good viewing monitors and PACs leading to some frustration at times. Rising standard of awareness and demands of quality standards are very strongly influencing the type of equipment especially in metropolis townships. Budgets are of course a constraint in this recession period globally. Atomic Energy Regulatory Board has very rightly stepped in to ensure registration of all X-ray based equipment through eLORA. This also must be ensured at the vendor end as is the case with ultrasound equipment. The market is poised for a giant leap in the coming years and more and more PPP projects will help providing the breakthrough. For more information visit: www.fortisescorts.in
Buyers Speak
Interventional Radiology: A Path Less Travelled
I
nterventional radiology (IR) is a medical sub-specialty of radiology utilising minimally-invasive image-guided procedures to diagnose and treat diseases. The range of diseases and organs amenable to image-guided therapeutic and diagnostic procedures are extensive and constantly evolving and mainly involving vascular, gastrointestinal, hepatobiliary, genitourinary, pulmonary, musculoskeletal, and the central nervous system. As part of IR practice, interventional radiologist provide patient evaluation and management relevant to image-guided interventions in collaboration with other specialists or independently. These procedures are less invasive than open surgery, therefore recovery is faster and generally less discomfort and fewer associated complications. In the last decade, IR practice was limited to hospitals in New Delhi, Mumbai, Trivandrum and Lucknow but over the years there has been an expansion in the practice of IR in India as a whole.
Dr Ajit Yadav Consultant, Department of Interventional Radiology, Sir Ganga Ram Hospital
In last few years there has been a gradual and steady growth of Interventional Radiology. If we had to evaluate growth of Interventional Radiology in India then we can see it is because increasing demands from referring physicians,
the widespread availability of imaging equipment for guided procedures, IR’s potential to serve as a convenient alternative to open surgical procedures and reduce recovery time, and the tremendous advances in IR hardware. Today, IR is an integral part of various clinical procedures, finding a role in peripheral vascular diseases like varicose vein and occlusive diseases. Neuro-interventions include stroke management and presurgical tumour embolisation. Interventional radiology also have special role in oncology like transarterial chemo and radio-embolisation in hepatocellular carcinoma, RFA in various malignancies. Uterine fibroid embolisation, prostatic artery embolisation and angio embolisation for bleeding are few of IR procedures, by which major surgery can be avoided. When we look at the future of IR in India, there are two challenges that should be addressed. The first is the need for vigorous efforts for the motivation of students and radiology residents in all the leading Indian medical institutions so that we can create a second rung of specialists who can gradually step into the shoes of the current practitioners. The second challenge is to reduce the cost of hardware. Most of catheterscoils and vascular stents are manufactured in USA and Europe and imported in India, increasing the cost of procedure and limit these minimally invasive procedure to private/corporate healthcare sector. We need to raise our manufacturing standard and follow the new formula of our government “Make in India’’ to reduce the cost of hardware, then only we can make IR treatment affordable to our peoples. For more information visit: www.sgrh.com
april / 2015 ehealth.eletsonline.com
27
Buyers Speak
What are your views on X-ray machines market in India vis-avis the global market? The demand for imaging techniques is constantly increasing across the world because of the increasing concept of evidence based medicine. In today’s world where consumer protection laws are becoming very strong, every doctor wants to have the confirmation of the clinical findings before starting the treatment. So no doubt, with the ease of its use, low cost, faster results and easy interpretation of it by the physicians, it took very less time to spread into every corner of the world including India. It is one such machine, which one can expect in any hospital setup and with the constant development of newer digital setups the market of X-ray machines is constantly maintaining a peak in the healthcare products both
Dr Rajat Jain
What are your views on the price sensitivity of the Indian market? Although the X-ray setup is not a very expensive investment for a hospital but the prices of machines would definitely make a difference for the smaller nursing homes, diagnostic centres or the ones in areas with less affordable population such as in villages who would try to compensate the prices of machine by either installing an older refurbished machine or by compromising with the
Increase in Demand of Imaging Techniques abroad and in our country. Further, the C-arms, fluoroscopy tubes and mammography are all X-ray based techniques, which further multiply the existing need of X-ray machines.
What are your ongoing operations in India and further expansion plans? In terms of diagnostic imaging, we have four establishments in Delhi and all have computed radiography (CR) systems, which are although compatible to meet the requirements of physicians and daily outpatient needs. We would soon be acquiring direct radiography (DR) systems particularly for our hospital because of the increasing patient load, which definitely have some benefits over CR systems.
28
april / 2015 ehealth.eletsonline.com
recent advanced techniques. Primus Super Speciality Hospital is very much concerned about the quality care for the patients and hence, we never compromise with the advanced techniques available in the market.
What are your views on government regulation? As all of us know that X-rays, being ionising radiations are harmful for the body and can lead to many side effects including cancers if proper precautions are not taken and hence it is a responsibility of the government as well as the organisation to ascertain the safety from the unwanted effects of radiation and frame certain rules and guidelines and also establish regulatory body for the proper implementation of the same. We completely agree
Dr Virendra Jain
with the guidelines of Atomic Energy Regulatory Board (AERB) for the use of these modalities however, there should be a check at all the levels for the proper implementation of the rules as they are only for the welfare of the society. We would say that these should be considered as fundamental responsibilities by the organisation or institute to comply with these rules rather than considering them as challenges.
What is your opinion on emerging trends and new technologies? Conventional X-ray systems are time consuming, have tedious procedures of film development and above all the image quality is inferior as compared to latest DR systems, which have many advantages such as image post processing softwares (magnification, contrast adjustment), image storage capability and the compatibility with the Picture Archiving and Communication System (PACS) server which helps in proper storage and teleradiology in there is a need due to lack of availability of specialist radiologist at a remote area. So the newer digital systems such as CR and DR’s are the trend of the day, which still needs to be spread in both the cities and peripheral Indian market and has an immense potential if the companies can offer good deals to the investors when it come to digital setups. The authors are Head, Department of Radio Diagnosis, Primus Super Speciality Hospital, New Delhi. For more information visit: www.primushospital.com
We know your time is precious so we thought we’d make this easy‌ The RX series of clinical chemistry analysers has been developed by Randox laboratories to meet the needs of clinical laboratory testing. Robust hardware combined with intuitive software guarantees real cost savings and consolidation in various laboratory settings. We offer astonishing flexibility through our world leading, extensive dedicated test menu ensuring routine chemistries, specific proteins, lipids, therapeutic drugs, drugs of abuse, antioxidants and diabetes testing can be run on a single platform, Guaranteeing performance like no other, the RX series provides unrivalled precision, reliability and accuracy for results you can trust.
Randox Laboratories Limited 55 Diamond Road, Crumlin, County Antrim, BT29 4QY T: +44 (0) 28 9442 2413 F: +44 (0) 28 9445 2912 E: therxseries@randox.com Randox Laboratories India Pvt Ltd. Plot 191-195, Bommasandra, Jigni Link Road Industrial Area, Bangalore, India 562106 T +91 80 2802 5000 F +91 80 2802 5012 E therxseries@randox.com
Learn more at
therxseries.com
Microbiology Analysers & Reagents
Digital Microbiology-
The Buzzword
Microbiology as a science has expanded by leaps and bounds in the past few decades due to advancements in sophisticated instrumentation and recombinant DNA technology, which added new dimension and revealed the understanding of the subject at molecular level. Now, the latest buzz in the clinical laboratory is automated specimen processing and digital microbiology.
T
he landscape of microbiology is rapidly changing from one of heavy manual procedures and multiday processing times to one of robotic automation and rapid results. Robotics automates plating and incubation to improve accuracy, consistency, and safety by reducing direct handling of plates or specimens.
30
April / 2015 ehealth.eletsonline.com
Clinical laboratories are greatly investing in molecular platforms that detect and quantify infectious disease agents. PCR-based tests have replaced culture for some organisms, reducing turnaround times from days to hours. Mass spectrometry provides identification at the species, genus, and family level in only minutes. The
Microbiology Analysers and Reagents
ability to report the organism to a clinician in a shorter time reduces assumptions and allows for more effective treatment by getting the right drug the first time. There is no denying that the ability to respond quickly to the ever-changing clinical needs of patients today can be achieved quite eloquently by modern molecular diagnostic methods. While molecular diagnostics and next-generation sequencing are still in their relative infancy and currently cannot replace bacterial cell culture in full, the benefits of the early generations of these technologies are apparent. Most importantly, they have given clinical microbiologists the tools to view their world from a new vantage point and contribute to the well-being of patients in a way that is simply not possible using culture techniques.
Indian Market The Indian microbiology analysers and reagents market in 2014 is estimated at `255 crore. The reagents at `204 crore dominate the market with 80 percent market share. There is an increase in the demand for laboratory automation, also it is of utmost priority to educate healthcare practitioners to better understand the quality and accuracy of their systems, follow recommended guidelines, implement best practices, accreditations, and improve the turnaround time for all laboratories, making it easier for the clinician to start his targeted therapy and better patient healthcare management. The key drivers for the growing market remain the need for user-friendly compact systems and PoCs, which bring about early initiation of goal directed therapy in the management of infectious diseases. The risk of healthcareassociated infections from invasive monitoring techniques, opportunistic infections due to immunosuppressive therapy, emerging drug resistance among microbes (bacteria, viruses, fungi, and parasites) are factors that have driven clinical microbiology into the fastest growing laboratory sciences in the last decade. The challenge remains in achieving quicker and faster diagnosis.
Global Market The global clinical microbiology market is expected to reach US$ 12,411 million in 2019 from US$ 6,727 million in 2014, at a CAGR of 13.03 percent between 2014 and 2019. The microbiology testing market is segmented on the basis of applications into clinical, energy, environment, food, manufacturing, and pharmaceuticals. The pharmaceuticals application segment accounted for the largest share of the microbiology market in 2014. Each of these market segments is further divided into multiple product segments and subsegments. The microbiology testing consumables market consists of two sub-segments, namely, kits and reagents. The kits segment accounted for the largest share of the microbiology testing consumables market in 2014 and is
expected to grow at the highest CAGR between 2014 and 2019. The microbiology testing instruments market is subsegmented into automated microbiology instruments, laboratory instruments, and microbiology analyzers. The laboratory instruments accounted for the largest share of the microbiology testing instruments market in 2014, whereas the automated microbiology instruments segment is expected to grow at the highest CAGR between 2014 and 2019. The laboratory instruments are further categorized into anaerobic gas systems, automated gram stainers, automated petri dish fillers, autoclave sterilizers, bacterial colony counters, incubators, microbial air samplers, and other laboratory instruments. The microbiology analyzers are further categorised into mass spectrometers, microscopes, and molecular diagnostic instruments. Increasing incidences of infectious diseases will be an important growth driver for the market. Furthermore, increased healthcare funding along with growing burden of new diseases will aid the growth of this market.
