eHealth Magazine June 2014

asiaâ&#x20AC;&#x2122;s first monthly magazine on The Enterprise of Healthcare

eHealth Magazine

volume 9 / issue 06 / june 2014 / ` 75 / US $10 / ISSN 0973-8959

Healthcare Leaders & ehealth.eletsonline.com

Game Changers Delhi NCR Special

Contents Policy

Special Focus

I C E CO ECT Connecting Technologies,Trends & Business

Infrastructure Construction Engineering

The

Viewing Healthcare Anew

editorial

Election manifestos become meaningless unless there is a core perspective of health. The government must do more than just talk about ‘Health For All’. Considering the emphatic mandate the Narendra Modi-led NDA government received, it becomes imperative for the government to deliver on its promises and commitments. The new government will have to prioritise its action plan for the next five years to ensure the economy upsurges towards growth trajectory. The Prime Minister’s compact ministry is certainly an opening move towards his promised approach of maximum governance and minimum government. The Budget Session is likely to begin by the first week of July. It is expected that the current government will increase healthcare allocation in the budget of 2014-15. Over the past decade, various healthcare reforms have been introduced which are excellent on paper, but have failed to create any difference on the ground. Mismanagement at the implementation stage and unbridled corruption at entry level are big spoilers. Despite substantial progress, our health care system is beleaguered with a plethora of problems. One of the most difficult conundrums for the new government is India’s fragmented healthcare system—where they should start from? This issue brings to bear the recommendations of the leading industry experts in the health sector. Union Parliamentary Affairs Minister, Urban Development, Housing and Urban Poverty Alleviation, Venkaiah Naidu communicated to the media that the government would leverage technology and social media to increase public interaction. This is a big step in the right direction. This should be introduced in the healthcare system as well. Use of technology as a tool for participative governance is the need of the hour. Though the Union Health Minister Dr Harsh Vardhan has a gargantuan challenge of lifting the healthcare system out of the doldrums, yet it is not impossible. The current issue is a special focus on the major hospitals of the Delhi/NCR region. Through series of interactions with the Chairman, CEOs and Director, we have analysed the work done by the private hospitals. Whilst, in this issue we also try to engage some small hospitals to get a better understanding of their services provided to patients.

Dr Ravi Gupta ravi.gupta@elets.in

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news

Harsh Vardhan for new energy into ‘Health for All; more inclusivity soon Dr Harsh Vardhan, Union Minister for Health and Family Welfare, has asked for thorough streamlining of systems in the distribution of free generic drugs to government health institutions at all levels throughout the country. The National Health Mission (NHM)’s two sub-mission — the National Rural Health Mission (NRHM) and National Urban Health Mission (NUHM) – will be vehicles for implementation of the programme. It was formally cleared by the Union Cabinet in May 2013. The Planning Commission had estimated that the free generic drug programme would cost Rs 28,560 crore during the 12th Plan period (2012-17) and had made its first financial allocation during 2012-13. While the Centre would bear 75 percent of the cost, the states are supposed to contribute 25 percent. Under the programme, 348 drugs under the National List of Essential Medicines are to be provided free from 1.6 lakh sub-centres, 23,000 primary health centres, 5,000 community health centres and 640 district hospitals by the end of the programme.

E-health authority to keep an eye on healthcare providers

The union health ministry was planning to set up a central authority to ensure the compliance of standards in electronic health record (EHR) by all healthcare providers, an official said. “The ministry intends to set up a mechanism to monitor and evaluate implementation of and adherence to EHR standards and guidelines by various healthcare practitioners and vendors,” said Lov Verma, the health and family welfare secretary. He was speaking at Associated Chambers of Commerce and Industry of India (ASSOCHAM) national summit on “ICT (Information, Communication and Technology) in Healthcare”.

Need For Manage- Nearly four million school girls to get free ment Skills in the sanitary napkins in Bihar Healthcare Sector Doctors driven by an urge to improve the fragmented healthcare sector in India are exploring career options in healthcare management. A considerable number of Indian doctors after gaining experience across the globe are relocating back to India and are increasingly making an informed choice of entering hospital management roles in the country. While the country has witnessed a boom of private hospitals, independent healthcare ventures and mid-size clinics across India, the challenge is to sustain and stand out, as the sector is facing an acute shortage of specialized trained professionals in hospital administration and management. India holds an advantage over peers in Asia and the West in terms of the lower cost of high-quality medical services, but specialization has become important to sustain this competitive advantage.

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Nearly four million schoolgirls in government-run middle and high schools in Bihar will be provided free sanitary napkins from this year, officials said. “With the state cabinet approving Funds (Rs 220 crore) for it Tuesday night, the government will start distribution of sanitary napkins to schoolgirls in the 2014-15 financial year,” an official in the Chief Minister’s Office told IANS. Principal Secretary of Cabinet Coordination Brajesh Mehrotra said the scheme, to be run under the Mukhyamantri Kishori Swasthya Karyakram, will cover girls from Class Seven to Class 12. Last February, the then chief minister Nitish Kumar announced the scheme but it was delayed due to the Lok Sabha elections. Bihar Education Minister Brishen Patel said it will boost girls’ education and stem the drop-out rate in higher classes. “It will help improve health and hygiene of schoolgirls,” he said.

Himachal to get generic medicine stores The state government will open generic medicine stores in two medical colleges in Himachal Pradesh on a pilot basis, state Health and Family Welfare Minister Kaul Singh Thakur said. “Initially the generic medicines stores will be opened in the Indira Gandhi Medical College and Hospital in Shimla and the Rajendra Prasad Medical College in Tanda town, and subsequently these will be opened in all zonal hospitals,” he said. Presiding

State-level campaign against drug abuse Kerala will launch an anti-drug campaign in all schools in the state this month after intelligence reports said a drug racket was supplying tobacco and narcotics to school children, a minister said. A surprise raid conducted in the past two days in shops selling tobacco products near educational institutions saw 134 cases being registered and 131 people arrested. Addressing a press meet, Home Minister Ramesh Chennithala and Education Minister P.K. Abdu Rabb said the state-level campaign would be launched by Chief Minister Oommen Chandy June 13. It would begin in all schools. “I was shocked when a mother of a 10-year-old approached me with her son and said he was addicted to ganja and that it was being supplied by a gang that operates among school children. We also received intelligence reports of a big drug racket that’s operating in our state,” Chennithala said. Rabb said a committee will be formed in all schools comprising students, teachers, parents and members of local organisation.

CM promises super specialty hospitals in all Telangana districts Telangana Chief Minister K.Chandrasekhara Rao Wednesday announced that a super specialty hospital will be set up in each district of the state. Speaking at his first public he said the proposed hospitals would be on the lines of Nizam’s Institute of Medical Sciences (NIMS) of Hyderabad. The chief minister said welfare of scheduled castes and minorities would be the top priority of his government and pointed out that he kept the welfare portfolios with himself. He said the government would spend Rs.1 lakh crore for the welfare of the weaker sections of the society during next five years. KCR said agriculture would be the other priority of the TRS government. He said the election promise to waive off crop loans would be implemented.

over the review meeting of the health department regarding National Health Programmes being implemented in the state, the minister said all the health institutions would be computerized in a phased manner. The hill state made it mandatory for doctors in government hospitals and dispensaries to prescribe 191 identified generic rather than certain branded drugs from Dec 1 last year.

Ensure 100 percent immunization for encephalitis The Union Health Minister Harsh Vardhan has ordered all stops be removed for 100 percent immunization of children in select districts of the states affected by annual visitations of two deadly strains of Encephalitis. The impulse has come from the death of 44 children in six districts of Bihar over the past fortnight but the Minister is concerned over the annual death toll in adjoining eastern Uttar Pradesh as well which is in the 500-600 range. Dr Harsh Vardhan said that “I am extremely distressed at the runaway conquest of encephalitis and it is high time extraordinary steps were taken to stymie it. I have asked the Ministry’s officials to work in tandem with their counterparts in the states to identify the most vulnerable districts within a day and the actual immunization will take place over June 22 and 23.” The high-level meeting was attended by Shri Upendra Kushwaha, Union Minister of State for Rural Development, former Health Minister of Bihar and many more...

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Tech in focus Trend

Status of Healthcare Associated

Infection Prevention in India Today

ealthcare in India is intervention driven and there is no emphasis on outcome analysis or review. Infection control programmes are difficult to sustain due to multiple factors like lack or shortage of basic requirement (e.g. gloves, hand washing facility), negligible administrative support, limited resources, overcrowding, understaffing and low levels of staff knowledge of infection control practices. In the days to come, there are going to be aging patients with high co-morbidity especially diabetes added to that is the drug resistance infections. The sacny data published show that in Indian hospitals there is high Gram-negative resistance infections, with very high prevalence of ESBL (Extended Spectrum Beta Lactamases) producers and also high carbapenem resistance rates. We need to come to ground realities that Healthcare Associated Infections (HAI) with superbug is a medical challenge and in days to come it is going to be pan drug resistant infection. Apart from lapses in evidence based practices (hand hygiene, sterilization methods, standard precautions, and aseptic techniques) the biggest threat is suboptimal doses of antibiotics. Raising awareness and implementing evidence based IC measures apart from judicious use of quality antibiotics will be crucial to combat HAI.. Safety practices across healthcare centres / hospitals are extremely important but a herculean task. Many a times prime areas like the operation

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Dr Ratna Rao, Convenor, Infection Prevention and Control Committee, Apollo Hospital, Hyderabad theatre, intensive care units receive the best attention. Aseptic measures are specific practices to ensure delivery of safe surgical care and are ideal deterrents to HAI. One of the important yet neglected areas in hospitals is the

Central Sterile Supply Department. Up-gradation of technology with new cutting edge STERRAD NX, a new low-temperature hydrogen peroxide gas plasma sterilizer with computerised record-keeping is essential to keep pace with changing times. Intro-

duction of STERRAD technology has improved the adherence to the Standard Sterilization Protocols because of its ensuring sterility with speed, safety, cost-saving and simplicity. It enables sterilization of all delicate instruments including advanced Robotics surgical instruments and offers the benefits of terminal sterilization over disinfection. The need to follow basic infection control measures have been taken for granted. As there is no regulatory authority or a notifying agency for HAI, there is no accountability. There is a dire need for introspection and change in mindset in the way we deliver healthcare. Certification of compliance to set standards by a third party (accreditation) has been one of the ways to ensure patient safety. Accreditation of healthcare setup by national (NABH) and international bodies (JCI) has raised the quality of healthcare delivery over the past decade in India. There are 21 JCI and 209 NABH-accredited hospitals across the country today. Patient benefits the most through this process as quality of care from trained medical staff is ensured. Staff is satisfied as they play

a major role in defining and implementing clear clinical processes apart from creating an environment of continuous learning, better working conditions. Healthcare, in turn, is able to benchmark with the best and gain the community confidence in providing quality care. Compliance, in practice, is poor in spite of written policy and procedures especially antibiotic policy. Management support, staff behavioural change, sustenance of the efforts, continuous monitoring are some of the factors responsible for this. Fortunately, Apollo Hyderabad has had a very productive and favourable in-

fection prevention programme over two decades. Innumerable policies and procedures are in place and its implementation has been continuously monitored resulting in infection rates being comparable to best of the hospitals abroad. Highly-motivated staff, team work, sustained monitoring by an extremely proactive infection control team has been instrumental in this endeavour. JCI accreditation, since 2006, has been a stimulus for this positive environment for the staff resulting in lowest attrition rates, continuous updating of technology and the best favourable patient outcome.

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in focus

J K Ansell Widens Scope of

Barrier Protection M

edical imaging has contributed to significant advances in healthcare delivery, leading to better health outcomes and reduced diagnosis/intervention time. Technology that was once unimaginable is now the medical standard of care. Today it is difficult to believe if many diagnosis/intervention procedures can be possible without advance medical imaging techniques. We are living in a medical era referred as the “minimal invasive-technological revolution” of unprecedented innovation in medical care. In less than a generation, imaging methodology has advanced the detection, diagnosis, and treatment of myriad diseases. With advancement in technology, now the surgeries are carried out with the help of fluoroscopic imaging. “It’s amazing, now healthcare professionals need not intervene patient every time to see the internal ailments. By using fluoroscopy imaging they can view the internal structures by just viewing it on the screen!” exclaim Ranju Mohan, Director and Business Head at JK Ansell Ltd. There is a surge in demand for imaging in daily practises due to growing multi discipline usage in hospitals. The interventional procedure team is repeatedly exposed to radiation during routine use c-arm fluoroscopy in operation rooms and cath labs. Increased use of intra-operative fluoroscopy exposes the surgeon to significant amounts of hazardous radiation. Fluoroscopic imaging is aids in multiple medical disciplines like orthopaedic, urology, gynaecology, interventional radiology, nuclear medicine and orthodontics. Fluoroscopic imaging helps the healthcare professionals to do surgery with higher precision

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but the exposure to radiation is a matter of concern for the healthcare professionals. Adverse effects like skin necrosis, leukemia, and genetic mutations can occur due to exposure to radiation. Multiple clinical studies and review has affirmed that hands, especially finger tips are one of the most exposed organs during imaging procedures. With an objective to protect the hands that care, JK Ansell has introduced Radiation Attenuation Gloves in India. Ansell’s radiation Attenuation Glove has been well accepted US and now JK Ansell is proud to introduce this protection solution in India. Organization aims in introducing all such hand barrier solution which can minimize bioterrorism/ionized radiation risk. Stochastic and deterministic effects due to ionized radiation are cumulative in nature and should be neglected as “one time small duration exposure”. Patient is exposed to radiation only once while a healthcare professional is routinely exposed due to occupational demand. Ansell being a socially responsible organiza-

tion has used bismuth oxide against lead as attenuating agent, which is eco friendly as no special bio-medical waste management is required. Other than special bio-medical waste treatment lead is also considered to be a toxic material and must be avoided in healthcare system. Moreover, lead being a heavy metal also compromises with the dexterity and precision of medical procedure. Ansell Radiation Attenuation Glove is designed keeping in mind the practical utility of glove that enhances dexterity and comfort levels without compromise on protection index. Healthcare professionals who are routinely operating under fluoroscopic imaging will be able to operate more number of cases as the exposure rate to radiation will be decreased on hand by new Radiation Attenuation Gloves. “We believe that this product further strengthens our position in Indian market as a leader in barrier protections and this time, we’ve widened the scope to the protection of healthcare professionals during fluoroscopic imaging,” affirms Ranju.

policy

Now that the jubilation of an absolute mandate, star-studded ceremonies and fierce debates about appointments are over, it’s time to get down to business. ENN’s Subash Deb interacts with a handful of leading stakeholders in the health sector to find out their expectations from the new government at the centre

What is to be done: Healthcare Agenda for the new Government

ust a decade ago, our country was abuzz with fascinating tales about its growth trajectory— that the nation was heading for a superpower status. India was equated with China in terms of growth and development. However, today, the reality is the country is still far away from its promise. Growth has plunged from sub-10 percent to sub5 percent. Corruption has adversely affected our economy. In 2012, India has been ranked 94th out of 176 countries in Transparency International’s Corruption Perceptions Index. The menace of corruption has eaten into the very soul of our nation. A nation which cannot ensure basic healthcare, education and housing to its citi-

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zenry, and where vast swathes of its populace go without a square meal a day, cannot call it a developed nation. Therefore, the priority of the new government should be to get growth back as close to double digits as possible. The BJP-led NDA claimed a landslide victory in the recently concluded Lok Sabha election, ending decades of Congress-led UPA rule. There was bonhomie across the country after the party registered a historic win. For the party, it was a significant victory in three decades, and for the nation, it is a harbinger of good things to come. Considering the mandate the party received, it becomes imperative for the new government to deliver on its lofty promises. The expectations are

high from the new government as the Prime Minister Narendra Modi has taken charge of the country at a more challenging time. In the recently held Union cabinet meeting, Modi discussed the top policy priorities of the new government. The top priorities included development of education, health, water, energy, and road infrastructure. The focus, now, is on Health Minister, a medical professional himself, Dr Harsh Vardhan who shot to fame after undertaking the most popular pulse polio drive when he was the health minister in Delhi government. He faces the herculean task of lifting India’s weak and fragmented healthcare system.