April / 2015 ehealth.eletsonline.com
31
Microbiology Analysers & Reagents
Go Digital Microbiology as a science has expanded by leaps and bounds in t.he past few decades due to advancements in sophisticated instrumentation and recombinant DNA technology, which added new dimension and revealed the understanding of the subject at molecular level. Now, the latest buzz in the clinical laboratory is automated specimen processing and digital microbiology. Laboratory automation and digital microbiology are trending topics high on a lot of laboratories’ list. During 2014, different manufacturers’ systems of the new generation of full laboratory automation and digital microbiology were installed in North American laboratories. The modular and open full laboratory automation systems for microbiology consist of front-end specimen processors that automatically seed cultures, prepare Gram slides for staining, and inoculate broths, with a conveyor track connecting the processors to smart incubators which include image acquisition stations that gather the images needed for downstream digital microbiology analysis. So, what are some of the early benefits and process improvements that these automated lines are bringing to laboratories across the globe? l Incubation technology
A key component of the new full
32
April / 2015 ehealth.eletsonline.com
Laboratory automation and digital microbiology are trending topics high on a lot of laboratories’ list laboratory automation in microbiology is the use of smart incubators, which place each individual plate on its own shelf. The initial rationale for individual shelves inside the smart incubators is mainly for random and faster retrieval when the laboratory professional wishes to access a particular plate. However, one interesting benefit of the smart incubators is that cultures grow faster in them as compared to traditional incubators, and therefore
cultures are ready to be read sooner. The reason for the faster growth is that each culture plate is placed on its own shelf inside the incubator, which provides for a homogeneous atmosphere and efficient thermal conductivity in the incubator to bring the culture plate up to optimal conditions faster. Because the smart incubators are not constantly being opened, they are able to maintain those optimal conditions uninterruptedly. As this incubation technology is implemented, microbiologists and clinicians will be able to work together to select the optimal reading time to benefit from faster growth with faster turnaround times for reports. l Digital image and sharing
Digital microbiology allows the laboratory to share the image of a culture plate and/or of the Gram stain with the physician, who may be in a remote location. This is a practice currently used in some laboratories that have adopted full lab automation of the microbiology laboratory. Laboratory personnel can provide key patient information and consultation to clinicians faster to expedite patient treatment and improve care. l Standardisation and
rationalisation
A downstream indirect benefit of full laboratory automation in microbiology
Microbiology Analysers and Reagents
As more and more laboratories embrace technologies, the benefits in terms of faster TAT, better patient care, and the relevance of traditional culture will be substantial
is the standardisation and rationalisation of sample containers. The adoption of automated specimen processing technology, however, is driving laboratories to standardise and rationalise the containers they receive to optimise the use of the automated processors. When laboratories adopt full laboratory automation they define, which specimens are to be included and stratify which have the highest priority, to be able to roll out the implementation in stages starting from the highest sample volume with the highest negativity rates. Automated specimen processors are able to handle non-liquid samples, but in order to maximize the use of the processors, microbiology
for medical or nursing staff (less confusion in collection device selection and fewer samples being collected), time savings for laboratory staff
laboratories are optimising workflow by standardising containers, such as vacuum tubes for urines, elution swabs, and sputum liquefying containers, among others. Standardisation of sample collection devices benefits clinicians by simplifying and reducing the number of specimen containers needed at specimen collection sites. In fact, liquid-based microbiology allows clinical specimen optimisation and has several important advantages: cost reduction (due to the smaller number of different devices used), time savings
(fewer samples to access and handle for individual investigations), and patient comfort improvement (multiple sample collection can be avoided). Faster colony growth, grouping culture plates by estimated number of colonies for streamlined analysis, providing clinicians with digital patient records with images of cultures and Gram stains for clinical actionable results faster, and laboratory standardisation are early buzz-worthy benefits of full laboratory automation and digital microbiology. As more and
more laboratories embrace this new technology, the benefits in terms of faster turnaround times, better patient care, and the relevance of traditional culture will be substantial. l Streamlined analysis
The image acquisition stations built into the full laboratory automation systems use highly sophisticated cameras and versatile lighting systems to obtain sharp, unparalleled high-resolution images. The high quality of the images acquired by the system enables laboratorians to zoom in on the culture plates and to detect even small colonies that could be obscured or potentially be hard to see. One manufacturer has pioneered discriminative image analysis software that uses the plate image taken at time 0, and compares it to the images taken after incubation. The software is able to discriminate artifacts present on the plate at time 0, focus on the growth, and recognise even small colonies. The software groups the plates according to the estimated number of colonies, and the system then sorts the plates from most estimated colonies to least estimated colonies and presents them to the laboratory professional for interpretation and analysis. The laboratorians can then decide which plates represent significant growth and choose to work these up first. According to Gabriela Franco, Director of Marketing, Copan Diagnostics, this new technology helps speed up the workup of positive cultures, by presenting them to the operator first, and leaving the nogrowth cultures for last. In the case of no-growth cultures, the laboratory professional, after reviewing the plates, can result them in groups, without having to manually discard the plates. It is important to emphasize that the new systems do not make the decisions for the laboratory personnel; the software simplifies and groups culture plates for faster interpretation and increased operational efficiencies.
April / 2015 ehealth.eletsonline.com
33
Buyers Speak
Age of Monumental Changes What are your views on Microbiology Analysers and Reagents market in India vis-avis the global market? In 2014, the global In Vitro diagnostics market in all probability surpassed the US$ 50 billion mark. One of the most important market drivers promoting this achievement is the regular need for detecting infections. Infectious disease testing will be a key driver for diagnostic testing because new pathogen strains develop each year, such as in seasonal influenza and H1N1. Additionally, hospital-acquired infections, such as Methicillin-Resistant Staphylococcus Aureus (MRSA), necessitate increased testing. While advances in viral diagnostic techniques have become widely adopted because of the difficulties associated with viral culture, to date, none of the technological innovations in clinical bacteriology have allowed microbiologists to completely abandon the doctrine of traditional culture techniques. As new molecular diagnostic assays for infectious diseases have become viable options to address the current clinical needs, microbiologists now face the challenge of leaving the comfort zone of traditional culture techniques. I also believe that a wave of automation is coming to microbiology laboratories in India too and that this change will occur much more rapidly than expected. Moreover, the changes associated with selection and implementation of microbiology automation solutions will place significant management and financial challenges upon laboratory leadership.
Could you tell us about your
34
april / 2015 ehealth.eletsonline.com
immunofluorescence setup for diagnosis of microorganisms that are difficult to isolate. We are currently planning to look for an automated bacteriological culture system for isolation and identification of bacterial infections.
What are your views on the price sensitivity of the Indian market, and how does your hospital counter this problem? current operations in India and your expansion plans? We are offering courses in nursing, optometry, medical lab technology, stem cell, biosciences, biochemistry & microbiology. We are also planning to offer molecular biology and genomics courses. Our institution is expanding its wings in biosciences- molecular biology, microbiology, medical laboratory sciences, biochemistry; we have some national and international collaboration for these health science courses. At ITM, we are planning to put up a high-end automated lab set up in collaboration with reputed hospitals and diagnostic industries for our biosciences programme. This will also be open for patients to access more accurate and reliable reports in a shorter turnaround time. At MGM Laboratory, we have a manual culture system for bacteriology, whereas we do have a real-time PCR and ELISA for diagnosis of viral infections and tuberculosis. We also have a Hain’s Line probe assay for rapid diagnosis of tuberculosis and resistance pattern. We also have an
Over the next few years, microbiology labs will see a significant transformation from manual processes to fully automated systems, allowing labs to increase throughput, enhance traceability, increase accuracy, precision, reduce costs, and, finally, improve patient care. Large microbiology setups are making significant capital investments to build total lab automation system (TLA). These systems will eventually prove to be inflexible, costly to maintain, and expensive to upgrade. The focus of interest for laboratories will be on the vendors that do not just automate an existing manual process but, instead, drive automation with new methods that create added value. But for mid segment and smaller microbiology labs cost saving is the need of the day. Our country’s laboratories are under increasing pressure to save money, resulting in the need for inexpensive, yet effective, and rapid manual microbiology tests. Automated microbiology is fast, but the costs per test and initial capital investment is quite high. Our research and development laboratory is developing fast, easy-to-use, rapid tests for pathogens such as Candida, Streptococcus, Pseudomonas, Nieseria, and
Buyers Speak
MRSA and has also developed a line of inexpensive, easy-to-use chromagenic culture media for MRSA, Candida spp., Staph aureus, Salmonella, Enterococcus, Mycoplasma, ESBL’s and common urinary-tract pathogens. Another issue facing the laboratory today is an aging workforce, with more microbiologists retiring than entering the field. We need to motivate young brigade to take this field for brighter prospects. Traditional culture-based microbiological analysis techniques are of very limited value because they take far too long to produce a result. Automated and rapid microbiological testing methods have been developed over the past few years and the trend nowadays is toward technology that allows continuous real-time monitoring and early warning of contamination problems.
What are your views on government regulation and challenges faced while operating the Indian market? In recent years, while automation has steadily spread throughout the biochemistry and clinical hematology areas of diagnostic laboratories,
clinical microbiology laboratories have largely been excluded from this trend. Although, continuous monitoring blood culture systems, automated microbial identification, and automated antimicrobial susceptibility testing systems are widely utilised in microbiology laboratories, microbiology specimen processing and culture workup, in particular, remain largely manual tasks, and indeed, few changes to the methods used to perform these tasks have occurred for many years. Government needs to be more focused on their approach towards infection control. There must be some strict regulations regarding infection control policy. But at present procurement of microbiology analysers and the running cost per test is too high. Government must take some further initiative to provide these equipments at an affordable rate to hospitals and laboratories. No doubt some initiatives are being taken up by the government, such as NABL and NABH standards for accreditation of hospitals even for Rajiv Gandhi Arogyayojana. Even under RNTCP programme Gene –Xpert is provided free to some centres for TB diagnosis. For a private non-government
unaided hospital or laboratory, it becomes difficult to procure and maintain such expensive high-end automated microbiology analysers. Lots of challenges are faced by microbiologists regarding buying such instruments and then maintaining them even on a no-profit scheme. I strongly believe that we need to come out of this vicious cycle and reap the benefits of automated microbiology analysers for real-time monitoring and control of infections. In summary, I believe that we are entering an age of monumental change for clinical microbiology laboratories. Though a precise assessment of the full impact of these changes is in its infancy, it is clear that the benefits of automation on microbiology laboratory efficiency and indirectly on clinical care will be profound.
The author is Dr Samir Pachpute, Director, ITM Institute of Health Sciences, Consultant & Quality Manager, MGM Microbiology Laboratory, MGM Medical College & Hospital, Mumbai For more information visit: www.itm.edu/ihs www.mgmmedicalcollege.org.in
april / 2015 ehealth.eletsonline.com
35
Buyers Speak
‘Reagents’ Most Consumed Microbiology Product What are your views on microbiology analysers and reagents market?