Healthcare in India—the current state of affairs In his address at Global Healthcare Conference –The Future of Healthcare: A Collective Vision, which was held in New Delhi, earlier this year, President Pranab Mukherjee said, “Healthy citizens are integral to building a healthy economy. Most often people do not fully comprehend the fundamental correlation between the state of a nation and the health of its people. Though India has made significant inroads in the healthcare sector since independence, a lot more still remains to be done. It is necessary to create an efficient healthcare delivery system, one that provides high quality, affordable medical facilities to the people, and in particular, to the weak and disadvantaged sections of society. India’s health indices need to improve to achieve the Millennium Development Goals and meet the World Health Organization mandates.” The president’s quote more or less sums up the current state of healthcare in India. At the beginning of this century, health outcomes in India and the quality of the basic health system were

extensively lagging that of peer nations. From such a weak health system, the progress made over the last decade in different areas of health has been mixed. The UPA government had recognized the need for structural reforms and introduced several in the 11th and 12th Five Year Plans. Despite the unparalleled growth experienced by the private healthcare providers in recent years, India is still far behind its peers on healthcare outcomes. Moreover, disparity in healthcare access across states and demographic within the population, poor public expenditure on health, infrastructure gaps, workforce scarcity have further exacerbated the situation. It is obvious that a ‘status quo’ approach would be insufficient to lift the healthcare system out of the doldrums. India’s reform journey needs impetus and implementation at scale. Now, with the new government at the centre, the 12th Five-Year Plan, based on a vision of universal access, is expected to user in a huge mass of revolution in India’s national health strategy.

Industry Recommendations: Increase healthcare spending The amount of public fund that India spends on healthcare is abysmally low compared to other emerging economies. India currently spends only 1.2 percent of its GDP on health care which is the lowest of the group of emerging economies that includes Brazil, Russia, China and South Africa, called the BRICS. Over 74 percent of the expenditure on health comes from the private sector. As a result, large numbers of people have to incur heavy out-of-pocket expenditures which further lead to increase in financial burden on the poor sections of Indian society. If truth be told, expensive healthcare pushes large swathes of the population into poverty. The

High Level Expert Group of Universal Health (HLEG) report, however, had recommended an increase in public expenditure on health from 1.2 percent of GDP currently to 2.1 per cent of GDP by the end of 12th Five-Year Plan. Emphasising the need for increasing public healthcare spending, Dr Rajeev Boudhankar, Vice President, Kohinoor Hospitals recommends that there should be at least 40 percent increased allocation in 2014-15 budget. “We expect the government to increase the public expenditure on health to somewhere around 5 percent of GDP by 2020. Out-of-pocket (OOP) private expenditure on healthcare by an average Indian is one of the highest in the world. Around 71 percent of the health care expenditure is borne through own resources as compared to average 15 percent spend by individuals in developed world. There should be no proposal in the next budget for widening of service tax net to cover diagnostics and hospitalisation in hospitals, which will create a larger hole in the pockets of patients. This is likely to be brought back in the budget of 2014-15 with Goods and Service Tax which we in the industry dread”, he adds. Dr N K Pandey, Chairman and MD, Asian Institute of Medical Science says, “Our healthcare spending is less then sub-Saharan countries, and this needs to improve. Budget after budget, we have seen that allocation on healthcare has not gone up. There is an urgent need to change it. The Government needs to take healthcare seriously”.

Improve access, equity and quality There is a high degree of disparity in quality and access to healthcare service between rural and urban Indians. While, in major urban areas, worldclass, five-star hospitals have sprung up, boosting the industry of medical

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policy

tourism, access to quality medical care is limited and unavailable in the boondocks. The UPA Government’s National Rural Health Mission (NRHM) has been greeted as one of the most ambitious rural health initiatives ever. It was launched in 2005 to correct the skewed access to healthcare facilities between the urban and rural areas. Though the NRHM mission conferred some benefits on rural areas, it has proven mostly ineffective so far. In addition to the severe shortfall in physical infrastructure, the programme has been beset by insufficient and erratic drug supply, poor staffing and ambulance facilities, lack of specialised medical professionals, etc. While sharing his pearls of wisdom for the new government on healthcare, Dr Rajesh Srivastava, Chairman, Rockland Hospital says, “Healthcare delivery up to village levels is the biggest challenge India faces today. It is sad to note that AIIMS, India’s No 1 Medical Institute, which can guide the entire healthcare industry through its research and development activities, is crowded with primary-care patients. The lack of quality and accessibility is forcing these patients to rush to metros”. “This problem can easily be resolved if quality diagnostic facilities are created in remote locations and linked with centres of excellence through IT and Telecom interfaces. Reports can then be read by specialist doctors, and then the patients can be referred to a primary, secondary or tertiary-care facility. This will ensure right treatment at the right time, and will also reduce the pressure on the tertiary-care hospitals in the metros”, he adds. Appreciating the initiatives taken by the previous government to set-up five AIIMS like institutions in India, Dr Aditya Vij, CEO, Fortis Healthcare Limited says, “This kind of set-

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Shortage of Beds/Doctors Details

2010

WHO Std

Hospital Bed Density (per 1,000)

1.3

3.5

Doctor & Nurse Density (per 1,000)

2.2

2.5

Source: McKinsey & CII report of Dec 2012 up should not be only at the tertiary level, but also should fan out and reach out to the community at large”. “Most of these hospitals are placed in metro cities, or Tier I and II cities, where a common man cannot access and afford the best facility”, he adds.

Gaps in healthcare Infrastructure It is estimated that by 2025, the Indian population will be 1.4 billion. In order to cater to this demographic transition, the healthcare sector would require more investments to expand its size and capacity in terms of hospital services. As per the National Health Profile 2011, the hospital bed density (per 1000) in India stood at 1.3 in 2010. There are 11,993 hospitals with 784,940 beds in the country, out of these 7,347 hospitals are in rural areas with 160,862 beds and 4,146 hospitals are in urban areas with 618,664 beds. This excludes the 148,124 subcenters, 23,887 primary health centres and 4,809 community health centres in India as on March 2011. Infrastructure gaps are extensive, and are complicated by under-utilisation of existing resources. Dr Rajeev Boudhankar observed that investments in healthcare infrastructure have not kept pace with population growth and increasing urbanisation. Increasing the number of beds to around 200 per1,00,000 would mean creation of 1.3 million new beds, which would require fresh investments of $80 billion”. “Health is a state subject in India and cash strapped state governments

are not likely to be able to provide budgetary support for such investment. The private sector, therefore, should step in, and provide bulk of these investments. The central government should give a strong impetus to the private sector”, he recommends. As per the World Health Statistics, India ranks among the lowest globally, with 0.9 beds per 1,000 population, far below the global average of 2.9 beds. Add to this doctor-to-patient ratio is terribly low in India. HLEG, formed by the Planning Commission, had recommended that the doctor-to-patient ratio should preferably be 1:1000. However, in India, it currently stands at 1:1800. Moreover, most doctors flinch from serving in the hinterland. Dr D S Rana, Chairman, SGRH aptly puts, “The government should give incentives to the doctors for working in the rural areas. Also, they should give incentives to the NGOs and individuals to open small healthcare centres in rural India”.

Improve health insurance scheme The objective of 12th Five Year Plan is to achieve universal health care. Until the 11th Five Year Plan, health insurance coverage has been inadequate, and the poor hardly had access to any insurance in in-patient care. In 2007, however, the ‘Rashtriya Swasthya Bima Yojana’ (RSBY), was introduced to provide health insurance coverage to the under-privileged. It is a superb health insurance scheme, but it covers only BPL (Below Poverty Line)

policy

families. Therefore, families marginally above the BPL can’t avail themselves of this facility, though they too need it. Moreover, RSBY provides only Rs. 30,000 cover per year which is essentially inadequate. While stressing on the need to raise the amount of health insurance coverage, Dr Boudhankar says, “The plan allocation for RSBY must be increased by at least 40 percent of the previous year”. At present, there are three central government health insurance schemes run by two ministries, Central Government Health Scheme (CGHS) by the Ministry of Health and Family Welfare, and Employees’ State Insurance Scheme (ESIS) and RSBY administered by the Ministry of Employment and Labour that separately assist healthcare treatment for different sets of population. The CGHS was started in 1954 with the purpose of providing complete medical care facilities to Central Government employees, pensioners and their dependents residing in

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CGHS covered cities. The medical services are provided through Wellness Centres under Allopathic, Ayurvedic, Yoga, Unani, Sidha and Homeopathic systems of medicines. The CGHS scheme has been plagued by huge outstanding dues towards hospitals. Recently, the amalgam of the private healthcare institutes warned that they would stop providing cashless treatment to CGHS patients if the government failed to release their payments. Dr S Warsi, Medical Superintendent of Holy Family Hospital says, “We don’t make the kind of profit that other big hospitals do. They can keep themselves going even with the CGHS payment delayed, we can’t. We need our daily income to look after our daily expenditures. That’s the only reason. Otherwise, we would love to have CGHS”.

Bottom Line Our health sector is beleaguered with multitude of problems. The longtime

demand for increased healthcare spending to 6 percent of GDP is still a pipe dream. The new government sholud make provision for an increase in the budget allocation. This will result in the reduction of economic burden on the common man. Accessibility to healthcare is one of the major problems faced by huge swathes of the Indian population. The government may not be able to immediately construct health facilities in rural areas, but they can partner with several private health providers and Non-Governmental Organizations, working in the rural areas, in order to bridge some gap in healthcare accessibility between rural and urban areas. Moreover, there are multiple schemes addressing the same problems. The Janani Suraksha Yojna (JSY), Janani Shishu Suraksha Karyakram (JSSK) and Indira Gandhi Matritva Sahyog Yojna (IGMSY) all cater to the needs of the same group of beneficiaries. It is important that such multiple schemes are identified and consolidated into one. This would lead to reduced financial burden on the government, and also benefit the intended beneficiaries. While addressing the first joint sitting of Parliament, as mandatorily required under the Constitution after general elections, President Pranab Mukherjee said that the Narendra Modi-led NDA government at the centre will work for development in a resurgent India in which corruption will have no place. Reducing corruption in the health system should be the first priority of the government, because no schemes and reforms measures will work unless corruption is stamped out of the system. The Union Health Minister Dr Harsh Vardhan needs to take into consideration all of these. He has a herculean task of lifting our healthcare system out of the doldrums.

????????? special focus

Reinventing Healthcare

Through Innovation

ention ‘healthcare’ and you have reasons to smile and frown. Smile at the rapid advancements in diagnostics, technology, delivery systems, clinical excellence, medical tourism and so on. Robotics have landed, cutting edge cyber-knives have taken over,neuro navigation technology is simply mind blowing, blood banks are now transfusion centres with a very proactive role in therapeutics. Information hungry patients are all online now, waiting for the social media to tweet the next health buzz. One can talk endlessly about the rapid advancements in healthcare, akin to science fiction that we see converging in our daily lives today. Enter a hospital and marks of excellence are inked and etched on the wall. Accreditations from NABH, NABL, JCI are some of the common factors to convince you that that quality is pertinent today. The business value of accreditation and quality is gaining recognition and most of the

hospitals are already accredited and others are in the process. The latest accreditation standards (the third edition) were released in January 2012 and it aims to strengthen the standards review process. Now comes the paradox. India’s giant leap and strides in healthcare is countered by the fact that the country continues to be the single largest contributor to the global disease burden today. Chronic diseases already contribute to over 50 percent of India’s disease burden. A 2010 World Bank Report estimates that India is annually losing over 6 percent of its GDP due to the premature deaths and preventable illnesses.There are tangible dichotomies in healthcare infrastructure and delivery crunch. Healthcare costs have risen dramatically and is expected to increase at a staggering rate of 25 percent a year. Child mortality and nutrition are major challenges. As much as 33 percent of all children under the age of 3 years in India are

expected to be moderately malnourished by 2015. The number of doctors per 1000 population stands at 3.31 in the US, 1.53 in China and 0.6 in India. Isn’t it shocking to hear that hardly 2 percent of Indian doctors practice in rural India ?

Upgrade ASHAs “Healthcare is basically disease management. We should build our system from the ground up to create a new blue-print of India’s healthcare. We have over 800,000 ASHAs (Accredited

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????????? special focus

Social Healthcare Activists) in India, but they are ill trained and don’t have any medical skills. Their costs are a huge burden on the exchequer and nothing gets accomplished in return. All we have to do is to upscale their skills so that they can be the eyes and ears of the healthcare system on the ground. They need to monitor hygiene and find out who in the community needs medical assistance. This will be a big help in ensuring quick diagnosis of diseases and reducing the incidence of NCDs.” Dr Naresh Trehan Chairman and Managing Director, Medanta, ‘The Medicity’

changes. This will not happen till the Government looks at medical education as integral part of the country’s development.’ ‘About 67% of anesthesia in the US is given by nurse anesthetists. In India, we don’t allow a nurse who has worked in critical care for 20 years to even prescribe a Paracetamol tablet!” Dr Devi Shetty Founder & Chairman, Narayana Health

Focus on preventive care “Technology has played a vital role in healthcare in the last 30 to 40 years, whether it is diagnosis or treatment.

India requires policy changes ‘In the US has 19,000 undergraduate medical seats and 32,000 PG seats, in India it is the opposite – the country has close to 50,000 undergraduate medical seats but only 14,000 PG seats. “The low number of PG seats results in a shortage of specialists. This can have terrible consequences on the ground. For example, India has one of the highest maternal mor-

tality rates in the world and this is unrelated to the amount of money we spend on healthcare. The reason is that we have created a regulatory structure where only a specialist can perform certain tasks, and the country simply doesn’t produce enough of these specialists,” ‘If we want to deliver better healthcare outcomes, India doesn’t require money. We only require policy

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Going forward It is going to trigger more changes in healthcare than any other factor. Healthcare access will get radically transformed with technology whether it is in terms of proximity through devices planted in our bodies or by low-cost healthcare using innovative technological solutions or the speed with which information is shared.” “A healthcare ecosystem would be created in future where different silos begin to talk to each other about patients and exchange information. Healthcare delivery is going to become more personalized in terms of tailormade treatments for an individual.” “We need to be more concerned for what we do to our health rather than what healthcare would do to us. We need to take ownership of our own bodies and mind and not outsource these to healthcare providers. People need to focus more on preventive care

rather than just landing in sick care – this is going to the mantra of healthcare in future,” Shivinder Mohan Singh Executive Vice Chairman, Fortis Healthcare

Indian Healthcare will achieve newer heights The Indian government has always been supportive of entrepreneurship. We expect the new government to support and encourage the medical industry. This is essential to boost the growth and development of the same. Today, India is considered as the leading healthcare destination for medical tourism, moreover India provides highly specialised and skilled nurses, clinicians and doctors to the majority of the world. India is beginning to be recognised as a leader in providing specialised treatment. The future of healthcare domestically and internationally is bright With the growing number of private players in the healthcare industry, we are able to bridge the gap. In a number of years we would be able to see leading secondary and tertiary care players providing healthcare services even in the far-flug areas of the country. Upcoming medical and nursing colleges would also help in bridging the manpower gap. With persistent efforts I am certain that the Indian healthcare industry will achieve newer heights.