What are your views on emerging trends and new technologie?
Reagents are one of the fastest moving and widely consumed products in microbiology as they are predominantly used in a wide range of analytical processes. Factors such as rise in number of government initiatives for the growth of industry and advancement in related technologies will have a tremendous impact on the growth of the microbiology reagents and analysers market. In comparison to our global counterparts, we now have new technologies, automated solutions and molecular tests in microbiology lab, which has reduced the time needed to provide test results. Though, higher cost of these tests is a limiting factor in smaller hospitals, these are being extensively used in tertiary care hospitals providing quality care to the patients. The Indian healthcare industry is expected to be a potential market in microbiology with high prevalence of infectious diseases, development of antimicrobial resistance, ageing of the population resulting in rising incidences of cardiac and other diseases and rapidly increasing awareness about disease diagnosis and prevention.
Over the next few years, microbiology labs will see a significant transformation from discrete manual processes to fully automated systems, which includes pre-analytical phase of processing, gram staining, culture including automated blood culture systems, identification and sensitivity of microorganisms. New molecular methods such as target amplification by different PCR’s, gene sequencing, pyrosequencing, reverse hybridisation, mass spectrometry and microarray analysis helps in fast and accurate identification of the causative pathogen as well as detection of associated resistance markers. MALDITOF MS (Matrix Associated Laser Desorption / Ionization-Time of Flight Mass spectroscopy) is an analytical method used for the detection of proteins and DNA molecules. Its application in clinical microbiology laboratory is as an alternative to traditional identification systems and Enzyme Linked Immunosorbent Assays (ELISA’s) and is commercially available in India. Point-of-care (POC) clinical microbiology also helps in real-time management of patients presenting with infectious disease emergency. The world is on the brink of a paradigm shift in global health. The old paradigm, exemplified by HIV and malaria, is one in which the rich world comes up with solutions and pays for their delivery in the poor world. India can lead the new paradigm in which emerging economies will solve their own problems and in so doing become global leaders for change.
What is your take on the price sensitivity of the Indian market, and how does your hospital counter this problem? The Indian market is very competitive and price sensitive market. Price is a major element but the quality of the services is the key. In our lab, we provide timely and high quality reports to the patients, which results in a greater inflow of samples. Also, our lab is accredited by National Accredi-
36
APRIL / 2015 ehealth.eletsonline.com
Dr. Anu Gupta, Associate Consultant - Microbiology, Fortis Escorts Heart Institute, New Delhi
tation Board for Testing and Calibration Laboratories (NABL), National Accreditation Board for Hospitals & Healthcare Provider (NABH) and JCI (Joint commission international) for quality standards, which assures the patients that our results are accurate and reliable.
How do you see the need for government regulation? Despite the huge technological differences, diagnostics are still treated as drugs by the Drug Controller General of India (DCGI). There is an urgent need for a separate well-defined regulatory pathway and regulatory authority for diagnostic products. Investments, both in terms of time and money (in addition to regulatory guidelines), towards this sector by the Government of India will not just lead to a spurt in affordable new products, but also bolster the quality infrastructure in the country. Government should also look at the measures such as removing service tax, VAT and higher budget allocations to reduce the cost of equipment and consumables so as to make diagnostic services more affordable to the patients.
For more information visit: www.fortisescorts.in
Ventilators
Motorising Breathing
Advancements
Indian ventilators market is poised to grow at a healthy rate in the coming years as more and more hospitals and nursing homes develop specialised care, says Anshuman Ojha of Elets News Network.
T
he roots of positive airways mechanical ventilation can be traced to World War II with the needs for pilots to breath at higher altitudes. Ventilation therapy then made accelerated progresses during the polio epidemic in the 1950s. Nowadays, mechanical ventilation is indicated when a patient’s spontaneous ventilation is inadequate to maintain life. It is also indicated as prevention for imminent
38
April / 2015 ehealth.eletsonline.com
collapse of other physiologic functions, or ineffective gas exchange in the lungs. Mechanical ventilation in hospitals and in the field have contributed to dramatically improve the life expectancy of patients during and after surgeries, or suffering from accidental disrupted lungs function or finally of patients suffering from acute chronic pulmonary diseases. More recently home care applications previously
Ventilators
40
April / 2015 ehealth.eletsonline.com
Competition
Drager Medical GmbH Maquet CareFusion Corporation GE Healthcare Covidien, Dima Italia ResMed Inc.
The United States: The Largest Market Asia-Paci�c: Fastest Growing at 8.3% CAGR
United States
Market Opportunity
China
South Africa
Market projected to reach US$4.2 billion by 2020
5.1 8.9
Malaysia
India
4.1
4.4
South Korea
Vietnam
6.8
Russia
6.9
5.1
Mexico
Argentina
8.1
9.0
6.3
United Kingdom
Brazil
9.4
Germany
Japan
10.1
11.3
Healthcare Spending as a % of GDP for the Year 2012
France
The global ventilators market is expected to grow at a CAGR of 6.6 per cent from 2013 to 2019, to reach an estimated value of US$ 4,248.7 million by 2019. According to the report by Transparency Market Research, the global mechanical ventilators market has already witnessed significant growth in the past two decades. The basis of this growth has been technological innovation. The current market is growing due to an increasing preference for and usage of home-care ventilators and portable ventilators. One of the key reasons for the growth of the global mechanical ventilators market is the disposable apparatus used in these devices. Improvements in the structural design that is combined with technological innovation and a wider range of usage settings on mechanical ventilators has greatly changed the construction, nature of use, and rate of use of disposables in the devices. The market for mechanical ventilation in Europe and the United States is mainly a replacement market. A majority of the hospitals in these regions have budget constraints; as a result, they purchase ventilators only when it is necessary, thus restricting the market demand. The fact that the replacement of the ventilators is nearly impossible unless they fail to work further hinders the market
Global Market by Geography
11.7
Global Market
Global Ventilators Market Trends
17.9
considered as comfort-improving therapies are showing premier medical interest in the race to extend people’s life. For instance, lower end mechanical ventilators devices known as CPAP and used at night to treat sleep apnea—a disorder once considered a simple discomfort and which is now recognized as a source of major medical complications such as increased blood pressure and diabetes—are increasingly popular and effective.
Global Market by Segment
Global Market Dynamics
Adoption of Non-Invasive Ventilators High Cost Rise in COPD Prevalence Concerns over VentilatorInduced Lung Injury High Respiratory Burden in Aging Population Increasing Competitions
Critical Care Neonatal
Technology Developments
Transport Drivers Expanding use in Sub-Acute Care
Challenges
Portable (Fastest growing at 7.1% CAGR) Non-Invasive
Indian ventilators equipment market is growing at a CAGR of 12 per cent and is estimated at `465 crore in 2013. The high-end segment market is growing at the rate of 11 per cent, whereas the mid-end market is growing rapidly at the rate of 15-18 per cent
growth. In such a situation, technological innovation would spur growth. The growing rate of neonatal mortality in emerging economies of China, Singapore, Thailand, and India has prompted growth in the Asia Pacific region. The region also experiences growth in the global mechanical ventilators market through other factors such as economic development and reducing unmet medical needs. The highest growth is shown by the Asia Pacific region, which has a CAGR of more than 7 per cent within the forecast period.
Indian Market Indian ventilators equipment market is growing at a CAGR of 12 per cent and is estimated at `465 crore in 2013. The high-end segment market is growing at the rate of 11 per cent, whereas the mid-end market is growing rapidly at the rate of 15-18 per cent. The market is dominated by Carefusion, Draeger Medical and Maquet Medical. Other aggressive players include Air Liquide, Covidien, Hamilton, Life Care, Nidek, Max Meditech, Medion, Philips, Rohanika, Schiller, Skanray, Trivitron, Zigma, Indian ventilator market is poised to grow at a healthy rate in the coming years as more and more hospitals and nursing homes develop specialized care. Also, the budget allocation towards the overall healthcare sector is in an increasing mode resulting in better infrastructural facilities all across the country. However, the poor quality of the devices used is among the factors hampering the growth of the market. Besides, as the government is not strict about the import of neonatal ventilators in India, no tab is kept on the quality. The market is also witnessing an increase in awareness
Better understanding of physiology, anatomy and disease patterns are also triggering a new wave of innovation in mechanical ventilation and rapidly rising brand consciousness in critical care area of hospitals. There is a definite preference for better presentation of data in cognitive form to reduce data overload. The availability of superior technological features coupled with good after-sales service accelerates the growth.
Market Trend The healthcare industry witnessed a paradigm shift from providing hospital care to home healthcare over the last decade. This has led to the development and adoption of HMV systems to improve the patient’s quality of life. Patients in need of continual or life-long ventilator support are considered a cost burden on hospital administration. Hence, to reduce hospital costs, there has been a growing trend of shifting such patients to non-hospital settings.
Growth Drivers and Challenges Ventilators like many other medical devices have undergone enormous changes thanks to the technological developments. The changing technology, market dynamics, disease patterns have all contributed to the metamorphosis of ventilators. The stringent regulatory and statutory compliance requirements also catalysed the innovation trend of ventilators. It is of great importance to understand the medical device market drivers so as to
AMI B.O.L.T
now available in
a
One - touch wireless health tracker
+91-44-66540922 1800-419-9868 contact@amibolt.com
Ventilators
Buyers Speak
Improving the Quality of Care
Dr. Minal Jariwala
What are your views on ventilators equipment market in India vis-a-vis the global market? Ventilator equipment marketed in India is on par with rest of the world standards. The care provided hence is corroborative, albeit overwhelming by the sheer volume of patients using them.
Please tell us about your current operations in India and your expansion plans. Nowadays, ventilator equipment are used in operation theatres and ICU’s of all tertiary care centres and their use is expanding rapidly in the country. In the near future with government efforts and financial backing, primary health centres may be included in using ventilators.
What are your views on the price sensitivity of the Indian market, and how does your hospital counter this problem? Presently, price sensitivity is the most pressing issue especially for smaller private institutes, as the initial capital and maintenance costs are adding to the burden. Recovery of the initial cost is a task, which can be achieved by calculating the revenue per ventilated bed. How-
42
April / 2015 ehealth.eletsonline.com
Dr. Kayan Siodia
ever, this puts an additional burden on the patients.
What are your views on government regulation? Government regulations will limit the price of the said equipment thereby reducing the total cost of the patient. It is disheartening to learn that a good number of the population is pushed below poverty line only due to medical expenses. A strong government policy, ideally implemented should be the need of the hour.
What is your opinion on emerging trends and new technologies? Medicine brings in new trends on daily basis in the nascent phase. The current ventilatory equipment, using artificial intelligence and guidance paths minimise human error and help in decision making thereby improving the quality of care. To reiterate, the only solution is to decrease the medical expenses with a strong government policy and price regulation, which will benefit the patients directly.
The authors are Intensivists at Nanavati Superspeciality Hospital, Mumbai
assess its impact on ventilators. Ventilators market has several growth drivers, of which the increasing ageing population is one of the major drivers. The ageing population is more susceptible to developing respiratory diseases. The growing number of aged patients in ICUs has raised the demand for mechanical ventilators. Emergences of new generation sensors, single chip solutions and new generation pneumatic components have impacted the design architectures of ventilators. Ventilating infants and newborn babies makes special demands on ventilation technology, which cannot be met partially by equipment designed for adults. The specific challenges of neonatal ventilation are smaller inspiratory volumes, faster changes in the gas flow and more particularly protection against too high airway pressures and too large mandatory breath volumes. Patient and operator safety is prime importance which has been regulated by the certifying authorities which has imposed huge challenges for the medical device manufacturers. Better understanding of physiology, anatomy and disease patterns are also triggering a new wave of innovation in mechanical ventilation. The challenge for future research in the area of ventilator technology is to generate controlled clinical studies to support its application. With the impact of financial constraints on healthcare, research will also need to examine the economic issues related to the application of newer modes of mechanical ventilation. Integrating the vital signs monitoring with ventilation in conjunction with other assessment parameters may prove to be useful tools to measure the impact of interventions such as suctioning, positioning, muscle reconditioning, weaning techniques, and comfort measures on mechanically ventilated patients.
Industry Speak
Elderly Care can be made Simple Knowing the challenges faced by elderly, an affordable home healthcare system should be implemented, says Sridharan Mani, CEO and Director, American Megatrends India Private Limited, in conversation with Elets News Network.
I
n a few decades to come, you and I would possibly be one among the 1.53 billion elderly living in this world. According to Census Bureau International, by 2050 around 1.53 billion (16%) of world’s estimated population of 9.53 billion will be 65 years and over. Based on rough calculations, it is estimated that population of age group of 60 years and over would be 2.43 billion (25%) by 2050. In the same time period (year 2050), the estimated working population between the age group of 20 and 60 would be around 4.73 billion (56% of total population). The Big Challenge Ahead: Growing ageing population, proportionately reducing workforce and increasing self-reliance for healthcare and wellbeing. A hefty amount of geriatric population is living alone because of the disintegration of the joint family system. According to the report published by United Nations Population Fund and HelpAge India, it is estimated that India had 90 million elderly persons in 2011 and the number is expected to grow to 173 million by 2026. In the 90 million, close to 30 million (33.33%) are living alone. It is also to be noted that number of elderly women is more than that of elderly men. Around 3 out of 5 (60%) single older women are very poor, and 2 out of 3 (67%) rural women are fully dependents. Though our country is zooming fast on healthcare highway lane, a
dedicated healthcare system for the elderly remains largely non-existent. It is well known that 45 percent of older Indians have chronic diseases and disabilities. The common diseases affecting the elderly are heart disease, hypertension, strokes, diabetes and cancer. Some of the health statistics published by the World Health Organisation (WHO) on elderly are as follows: Compared to developed countries, elderly in developing countries lose twice as many in stroke and five times as many to chronic lung diseases. 25 percent of men and equal number of women suffer from high blood pressure in India. 75 percent of men and 80 percent of women have abdominal obesity in India that increases the risk of cardiovascular disease. 65 percent of elderly suffer from a chronic ailment. 33 percent of elderly suffer from multiple chronic ailments. The current geriatric services market in India is about US$ 250 million, but is expected to grow to US$ 1 billion by 2012 and US$ 2 billion by 2017. The Indian home-healthcare market stands at US$ 1.5 billion.
Elderly Care – The Way Forward After long tiring days of work and when people retire, they expect their quality of life be to improved and enjoyable. Senior citizens deserve peace and support. They have put in dedicated efforts to build nations & support the infrastructure. It is time for them to have a pleasant retired life. It is un-
fortunate that the cost of healthcare for simple vital check-up is increasing, and with mobility constraints, increasing costs and dependency on others put elderly in difficult and delicate situations. Knowing the challenges faced by elderly, an affordable home healthcare system should be implemented. AMI B.O.L.T – An AMI Wellness Initiative is a patent pending unique solution that supports elderly with their wellness initiatives B.O.L.T helps senior citizens to take the vitals periodically at their home comfort and shares the details of the same with their physicians, specialists, near and dear ones at a click of a button. B.O.L.T has built-in scheduler for periodic vitals collection and can build custom alarm reminders to regularly take medication on time. With the mobile interface, one can extend it to provide facility to order medication and food online, have video chat with doctors and dear ones. With mobile having built-in support for Internet, email and entertainment system to listen to music and watch videos, senior citizens can relax at home and have all the facilities at their fingertips. Healthcare institutions like Astermed City, Portea Medical Center and several others have integrated AMI B.O.L.T with their healthcare applications to provide the best care possibly for the elderly. For more information visit: www.amibolt.com
april / 2015 ehealth.eletsonline.com
43
Industry Speak
NAVA: Redefining Mechanical Ventilation Neutrally Adjusted Ventilatory Assist (NAVA) is a new approach to mechanical ventilation based on neural respiratory output, says Eric Noronha, Manager-Operations, TBS India Private Limited to Elets News Network.
T
he act of breathing depends on rhythmic discharge from the respiratory centre of the brain. This discharge travels along the phrenic nerve, excites the diaphragm muscle cells, leading to muscle contraction and descent of the diaphragm dome. As a result, the pressure in the airway drops, causing an inflow of air into the lungs. Conventional mechanical ventilators sense a patient’s effort by either a drop in airway pressure or a reversal in flow. The last and most slow reacting step in the chain of respiratory events is used to sense the patient effort, creating a system that is sensitive to hyperinflation, intrinsic PEEP (positive endexpiratory pressure) and secondary triggering problems. With NAVA, the Electrical Activity of the Diaphragm (EAdi) is captured, fed to the ventilator and used to assist the patient’s breathing. As the ventilator and the diaphragm work with the same signal, mechanical coupling between the diaphragm and the ventilator is practically instantaneous.
Some of the Potential Benefits Improved synchrony: In NAVA the ventilator is cycled on as soon as neural inspiration starts. Moreover, the level of assistance provided during inspiration is determined by the patient’s own respiratory center
44
april / 2015 ehealth.eletsonline.com
demand. The same applies for the cycling off phase – the ventilator cycles off inspiration the instant it is alerted to the onset of neural expiration. By utilising the EAdi signal, maintenance of synchrony between the patient and the ventilator is improved. Lung protection: With NAVA the patient’s own respiratory demands determine the level of assistance. It gives the opportunity to avoid over or under assistance of the patient. Unique monitoring capability: The EAdi signal is a new unique parameter in mechanical ventilation. It can be used as a diagnostic tool to monitor the EAdi. The EAdi curve
and its associated value can thus be used as a powerful monitoring tool in all ventilation modes, providing information on Respiratory Drive, Volume requirements and the effect of the ventilatory settings, and to gain indications for sedation and weaning. NAVA for infants: The EAdi signal provides a tool that allows the clinicians to interpret the background of the chaotic breathing pattern so often seen in the infants. The direct access to the respiratory center output gives prompt information on the effect of any intervention relating to ventilation of the lung. PEEP adjustment and the degree of unloading can now are based on informed decisions. Patient comfort: With NAVA, the respiratory muscles and the ventilator are driven by the same signal. The delivered assistance is matched to neural demands. This synchrony between patient and ventilator helps minimize patient discomfort and agitation, promoting spontaneous breathing. Decision support for unloading and extubation: The EAdi signal can be used as an indicator to set the support level from the ventilator, and to optimize unloading. As the patient’s condition improves, EAdi amplitude decreases, resulting in reduction in ventilator-delivered pressure. This pressure drop is an indicator to consider weaning and extubation.
4 HLF 2015
Event Report
A Peep into the Future of Healthcare
The all-pervasive medical technology has been aiding the Indian healthcare sector well, taking the industry to the next level in service delivery. However, some challenges still remain, and the stakeholders are earnestly pushing the agenda forward. In recognition of the excellent work done by the major healthcare centres, Elets Technomedia Pvt Ltd organised the 4th Annual Healthcare Leader’s Forum (HLF) on March 12, 2015, at Hotel Royal Plaza, New Delhi. Here, we try to bring you the bird’s eye view of the Indian Healthcare Industry from HLF 2015. 45
april / 2015 ehealth.eletsonline.com
april / 2015 ehealth.eletsonline.com
45
Event Report
HLF 2015
NB Dhal Joint Secretary, Ministry of Health and Family Welfare, Government of India Some of the states like Gujarat and Tamilnadu are at an advanced stage of IT in various areas. We have so many national level systems like the Mother Child Tracking System (MCTS), the Health Management Information System (HMIS), the Integrated Digi Surveillance Programme (IDSP), etc. One of the issues is of the privacy and confidentiality of the patients’ health records. We are basically of the view that we need a special legislation in this regard. The National Knowledge Commission way back in 2007-08 spoke about establishment of National Health Information Authority. BJP’s manifesto talked about National e-Health Authority. It is to promote standardisation and ensure that the electronic record is actually made available. Further, we are emphasising an integrated health information system, and we will start with the public healthcare system. The five focus areas for this initiative would be Health Information System (electronic health record); National Optical Fibre Network; Government User’s Network; National Information Infrastructure (NII); and UID (Unique ID). Basically, the user should be at the core of development. We will be really promoting open source and open standards to some extent.
Naveen Jain Mission Director, National Health Mission, Ministry of Health and Family Welfare, Government of Rajasthan Sometimes, thinking like a common man gives an innovation. Rajasthan is the largest state now with 3.42 lakh sq km of area, with a population of seven crore residing in it. We are having over 17,000 institutions, including 14,000 sub centres with around 100 district hospitals and subregional hospitals. We are the State with very high Maternal Mortality Rate (MMR) and Infant Mortality Rate (IMR), but a bad Total Fertility Rate (TFR). Expectations from e-governance in healthcare includes more use of IT by doctors and make their accounts on the National Health Mission expenditure. Around 5-6 years back, the IT solutions was implemented by the Government of India. In government sector, development of software is only 10 percent. It takes care of only 10 percent of your problem. 80 percent, it is implementation strategy for how people will take and sustain it. The challenge is to fund the activities later on. In last ten years, we saw various e-governance initiatives taken by various governments. Currently, we have implemented some of the initiatives. These include AshaSoft, HMIS, e-subalaxmi, SNA database/website and e-Aushadhi for free medicine amongst others. We are also making a software called e-upkaran, and in our budget it has been announced that we will implement it. We have prepared the software and we are ready to share it with the Government of India too.