Dr Dharminder Nagar, Managing Director, Paras Hospitals, Gurgaon

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Providing World-class

Healthcare with a Humanitarian Touch Dr D P Saraswat, CEO, Sri Balaji Action Medical Institute and Action Cancer Hospital, began his medical career, in 1972, with the Indian Army Medical Corps, where he served on various administrative assignments for 22 years. Dr Saraswat, in an interaction with Ekta Srivastava, ENN, discusses his journey and vision ahead

What was your objective at the time you joined the Action Group of Hospitals and how much have you achieved so far? The objective was to be a part of the most preferred hospital for rendering a large spectrum of clinical services, to build centre of excellence blended with high-quality service to patients, and also keeping our clinicians happy and motivated. Achievements have been exciting, and we keep raising our own benchmarks.

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What challenges have you faced when you planned to come up with a single-specialty hospital? Good question! Single-specialty hospital becomes centre of excellence with operational efficiencies in terms of time and cost. However, challenges are to arrange doctors of other specialties for cross references especially for cancer patients. The Action Cancer Hospital is located within the same premises of the Sri Balaji Action Medical Institute which is a multi-disciplinary super-specialty. Modern facilities for the cancer treatment are not easily accessible in North India. And, the government hospitals which have advanced facilities have a capacity limitation. So, people, who have to travel long distances from neighboring states, have to wait for long for their turn, which is not desirable in cancer-care management. We wanted to give something which the community needed the most. So, to cope up with the needs of the cancer patients we have come up with this institute.

What latest services have you introduced in the hospital for your patients? Basic necessity is to have a team of qualified, experienced and competent cancer doctors. Besides that, the spectrum of services should be complete so that end-to-end treatment is available under one roof. Doctors deliver their best through hi-tech technologies, equipments and instruments. We endeavour to procure the latest technologies in order to avoid obsolescence. Our service profile is Medical Oncology, Surgical Oncology, Gynae-oncology, Uro-oncology, Radiation Oncology, Musculo-oncology, Neuro-surgery, Pediatric Hematology Oncology, amongst others. To support them, there are PET-CT scan to ascertain the extent and spread of cancer to other parts of the body. Dual-head gama camera adds value in diagnostics. High-energy RAPID-ARC linear accelerator for

short exposures and better outcomes was the first one in this geography. One more linear accelerator with advanced technology is being procured to avoid long waiting of patients. Most modern modular operation theaters with advanced OR-1 facility are working. Some more theaters are added. We have done blood stem cell transplantation with 100 percent success. Modern ICU and step-down ICU are giving high-end intensive care. In an extraordinary case of one tiniest baby where its mother had only 26-week pregnancy, the mother came to us and asked for abortion. We took the lady in the OT and the baby came out alive. The weight of the baby was just 550 grams, and in India this is an unprecedented case. Amazingly, baby survived and he is still surviving today. The mother is from the weaker section

should feel at home when he comes here. The food he gets, the conversation he is indulged into with the staff should put him at ease and comfort, and we try to give them a home-like environment. With high-end technology our doctors, who are experienced, qualified and confident can deliver their best to the patients.

What is your roadmap ahead? So far as our global visibility is concerned, we had a lot of patients from Iraq, Uganda, Nigeria, China, UK, the United States, amongst other countries for super-specialised treatment. We have entered into an agreement with the Iraq Government. They will be sending their patients to our hospitals for cancer treatment. In addition to this, the Iraq government wants us to send our team of surgeons, anesthetics

Our long-term plan is to set-up a medical college, dental college and a college of allied health to cope up with the requirement of technical skills at national level of the society, we kept her for three months, and she paid no money. Our team of pediatricians was very happy for the support they got from the intensivists and the best of the equipments we had. Another incident was with one of our patients who had four stones in his kidney, where one stone weighed around 700 grams, and diameter of which was 9 cm. This is a record operation on a patient with such a huge stone removed. We have also done blood stem cell transplantation.

What is the USP of the Action Group of Hospitals? Our USP lies in our clinical excellence with service quality. Our endeavour is to cover large volume at affordable cost with a humanitarian touch. The person

and technicians to their hospitals, and operate their patients in their operation theater, thus saving time, pain and cost of sending their patients to India or any other country. We are also trying to make similar arrangement with Afghanistan. Besides, we are into academics, and at the moment we are also conducting DNB programmes in six specialisations with other degrees, certificates and fellowship programmes along with some para-medical courses. We have our own nursing school, we have created an opportunity for girls to enhance their skills, and all of them are assured of jobs. Furthermore, we are into research also. Research is happening under two groups, i.e. research on basic sciences and research on clinical trials.

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Healthcare is Yet to

Come Closer

to Patients

After being recognized with prestigious awards for outstanding contribution to the field of Medicine and Surgery, what is the roadmap ahead to take your vision further? After having spent a lifetime in healthcare, my energies are focused on AIMS as a brand. The aim is to consolidate the group and take it further. The company is already in the process of starting a green field project in Tier III city of Palwal. Plans are also afoot to put up a 100 bedded hospital in Delhi-NCR. Another project which is very much on the cards is at Patna (thatâ&#x20AC;&#x2122;s where I had my preliminary medical education) for which we are looking to acquire land and scouting for the right partners.

With your wide experience in medical education, what is your take on rural posting of doctors? In my opinion, we are handling it the wrong way. How can we compel them to go to rural areas when we canâ&#x20AC;&#x2122;t

Dr Narendra Kumar Pandey, Chairman and MD, Asian Institute of Medical Science (AIMS) was conferred with the prestigious Padma Shri award for his outstanding contribution in the field of medicine and surgery. He was also awarded the prestigious Dr B C Roy National Award in the year 2005. Dr Pandey, in conversation with our correspondent Ekta Srivastava, ENN, shares his vision on making treatment affordable to everyone

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provide them with basic amenities like infrastructure and safety? What about educational facilities for their children? These are the major hurdles to the problem of shortage of doctors in rural areas. Unfortunately, even after so many years of Independence, we donâ&#x20AC;&#x2122;t find any organized rural area where a doctor can go and work peacefully without bothering about the day to day problems of life. In addition to addressing the issue of basic amenities, what we need to really do is to build in incentives for working in rural areas. Ask any doctor and you will have your answer. We also need to fill in all vacancies in government hospitals and medical colleges and have rotational posting for shorter duration once we have improved the infrastructure. This will result in better distribution of manpower and eventually result in giving better care.

Do you think that the advancements in technology are reaching the masses? No. The majority of the Indian population still does not have access to basic healthcare, forget about the advanced technology. Our first priority should be to make healthcare accessible to all. We have been making plans only on paper (Health for all, now the target is 2020). With the change in Government, I sincerely hope that we shall be able to achieve this target. Also, please remember that all these technologies are good servants but bad masters. We still need doctors to be physically available because healthcare is personal and not something which can be run through remote control.

What are the major challenges that our country is facing in providing better healthcare? The government spends only a miniscule amount on healthcare in India. Private players are the major contributors today and they can only survive if it is profitable. A large majority of the

population canâ&#x20AC;&#x2122;t afford treatment at these hospitals. Even the middle class finds it difficult. If they do, they can sometimes land up in the BPL category as they have to sell their assets. The problem is that insurance penetration is still not up to the mark (barely 10 to 15 percent). Even if we include all the government agencies which provide free health insurance schemes like ESI, CGHS, ECHS, etc. it is still insignificant. We need to improve on this. Another problem which the healthcare sector is facing today is a gross shortage of qualified personnel whether it is doctors, nurses or technicians. We are just not producing enough doctors because there are not enough seats in medical colleges. The quality of medical education has gone down substantially. There is no good faculty in most of the medical colleges. And to top it all, it can cost a fortune to do medicine from a private medical college. I think it is high time that the government took stock of the situation and revamped the Medical Council of India which should be given the powers to monitor medical education and improve its quality. At one time, nursing as a profession was not very popular especially in Northern India. However, now in places like Haryana, UP, Rajasthan, Punjab, more and more people are joining nursing colleges. So we will have more trained nurses who can speak the local dialect and there would be less communication prob-

lems between patients and nurses. Unfortunately, these nursing colleges are not up to the standards and unable to provide proper training. I think the Nursing Council of India needs to be given more teeth. The same is true of the colleges providing training to technicians (radiographers, laboratory technicians, OT, CSSD etc.). We would really need to improve our standards of training if we are to compete with the rest of the world.

What are the key achievements that your hospital has witnessed so far? We are a relatively young organization but very quality conscious. We started our operations in February 2010. The standards for quality were set from the designing stage itself. As a result we were able to get our NABH accreditation in the shortest span of time (June 2011). We got our NABL accreditation in 2012. Our hospital was voted as the seventh best hospital in Delhi NCR by The WEEK (The WEEK â&#x20AC;&#x201C; Nielsen best hospital survey 2013). Our aim has always been to provide quality care with empathy and compassion because we strongly believe that the simple gestures of kindness are often the most meaningful. There is very strong emphasis on training because we would like to foster an environment that is nurturing and because of our belief that every staff member contributes to the overall patient experience.

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With grit and passion, Dr Devlina Chakravarty has steered the wheels of healthcare in various verticals. From a Radiologist to CEO, she has imbibed the values of an administrator who sets her own benchmarks. In conversation with Shahid Akhter, ENN, she talks about the making of Artemis

Maintaining Standards

Par Excellence To begin with, please tell us about the inspiration behind the launch of Artemis Hospital? Lack of quality healthcare in and around this place prompted the

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Chairman of Apollo Tyres Ltd, Onkar S Kanwar to initiate an integrated world-class healthcare system. Artemis, spread across nine acres, took shape in 2007. Over the years,

the hospital has consolidated into a 350-bed hospital that is abuzz with modern technology from simple hand wash to sophisticated surgical interventions. A graduate from the University of California, Onkar Kanwar is a visionary entrepreneur with a vivid vision for healthcare. One such initiative close to his heart is Apollo Tyresâ&#x20AC;&#x2122;s HIV-AIDS awareness and prevention programme for the trucking community.

What are the latest technological advancements housed and provided at Artemis? In terms of medical technology, Artemis is replete with cutting-edge, stateof-the-art medical technologies in all

dimensions of healthcare. In imaging (predictive, diagnostic and therapeutic ), for instance, we can mention a few of our equipments like 3 Tesla MRI, 64 Slice Cardiac CT Scan, 16 slice PET-CT, Dual-head Gamma Camera, Fan-beam BMD, High-end Colour Doppler Ultrasound Systems, Functional MRI Scanning using Non-Contrast Imaging for Cancers (DWIBS), Image-Guided Radiation Therapy (IGRT) LINAC from Elekta. Add to this the Endovascular Hybrid Operating Suite and Flat Panel Cath Labs with stent boost technology. The list is simply endless.

What are the centres of excellence at Artemis?

Artemis Hospital • First JCI accredited hospital in Gurgaon • WHO had declared Artemis as the winner for its Asia Pacific Hand Hygiene Excellence Award in 2010

Our Centres of Excellence include — Artemis Cancer Centre, Artemis Heart Centre, Artemis Neurosciences Centre, Artemis Joint Replacement and Orthopedics Centre, Artemis Minimally Invasive and Bariatric Surgery Centre, Artemis Renal and Transplant Centre, Artemis Birthing Centre Artemis Fertility Centre, Artemis Critical Care and Pulmonology Centre, Artemis Gastrosciences Centre, Artemis Liver Transplant Centre

on call, and finally the plan of treatment devised and activated soonest possible. Our ambulances are wellequipped with advanced cardiac life support, and this includes doctors, nurses and paramedics on board. Further support comes from blood bank and the imaging centre. Add to this air ambulance services that is pressed into action in case of life-threatening emergencies emerging in remote or distant areas.

What kind of emergency services can we expect at Artemis?

Artemis is very particular about accreditations and International Board Certifications?

In case of an emergency, time is precious and every second counts. To cater to this, we have a round-theclock, comprehensive emergency and trauma-care facility at Artemis. Emergency Department, which believes in providing life-saving care, and is customised to meet the precise need of the patient. The department is supported by ambulance service which includes trained personnel (experienced physicians, highly-trained nurses and paramedics), and life-support equipment geared to cater to the needs of pre-hospital emergency care. Our emergency service is based on three planes — save life, doctor

Yes, Artemis Hospital is the first JCI and NABH accredited hospital in Gurgaon. Besides, we have the NABL accreditation. Shortly, our blood bank and other centres of excellence will be accredited by respective boards. The medical practices and procedures followed at Artemis are research-oriented and benchmarked against in the world. Certifications are not mandatory, but it spells the service and showcases the quality of the hospital. It gives the consumer a sense of assurance and confidence about the hospital, he is stepping in. Care and quality are two of the most important components in healthcare.

We periodically monitor our services, some of them on a daily basis; some are weekly and so on. The idea is to ensure highest degree of patient satisfaction. Besides our internal audit it is better to be examined from an external agency as well.

Do you keep a tab on Hospital Acquired Infection (HAI)? It is a part of the protocol, and we are very particular about all aspects of hygiene. This is precisely the place where board certifications and audit matter. In 2010, WHO declared Artemis as the winner for its Asia Pacific Hand Hygiene Excellence Award. We were selected on the basis of our dedication and commitment to incorporate proper hand hygiene practices. This included hospital design and layout designated for sinks (wash basins) with a 10:1 patient bed to sink ratio. We ensure that all trolleys used for patient care are equipped with alcohol hand-rub dispenser. The hand hygiene compliance rate at Artemis as per the ‘5 Moments for Hand Hygiene’ is 80 percent, and random check on Artemis staff showed that 80 to 90 per cent of them were well-conversant with hand hygiene knowledge and techniques.

How is the flow of international patients, and how good is medical tourism at Artemis? There is a regular influx of international patients. Around 25 percent of our business comes from them. It is not just the war veterans from Iran and Afghanistan pouring in, but we also have patients from Europe.

What are your future plans for the hospital? In the near future, we intend to increase the bed strength to 450, and by 2016, we will be introducing another tower so that 1,000 more beds are added.

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Leading the Way in Healthcare Be it Cyberknife or the Blood Irradiator, BLK Super Specialty Hospital has been at the forefront of technology. The hospital has pushed the frontiers of care through excellence in clinical care, research and education. Naresh Kapoor, Director, Finance & Strategy, shares the making of a mammoth healthcare centre with Shahid Akhter, ENN From a humble beginning in 1959, BLK Super Specialty Hospital today is hailed as one of the largest private hospital in Delhi. Please share the timeline and the legacy. Allow me to travel back to 1930 when Dr B L Kapur, an eminent Obstetrician and Gynaecologist, set up a Charitable Hospital in Lahore. It was registered in 1942 as Lahore Hospital Society. Following the partition, Dr Kapur moved to Ludhiana and set up his Maternity Hospital in 1947. At the invitation of the then Prime Minister Pandit Nehru, he initiated the project for setting up a 200 bed hospital in Delhi which was inaugurated in 1959. By 1984, when the hospital celebrated its Silver Jubilee, it was an expanding hospital well on its way to becoming Delhiâ&#x20AC;&#x2122;s premier multispecialty institute. The Trustees of the hospital felt the need to upgrade it to a tertiary care hospital and tied up with Radiant Life Care Private Limited in the late 1990s to re-develop and manage the facility. Today you can see the state-ofthe-art tertiary care hospital in place of the old hospi-

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tal. It is one of the biggest stand alone private Hospitals with 700 beds in the National Capital Region today.

What are the highlights of the super specialty hospital and its infrastructure? It is not just about the sheer size but equally about the services offered by BLK Super Specialty Hospital that makes it a giant in tertiary healthcare. The infrastructure speaks volumes about BLK’s commitment to ‘passion for healing’. Our vision is to create a patient centric tertiary healthcare organization focused on non-intrusive quality care utilising leading edge technology with a human touch. All ambulatory services have been designed with intent to create dedicated aides for all specialties, with their interventional services in close vicinity. The outpatient services are spread on two floors with 60 consultation rooms. Therefore, whether it is the proximity of diagnostic services and blood bank to the emergency or one of the best Endoscopy suites to ensure timely and efficient services. The hospital banks on 17 stateof-the-art well equipped modular operation theatres with three stage air filtration and gas scavenging system to ensure patient safety. The operation theatres are equipped with best-in-class operating lights, anaesthesia work stations and advanced information management system. The hospital has one of the biggest critical care programmes in the region with 125 beds in different intensive care units. Each critical care unit is equipped with high-end patient monitoring devices, ventilators and dedicated isolation rooms. Facilities for haemodialysis, CRRT, SLED, endoscopy and bronchoscopy are available 24X7 by the bedside.

The entire campus is Wi-Fi enabled, with the vision of the hospital becoming the first truly paper-less healthcare facility in the country mation System (HIS) system which is connected across outpatient, inpatient and diagnostic areas. The system has facility for contemporary electronic medical records (EMR) with remoteaccessibility enabling ongoing consultation to patients from distance as well. BLK’s advanced Building Management System provides for multi-tiered access control, electronic security systems with integrated CCTVs spanning across the facility and advanced fire management system amongst other utilities. The hospital is the first in NCR to install and start using automatic pneumatic chute system to enhance the efficiency and efficacy of health care delivery.

What are the technological advancements that the hospital has introduced lately? Cyberknife VSI - BLK recently became the proud home to Cyberknife VSI, Asia Pacific’s first whole body robotic radio-surgery system for treatment of hitherto inoperable tumors. A TriologyTx Linear Accelerator with cone beam CT for Radiation Oncology - Image guided radiotherapy (IGRT), Intensity Modulated Radiotherapy (IMRT) and Gated Radiotherapy.

How about the hospital’s information system?

What are the centers of excellence at BLK?

BLK has top-of-the-line Hospital Infor-

BLK Cancer Centre,

BLK Centre

for Bone Marrow Transplant, BLK Heart Centre, BLK Centre for Neurosciences, BLK Centre for Digestive & Liver Diseases, BLK Centre for Renal Sciences & Kidney Transplant, BLK Centre for Orthopaedics, Joint Reconstruction & Spine Surgery, BLK Centre for Plastic & Cosmetic Surgery, BLK Children’s Heart Institute and BLK Centre for Critical Care.

How about advancements in blood bank and laboratories at BLK? A state-of-the-art blood bank at BLK meets all standards that have been set up with facilities like Aphaeresis, blood component separation and stem cell harvesting. The Blood Bank is equipped with the NAT (Nucleic Acid Testing) System for the screening of Blood to ensure the safest possible blood for all its patients. In addition, a Blood Irradiator- another First of its Kind in any corporate hospital for specially treated blood for cancer and other subgroup of patients, shall be installed in the current year. BLK has one of the most well equipped labs in the NCR for entire gamut of diagnostic services in Haematology, Biochemistry, Microbiology, Molecular Biology and Histopathology.

How much does BLK contribute towards medical tourism? Recently we were in news for the successful operation of Nigerian conjoined twins. They were the first foreign conjoined twins separated at BLK super-specialty hospital after a 13-hour surgery. BLK has been a preferred healthcare destination for international patients. The hospital has attended to medical needs of thousands of global citizens from across the globe. We are also helping in the establishment of medical centers in various countries like Nepal and Ethopia.

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Colossus of Healthcare Cygnus Medicare -the chain of ten super specialty hospitals, has carved a niche for themselves. Dr Dinesh Batra, Director, Cygnus Hospitals, is a prime mover of various hospitals in India and abroad. He talks about his recent flagship hospitals with Shahid Akhter, ENN

In a short span of few years, Cygnus has illuminated the healthcare landscape. Please share your journey so far. Cygnus Medicare is a company formed by a group of highly-skilled doctors with a vision to open centres for specialised surgeries throughout North India. For us, it is more of passion rather than profession. We share a common belief that every individual has the right to finest quality healthcare. Keeping in tune with our belief, we endeavour to provide the highest quality of healthcare to our patients by creating, using and disseminating knowledge through research and education. We further aim to run centres for specialised surgeries in those areas where super specialty care may be missing.

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If we look back at healthcare three decades back, it was the era of charitable hospitals and nursing homes. Gradually, the shift came with the advent of corporate hospitals. This changed the healthcare scenario. People, now, have reservations about visiting charitable hospitals that lacked critical care, handling of medical complications and emergency services. Apollo emerged in 1990s, and that was the turning point. People were looking up at multi super specialty facilities under one roof. We observed the changing landscape, and four of us (all doctors) joined hands to create super specialty healthcare hub to cater to all the sections of the society. Currently, we are focusing on bringing super specialty care to B and C category town of North India. With this aim and vision in mind, Cygnus Medicare was created in 2010, and we started to brush up these charitable hospitals and changed their outlook. By now, we have already acquired ten hospitals, and we are in the process of further expansion. This makes us the largest chain of multi specialty hospitals in Haryana and Delhi. This is not about the numerical value, or strength, but it brings together the finest doctors, and the best of technology.

Please shed some light on your best performing hospitals We strive to make all our hospitals a multi specialty hospital with best of infrastructures. Bensups Hospital in Dwarka Sub-City, for instance, is a 138bed multi-specialty hospital (14 beds reserved for the economically weaker section). The hospital is well-equipped for emergencies (E4E). The golden rule during medical emergencies is to waste minimum possible time to provide medical care to the patient. The hospital boasts of the best infrastructure and faculty in terms of advanced ICU, NICU labs, modular operation theatres, state-ofthe-art fully digital cardio catheterization Lab and other advanced life-sav-

Cygnus Network Cygnus Bensups Hospital Dwarka Cygnus J K Hindu Hospital Sonipat Cygnus Hemraj Jain Hospital Pitampura Cygnus Sanjiv Bansal Hospital Karnal Cygnus Super Speciality Hospital Krukshetra Cygnus Magnus B S Sanjivini Hospital, Bahadurgarh Cygnus Maharaja Agarsain Hospital, Panipat Cygnus Kalwati Hospital Kohand Cygnus Sonia Hospital Nangloi Cygnus Orthocare Hospital Hauz Khas

ways ready to treat any type of patient coming in with the rarest disease. Our mission is to provide benchmarked quality at affordable cost with the help of caring and efficient human resource. We believe that every individual has the right to finest quality healthcare at minimum possible cost and easy accessibility. To run centers for specialized surgeries in the population areas which lack in super specialty care, we aim to provide the global standards in healthcare to masses at affordable prices.

Who are your growth capital partners? Our initial funding came from Somerset Indus Capital Partners, a private equity firm focussed on making healthcare investments in India. This funding supported us in a big way, and now we are going in for a second investment for further expansion.

Are Cygnus Hospitals accredited, and how do you view quality healthcare?

ing infrastructure. During the past 12 months, the hospital has helped 1,124 cases of heart emergency, 147 cases of neuro emergency, 3,228 cases of trauma amongst a total of over 28,000 casualties in the last 12 months.

All our hospitals are in the process of NABH accreditation. Pre-assessment has already been done. Irrespective of this, we aim at providing international standards in healthcare and most importantly at affordable price.

What core values you have emulated to bring transformation in healthcare?

Where do you see Cygnus hospitals five years from now?

Though we are late players, we have carved a niche for ourselves in healthcare. We believe in endless pursuit of excellence in all the fieldsâ&#x20AC;&#x201D;be it patient treatment, research or teaching. We believe in a more humane approach and touch. We donâ&#x20AC;&#x2122;t mind going the extra mile for our patients, doctors, colleagues and co-workers. As India is a diverse country, we have patients, doctors, clinicians and staff workers from all parts of the country. We even have patients coming in from different parts of the world for treatment. Therefore, we are al-

Today, we have five hospitals in Haryana at Sonepat, Panipat, Karnal, Krukshetra and Bahadurgarh. Four of these hospitals are well connected to each other, and can be reached within 30 minutes. These hospitals receive a high rate of trauma cases, almost 200 each day. We are trying to address this section by way of strengthening E4E (equipped for emergency services) set up. Out of 21 districts in Haryana, only three can claim medical coverage by way of tertiary care. What about the remaining 18? We endeavour to fulfill this gap and come up with healthcare facilities so that everyone benefits.

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Please tell us about the genesis of Dharamshila Hospital?

Ushering a New Era in Oncology Leaders in comprehensive cancer treatment, Dharamshila is a healthcare giant to reckon with. Dr Sandeep Chatrath, CEO, Dharamshila Hospital shares his vision, milestones and mission with Shahid Akhter, ENN

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The year 1990 witnessed the foundation of North Indiaâ&#x20AC;&#x2122;s first comprehensive cancer care centre. The effort was initiated by a group of concerned relatives and friends of cancer patients who felt the need to provide complete cancer treatment under one roof. A non-government voluntary organization - Dharamshila Cancer Foundation and Research Centre (DCFRC) was dedicated to the cause of making cancer treatment available, accessible and affordable. The initial phase took off with 100 beds in 1994 and the hospital land area was 8097 square metres. By 2006 the hospital bed capacity had expanded to 300 and today the hospital is spread across 3.5 acres of land. Around 1994, the first mammography machine was installed and the following year Leukaemia wing was introduced along with blood bank with blood cell separator. Spiral CT scanner was installed in 1998 and the next year saw the inauguration of Nuclear Medicine Dept and TMT. In 2001 we installed LOGIQ 500 PRO â&#x20AC;&#x201C; the most advanced ultrasound machine with colour Doppler capability. The following year, we installed state-of-the-art digital, dual energy, Linear Accelerator and Eclips 3D treatment planning system.In 2003 we installed high speed NXI digital dual slice CT Scanner. By the time we celebrated our tenth anniversary, we started upgrading our existing structure. For instance, the blood bank saw the induction of Heraeus deep freeze and cold room facility with storage capacity of 8000 FFP units and 2000 blood unit. Simultaneously, Endoscopy Suite was revamped with state-of-the-art video endoscopes, video colonoscope and colposcope. The year 2005 saw the construction of a new hospital building. In 2007 the name of Dharamshila Cancer Hos-

Dharamshila is the first and the only cancer hospital of India accredited by NABH Dharamshila Labs are accredited by NABL Dharamshila BMT Centre is Indiaâ&#x20AC;&#x2122;s first and only world class facility for blood and Marrow stem cell transplantation for patients without fully matched family donor pital And Research Centre (DCHRC) was changed to Dharamshila Hospital and Research Centre (DHRC).

With so much of pioneering steps, where does DHRC stand today? Gradually, other allied services like Neurosurgery, Cosmetic and Plastic Surgery, Dental and Faciomaxillary Surgery, Orthopaedics, Gastroenterology, Nephrology and Urology etc were added. This was done in keeping with the healthcare needs of the community. Simultaneously we strengthened the preventive, diagnostic, therapeutic, rehabilitative, palliative and support services under one roof. Moreover, we continue to add cutting edge technologies and follow the international treatment protocols to ensure the best outcomes by way of care and treatment. We strive for the highest quality standards of treatment, patient satisfaction and safety. Adding quality to life and improving cure rates are our hallmark. All this has helped us to enhance our referral base and today we have patients from India and neighbouring countries.

What technological advancements have been introduced lately ? We offer Third Generation Radiation Technology i.e. Elekta Synergy VMAT with IMRT, IGRT, SBRT and SRS / SRT and Respiratory Gating Capabilities

and best Treatment Planning systems like Monaco, CMSxi0, ERGO++ and Plato. Elekta Synergy Linear Accelerator with triple photon and seven electrons energies is the latest technology that delivers targeted and precise radiation with the help of highly sophisticated software. It delivers personalized, safe, efficient and high quality radiation with enhanced dose conformance as per the tumour size, shape and pathology. With this new technology, total integral radiation dose has been reduced to one tenth and treatment time to only 2 - 3 minutes as against 30 minutes with older technology. This leads to higher tumour control probability, reduced probability of secondary tumours and minimal side effects.

Besides all associated diseases of cancer patients, DHRC seem to have forayed into other specialities as well? Besides cancer care services, we have proliferated into diagnostic services and have also added a wide range of multi speciality services. We have also achieved a pioneering step by commissioning Dharamshila BMT (Bone Marrow Transplant) Centre with 21 beds. We offer BMT as a treatment option for a variety of congenital and acquired disorders of children and young adults, eg Leukemia, Lymphoma, Myeloma, Thalassemia, Aplastic anaemia, etc.

Our in-house stem cell processing and BMT Lab covers a wide range of diagnostics like flow Cytometry, molecular diagnosis, etc.

What is DHRCâ&#x20AC;&#x2122;s role in mentoring the next generation in healthcare? We contribute to the pool of trained and skilled manpower in healthcare. We were first in India to start three years full time doctorate course - DNB Medical Oncology in 2002, DNB Surgical Oncology in 2003 and Post Basic Diploma in Oncology Nursing in 2010. In 2004, we enrolled the first batch of studentsin Radiation Oncology. Besides fellowship programmes in head and neck Oncology and Oncopathology, we also have diploma courses in medical technology in various verticals like medical laboratory technology, X-Ray and imaging technology and operation theatre technology.

DHRC is one of the best cancer hospitals in India. How about the influx of patients from neighbouring countries? In harmony with our vision to fight cancer and win the battle against cancer, we have become leaders in comprehensive cancer treatment and this draws a lot of patient from around the world, not just neighbouring countries. We help to detect cancer at an early stage and thus save time, money and most importantly life of a patient, which has attracted patients from across the globe, not only for cancer but also for other specialities and super specialities as well.

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Aditya Vij has been the Chief Executive Officer at Fortis Healthcare Limited since July 2011. In an interaction with our correspondent, Ekta Srivastava, he delibrates on the ample scope for automation and modernization in Indian Healthcare scenario

Making Quality

Healthcare Affordable

How do you plan to provide affordable healthcare to Indian middle class?

Aditya Vij CEO, Fortis Healthcare Limited

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India is among the few countries that provides one of the lowest cost, yet highest quality of healthcare. At Fortis, our intent has been to reach out to the middle class and beyond and offer world-class capability, technology and medical treatment at affordable costs. With 66 healthcare facilities in India (including projects under development), over 10,000 potential beds and approx. 260 diagnostic centers, we have significantly expanded our reach to tap the middle class. The mass market opportunity is a compelling business case. With a low bed to population ratio in India, the Indian demographic is more than enough to ensure volumes at hospitals. We have multiple operating models to approach the middle class segment. One is a segmented approach to healthcare deliv-

ery. Some of our hospitals cater to the premium segment, such as our flagship hospital, The Fortis Memorial Research Institute (FMRI) that offers highly specialized medical programmes, super specialties and advanced levels of medical treatments, while some others focus on the mass market offering secondary to lower tertiary level medical programmes. We have leveraged technology to expand our reach in the mass market. For example, Critinext, our remote ICU (eICU) programmes helps to make critical care accessible and affordable to critically ill patients in remote areas of India. A more active role by the Government investing in healthcare as an overall percentage of Gross Domestic Product (GDP) will also help expand reach to a larger section of the populace.