46
april / 2015 ehealth.eletsonline.com
Kavita Singh Director-Finance (National Health Mission), Ministry of Heath and Family Welfare, Government of India Today, the public, private and government sectors all work in convergence and come out with the model that with minimum resources we have, we go ahead with some results. Burden of infant mortality rate and maternal mortality rate still exists. We have reduced it drastically, but it still exists. On the other side, when you see communicable diseases, they are still a burden on us. In addition to it, 56 to 60 percent deaths are caused due to these. Even an approach that we look, whatever is the private sector or the government sector, we synchronise and go ahead or we look for all options. Even domestic budget and external aid component till March 2015 was `1500 crore. It has now come down to `400 crore. So, the support we were expecting from the international agencies is being stopped. It is a signal that we need to enhance our budget. Further, we are empowering states by shifting more budget to states as health is a state subject.
HLF 2015
Dr Madhu Raikwar Director and Head, Central Bureau of Health Intelligence, Directorate General of Health Services, Ministry of Health and Family Welfare, Government of India We are in a baby boom at the point of this time. But over a period when the expected age will be increasing, that time we will be having real trouble for the ageing population and we have to cater for their needs. In this area, the technology is going to play a big role when devising some kind of tool where they are more appropriate for the geriatric population. But then we have to look into the economic part of this also. We have to prioritise the needs based on whether this is cost-effective method as compared to the basic health needs. India’s expenditure on health is around 4.8 percent of total GDP and where government is spending only 1.6 percent. There is a huge rural population in India which is 69 percent. Only 31 percent stay in urban population and a major chunk of it is urban poor. So, we have to keep in mind all these factors and there are several issues like, accessibility, availability, affordability, which need to be addressed. Only then, we can talk about the latest technologies and the way they are going to be feasible in India also.
introduce big plans in terms of information and communication technology (ICT) but it fails to get implemented and the time and money goes out for waste so the basic plan we have is to think big what we can do practically in a high volume situation that occurs usually in AIIMS.
How do you keep your medical staff updated in Deepak Agarwal Chairman, Computerisa- terms of new ICT? tion, AIIMS, New Delhi We in academic institutions What are your best practices in keep AIIMS updated in terms of technology? The best practice for me is to have an implementable plan. A lot of people try to
such as AIIMS have lot of information portals and we have created a new group of nurses called ‘Nursing Informatics’. The primary objective of the group is to keep the medical staffs, doctors updated about the
Event Report
Dr T Sundararaman Executive Director, National Health Systems Resource Centre, New Delhi We are looking back and forth on the exclusive development of the application of Information and Communication Technology (ICT) in the area of public healthcare. In 2005-06, when National Rural Health Mission (NRHM) was starting, there were very few functional systems at that time. In 2008, we regularised our routine presentations so that from 600 districts, monthly district report to the delivery of services in public hospitals started coming. By 2007-08, we have gone to 5400 block hospitals and by 2011, we were close to dealing with 200,000 facility-based reports. The expectations of information technology have greatly changed. Under the universal healthcare, and in the Government of India, there are many interesting moves towards international health assurance mission that is in the coming. That is a new draft called National Health Policy, which has a major section on Information and Communication Technologies and there are lot of expectations that the government has from the IT industry to be able to afford its growth and its delivery. latest tools we implement in the institution regularly. They also inform the staff about the medical portals we introduce along with the implementation of the technology.
the current modern era.
Where do you see the healthcare sector in coming five years?
I am sure that there will be a revolution in the coming five Do you think it is the right years and if they continue to time for healthcare sector implement the technology in the same pace then by 2020, to implement the best IT India will be forefront in the tools? healthcare technology as good Yes absolutely, it’s the best as the healthcare companies time for implementation from the western countries of the latest IT techniques are performing. in the healthcare sector. We are already in terms of IT implementation in our How was the healthcare organisation. The best thing leaders’ forum organised about current era is almost by Elets technomedia? everybody in knowing about The event was very good and technology especially like brought very useful informaTwitter, Facebook, WhatsApp, tion from the different players which keeps everyone ahead in on the market.
april / 2015 ehealth.eletsonline.com
47
Event Report
HLF 2015
Dr Girdhar J Gyani Director General, Association of Healthcare Providers (India) The universal health coverage has four characteristics availability, affordability, accessibility and acceptability. As far as availability and accessibility is concerned, India is doing very well now. However, the problem is affordability and accessibility. Acceptability is by the standards. If you want universal health coverage by the government, the fundamental is, the government must spend 50 percent or more money in the healthcare, which it is not doing today. But, thanks to the private sector which is coming in a big way that very soon we will be able to meet this universal health coverage. The World Bank Report which came last month says that 50 percent population of India is being covered under one or the other insurance because many state governments have launched their own insurance schemes.
Dr Shakti Kumar Gupta Medical Superintendent, All India Institute of Medical Sciences (AIIMS), New Delhi Lots of changes are occurring as far as health delivery is concerned. There are certain essential healthcare services criteria. First and foremost is efficacy of the technology. Second is effectiveness, that how effective the technology is. Third is that how many people get access to the technology and how many can afford it. Apart from that, whatever technology we implement in the healthcare whether it is acceptable to our healthcare people who are providing services, the doctors and the patients. In addition to it is the issue of cost-effectiveness and the social ethical impact. The safety and capability, and the result we want to achieve with that technology and the therapeutic impact this technology is going to have on the patients. In our hospital, doctors demand high technologies. One thing we need to keep in mind is that we must balance the wishlist of the healthcare industry, the needlist of the professionals. Above all, the most important is the wantlist of the patients. We have to keep a balance among all these.
48
april / 2015 ehealth.eletsonline.com
Gunjan Kumar Chief Information Officer and Head- New Initiatives, Regency Healthcare Almost 18 months back, we decided that we have to scale a big way. We came up with RenalCare Hospital ad exceeded 105 successful kidney transplants. Our role was to bring up three more institutions. One was the rapid deployment model. We opened up this centre with 13 dialysis machines, a diagnostic centre and OPD clinic. This was the model we planned to deploy in 16 cities. We are also setting up a cancer oncology centre with surgical oncology, radiation oncology, medical oncology, as a joint venture with HCG. Another is a multispecialty secondary care hospital. The approach for agile was to have a disconnect development from the existing ERP, speak to the users, develop a very legitimate solution as a pilot project and then venture into other areas. Further, we brought in a model wherein people will be giving feedback. So, the application throws the relevant information to the relevant stakeholders. The voice file also has an escalation matrix, it gets thrown to a couple of specific people. We have a proper feedback mechanism wherein we get back to the patients, speaking to them touching the base. We feel that yes, we have addressed and this is what we are doing completely on open source.
HLF 2015
Event Report
UK Ananthapadmanabhan Group President, Rainbow Hospitals, Hyderabad In the year 1983, the government realised that it cannot pay for the entire healthcare. Thus, it allowed the corporate healthcare to enter and it was that time when Apollo Hospitals came in. Further, it was the first time the government allowed the financial institutions to fund the healthcare. An amount of Rs. 17 crore was given by ICICI and IDBI and the hospitals started coming in. After ten years, the second generation hospitals like Tamilnadu Hospital came in. They are also funded by the financial institutions like ICICI and IDBI. Prior to 2010, 70 percent was handled by the government and 30 percent by the private healthcare. Later, the private hospitals started handling 60 percent of healthcare and 40 percent is handled by the government. The hospitals which were multi specialty became specialty hospitals. When such a thing happened, the governance also put lots of technology in place. The landscape of entire healthcare in India changed completely. Now, we are on a threshold of great revolution and transformation.
Dr Neena Pahuja Director General, ERNET India We still have very few hospitals which have got recognised due to some of the problems faced by the healthcare industry. However, we all have heard about IT helping healthcare. A report by BBC suggests that the death rate has actually gone down by 17 percent among emergency patients, which means 16000 deaths are preventable in a hospital. The number of footfall in AIIMS is very high. One of the systems implemented in AIIMS also has facilities of ensuring that medication energy can be tracked. Reduction in medical error is also there. It is reduced by half. We always talked about not enough doctors in India. Now, we are talking about opening a large number of medical colleges. We have 1.4 doctors per 1000 population, which is rarely low. Further, patient to hospital bed ratio is 0.9 per 1000 in the country. We have 1.4 doctors per 1000 population. Can technology help in increasing the ratio in the next 10 to 15 years? Can we electronically transfer the data of patient to a place where it can be analysed? We as a
team have to think of solutions to improve the situation. Also, during pregnancy there are many women who are unable to reach the hospital for regular checkups. We have seen a system wherein people come to your house and take the blood samples. The concept of mobile X-rays, mobile ECGs is a part of diagnostics, which can actually send the data to cloud which can further be analysed over a period of time. We cannot take the hospitals to the patients, but we can take some of the diagnostics to the patients who are unable to travel. Digital India, one of the initiatives started by the Prime Minister Narendra Modi is also a great help in the healthcare domain. The world is changing, and
through a part of the Digital India Initiative, we are preparing ourselves to be ready for this new changing world. Years ago, the e-commerce projects were being established. Some of them worked, some did not. However, today e-commerce is working so well and making money because now we are ready from the connectivity point of view. We have Internet of Things (IoT), Internet of places. What we do not have is something which is one cloud of data of patients. If we have it, we will be able to create lots of drugs very easily. Some tools are there which say that this is the condition, then this should be the medication and the doctor can reconfirm. Artificial intelligence will come in, which will be able to create thousands of doctors. There is a concept of three Cs: Connectivity, Collaboration and Cloud, which will be taken to medical facilities. Hospitals and healthcare trends are changing. We are also working on ERNET and the national policy of IoT. The data could go by bluetooth, and other protocols. But, if you combine these data coming from a body to sense to a hospital or a doctor or a portal or ambulance, this is how things will go.
april / 2015 ehealth.eletsonline.com
49
Event Report
HLF 2015
D P Saraswat CEO, Sri Balaji Action Medical Institute & Action Cancer Hospital, Delhi What are the challenges faced by healthcare sector, in terms of Information Technology? The challenges we faces are the rising cost day by day and over population because being in Delhi/NCR, people from other neighbouring states prefer coming to us for treatment. So giving the best technology for treatment to such large number of people is a big challenge for us. Along with this, the cost of technology is becoming so expensive that it has to be taken care of. We need to keep up a pace in the sector so the prices of the technology should be rationalised or should be cost effective. The services have to affordable for people and accurate.
According to you, what more needs to be done in Healthcare in the coming five years? The major challenges we have been discussing is accessibility. Can people afford the services offered and what they really need at that moment. So firstly the services of the healthcare sector needs to be made more affordable for the people. So that the person pay for their treatment according to their capacity and do not have take from someone else.
Do you think technology will help in reducing treatment cost for the patients? Yes, certainly. Lots of medication errors have corrected in automation, identification, drug giving to the person so the human errors are eliminated. The patients can check their all information related to treatment, medicine given, treatment given and test done online so that they can get it authenticated from others also and it will help us indeed in increasing speed and accuracy as more and more work is done when its paperless.