What are your thoughts on the rise of multi-specialty hospitals? What advantages it offers? A multi-specialty hospital nurtures a milieu of collaboration among many physicians and different specialties under one roof. It offers advantages of housing the best clinician talent across specialties, the best technology and medical care under one roof. Multi-specialty hospitals are superior in delivering higher medical quality and offer both depth and width in the healthcare sector by allowing hospitals to provide a continuum of care. These hospitals have come of age and are capable of delivering medical treatments at par with the best in the world. Now, Indians are not going abroad for treatment but patients from overseas are pouring in as India offers affordable and high quality healthcare. Though capital intensive, the model confers significant advantages in terms of cross referrals, attending to emergencies and offering the best clinical talent under one roof, aiding patient ease and comfort. Moreover, as a country we are plagued by several lifestyle disorders which require a multi-disciplinary care.

â&#x20AC;&#x153;Affordability will continue to increase over time as innovative lower cost solutions are offered that make pricing more competitive How do you visualize the progress of technology in Indian healthcare? Technology in the last two decades has transformed the way healthcare is delivered. It has greatly aided patients and providers alike by enhancing the quality of delivery, reduction in turnaround time of workflows and thus the overall cost, besides bringing in higher accountability into the system. Advancements in medical technology are playing a positive role in saving lives, in improving diagnosis and clinical outcomes. India is growing at a faster pace as compared to the West which has seen a slowdown. However, India has a lot of scope for automation and modernization. There is abundant scope for introducing better processes and in lowering technology costs. There will be increased investment by healthcare providers in installing best in class medical equipment, upgrading technology and seeking quality accreditation. Innovation across the value chain in service delivery will help to expand the market and take it to the next level of growth. As a country, we need policy interventions that encourage indigenous manufacturers, and local manufacturing by MNC companies.

Most of the research in Medicine is done abroad, even after having a pool of medical experts in

our country. Whatâ&#x20AC;&#x2122;s your take on that-- where are we lagging? As a country, we are yet to leverage our research potential. Our leading academic institutes, though extremely rigorous in education, do not adequately focus on research and innovation. This is a trend across fields, not just limited to medicine. However, in the last few years, there has been a growth in terms of research work in the country, though are behind our western counterparts.

What are the major challenges that a private or corporate hospital faces today in a country like India? Despite the sprinting pace of the healthcare sector, we face many obstacles in our path towards greater growth. Some of the immediate challenges being faced by corporate hospitals include, low penetration of health insurance, lack of medical and paramedical talent; high initial-stage capital investment; and lower returns. There are also significant cost pressures (rising implant costs, medical equipment costs, wage rates, power tariffs etc), low value, and challenging payment turnaround time from the Government.

What is the USP of the Fortis Healthcare Limited? At the core of our offering is medical excellence and we endeavor to provide the highest quality of medical care with compassion. Our patients are at the centre of what we do. In addition to the best clinical diagnosis and treatment, we also provide an envelope of facilities and services that make the hospital experience stressfree and calming. We offer thoughtful conveniences, comfort and diversions that can help lower anxiety levels and encourage healing for the patients and their families. Patient flows and medical facilities are planned in an intuitive manner so they are easy to navigate even for first time visitors.

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Providing Quality Healthcare

to Local and Global Patients Located in Udaipur, GBH American Hospital is a multi super specialty hospital that provides quality healthcare to locals as well as tourists. Its CEO and Medical Director Dr Vallabh Parikh talks to ENN’s Rajesh K Sharma about the hospital’s objectives and achievements Please tell us about the GBH American Hospital—the number of beds, kinds of treatments it provides, class of patients it serves. GBH American Hospital is a 150-bed state-of-the-art multi super specialty and tertiary care hospital located in

Udaipur, Rajasthan. It is NABH accredited and ISO 9001:2008 certified. We provide medical treatments in Neuro-Intervention, IVF, Endocrinology, Cardiology, Cardiacthoracic surgery, Arthoscopy, Arthoplasty, Spine surgery, Uro-laser surgery, Cosmetic surgery and Hair transplant. While

our services are available to the people of Rajasthan, we do get patients from neighboring states as well, in addition to foreign medical tourists. We treat patients of all economic strata.

How many patients do you treat on a single day across all departments? What are the most common kinds of queries you deal with (are they infection or lifestyle-related)? We treat around 350 patients per day across all our departments. The nature of medical cases that we see is a mix of infectious as well as lifestyle diseases.

Please tell us about the role technology plays in providing healthcare in GHB American Hospital. What are the latest technology implementations in GHB American Hospital? Technology plays a very vital part in GBH American Hospital in treating patients, and also helps us to stand apart from the other hospitals in the city. We, at GBH American Hospital, have introduced Uro-laser surgery equipment, Brain Lab, state-of-the-art IVF lab, advanced Neuro and Cardiac Intervention Lab and Linear Accelerator Dosimetry.

What are the measures taken to prevent nosocomial infections at your hospital?

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GBH American Hospital at a Glance GBH American Hospital is a NABH accredited state-of-the-art multi-specialty hospital located in Udaipur, Rajasthan. Founded by Dr Kirti Kumar Jain, it aims to provide high quality medical care to the local population as well as to a global clientele through dedicated and highly skilled staff. The hospital caters to the local population of Udaipur and also provides healthcare to medical tourists from foreign countries. GBH American hospital has 150 beds and the latest medical equipments to aid its doctors, as they provide world class medical care to the patients. In line with its vision to provide high quality medical care, the hospital follows Total Quality Management (TQM) and Continuous Quality Improvement. It also holds regular educational and health camps to educate the people of Udaipur about healthcare. Since it is located in the tourist town of Udaipur, GBH American Hospital has been able to tap into its medical tourism potential. It offers world class medical treatments at competitive rates. A patient visiting Udaipur can combine tourism with quality medical care. While its team of highly qualified doctors takes care of patients, the persons can avail sigh seeing in an around the city. We organize aggressive hand-washing campaign for our staff, physicians and visitors. Appropriate isolation protocols are enforced and adherence to evidence-based safety standards in cleaning for rooms and equipment, promote standard precaution and many more are ensured.

Given the high costs of medical instruments, and the high taxes for importing such instruments, do you feel that the benefits of

the latest medical technological advantages have not reached the common man? I feel, it is reaching to many, if not to everyone. With the right government policies and the support from NGOs, it can reach all sections of the society.

How wide is the difference between the standards of medical treatment given to the rich and the poor? At GBH American Hospital, the

medical services provided are equal to all. The government has laid emphasis on healthcare during the 12th Five Year Plan, and also launched the National Health Mission to promote telemedicine and mobile health.

Do you think it has been successful? I feel telemedicine and mobile health are the need of the day, but there are challenges which need to be tackled properly to ensure a better outcome.

Please tell us about medical tourism at GBH American Hospital. Does the fact that you are situated in Udaipur, a tourist town, help you in promoting it? What is the outlook for medical tourism in India? Medical tourism in India is growing at an exponential rate and yes being in Udaipur is a big advantage.

What are your expectations from the new government for the healthcare sector? Healthcare sector is the basic necessity, and the new government will definitely take measures to improve the standard of medical care in India.

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For Service,

Not for Business

Dr S Warsi, Medical Superintendent of Holy Family Hospital, Delhi in a conversation with ENN’s Rajesh K Sharma talks about the hospital’s vision and the challenges in providing affordable healthcare except Cardiac surgery. However, we do Non-Invasive Cardiology. We don’t have a big set-up of Oncology either.

How many patients does the hospital see daily?

To begin with, tell us something about Holy Family Hospital Holy Family Hospital celebrated its Diamond Jubilee celebration last year. We started functioning in 1953 as a 50-bed hospital. We are now a 352-bed hospital, of which 52 beds are in the ICU. We have a Neo-Natal Intensive Care and a Pediatric Intensive Care. We have a very busy maternity ward which is one of the oldest in South Delhi. Our aim is to provide healthcare at a reasonable cost. We try to offer what we can. We do have super-specialties like neurosurgery. We do around 800 dialyses a month. In our orthopedics department, we do transplants like hip transplant and knee replacement. All the super specialty surgeries are done but at a much lesser cost. We provide the same care which is provided in the other hospitals.

In all, how many departments do you have? We have all the major services present

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We have two OPDs – private OPD and general OPD. In private OPD, we see around 250 patients per day, while in general OPD, the figure can be as high as 1,000 patients in a day. We run general OPDs for all our specialties, so the actual number is quite high. We have a very strong infectioncontrol committee, and our infectioncontrol rate can be compared with any hospital in Delhi or internationally. We have a very busy intensive-care unit, but our nosocomial infection rate is very low.

With such high numbers, how do you prevent nosocomial infections? It is achieved simply by hand-washing. That is the simplest thing. You don’t need hi-tech instruments to prevent infections. Also, we do periodic audits for hand hygiene at Holy Family Hospital for all doctors and nurses. We usually get 80 to 85 percent compliance in hand washing in the intensive care areas, and that it probably the biggest reason why we are able to keep our infection figures very low.

How difficult is it to provide affordable healthcare today?

Healthcare has become expensive. It is a major and very difficult task for us to try and keep the prices as possibly low as we can. We have a private ward and a general ward. Whatever income we generate out of the private ward, we use it to subsidise our general OPDs and general ward. For as little as at `100, a specialist will see a patient in the general ward; this will not happen anywhere else except in government hospitals. However, government hospitals are overcrowded. I am myself trained in a government hospital, and I am not saying that they don’t do good work, they do, but they have been unable to cope up with the sheer numbers.

How important is insurance in making healthcare affordable? It has made healthcare affordable. I have been associated with this hospital for close to 28 years, and have seen the changes. A significant number of our patients, now, have insurance cover. It has grown in leaps and bounds in the last few years, and I think people will opt for it, because not many can afford healthcare nowa-days.

Are you empanelled under CGHS? We are trying to provide competitive and low-cost care, and we cannot afford to block a large amount of money in CGHS payments. We don’t make the

kind of profit that corporate hospitals do. They can keep themselves going even with the CGHS payment delayed, we can’t. We need our daily income to look after our daily expenditures. That’s the only reason. Otherwise we would love to have CGHS and look after any patient.

Do you serve only poor patients? What about middle class patients? The definition of middle class has changed a lot! We get a spectrum of patients, the reason being that we have single rooms which are bigger than anywhere else in South Delhi because ours is an old hospital. So, we do cater to some patients from the upper and middle class.

What role does technology play in providing affordable healthcare? Modern technology is very expensive to afford. By technology, if you mean that sitting in your home, a doctor will be able to look at your EKGs, and your echoes on your mobile, it will become more affordable. But, I don’t think, we have reached that stage.

It is a major and very difficult task for us to try and keep the prices as possibly low as we can we use social media to send X-Ray images, or we would have a senior consultant reporting over CT scans and other reports through the night. That way, telemedicine helps us. We have three satellite hospitals coming up in smaller places like Gurgaon, Mewat and Badashahpur. When these come up, then we will probably the parent telemedicine service provider to them. That is our long-term plan.

How often do you upgrade your technology? We are renovating our hospital, changing it right now. We have a got a HMIS system which will make appointments, availability of reports and many mundane tasks a lot easier for the patients and the doctors. If you talk about instruments, then every instrument has a fixed life, and then we change it. We go through the process of upgradation as and when required.

But the government is promoting telemedicine and mobile health…

How successful has the government has been in its ‘Health For All’ initiative as stated in the 12th FYP?

Telemedicine, yes. Telemedicine helps, if in the middle of the night, we want consultations from anywhere,

I think, we in the medical fraternity must work towards ‘Health For All’. It should be our prime goal in life. I believe, every-

one in the country, should be entitled to healthcare including the poor. That has been the philosophy of this hospital.

You are the same size as the other corporate hospitals, so how do you attract the rich patients? Medicine is now a service industry, unfortunately. If patients are looking for ambience, we will not be able to match up to any of the corporate hospitals, because our charges are not high. However, if they are looking for care, I don’t think there is any deficiency. We don’t say that we provide all the services, but whatever we do provide, we provide it at par with other hospitals. We are an old building, so we are also in the process of gradually renovating our hospital.

What are your expectations from the new government? Health for all. It is totally achievable. We have to increase our health expenditure. We cannot have a health expenditure which is less than the majority of other places. We are quite low as far as our health expenditure is concerned. No economy can grow if your people are not healthy.

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‘Why Not in India?’ Questions Prof Anupam Sibal, Group Medical Director, Apollo Hospitals Group, New Delhi, when asked about stringent quality control and technological usage in hospitals. In conversation with Shahid Akhter, ENN, he shares his optimism in healthcare and the best practices in Apollo hospitals

Apollo Hospitals is believed by many to be the most preferred destination in healthcare delivery. Why? Since its inception in 1983, we have strived to develop Apollo into one of the best multi-speciality hospitals chain. Be it the doctors, infrastructure or technology, we have always been driven by the passion of ‘patient first’. With over 9000 beds, and almost all specialities in 54 hospitals, we can certainly claim to be the most sought-after destination in healthcare. Our passion can be gauged from the fact that Indraprastha Apollo Hospitals became the first hospital in India to be internationally accredited by the Joint Commission International (JCI) and today we have 8 JCI accredited and 10 NABH accredited Apollo hospitals.

What initiatives have been taken by Apollo Hospitals in the field of medical research? The Apollo Hospitals Educational and Research Foundation (AHERF) is an independent entity recognized by the Department of Scientific and Industrial Research (DSIR) as a “Scientific and Industrial Research Organization(SIRO)”, to carry out research, educational and training programmes in quest of quality healthcare. AHERF, in collaboration with other institutions in India and abroad, is working on several research projects that have a bearing on the health, social, economic and industrial needs of India. Some of the research areas are clinical aspects of stem cells, molecular diagnostics, personalized medicine, genomics, new trials in therapies and drugs, integration of traditional Indian medicine into modern healthcare, etc. Our consultants are actively involved in clinical

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research and publish many research papers in high impact journals. Our â&#x20AC;&#x153;Apollo Medicineâ&#x20AC;? journal is indexed on Science Direct and included in the Directory of Open Access Journals.

Please trace Apollo Hospitalsâ&#x20AC;&#x2122; contribution to medical education? In a tertiary healthcare institution, clinical excellence shares a symbiotic relationship with academic excellence with emphasis on training and research. Various post graduate and post doctoral medical education programs are being offered at Apollo Hospitals group. Fifteen hospitals of the Apollo group currently offer the Diplomate of National Board (DNB) and Fellowship of National Board (FNB) programs in 38 specialties and subspecialties. Besides these, other post graduate diploma and fellowship programs accredited to national and international universities are being offered. There are a 1000 postgraduate medical trainees at Apollo currently. Our first undergraduate medical college, Apollo Institute of Medical Sciences and Research (AIMSR) was started at Apollo Health City, Hyderabad, in July 2012. We organize close to a 100 major CME programmes every year. Eminent medical experts from around the world come together to discuss latest developments in various specialties including lectures, live-surgical cases, discussions and so on. We organized the Cancer Conclave in Chennai this year with participation from over 500 eminent pioneers, researchers, medical practitioners from India and across the world. There are web broadcasts on a wide range of our ongoing CME programmes, and other such academic events. We hold an annual International Congress on Patient Safety which is attended by over 850 delegates and 75 speakers every year.

How does accreditation substantiate the level of quality?