What has been latest technology tools implemented by Action Cancer Hospital? We are introducing the next level of electronic health records to ease our team as well as patients to keep themselves updated about their details and data. This would also help in sharing the past records of the patients if asked in future.
50
april / 2015 ehealth.eletsonline.com
Kapil Mehrotra Head-Information Technology- Artemis Hospitals, Gurgoan What has been the latest IT tool implemented by Artemis hospitals? The best thing we have adopted in our organisation is cloud. Secondly the digitisation has been our second biggest achievement in terms of IT. Company was facing lot of problems in terms of storage of data and records. In order to get rid of the same problem, we have recently adopted a cloud and it has been great help for us. The reports have lot of images, so we have designed a system to take them down on cloud.
According to you, how has been the adopting of ICT in healthcare sector? The adoption of IT is the healthcare has been remarkable so far. The first thing that has to be done is to create more awareness across the market. Selecting the toughest problem in your organisation and using IT tools to solve that issue can improve the IT scenario in the country. This is what we have done in Artenis Hospital.
How often you train your medical staff about ITC tools? I do a program in Artemis called ‘Know your IT’ where all the medical staff from the Artemis hospital participate and learn every month about the IT tools. The main objective behind this program is to educate the staff about how these told can make their work faster and more accurate.
What new technology would Artemis hospital roll out in 2015? We would be bringing all our data on cloud storage. The main reason behind this step is to help the research team. They would easily get the data, facts and reports for better research in short period of time. A proper training program would be conducted for knowledge on how to get data from cloud storage. Data like how many were treated, how many operations happened in a month would be available there.
How would you rate the Union budget 2015? I am really impressed with the budget 2015 as it has allotted sufficient budget to the healthcare sector. This budget is more focusing on telemedicine. Telemedicine is a program in which user can take the appointment online, instead of coming directly. They can share the reports with doctors with the help of telemedicine.
HLF 2015
Narendra Saini Member, Delhi Medical Council, Delhi What would you say about the adoption of IT in healthcare sector so far? IT services are slowly coming up in India. IT services should be used as it is more controlled but at present it comes at a huge cost. Cost has been a important challenge in terms of its adoption. It is the most useful tool for data generation but it should be at standardised rates.
How would be the market scenario in 2020 for IT adoption? The market’s IT scenario would be quite progressive in the coming 5 years and if it becomes more affordable for the healthcare sector, It would really cover more of the market because it becomes very easy for people practicing in remote areas and he can easily expand his reach.
Do you think India has reached to a maximum time, where they need to adopt IT services?
Event Report
Yes, completely, for the knowledge of the doctor, medical staff it is much necessary to learn about It tools. IT plays an important part in reaching to the Tier II and Tier III cities. It covers all the aspects in healthcare sector.
How do you plan to train your staff about latest IT tools? The only way to update people is by organising workshops and providing them those tools. In the workshop, they were providing all basic knowledge on how to use the IT tools for ease and accuracy. We also keep in mind that those tools are available in the infrastructure so that they keep learning more about that.
What would you say about Union budget 2015? I was disappointed with the Union budget as we were expecting more in this budget. In the last budget around 39000 crores was allotted to the healthcare sector but this year it has been reduced by 6000
crores to around 33000 crores. How would reducing of budget help the population in getting proper medical treatments
Can technology play an important role for cost effective solutions? The things become faster and easier with the help of IT. In diagnostics, the time frame for making of reports has reduced to a larger scale, which has also reduced the cost of manpower.
Arvind Sivaramakrishnan Chief Information Officer, Apollo Hospitals, Chennai As Chief Information Officers, we are responsible to advise our organisations on the right use of ICTs in transforming healthcare, what is realistically possible. The easy enemy around it is the budget. But, what is technology that is actually used in organisations where we can transform healthcare for the right direction? How important is it to connect the patient and the provider, the provider and the patient? The patient wants to be connected to the provider, but many a times, it is the provider wanting to be connected to the patient. How important is technology as we streamline patient experience? Since the doctor’s experience is indeed valuable, clinical excellence is exactly why we go to a hospital. It is why we embark on the healthcare journey. No hospital is Disney land, and we are now transforming healthcare using technology in an industry that demands the highest level of services.
april / 2015 ehealth.eletsonline.com
51
International News
Apple Introduces New Apps to Revolutionise Medical Studies
A
pple introduced ResearchKit, an open source software framework designed for medical and health research, helping doctors and scientists gather data more frequently and more accurately from participants using iPhone apps. Various research institutions have already developed apps with ResearchKit for studies on asthma, breast cancer, cardiovascular disease, diabetes and Parkinson’s disease. Users decide if they want to participate in a study and how their data is shared. ResearchKit turns iPhone into a powerful tool for medical research. The apps can access data from the Health app such as weight, blood pressure, glucose levels and asthma inhaler use, which are measured by third-party devices and apps. HealthKit is a software framework Apple introduced with iOS 8 to provide developers the ability for health and fitness apps to communicate with each other. Developed by the Icahn School of Medicine at Mount Sinai and LifeMap Solutions, the Asthma Health app is designed to facilitate asthma patient education and self-monitoring, promote positive behavioral changes and reinforce adherence to treatment plans according to current asthma guidelines.
The Share the Journey app, developed by the Dana-Farber Cancer Institute, Penn Medicine, Sage Bionetworks and UCLA’s Jonsson Comprehensive Cancer Center, is a research study that aims to understand why some breast cancer survivors recover faster than others, why their symptoms vary over time and what can be done to improve symptoms. Developed by Stanford Medicine, the MyHeart Counts app measures activity and uses risk factor and survey information to help researchers more accurately evaluate how a participant’s activity and lifestyle relate to cardiovascular health. Massachusetts General Hospital developed the GlucoSuccess app to understand how various aspects of a person’s life—diet, physical activity and medications—affect blood glucose levels. Developed by Sage Bionetworks and the University of Rochester, the Parkinson mPower app helps people living with Parkinson’s disease track their symptoms by recording activities using sensors in iPhone.
Biomedical Systems Unveils New ePRO Technology
B
iomedical Systems has introduced new electronic patient recorded outcome (ePRO) technology, second generation clinical outcome assessment software that provides three easy-to-use platforms to collect patient data. The new ePRO technology is said to improve patient compliance and enhance study setup by simplifying site tasks and reducing errors. According to Biomedical Systems CEO Tim Barrett, the eCOA market is growing fast, and launching this technology enhances our ability to offer centralised diagnostic services. The firm’s electronic clinical outcome assessment (eCOA) technology is used for clinical trials in around 40 countries for multiple therapeutic areas such as respiratory, gastrointestinal, dermatology, oncology and women’s health.
Smiths Medical’s Snuggle Warm Blanket for Surgical Patients
S
miths Medical, a medical device manufacturer has introduced a new snuggle Warm poncho-style convective warming blanket for pelvic, abdominal, and lower extremity surgery patients. The warming blankets help maintain the patients body temperature before, during, and after surgery and allows full access to those areas. The Snuggle Warm poncho blanket warms the patient’s back, shoulders and chest. The blanket can also be reversed for use before or after surgery, in a bid to warm the front of the patient’s torso as well as the shoulders and upper back. According to the company, the blankets are made of soft, flexible and durable material and conform to patient anatomy for maximum heat retention and comfort.
april / 2015 ehealth.eletsonline.com
53
National News
Becton Dickinson Completes Acquisition of CareFusion
M
edical technology company Becton Dickinson has completed the acquisition of CareFusion Corporation pursuant to the terms of its previously announced agreement and plan of merger. Vincent A. Forlenza, BD’s Chairman, Chief Executive Officer and President, said, “We are very excited to announce the consummation of the CareFusion acquisition, as it represents a major milestone in BD’s 118-year history. This acquisition significantly accelerates BD’s strategy and builds scale and depth in medication management and patient safety solutions. We look forward to the future with confidence as we become one of the largest global leaders in medical technology, and are better positioned to partner with healthcare providers around the world to provide safer, more economical and improved care.” Pursuant to the terms of the Merger Agreement, upon completion of the acquisition, CareFusion became a wholly-owned subsidiary of BD and each outstanding share of common stock, par value US$0.01 per share, of CareFusion (other than shares with respect to which appraisal rights have been properly demanded and not withdrawn) was converted into the right to receive - US$49.00 in cash, without interest and 0.0777 of a share of common stock, par value US$1.00 per share, of BD. As a result of the completion of the acquisition, CareFusion shares will cease trading, and will be delisted from the New York Stock Exchange.
PM Health & Life Care Steps into Online Health and Lifecare Venture
P
M Health & Life Care (PMLC) promoted by former iGate CEO Phaneesh Murthy plans to launch an online market place for healthcare products and services. The venture aims to connect chemists and druggists with consumers. The company has been co-founded by four other technologists, handling different business functions from technology to back-office support. Murthy is going to play the role as Executive Chairman. As per reports the technology can connect chemists, druggists, consumer hospitals and diagnostic centres, which would help in increasing and availability of drugs. The information of patients can be stored in the cloud with adequate security built into the solution to safeguard patient confidentiality.
Carestream Sells 100th Vita Flex CR System within Two Months of Launch
C
arestream Health India has sold its 100th Vita Flex CR System, which was launched in January, 2015. Carestream Health’s engineers used innovative design methods and components for the Vita Flex CR platform, which combines high image quality with reliability, a compact footprint and an affordable price tag. According to Sushant Kinra, Managing Director, Carestream Health India, the sales have exceeded the expectations and has boosted company’s production
54
april / 2015 ehealth.eletsonline.com
capacities to keep pace with the increasing demand. The customers have appreciated the improved performance and image quality offered by this tabletop CR system. Easy installation and reduced
service cost is add on to customers delight. The company’s Vita Flex CR system is being used by independent imaging centers, clinics, multiphysician offices, hospitals and orthopedic facilities who want an affordable, compact CR system that is easy to use. The Vita Flex CR system weighing 25 kgs and is smaller and lighter than many other tabletop CR solutions. It is flexible enough to be operated vertically as well as horizontally, and can process CR cassettes sitting on the floor, a tabletop or desktop or
even from the back of a van. Dr Abhijit Agashe an Orthopedic surgeon from Agashe Clinic, Pune, one of the users of Vita Flex CR System feels that VITA Flex CR system is suitable for both centralised and decentralised workflow environments and can be used right in the exam room. Dr Saji Varghese, Director of Mangalam Diagnostic Center, Kottayam Kerala said Vita Flex CR system provides fast and easy access to quality images allowing them to manage increase in patient throughput.