Apollo Hospitals Touched 39 million lives 9 million Preventive Health Checks Patients from 120 countries 1,52,000 Cardiothoracic Surgeries 10,000 Joint Transplants Replacements in 5 years First Liver Transplant in Children and Adults First Multi Organ Transplant Over 1300 Kidney Transplant Over 500 Bone Marrow Transplantation Over 1700 Liver Transplants Busiest Solid Organ Transplant Programme Accreditation translates into patientsâ&#x20AC;&#x2122; satisfaction, and this comes from the quality of care that one gets. We aspire for the highest-level of quality care going beyond accreditation and to achieve this we have various protocols in place. Standardization of processes and measurement of outcomes ensure quality care for the patients which is objective, trackable and amenable to improvement wherever required. The Apollo Standards of Clinical Care (TASCC) was implemented across Apollo Hospitals to standardize processes and outcomes for clinical excellence and patient safety. It encompasses six initiatives Apollo Clinical Excellence dashboard (ACE), Rocket ACE (RACE), Apollo Quality Program (AQP), Apollo Mortality Review (AMR), Apollo Incident Reporting System (AIRS) and Apollo Critical Policies Plans and Procedures (ACPPP). ACE and RACE are clinical balanced scorecards incorporating 25

clinical quality parameters involving complication rates, mortality rates, one-year survival rates and average length of stay after major procedures with international benchmarks. TASCC scores showed a steady increase from 216 in April 2012 to 293 in Dec 2013 showing increasing standardizationof processes and improvingoutcomes. 90,000 patients admitted to Apollo every quarter benefited.

What technological advancements can one expect at Apollo? We are on the forefront of investment in technology because it is a crucial pillar of healthcare. If a new technology pops up, we should be aware of it, and certainly incorporate it, if found to be productive and useful, so that our patients could get the maximum benefit. To name a few, we have with us 3 Tesla MRI, PET-CT (4), Cyberknife, Novalis Tx (5), 320 Slice CT, HIFU, DaVinci Robotic systems (4), PET-MRI, Brain Lab Navigation System, HDR Brachytherapy, DSA Labs, Hyperbaric Chambers, Fibroscans and Endosonography. The list is fairly long. We are also expecting to install the first proton-therapy unit in South Asia in 2016.

Apollo is hailed as a hotspot in medical tourism. Please share your achievements so far. At Apollo Hospitals, we strongly believe that India will find its rightful place as the Global Healthcare Destination. We have developed international delivery capabilities and demonstrated our global excellence in almost all specialities. We treated over 1,10,000 foreign patients from across the world last year .

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Where Quality Meets Care Dr Dharminder Nagar, Managing Director, Paras Hospitals is a visionary entrepreneur whose business acumen and love for technology keeps him to the fore. He discusses his robust healthcare vision and mission with Shahid Akhter, ENN Please tell us something about the inspiration behind Paras Healthcare. Paras Healthcare, is a venture of passion, dedication and achievement. The real inspiration behind the hospitals, now the healthcare chain, is my father Chaudhary Ved Ram Nagar, who was determined to ensure that his children excel in education and in life. He encouraged entrepreneurship, and always believed in providing the community with the resource that it lacked in.

How do you compare the services and infrastructure, at the time of inception in 2006, with what you have achieved today? Evolution is a part of growth and development, and for a tertiary care hospital it is imperative. The systems, processes, trainings, and most importantly the manpower has to grow every year. Today, Paras Hospitals, Gurgoan is a 250-bed leading tertiary care hospital of the region. Moreover, the hospital is now recognised as the foundation stone of the upcoming healthcare chain. Paras Healthcare â&#x20AC;&#x201C; Gurgaon, NewDelhi, Patna â&#x20AC;&#x201C; equipped with the doctors and clinicians of repute, has been

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able to establish itself as the leading healthcare chain in – Neurosciences, Cardiac sciences, Orthopaedics and Joint Replacement, Cancer Treatment and Mother & Child Care.

What technological advancements your healthcare chain has introduced lately? We strongly endorse the skills of our doctors. For us technology is a way that enables our doctors to perform better. Paras Hospitals, Gurgaon has been the first private hospital in Delhi & NCR to equip itself with a standalone Image-guided Tumour Navigation tool. This technology helps our exceptionally skilled neurosurgeons to have functional MRIs and Tractography during the surgery. It is mostly useful in deep-seated tumour surgeries- this type of surgery is rarely performed by neurosurgeons in other parts of the country. Dr V S Mehta, Director Neurosciences, Paras Hospitals, has been the driving force for establishing Paras Hospitals, Gurgaon as the leading Neuroscience centre of this region. In our Cardiac Sciences Department, Paras Hospitals, Gurgaon, has evolved and adopted the latest clinical recommendations. Today, 98 percent of the patients are treated through Transradial Catheterisation. Our entire interventional team, under the leadership of Dr Tapan Ghose, is equipped to perform Transradial procedures—a technique still rarely used by the cardiologists due to the requirement of extensive skill and training. In Paras HMRI hospital, Patna, we have launched the regions first PETCT. This technology is the first in Bihar and Jharkhand. It is an integral part of the oncology centre in Patna.

What are the centres of excellence at Paras Healthcare? The pillars of Paras Healthcare are Neurosciences—Neurology and Neuro Surgery; Cardiac Sciences—Cardiology and Cardiac Surgery, Oncology and

Oncosurgery, Orthopaedics and Joint Replacement, Spine Services, Mother and Child Care.

What kind of emergency services can one expect at Paras Hospitals? Paras Hospitals has well-equipped emergency care services. We have a reputed team of trauma experts — Emergency Clinicians, Cardiologists, Orthopaedics, Vascular and Plastic Surgeons. Due to the location of the hospital, we receive a number of emergency cases. We are able to provide urgent and immediate care to the patients who may have issues ranging from a cardiac emergency to an accident. Our emergency, pharmacy services are available 24 X 7. At all times, we have specialised doctors in the hospital to ensure that timely clinical intervention is provided to all.

What about care and quality? Paras Hospitals, Gurgaon, strongly believes in quality and patient delivery. We were the first hospital in Gurgaon to achieve NABH and NABL accreditation. Today, Paras Hospitals, Gurgaon, has a tremendous outpatient and inpatient flow, hence for us, quality care and healthcare delivery is a continuous and persistent effort.

Has Paras Hospitals tapped into medical tourism? Paras Hospitals has always believed in the vision of establishing itself as the preferred healthcare provider to the community – for domestic patients. However, due to the presence of an exceptional team of reputed doctors, we receive patients and treatment re-

“We strongly endorse the skills of our doctors. For us technology is a way that enables our doctors to perform better quests from all over the world. Our international patient cell has been able to establish its network in a number of Gulf and African countries. The number of international patients visiting Paras Hospitals has been growing every year by the continuous efforts and involvements of our doctors in promoting our services internationally.

Are there any expansion plans for Paras Healthcare?? Today, Paras Healthcare has three running commissioned hospitals. Our presence is now beyond Gurgaon, and today, we have a centre in Delhi, Paras Spring Meadows, a sought-after centre for mother and child care. According to our mission of providing healthcare services to regions where the same is not easily available, we now have a 350-bed hospital in Patna, Paras HMRI, a tertiary-care hospital with a wellequipped cancer centre. In the second half of the year, we shall be launching a hospital in Darbhanga (135 kms from patna)—Paras Global Hospitals. It would be the first hospital in the region to have an ICU, cardiac facility and full-fledged inhouse diagnostics. Also, soon we shall be coming up with a 500-bed green field project in NCR. The same shall have the state-ofthe-art cancer-care centre. Paras Healthcare shall continue to expand in unexplored markets.

june / 2014 ehealth.eletsonline.com

Special Focus

Combining Healthcare and

Compassion

Dr TS Jain, Medical Director of Pushpanjali Crosslay Hospital, in conversation with ENN’s Rajesh K Sharma, talks about ensuring quality healthcare to every patient Please tell us something about Pushpanjali Crosslay Hospital. Pushpanjail Crosslay hospital is a multi super specialty hospital. We provide all services including Surgery, Medicine, Cardiology, Cardiac Surgery, Neurology, Neurosurgery, Plastic Surgery and Oncology. We currently have 350 beds.

How do you combat nosocomial infections at the hospital? The disposal of bio-medical wastes is one way of preventing nosocomial infections. In addition, we also have a hospital infection-control committee. It is headed by the head of Micro-biology, and the heads of all the clinical departments are its members. We also have infection control nurses who ensure that no infection takes place inside the hospital. Hand washing is the most effective way of preventing nosocomial

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infections. Besides the washing, we employ alcohol-based hand rubs at all the important areas in the hospitals. Before and after touching the patients for a procedure, everyone is required to hand rubs. We also have barrier nursing, so that there is no spreading of infection from one place to another. These are the measures taken to prevent the spread of hospital acquired infections.

Please throw some light on the latest technologies that you have introduced at Pushpanjali Crosslay. We have the most advanced oncology centre. We have just installed ImageGuided Radiation Therapy (IGRT) machines. We also have a 30-channel Brachytherapy unit for cancer. We also have advanced Cardiac Surgery centres at our premises. We have a nuclear medicine lab. We have all the latest gadgets including MRIs and CT Scans. At Pushpanjali, we also have the Pushpanjali Wellness Centre, where we have various health packages. Our blood bank is one of the most modern blood banks. We take care to minimize the diseases that spread through blood like HIV/AIDS, Hepatitis B, Hepatitis C. We also perform Nucliec Acid Testing (NAT) on all blood samples to detect harmful infections at an early stage. NAT reduces the window period of testing to as little as one week. This is how we provide a safe blood transfusion.

Of late, we have started telemedicine services at Pushpanjali Hospital. We have a centre near Rudrapur in Uttarakhand. When patients come to our doctors for consultation there, they have the option of consulting the doctors from here as well. If necessary, the patients’ medical images are shared via video conferencing. The doctor, here, can talk with the patients and advise them. In smaller centres, specialists may not be available. But with teleconferencing, the doctor can consult with specialists in a particular field.

In your opinion, does investing in healthcare technologies bring down the cost of healthcare? Unfortunately, healthcare input costs are very high now-a-days, because the cost of machines runs into crores. In addition, a large infrastructure needs to be developed with a large manpower. The advanced medicines needed these days are also very costly. I agree with you that patient care is fairly costly. However, we do try to minimize the cost to the patient as far as possible. Though we are not legally obliged to provide free treatment to our patient, there is a clear-cut instruction from our chairman that no patient will die in this hospital just because he doesn’t have any money. This is very important to us, and for this, we have floated the Pushpanjali Trust which is a charitable trust. So, if we get poor patients, they are treated through

Special Focus

the Trust. We charge the patient only for the medicines, and everything else is provided free.

The government laid emphasis on health in the 12th FYP. How successful do you think the government has been? The health infrastructure is fine, but there is still a long way to go because the number of beds and health personnel in the country is dismally low. People say that private healthcare is very expensive as compared to government hospitals, but if you compute the total cost of government hospitals, the infrastructure cost, the equipment, the staff salaries, then the per-bed cost of government hospitals is higher than the private hospitals. When the government hospitals calculate their per-patient costs, they don’t take into account the huge infrastructure costs and the money that is being paid as interest on it. But effectively, the perpatient cost incurred in a private hospital is much less than the per-patient cost incurred in a government hospital. The only difference is that in a private hospital, it is the patient that has to pay while in government hospitals, it is the government that pays.

The government is also promoting the PPP model for improving healthcare. What’s your take on that? Recently, the Delhi Government wanted to start super specialty hospitals on the PPP model, but their terms and conditions are so one-sided that nobody bid for them. It has been years that these hospitals have been lying unused, but the government has not been able to get any private partner to deal with them.

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Though we are not legally obliged to provide free treatment to our patient, there is a clear-cut instruction from our chairman that no patient will die in this hospital just because he does not have any money In the other schemes that the government runs, the rate it provides is so abysmally low that most hospitals cannot afford it and most good hospitals don’t even entertain ESI and CGHS patients. I wonder how the hospitals that do provide these facilities survive.

Please tell us about Pushpanjali Hospital’s medical tourism initiative. We have patients coming from Middle East and African countries as well as from Russia. At any given time, we have five to six international patients admitted at our hospital. There are some agencies that do promote medical tourism, but we feel that the best marketing strategy for us is when a patient is satisfied with our services and recommends us to other patients.

Does Pushpanjali Hospital go to foreign countries for promoting its services? As of now, we don’t do it, because such things require a lot of investment. But the patients that come to us end up becoming our agents when they recommend us to other patients. There are a few people who represent us, but I sincerely feel that the best marketing for us is a satisfied customer. We don’t promote our services outside like the bigger hospitals do, but we are in advanced talks with the Government of Gambia over the possibility of setting up a hospital there. Also, we are planning to have an exchange programmes with some of the Russian states, whereby their doctors and para-medics can come here for training.

Special Focus

Interest and Comfort

of our Patients is Paramount QRG Health City, a 450-bed multi-specialty hospital in Faridabad, is driven by the philosophy of patient first. Promoted by QRG Medicare, the healthcare venture aims to break the perception that hospitals have become profit centres, and instead work solely on the principle of honesty in the medical profession. Dr D K Baluja, President, QRG Medicare Ltd in an email interaction with Ekta Srivastava, ENN, elaborates on the objectives and plans of the hospital

Dr D K Baluja

Please tell us about the inspiration behind the launch of QRG Health City? QRG Health City strives to be a cutting edge super speciality hospital committed towards providing exemplary medical care by ethical practices and deliver international services to people of Faridabad and beyond. The hospital will run on social entrepreneurial belief where all earnings and profits will be reinvested for constantly upgrading technologies, services and facilities to enhance comfort and well-being of patients. The thought is to offer a patient-centred collaborative learning experience, driven by the primary value, “The needs of the patient come first.” With top-of-the-line doctors, medical staff,

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latest medical devices, and cutting edge technology, patients can get specialized treatment and surgeries. The foundation for setting priorities and aligning efforts across the organization is our five pillars of excellence based on quality, patients, academics, employees and finance.The basic inspiration behind launching this project is to give an utmost care to people of Faridabad with advanced technology and infrastructure for which they have to go beyond the city or country.

How do you plan to provide affordable healthcare to all? The healthcare scenario in India indicates that it’s the need of the hour to focus on providing quality healthcare and accessibility to healthcare facilities in an ethical way. Healthcare is changing before our eyes. With greater awareness and better access to information now-a-days, there is a higher emphasis on health and disease prevention. QRG Health City will be a unique healthcare facility in Faridabad that will offer world class healthcare facilities, best doctors and latest tech-

niques delivered ethically, with full transparency and honestly. The hospital will help everyone to make a safe and informed decision regarding one’s health and healthcare requirements, conforming to global standards under one roof delivered at affordable rates. This will definitely save the opportunity costs and time for which the patients have to go out of city.

In setting up of hospitals what are the challenges that you have faced and how did you overcome them? Whenever you start a new project, we are bound to face some or other form of blocks and hurdles. What matters is to develop a successful strategy and by following careful consideration, it is possible to develop a tailored approach to overcome the barriers, encourage changes in behaviour and ultimately implement them. The only way to overcome challenges is to face them and overcome them by keeping a positive approach, confidence in the team and the project and enthusiasm to achieve the goal.

The hospital infrastructure is particularly designed to ensure that all the requirements are met efficiently and effectively at times of emergency. For Example, typically, hospitals have emergency section on the ground floor while operation theatres are either located on the second or third floor. However, at QRG Health City, there will be an exclusive OT to attend to emergency cases on the ground floor to cut down on the time needed to take a patient to second or third floor. Those few minutes or even seconds can be the difference between life and death.

What are the objectives of this hospital? QRG Health City is committed to create an ethical and high quality healthcare organization that serves all sections of society sustainably through a three way focus on education, research and deliver transformative therapies for patients. It is solely driven by the philosophy that interest and comfort of our patients is paramount. Further, in order to ensure maximum commitment, doctors will work full time here and will not practice at other hospitals or their own clinics. At the core of our vision, it’s patient first and always and hence, doctors will recommend tests and surgeries only if they are utterly needed and not for sake of commercial interests.This will avoid excess investigations and over prescription of drugs which is taxes patient’s health.

The USP of the hospital would be cutting edge technology and the clinical care which is patient centric and would aid in correct and early diagnosis and hence treatment What are your thoughts on the rise of multi-specialty hospitals? What are the advantages it caters? I strongly encourage and am in favour of such practice in the interest of patients as well as caregivers, provided they offer their services following the ethical route. Multi Specialty Hospitals are multifarious healthcare institutions that include every branch of medicine and surgery available under one roof. The emerging number of multispecialty hospitals in India over the last decade confirms the emergence of improved and better medical facilities on rise. This has resulted on the growth and better outcome of overall healthcare system in India and there have been many more intended, especially for the suburbs of cities and in rural India, where is a need for the same.

What technological advancements are you planning in your hospital? We will introduce a number of medical devices and equipment for the first time in Delhi’s satellite city of Faridabad. Once operational in June 2014, the hospital will be biggest in the city with capacity of 450 beds and is

expected to provide a number of stateof-the-art facilities. For example, we will have the first FD 20 Clarity Cath Lab in North India and the third in India. The Cath Lab will perform full spectrum of cardiac and vascular interventions, have advanced interventional tools for vascular and PTCA procedures. Similarly the hospital’s radiology department will provide a number of services under one roof including 3 Tesla Magnetic Resonance Imaging, 128 Slice CT scanning, mammography, and bone densitometry. The hospital will be first in the city to offer Bronchoscopic Ultrasound, which will allow faster and accurate diagnosis of respiratory diseases.

How QRG will cater the need of the patients differently from other multi-specialty hospitals? Our sole aim is to give best facilities to our patients so that any abnormality in the body is detected at the earliest and necessary interventions are made so that the patient can recover. The hospital is also located close to National Highway that cuts across Faridabad and is notorious for fatal accidents.

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Special Focus

Delivering on National

Healthcare Agenda Equipped with the latest technology, Rajesh Srivastava, Founder and Chairman of Rockland Group of Hospitals, plans to cover the entire country through the â&#x20AC;&#x2DC;Rockland Network Modelâ&#x20AC;&#x2122;. In conversation with our correspondent Ekta Srivastava, he elaborates on the mission of creating a network of accessible and affordable healthcare in India Please shed some light on the key achievements. Rockland Hospitals has completed ten years in healthcare. From a single unit 80-bed hospital in South Delhi, it has grown into a chain of three hospitals located at Manesar, Dwarka and Qutab Institutional area in the NCR with a bed capacity of 808. Land has already been acquired in Noida for another 500-bed hospital with training facilities. In 2004, when Rockland was launched, there were no quality standards for Indian Hospitals. Little did the Rockland team know that a small step taken by them in the form of an Industry seminar would result in something as big as NABH. This seminar was attended by several leaders from the government and the private sectors. Rockland was chosen as the pilot study centre for setting the quality standards for Indian Hospitals. These standards, today, are known as NABH. In 2008, World Bank and IFC invested in Rockland Hospitals due to its unique model of healthcare delivery. In 2009, Rockland, in a Governmentsponsored study conducted by the India Today Magazine, was rated by the doctors among the top 5 hospitals in India. Since the last few years, several global players have visited our facilities with a desire to enter into joint ventures. Our top team has recently visited Japan on the invitation of Hitachi and Japanese Government to share its network model and move forward with joint ventures and

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Rockland Health Network Rockland Health Network Five layered Healthcare Delivery Mechanism to connect the Rockland tertiary Five layered Healthcare Delivery Mechanism to connect the Rockland tertiary care care hospitals with secondary care and primary care . Rockland has done a 10 hospitals with secondary care and primary care. Rockland has done a 10 years R & l to ensure h d l f l at each f stage to ensure h that D foryears R & D for developing this model to ensure filtering of patients at each stage developing fthisdmodel filtering of patients to ensure that the tertiary care hospital would get mainly tertiary care patients the tertiary care hospital would get mainly tertiary care patients in larger volumes. in larger volumes.

Network Partners

PATIENT

HEALTH VOLUNTEER

GP/Clinic

DIAGNOSTIC

PRIMARY CARE CARE

SECONDARY CARE

CENTRE

(NURSING

(SMALL HOSPITAL S)

HOMES)

Rockland Owned/promoted d/ d

Japanese Government in the area of technology, medical care and preventive health care.

How do you visualize the progress of technology in Indian healthcare? What latest services have you deployed in hospital for betterment of the patients? Technology has moved fast, however its implementation has been slow as the healthcare sector is moving from a disorganized to an organized industry. Several global players are in advanced stages of negotiation with the group for technological tie-ups due to the unique healthcare network model developed over the last 10 years which connects the patients through a chain of health volunteers, clinics, diagnostic centres,

TERTIARY CARE

Rockland Owned/promoted

primary, secondary and tertiary care facilities through IT and Telecom interfaces. This will ensure that the patients are first of all correctly diagnosed, and only then referred for treatment to a primary, secondary or tertiary-care facility. This will help the patients save a lot of time and money. The technology is based on mobile-apps, so it can be used up to village levels for communication with the entire network. AIIMS had recently invited us to share its network model for the benefit of the entire healthcare industry.

How are you planning to give a sustainable quality healthcare? Quality is connected to efficiency and affordability. We, through our unique health-network model, will be able to

reduce the costs due to early diagnosis and by filtering out patients for primary and secondary-care treatment locally, and only those patients that need tertiary care would need to travel to larger towns. Right diagnosis and right treatment need quality doctors and support staffs which are often missing in smaller hospitals, nursing homes located in remote areas. By connecting these facilities with the Rockland Tertiary care facilities in NCR, the doctors will have back-up of the super specialists through IT & Telecom connectivity. We will collaborate with primary care and secondary care players by upgrading their facilities through joint ventures. Doctors, located in remote areas, will have access to our managed OTs, diagnostic facilities and back-up of trained support staff for primary and secondary care so that the patients can be treated locally, and only tertiary care patients are referred to NCR-based hospitals of Rockland.

What is the USP the Rockland Group of Hospitals? Our greatest assets are our doctors, and we feel our USP lies in our unique work culture due to which many worldrenowned doctors, who have been with us since our inception, are still continuing with us.

What is the roadmap ahead for Rockland Hospital? The Rockland Group of Hospitals is planning to set up a Cancer Centre at Manesar, a 500-bed hospital with advanced training facilities in Noida, and has already begun to expand its health network programme by operationalising a large number of primary, secondary and diagnostic centres in the NCR in a 50-km radius around its current facilities. The Rockland Network will also cover several under-developed countries like Africa, Middle East, CIS and SAARC regions. Rockland doctors are already conducting OPD and surgical procedures which can be conducted locally.

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special focus

Please tell us about the healthcare facilities taking shape at Sarvodaya since its inception in 1997. Late in the mid-1980s, I was ensconced in Sector 19, where I worked in various capacities in different healthcare set-ups. I was catering to the middle class, but I was not satisfied with my little contribution and performance. I always looked beyond the small hospitals, and thought of creating one super-specialty centre, where all three verticals (clinical care, medical research and academics) of healthcare could be pursued under one roof. Further, the focus was on affordability and medical excellence. The opportunity came in 1997, when we finally created an integrated healthcare system. Gradually, we were able to increase the bed strength, expand our infrastructure and install state-of-the-art technology. The motivation or the philosophy behind Sarvo-

‘Happiness for all’

Located in the heart of Faridabad, Sarvodaya Hospital has evolved into a multi super-specialty medical institution. Dr Rakesh Gupta, Chairman and Medical Director, Sarvodaya Hospital in conversation with Shahid Akhter, ENN, talks about his passion and problems in healthcare daya Hospital is ‘Sarve Santu Niramaya’ or ‘Happiness for all’. Today, the hospital has a capacity of over 300 beds with a fully operational super-specialty wing in place. Our team of doctors are committed to exceptional care amidst a sense of professional approach with a person-

al touch. They add value to their work to help patients recover faster. Add to this their passion to heal patients and their constant drive towards higher quality outcomes is unmatched.

What are the centres of excellence at Sarvodaya Hospital? Sarvodaya Hospital has set benchmarks in multi-specialty with exceptional work performance. This sets in place, its recognition as a centre of excellence, providing super-specialty services in Cardiology, Cardiothoracic and Vascular Surgery, Cancer Care, Neuro Sciences, Minimally Invasive Surgery, Gastroenterology and GI Surgery, Orthopedics and Joint Replacement, Urology and Nephrology. Centre for gynaecology and obstetrics is another state-of-the-art hub that provides comprehensive care under one roof. We have the most advanced equipment to provide maternity health care services. Our facilities include ante-natal care, highrisk pregnancy, besides conventional gynaecology.

What support services are available at Sarvodaya Hospital? This constitutes the blood bank, laboratory and the imaging services. They

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personal-relationship executive, round the clock. Prior to the patient arrival, our team of doctors evaluate the case, and provide the cost and treatment plan prior to patient arrival.

What are the healthcare courses offered by Sarvodaya Institute of Allied Health Sciences (SIAHS)?

are well-equipped with state-of-the-art technology. Each department is selfcontained, and replete with essential services. Blood bank and Transfusion service, for instance, incorporates Clinical Biochemistry, Haematology, Clinical Pathology, Immunology and Serology, Microbiology, Histopathology and Cytology.

Your focus on care and quality. We are very particular about care and quality. We scrutinise the feedback from our patients, and try to see if there was any room for improvement, or if we missed anywhere by way of care or time lapse or any other detail that suggests an improvement or remedial measure. To ensure what we say and to bring greater visibility, we went in for NABH and NABL accreditations. Besides, patients, even our staffs feels greatly motivated to see quality measures in place and practice.

How good is your response in case of emergencies? Our emergency number 0129-4184400 can be activated to summon an ambulance service from your home. In Faridabad, the ambulance is expected to reach your home within 20 min-

utes, and the treatment starts from there itself. If it is a case of heart attack, the treatment should commence soonest possible. Any delay may jeopardize the outcome. Following admission into the hospital, an emergency cardio angiogram can be performed to detect the blockages in the artery. 24-hour Heart Service at SHRC is equipped with two mobile intensive-care unit ambulances, nine-bed heart care beds, two Echocardiography machines, Cardiac Cath Lab for emergency Angiography, Angioplasty, full-fledged heart surgery operation theatres, cardiac rehabilitation and life-saving fitness programmes to prevent recurrence of heart attacks.

Do you cater to international patients? Yes, we have International Patient Care Centre. We endeavour to provide a one-stop care for such patients, and their family members. Our services begin with tele-consultation and predeparture evaluation. We facilitate visa and other travel arrangements, including air-ambulance service. We have a choice of rooms from private to luxury suites, interpreters are available, and all this is monitored through

Sarvodaya Institute of Allied Health Sciences (SIAHS) is aimed at improving Healthcare Services by enhancing the number of trained primary and supportive health-care workers. Sarvodaya Nursing Institute offers specialized training to nurses, paramedics and hospital support staff. Medical education, in these verticals, is backed by practical training and exposure at Sarvodaya Hospitals.

As you are in close proximity to the villages, do you encourage awareness programmes so that you can reach out to them? Yes, at Sarvodaya Hospital, we consider ourselves accountable to the community. Indian healthcare scenario is vexed with various issues like nonavailability, non-affordability, lack of quality, lack of awareness, preventable measures and so on. Considering this lacuna, Sarvodaya Hospital and Research Centre conducts multiple Community Outreach Programmes as its commitment and obligation towards the poorer section of the society. The primary aim of these programmes is to address and redress the imbalance by providing quality and advanced healthcare to the deprived and the underprivileged. We conduct regional camps, and our focus is on clinical examination, diagnostics, treatment and surgeries to the underprivileged. Regularly, we reach out to them with extensive awareness programmes with the aim of providing the community with knowledge on prevention, benefits of early diagnosis and treatment of health issues.

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Special Focus

Caring and Serving

with Excellence

Dr Ashok Malik, Director, Sarvodaya Hospital, Ghaziabad, discusses with ENNâ&#x20AC;&#x2122;s Rajesh K Sharma about how healthcare is getting more expensive Please tell us something about Sarvodaya hospital.

healthcare to the lower class as well as the middle class.

Sarvodaya hospital was started in 1987 as a 25-bed hospital. It was the first hospital in Ghaziabad. It is now a 150-bed hospital. Last year, we started another 150-bed super specialty hospital, having Cardiology, knee transplant, etc. Last month, we performed five knee transplants.

In the 12th FYP, the government has laid emphasis on healthcareâ&#x20AC;Ś The problem is not with the government initiative. It has to do with the lack of good doctors. Most doctors join the corporate hospitals or get into private practices.

What are the services that you provide at your hospital?

The government is promoting telemedicine and mobile health through its National Health Mission. Do you think these initiatives have been successful?

We provide Urology, Neurology and Gastroenterology services. In fact, we perform all surgical procedures except Cardiothoracic. Should the patient require super-specialty care, he/ she is shifted to our super-specialty unit which is nearby.

How many patients do you see every day? We get about 70 to 80 patients every day across all departments.

How do you counter the threat of nosocomial infections? Since most infections are air-borne, we ask the staff to cover their mouths with masks, and ensure that they keep their hands sanitised all the time. As far as our medical instruments are concerned, we use auto-cleaning to clean them.

What sections of society does Sarvodaya Hospital serve to?

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We serve all sections of the society. We have different category for each section. In fact, even for the lower classes, we provide air-conditioned general wards for as low as `1,500 per day, which is quite cheap. As we move higher, the quality of offering improves.

Are the benefits of medical technology within the reach of poor? Benefits of medical technology have not touched the poor, and we are aware of that. Government hospitals do not work properly and their services are not proper. Besides that, they also face shortage of manpower. That is why, we aim to provide affordable

I think all this is wastage of money by the government. They donâ&#x20AC;&#x2122;t have the manpower for such an initiative. Also, the people are not interested in these initiatives. They want a clean and neat place, where they can go to for treatment of their ailments, rather than remotely talking to the doctor on phone.

How can private hospitals help in providing healthcare to all? Healthcare is becoming expensive, but at the same time, the educated people are getting medical insurance through their employers. This makes healthcare available to them.

But not everyone has medical insurance... Most salaried people have medical insurance provided by their employers.

How important is medical insurance to running a hospital now-a-days? It is very important. In fact, nearly 10 to 15 percent of our treatments are paid through medical insurance, and this figure will only rise in the future.

The government is promoting the PPP model in providing healthcare. Is Sarvodaya Hospital also looking to partnership with the government? I feel the government’s PPP initiative is still in its initial stage. For a start, government bodies like Employee State Insurance (ESI) and Central Government Health Scheme (CGHS) have started recognizing private hospitals in addition to the government hospitals. This way, even the less privileged patients can avail themselves of our facilities.

But CGHS has been plagued with mounting dues towards the hospitals… That is true, but it is a different issue altogether.

What are your views on the advances in medical technologies? As time goes, one has to adopt newer technologies according to the economy and the needs of the patient.