eHEALTH Magazine
Knowledge Exchange
INDIA’S PREMIER ICT EVENT
2015
KNOWLEDGE EXCHANGE, Higher Education
2015
dig
ita
lL
EA
RN
ING
6th Annual
Government Desk
Four Government Medical Colleges in Tamil Nadu
T
he State and Central Governments have sanctioned `451.60 crore to four government medical colleges in Tamil Nadu to address deficiencies pointed out by the Medical Council of India (MCI). A team from council had visited the colleges during January to assess their proposals for addition of MBBS seats. The total capacity addition proposed in these four colleges is 345 seats. The Central Government will contribute `289.80 crore with the State Government pitching in the rest. Health Secretary J. Radhakrishnan has directed the Directorate of Medical Education to submit proposals for addressing the shortcomings pointed out by the Council. An Empowered Committee of Union Ministry of Health and Family Welfare had met in New Delhi recently and approved the State Government proposal
for capacity addition in the four colleges. Following this, a team of assessors from the MCI inspected the colleges and pointed out shortcomings in teaching faculty and infrastructure such as buildings, equipment and staff. The funds now sanctioned would be used to address the issues raised by MCI. The four colleges are the Government Kanyakumari Medical College, which had sought an increase in seats from 100 to 150 seats, Coimbatore Medical College (from 150 to 250 seats), Government Tirunelveli Medical College (from 150 to 250 seats) and Madurai Medical College (from 155 to 250 seats). Two hundred and fifty is the maximum number of MBBS seats for a Government medical college in India. The Coimbatore Medical College will receive `120 crore to take
up development and expansion works. Hospital officials said that the works include establishment of a multi-disciplinary central research laboratory and an examination hall spanning 2,000 sq. mts. besides expansion of the central library and the hostel. A staff quarters would also be constructed. Sources said that with the plans already having been approved, construction would be taken up by the Public Works Department (Medical Wing) soon. The Coimbatore Medical College officials said that they were confident of getting the additional seats by for the academic year 2016-17. While the Government Kanyakumari Medical College has been allotted `91.60 crore, the government medical colleges at Tiruneveli and Madurai have been allotted `120 crore each.
Health Ministry Gives Nod to Materio Vigilance Programme
T
he health ministry has approved a Materio Vigilance Programme in an effort to ensure safety of medical devices. The proposed plan, to be coordinated by the Indian Pharmacopoeia Commission in Ghaziabad, envisages a nation-wide programme, involving district hospitals, medical colleges and corporate hospitals. The biotechnology wing of the Sree Chitra Thirunal Institute of Medical Sciences and Technology in Thiruvananthapuram is to be the national collaborating centre for the programme, which is to be run in collaboration with the Central
56
APRIL / 2015 ehealth.eletsonline.com
Drug Standard Control Organisation (CDSCO). Technical support for the programme is to be provided by the Division of Healthcare Technology, a proposed World Health Organisation collaborating centre for priority medical devices and health technology policy in the National Health Systems Resources Centre (NHSRC). The Materio Vigilance Programme of India (MvPI) is meant to enable safety data collection in a systematic manner so that regulatory decisions and recommendations on safe use of medical devices for India could be based on data generated here.
The programme is meant to monitor medical device associated adverse events (MDAE), create awareness among health care professionals about the importance of MDAE reporting in India and to monitor the benefit-risk profile of medical devices. It is also meant to generate independent, evidence based recommendations on the safety of medical devices and to communicate the findings to all key stakeholders. The Pharmacovigilance Commission is supposed to meet every three months to examine the reported adverse events and confirm the events to be reported to the drug committee. Based on these reports, a decision will be taken on whether any change is required in the labeling of the devices, or whether a recall or a ban on the product is called for.
Hospital News
Proposal for `160 crore 750 Beds Hospital in Kolhapur
T
he Rajarshi Shahu government medical college has proposed a 750-bed hospital in Shenda Park, Koihapur. As per reports the proposal of `160 crore will take at least a year to sanction. The college had acquired the Chhatrapati Pramila Raje (CPR) general hospital a decade ago. Once the new hospital proposal is approved, it could open the avenue to convert the CPR into district hospital. The college recently submitted a proposal to the Directorate of Medical Education and Research (DMER), the state’s apex body for medical education. This proposal will then reach the Union health ministry as DMER seeks central government funds. According to Dashrath Kothule, dean of the college, the proposal
was in consideration for the last couple of years and recently was submitted to the DMER. At present, the college is using the CPR as its primary hospital. Of the 669 beds in CPR, 550 are being used at all times. However, since the college has 150 students and the seats are likely to grow in future, the administration has proposed the new hospital. Civic activists have been demanding the conversion of CPR into a district hospital since the last five years. With the formation of the CPR Bachao Kruti Samiti last year, the demand was presented before state’s medical education ministers. The Samiti welcomed the proposal of new hospital and expects more funds for the CPR will flow after the change.
300-bed Cardiac Speciality Hospital in Offing at Pailam
A
n assistant professor of cardiology at IPGMER and SSKM hospital plans out a 300-bed cardiac care superspeciality hospital at Pailam, South 24-Parganas. Dr. Saroj Mandal, plans to build the hospital on three acres of land near Chak Balaibag at Nepalgunge, Pailan and run it on a no-profit no-loss basis. The project is expected to be completed within next 2-3 years. The 24X7 hospital will associate itself with around 30 specialists to be benefitted by the middle-class. The hospital is also planning to carry out tests on patients at 30-40 percent of the cost one would incur at a private set up outside.
TMC signs Mou with Punjab Government for Cancer Hospital
T
ata Memorial Centre (TMC) Mumbai has signed a Memorandum of Understanding (MoU) with the Punjab Government for setting up Homi Bhabha Cancer Hospital (HBCH) at Sangrur. According to the pact, HBCH would be set up at Civil Hospital, Sangrur and would act as an outreach facility to the upcoming Homi Bhabha Cancer Hospital Research Centre at Mohali. The main aim of setting up HBCH was to set up a cancer care facility in District Civil Hospital, Sangrur for catering the population of the Sangrur and
other adjoining districts of the Malwa region. The HBCH would have 10 daycare bes, three Intensive Care Unit (ICU) beds, three recovery beds and eight inpatient beds. It will also be equipped with hiend cancer diagnostic and treatment facilities and RT treatments such as 3D-CRT, SRS, IMRT, IGRT etc. besides
having chemotherapy and surgical facility. The hospital is expected to cater 2500 and 3000 cancer patients in the coming four to five years.
April / 2015 ehealth.eletsonline.com
57
Product Launch
DX-D 40: It Only Takes an Instant to Go DR
T
he DX-D 40 Digital Detector with Automatic Exposure Detection (AED) offers a fast and effective way for radiography facilities to benefit from high quality digital imaging using any X-ray equipment.
The easiest way to go “instant DR” For both conventional and mobile digital X-ray systems, the DX-D 40 Digital Detector offers general radiography facilities all the advantages of direct digital imaging, while maximizing the use of their existing equipment. The Automatic Exposure Detection (AED) means no electrical connection to the X-ray system is required, for seamless use with virtually all X-ray systems. At 43x35 cm in size, the detector fits into any standard bucky tray and can be easily removed to ensure versatility for all exams. Wireless technology enhances operator comfort, and improves exam flexibility and convenience, even in challenging imaging situations.
Faster and more efficient workflow The DX-D 40 is an integral part of an Agfa HealthCare Instant DR solution, which includes the NX image acquisition software with MUSICA processing and detector. These cassette-less and filmless solutions provide a range of workflow benefits that improve productivity and speed up exam time. In its minimal configuration, the DX-D 40 instant DR solution delivers ultra-mobility: the use of AED technology and standard wireless communication can reduce the configuration to a DR detector and a laptop. You have
58
april / 2015 ehealth.eletsonline.com
cable-free, wireless and fully DR image acquisition instantly combined with an existing or new X-ray source. Both laptop and detector are battery-powered, so they do not require a power outlet. With this platform your mobile analogue radiography systems can be upgraded or retrofitted to ultra-convenient DR in a snap – without replacing your existing equipment. It even allows sharing of the DR imaging system with multiple X-ray systems.
MUSICA and DR image quality: Improved diagnostic confidence The DX-D 40 is compatible with our ‘gold standard’ MUSICA image processing, which has been specially adapted and tuned to further enhance the excellent DR image quality. Exam-independent, it delivers consistent image quality and high contrast detail. Combining MUSICA with the high quality of the DX-D 40, in terms of both sensitivity and sharpness, provides improved diagnostic confidence and efficiency. The choice of Cesium Iodide (CsI) or Gadolinium Oxy-Sulphide (GOS) detectors best meets your exam and budget requirements. Both detectors give you exquisite image quality with our industry leading MUSICA Image Processing, and CsI detectors offer the potential for radiation dose reduction up to 50 percent depending on conditions*, a benefit for radiation-sensitive patients. *Testing with board certified radiologists has determined that Cesium Bromide (CR) and Cesium Iodide (DR) detectors when used with MUSICA processing can provide dose reductions of between 50 to 60% when compared to traditional Barium Fluoro Bromide CR systems. Contact Agfa HealthCare for more details.
Product Launch
Advances in Neumovent Ventilation Technology
T
echnology is advancing each day and leading to the advent of sophisticated features and different modes of mechanical ventilation. Efforts to reduce morbidity and mortality have led clinicians to use a lot of ventilatory support modalities. Realising the clinicians’ and technicians’ increasing need for ‘Ease-of-Use’ of advanced modes, Schiller India with Tecme has introduced innovative, yet simple to use ventilation modes in Neumovent ventilators like MMV, Bi-directional Apnea, keeping the critically ill patient in mind. The new modes and techniques of ventilation provide much needed alternative ventilatory support for the patient. Reduction of airway pressure, improved oxygenation, recruitment of alveoli, and redistribution of ventilation are the major advantages of these new modes. Neumovent provides all these advanced respiratory mechanics, which operate as standard features, resulting in a significant reduction in mechanical ventilation time and total hospital expenses.
Most Useful Creative Modes l
MMV+ PSV-spontaneous Mode with MV target. PSV level is adjusted according to patient TV & RR. l Bi-Direction Apnea - VC-Volume Support Mode, PCPSV mode & Vice Versa.
Advanced Respiratory Machines l
Trapped Volume and AUTO PEEP RSBI Index, C, R l Slow Vital Capacity l Negative Inspiratory Force (MIP) l Occlusion Pressure (P0.1) l
l
Imposed work Of Breathing (WOBi)
Extremely Reliable Sensors and Pneumatics The Neumovent ventilators operate with proportional solenoid (PSOL) valves (5th Gen). These valves help improve synchrony by taking active control of exhalation, which ensures precision and flexible breath delivery. Its solid state pneumatic with minimal internal tubing, helps lower the running cost of ownership spread over the life cycle of the product. l Active exhalation valve to preserve spontaneous breathing at all the time l Highly accurate and inexpensive differential pressure sensing technology l Proximal flow sensor for neonatal ventilation
Integrated Advances Feature l
12 inch large display with loops and graphics Integrated nebuliser l Volumetric capnography l Automatic ET Tube Resistance Compensation (ATC) l P/V Flex Calculation l Downloadable Trends Data The uniformity of the product helps the hospital in minimising the cost of training (for the nursing staff and biomedical engineers), consumables, maintenance, servicing, and the like. Schiller India offers variety of models like mid to high-end, universal to dedicated, transport and HFOV, which cover all the segments in critical care units. This enables Schiller India to provide a total respiratory solution to various departments and segments of the hospital. l
april / 2015 ehealth.eletsonline.com
59
Product Launch
Hb–Vario - Latest System for Diabetes Management
T
ransasia Bio-Medicals Limited, an in vitro diagnostic company has been offering the highest quality diagnostic solutions for precise disease detection since more than thirty five years across various segments. The newest addition to the Transasia’s product range is HbA1c & HbA2/F, which is a fully automated analyser. India has earned the dubious distinction of being the ‘next diabetes capital of the world’. It is estimated that millions of diabetics in India are carrying the disorder and hence having complications of uncontrolled diabetes. HbA1c is related directly to risks for diabetic complications and hence used routinely to monitor long-term glycemic control in people with diabetes mellitus. The newly introduced Hb-Vario comprises HPLC with unique CLE technology. The patented CLE technology enables complete elimination of labile glycohemoglobin thereby ensuring accurate HbA1c results. This product has been developed in Europe after years of research and HbA2 is in the final stages of development. High Performance Liquid Chromatography (HPLC) is still considered as the gold standard method for determination of HbA1c.
Key features: The analyser measures HbA1c in approximately 3.5 minutes. l Sampling from multiple sizes primary tubes, including micro capillary collection tubes. l Dual pump technology providing meticulous system control, resulting in exceptional accuracy and precision l Unique CLE technology enables complete elimination
l l l l
l
60
april / 2015 ehealth.eletsonline.com
l l l l
of labile glycohemoglobin thereby ensuring accurate HbA1c results. Capable of giving true HbA1c values in presence of Hb S, Hb C, HbD, &Hb F No interference of Hb F up to 10 percent CE, NGSP-certified and traceable to IFCC reference method. Large color touch screen, in a compact footprint enables user friendly operation. Automatic barcode identification of samples and RFID identification and tracking of reagents. IFCC traceable calibrators and controls. On board Quality control functions with Levey Jennings and statistical calculations. Unlimited storage of calibration, QC data and chromatograms.
Product Showcase
iSpO2 Converts Smartphone into Pulse Oximeter
i
SpO2 is a revolutionary design from the global leaders of pulse oximetry which converts a smart mobile device into a pulse oximeter. It is available for a variety of android and iOS devices. The iSpO2 pulse oximeter allows you to noninvasively track and trend blood oxygenation (SpO2), pulse rate (PR), and perfusion index (PI). The iSpO2 application can be installed on android and iOS devices. Pulse oximeters have been long plagued by inaccuracies, especially in the out of hospital settings, where patients and caregivers have had to rely on not so accurate finger clip pulse oximeters. iSpO2’s key USP is that it combines the convenience of a spot check pulse oximeter, with the technology and quality of a hospital grade device. Masimo’s iSpO2 operates on the same signal extraction technology SET found in hospitals worldwide and is considered to be the gold standard in reading through motion & low perfusion. SET pulse oximetry technology is the most sought after technology and is available with leading patient monitoring manufacturers spanning the globe, such as Atom, Drager, GE Medical, Medtronic, Mindray, Philips, Spacelabs, and Zoll. iSpO2 can help you track and trend up to 12 hours of measurement. The intuitive next generation interface of the app allows you to view the history and e-mail the file with the measurements, facilitating in remote assessment. The design has been praised by the industry for its
Key features The iSpO2 pulse oximeter comes in six versions— small and large options for the lightning and 30 pin connectors (iOS devices) and micro USB (Android devices). l Signal I.Q. to assess measurement confidence l Operates with either iOS or Android devices l Ability to email up to 12 hours of measurement history and share that data through email l Portable, lightweight and comes with a carrying case l Measures oxygen saturation and pulse rate during movement, even under challenging situations such as low blood flow to the finger l One year limited warranty
portability and compact design. The device also has a real time display of pleth waveform. iSpO2 has been designed to be used by a large crosssection of people that would include caregivers, people with respiratory disorders, sports and fitness enthusiasts and more importantly as a general health monitoring tool for daily use by every individual. Available on all leading e-commerce websites- Flipkart, Amazon, Snapdeal and Healthkart.
april / 2015 ehealth.eletsonline.com
61
Pharma Buzz
‘Make in India’ Enters Pharma Sector
T
he government in order to include ‘Make in India’ in pharmaceutical sector had constituted a committee under the chairmanship of Secretary, Department of Health Research. The mandate of this committee was to carefully study the whole issue of Active Pharmaceutical Ingredients (APIs) of critical importance by identifying important APIs and then working out a package of interventions, concession required to build domestic
‘Jan Aushadhi’ Stores to Sell Generic Drugs for Less
Cipla’s Sofosbuvir to treat Hepatitis C in India
T
C
he government’s ‘Jan Aushadhi’ stores would now provide generic drugs at 20-30 percent lesser cost of its actual market price. According to Union Minister for Chemicals and Fertilisers Hansraj Gangaram Ahir, a total of 3,000 such drug stores are proposed to be opened at government district hospitals, public health centres at block level and medical colleges in the first phase. The government aims to open 50,000 such stores over a period of five years. The ministry would give a subsidy of `2.5 lakh to those selected to run these stores towards expenses to buy computer and show-case.
62
production capabilities and examine the cost implications. Besides this, with a vision to catalyse and encourage quality, productivity and innovation in pharmaceutical sector and to enable the Indian pharmaceutical industry, especially SMEs to play a leading role in a competitive global market, a scheme titled Cluster Development Programme for Pharma Sector (CDP-PS) is being implemented. The government has approved the National Pharmaceutical Pricing Policy-2012 and thereby has put in place a regulatory framework for pricing of drugs that would ensure availability of essential medicines at reasonable prices even while providing sufficient opportunity for innovation and competition to support the growth of industry, employment and shared economic well-being for all.
april / 2015 ehealth.eletsonline.com
ipla has launched a generic drug Sofosbuvir for treating chronic Hepatitis C under the brand name ‘Hepcvir’ in India. The availability of the product in other markets is subject to approvals from regulatory authorities in respective countries. Sofusbuvir marks a new era of medicines in oral treatment of Hepatitis C, which reduce the need for injectables. Earlier, pharmaceutical firm Dr. Reddy’s entered into an agreement with Hetero to distribute and market generic version of US-firm Gilead Sciences Hepatitis C drug under the brand ‘Resof’ in India. In India, around 12-18 million patients are estimated to be infected with Hepatitis C, which is several fold greater fold greater than those with HIV/AIDS.
The Flu and ARDS. Get the Facts.
ARDS results in an average mortality rate of 40% In 2009, H1N1 patient survival using HFOV alone was 80%
The right ventilator can help make the difference when treating flu related ARDS. Acute Respiratory Distress Syndrome (ARDS) is a severe lung infection with numerous causes, including the flu and pneumonia. With an overall average ARDS mortality rate of 40%,1 clinical experience suggests high frequency oscillatory ventilation (HFOV) may be beneficial when protective lung ventilation is failing.2 A retrospective analysis of the 2009 H1N1 at Duke University (USA) showed an 80% survival of H1N1 patients treated with HFOV.3 Clinicians should consider transitioning to the 3100B HFOV when a patient’s conventional ventilator settings are: a plateau pressure of 30 cmH2O, fraction of inspired oxygen (FiO2) of greater than 60%, and positive end-expiratory pressure (PEEP) greater than 10 cmH2O.4 In India, the 3100B HFOV is available only from CareFusion, a leading manufacturer of mechanical ventilators worldwide including the AVEA®, Vela®, and Infant Flow® SiPAP System. Don’t wait until it’s too late. Learn the facts about how the 3100B HFOV can help your patients now.
Contact your local CareFusion representative or our local office or visit carefusion.com/HFOV/flufacts.
carefusion.com/HFOV/flufacts References 1. Beigel, J. Influenza. Crit Care Med, September 2008, 36(9):2660-2666. 2. Acute respiratory distress syndrome website. Facts. 2014. Retrieved on October 6, 2014, from: http://ardsusa.org/facts/. 3. Norfolk, S., Hollingsworth, C., Wolfe C., Govert. J. et al. Rescue therapy in adult and pediatric patients with pH1N1 influenza infection: a tertiary center intensive care unit experience from April to October 2009. Crit Care Med, November 2010, 38(11):2103-2107. 4. Johnson J., Bachman, T. Refining and validating a risk assessment tool for HFOV rescue of ARDS patients. Respiratory Therapy, April-May 2007, 2(2):42-47. © 2015 CareFusion Corporation or one of its subsidiaries. All rights reserved. CareFusion and the CareFusion logo are trademarks or registered trademarks of CareFusion Corporation or one of its subsidiaries.
CareFusion India New Delhi Tel: 011-41422273 rajiv.julka@carefusion.com
Ezy MIC STRIPS TM
MIC
Determination
Strips
The Most Promising Diagnostic Tool for Healthcare Sector For MIC determination For Phenotypic Detection
2
1
3
Ezy MIC™ Strip can help you to 4
5
Determine the MIC of fastidious, slow-growing or nutritionally deficient micro-organisms Confirm/detect a specific resistant phenotype e.g. MRSA, ESBL, MBL, AmpC, VISA/hVISA.
1. 2. 3. 4. 5.
EM070 Cefepime Ezy MIC™ Strip EM097 Ceftriaxone / Sulbactam Ezy MIC™ Strip EM093 Cefepime / Tazobactam Ezy MIC™ Strip EM094 Cefoperazone / Sulbactam Ezy MIC™ Strip EM112 Cefoperazone Ezy MIC™ Strip Tested against E.coli ATCC 25922
1
2
Detect low levels of resistance. It provides high medical value to critical care cases to, refine or guide treatment decisions. Also helps in determining the choice and dosage of antimicrobials in patients with sterile site infections (e.g. endocarditic), severe nosocomial infections, chronic infections (e.g. cystic fibrosis) and immunosuppressed patients.
PACKING : Ezy MIC™ strips are available in a pack size of 10/30/60/90/120/150 Strips per pack. 1. Triple ESBL detection Ezy MICTM Strip (EM079A) 2. ESBL & AmpC Detection Ezy MICTM Strip (EM081A) Tested against known ESBL & AmpC positive strain
A-516, Swastik Disha Business Park, Via Vadhani Indl. Est. LBS Marg, Mumbai - 400 086, India Tel: 00-91-22-6147 1919, 2500 3747, 2500 0970 Fax: 6147 1920, 2500 5764, 2500 2468, 2500 2286 Email : info@himedialabs.com
www.himedialabs.com
CERTIFIED QUALITY CHEMICALS