Is the rising cost of healthcare investment making basic healthcare even more expensive? Yes, that is true. The government does not provide any help to the healthcare providers. We have to pay commercial rates for the land on which we build our hospitals. We pay house tax according to the commercial land. The taxes that we pay are also quite high. In addition, we have to pay for electricity at commercial rates as well as pay employees their salary, and con-

tribute towards their provident fund. With such high expenditures, we cannot afford to make our services cheap.

What are the positive changes in medical practice that you have seen in your vast experience? In the last 27 years, the average du-

patients have also started asking for a better infrastructure and better facilities from us. Due to this, we are always on our toes in keeping our facilities up to date.

Has the nature of ailments that you have been treating

I feel the government’s PPP initiative is still in its initial stage. For a start, government bodies like ESIS and CGHS have started recognizing private hospitals in addition to the government hospitals ration of the patient’s stay in hospital has come down because of the medical advances like endoscopic and laparoscopic equipments. It is now down to just one or two days. This benefits the patient immensely. He can be on his feet sooner after a surgery. This benefits the hospitals also, because after three days, the patient’s stay becomes a burden on the hospital. With modern technologies and equipments, we can perform a diagnosis as soon as the patient reaches, and perform surgery on second or third day itself. By ensuring fast treatment for less serious patients, we can also concentrate on treating the chronic patients, who stay in hospitals for a longer time. During this time, the

changed in the last 27 years? No, there hasn’t been much change. Even earlier, we treated lifestyle-related ailments in our OPDs. I haven’t seen any rise in the number of cases in our hospital.

What are you expectations from the new government regarding healthcare? Since we are governed under the UP state government, a change at the centre does not affect us directly. However, if the government wants to help private hospitals, then it must provide us with cheaper land, and also lower the taxes on medical equipments. Only then will we be able to provide cheap treatment.

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Special Focus

Providing Quality Healthcare at Reasonable Cost Dr D S Rana, Chairman, Board of Management and Department of Nephrology, Sir Ganga Ram Hospital, has a vision to be a leader in healthcare delivery, medical education, training and research, and to meet the changing expectations of the community. Dr Rana, in an interaction with Ekta Srivastava, ENN, talks about the present scenario and future plans of the hospital How do you visualise the progress of technology in Indian healthcare? Medical Technology has witnessed incredible growth over the last half century. It has changed the delivery of healthcare in preventive, diagnostics and therapeutic aspects. Sir Ganga Ram Hospital had been and is always on the forefront to acquire latest technology. It is matter of satisfaction that during last two decades lot more hospitals have come up all over the country having modern technology to provide cutting-edge tertiary care health services to our people. Most of the research in Medicine is done abroad. Even after having a pool of medical experts in our country, we are still lagging behind. Whatâ&#x20AC;&#x2122;s your take on that? No doubt, both Central and State

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Governments have to focus on providing primary and secondary healthcare in such a vast country which itself is a uphill task. However, I strongly feel that time has now come that premiere medical institutes in Public Sector and prominent NonGovernment Hospitals should have reasonable budget for carrying out, not only clinical research work but also basic research in medicine. At Sir Ganga Ram Hospital, we have give significant stress on providing quality medical education and carrying out meaningful clinical and basic research.

What are the major challenges that a private or corporate hospital faces today in a country like India? The modern medical technology and

also glittery physical infrastructure adds to the rising cost of healthcare. There is huge gap between supply and demands of hospital beds. The focus should be to increase the number of beds, both in public and private sectors. In addition, all efforts should be made to make optimal use of hospital beds. Promotion of Day Care Surgeries and Home Care Services are two major steps to cut down the cost of hospitalization and make beds available for more needy patients. I am glad that this philosophy is becoming popular in the country.

Do you get any government aid? We do not get any government aid nor we require it. Our model is cross subsidized model of providing quality healthcare at affordable price to

USP of every hospital should be to work with a policy of ‘Patient First’, and all efforts should be made to provide patient with quality healthcare at reasonable cost all sections of the society. Our hospital is in true sense People’s Own Hospital, where some people pay more than the break-even cost to cover their fellows being those who pay below break-even prices or get free treatment. Under this model we provide free treatment on 20% of the beds and highly subsidized treatment on 25% beds.

What is the USP of SGRH? Our USP is to provide quality healthcare at affordable price to all sections of the society. We at Sir Ganga Ram Hospital work with “Patient First “ in providing cutting-edge healthcare. At the same time, we are aware of our duties to give equal importance in the field of medical education and research. Sir Ganga Ram Hospital is not only famous for providing healthcare, but is also the most sought place for doctors having passion for teaching and research. Sir Ganga Ram Hospital is nursery for training medical and para medical manpower.

Dr D S Rana

What is your vision for the hospital in the next five years? Our present strength of beds is 675 and in addition, we are having 180 beds more in nearby affiliated hospitals. There is constant pressure for more beds. Within next one year, we are completing renovation of our old blocks to match our newly constructed blocks. Very soon we are starting construction of multi-level car parking and OPD block and we will have one more 10 storey block to house Department of Radiotherapy and ad-

ditional 200 beds. In addition we will continue to maintain our stress on medical education and research. Our main focus will be to strengthen our present physical infrastructure during the next five years so that proper physical space with adequate infrastructure can be provided to the departments which have been given the status of institutions. Under public-private partnership model, we will endeavour for our presence outside this hospital.

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????????? ?????? special ????????? focus

‘Need to Inform the Patients Transparently’ says Abhishek Bhartia, Director of Sitaram Bhartia Institute of Science and Research, a nonprofit hospital, that has carved a niche in women’s health. In conversation with Shahid Akhter of ENN, he focuses on the changing scenario in birthing When was the Sitaram Bhartia Institute of Science and Research founded and what it its legacy? Sitaram Bhartia Institute of Science and Research (SBISR) was founded in 1979. It took off under the aegis of its first director, Dr N Gopinath, a renowned cardiologist noted for his expertise in heart bypass surgery. The institute conducted one of the largest community based studies of coronary artery disease in India. It then took up a large study of blood pressure in Indian school children. Similar studies yielded valuable information on the risk factors for cardiovascular disease in our country. SBISR was established with a spirit of serving society through research and the motivation was to establish excellence in healthcare delivery, research and education. With the passage of time, we have evolved into an organization that combines medical research with excellence in patient care.

When did you shift to patient care and what was the outcome? Our research continues to focuses on collecting healthrelated information, translating evidence-based guidelines in clinical practice, developing cost-effective interventions for improving care, investigating factors influencing disease development, and analyzing medical literature for developing clinical guidelines. In 1995, we decided to broaden our range of activities and thought of providing a sustainable base for research. The ground work was laid by eminent physicians and surgeons from All India Institute of Medical Sciences. Professors J S Guleria (Padma Shree), the late M M S Ahuja, R Tandon, I K Dhawan, and V L Bhargava were among the early faculty members to join. Today they serve as outstanding care providers and role models for the next generation of doctors

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What clinical specialities and services Sitaram Bhartia offer? Our specialities are spread across from anaesthesiology to urology, with special focus on obstetrics and gynaecology. We offer radiology and diagnostics, laboratory tests, pharmacy and preventive health check-ups.

Sitaram Bhartia is noted for women’s health. Tell us more on the services in this speciality? We care and support women in every phase of life, from adolescence to menopause. True, Sitaram Bhartia is a leading centre for women’s health. The patients admitted here rate Sitaram Bhartia high on desirable outcomes and quality of care. In obstetrics, our comprehensive birthing program spans a duration of nine months. It lays emphasis on education and empowerment as key elements for a fulfilling journey to motherhood. An inter-disciplinary team consisting of obstetricians, women’s health educators, physiotherapists, nutritionists, paediatricians and nursing staff deliver the comprehensive program. When it comes to labour, delivery and post-delivery care, Sitaram Bhartia offers a safe and satisfying birthing experience. The patient is comfortable with physical and emotional support that reduces the need for medical intervention and improves infant outcomes. The mother is given lactation counselling, and informed about postdischarge care after the delivery.

What are your views on the surge in caesarean rates? Cesarean section is a major surgery and like all surgeries, it carries risk. Recently, the American College of Obstetricians and Gynecologists issued a statement that “pregnant women plan for vaginal birth unless there is a medical reason for a cesarean.” They pointed out that cesarean delivery can increase the risk for infections, bladder and bowel injuries, and serious

We are not only disclosing the cesarean rates in our unit, but are also providing guidance on how to interpret those rates complications in future pregnancies. They noted that babies born vaginally have fewer respiratory problems. Thus as a society we should be concerned about high cesarean rates that are not medically justifiable.

How does one decide or choose the doctor and the hospital ? Many of us do extensive research before buying a mobile phone or a car, booking a hotel for a holiday or even selecting a new restaurant. But when it comes to choosing a doctor, many of us do little more than get a word-of-mouth reference. Unfortunately, what often drives patient satisfaction and thus recommendation of a practitioner to others is “bedside manners” and may not always reflect evidence-based medical practice. Doctors are picked on reputation, and yet some of the most popular doctors have undesirable outcomes such as high cesarean rates!

Is it important for maternity providers to disclose Cesarean rates?

Most hospitals don’t collect data on clinical outcomes – they may not have electronic health records or lack the manpower to manually collect the data. Doctors and hospital administrators may also be hesitant to disclose quality-related data because of concerns about misuse by competitors or patients. Yet these concerns should not hold back efforts at promoting transparency if we want healthcare to become better and safer. The National Patient Safety Foundation of USA has identified transparency is “the most important single attribute of a culture of safety.” We at Sitaram Bhartia Institute are taking a step towards becoming more transparent and accountable to our patients by disclosing cesarean rates of our staff Obstetrics and Gynecology (O&G) unit. We are not only disclosing the rates in our unit, but are also providing guidance on how to interpret those rates.

What are the cesarean rates at Sitaram Bhartia? Our staff O&G unit delivered 561 babies in 2013 with a cesarean rate of 40 percent. This rate is much above the 10-15 percent rate recommended by the World Health Organization and the average rate in countries like Sweden (17 percent), UK (26 percent) or USA (33 percent). However, our 2013 rate is an improvement over the 52 percent rate in our own unit in 2011 and the 65 percent rate reported by a leading health insurance company in India for their claims.

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special focus ?????????

When Size Does not Matter

he fact that the healthcare sector in India is growing is uncontestable. It is expected to be worth $ 158.2 billion by 2017, according to a report by Equentis Capital in 2013. Spearheading this growth, no doubt, are the big corporate hospitals offering boutique treatment and the latest medical procedures. These hospitals showcase Indiaâ&#x20AC;&#x2122;s ability to compete with the best in the world in terms of healthcare. Though these hospitals provide world-class facilities, the cost of treatment in these hospitals is affordable only to the affluent, making it out of reach of the salaried middle class persons. The spread of medical insurance and cashless transactions, however, has put their

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services within the reach of the middle class. But while the big hospitals push the standards healthcare in India, the smaller hospitals also play a valuable role in making healthcare available to all. People prefer going to a neighborhood hospital for regular and non-serious ailments. The smaller hospitals, too have adopted the latest technologies and can offer a host of surgeries and treatments at a substantially lesser price compared to their bigger kin. Certain procedures like Laparoscopic surgery, Neuro surgery, plastic surgery and knee replacements can now be done at smaller hospitals itself. Also, most of the times, these hospitals are run by doctors who were earlier attached to the bigger

hospitals and bring a lot of valuable experience with them. The smaller hospitals, along with treating middle class patients, often strive to provide a similar healthcare to the underprivileged and the destitute, something which their bigger brethren would not be able to do. They usually charge a fraction of their regular consultation fees for such persons, thus ensuring that nobody is deprived. In profiling hospitals of note in Northern India, eHealth also throws a spotlight on a few smaller hospitals (number of beds less than 100) and how they measure up to the bigger hospitals. It looks at what services the hospitals provide, what are the challenges they face and how they cope with it.

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Medical Technology

is Not Cheap in India as Yet Catering primarily to lower and middle-class patients, Dr Yuvraj Sharma, Medical Superintendent, Avantika Hospital, talks about the challenges in providing affordable healthcare amidst rising costs to our correspondent Rajesh K Sharma Please tell us something about Avantika hospital. Avantika Hospital is a 35-bed hospital, predominantly dealing with trauma, accidents and surgeries. We have specialty as well as super-specialty departments except cardiothoracic surgery and oncology.

What are the super-specialty disciplines that you offer? In super-specialty, we have neurology, neurosurgery, plastic surgery and joint replacements like spine. We have medical oncology, but not surgical oncology. In cardio, we provide Cardio therapy, but not cardio surgery.

What section of society do you cater to? We cater to all classes of patients, lower middle class to middle class to upper middle class.

How many patients does the hospital see daily? On an average, we treat around 70 to 80 patients in our various OPDs at Avantika Hospital. At times, the number of incoming patients touches 100.

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special focus ?????????

How do you streamline your day-to-day operation? At Avantika Hospital, we rely on our staff for managing our patients. We do not have an HMIS or any other software installed specially for this purpose. Our hospital staff is our HMIS.

Given the high number of patients, don’t you feel that you should have a real-time monitoring system to efficiently manage the patients?

“While the medical equipments are not cheap, they cannot beat the human mind in providing quality healthcare

It is not that we don’t have any software for managing our different departments. Currently, we have billing software for accounts, software for our various labs, and other departments. But they are not integrated. Very soon, we will integrate our various departments.

more for the doctors than the patients. They help the doctors in managing the business part of their practices, but their contribution in the patients’ well being is still minimal. For that, the human mind is still the best option.

Are you planning to introduce HMIS in the future? Yes, we are planning to have an HMIS system in our hospital this year.

In your opinion, what is the role of technology in making healthcare affordable? Medical technology is not cheap in India as yet due to the high taxes in importing of medical instruments. In addition, since most of the equipment is not made in India, their timely upgradation is not possible. There is subsidy on other products, but not on medical equipments. The upkeep of these equipments is not cheap either. Though, the medical equipments are not cheap, they cannot beat the human mind in providing quality healthcare.

But of late, Indian manufacturers have also started making these equipments as well as providing software solutions. The best equipments are still made by foreign countries. Indian-made equipments have not come up to the mark as yet. As regards the medical software solutions, these are designed

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How can healthcare be made more affordable? First and foremost, the government should reduce the taxes and promote the import of healthcare-related instruments. There should be no import duties on them. Also, the electricity rates for hospitals should be reduced. If they charge us commercial rates, then they control the bed charges in our hospitals. They cannot force us to limit our bed charges. If the government cannot provide us electricity at subsidized rates, then at least give it to us at residential rates. The patient lying on the bed is residing here. If no relief is given, then ultimately the charges will go to patients. There should also be minimal interference of inspections on the doctors’ and hospitals’ hours. The government does not give any benefit in the land rates as well. Currently, only corporate hospitals can afford to start new hospitals. Higher land prices are wiping out the smaller hospitals, while the bigger hospitals don’t charge anywhere near what we do. Their in-and-out charges are in the range of `4,000 to `5,000. Even a minimal laparoscopic surgery costs

between `70,000 and `80,000, which very few can afford. If the government thinks that by raising the healthcare standards they will be able to make healthcare affordable for rural and poorer section, then they are wrong — you need smaller hospitals, mid-sized hospitals. The WHO’s ‘Health For All’ says that there should be a set up to stabilize critical patients as well as a referral system.

Doesn’t India have a referral system in place? India does not have a concept of referrals. The Health Minister is not a medico, the Health Secretary is not a medico. They look at policies in other countries and try to fit it in our health policy without understanding the concepts.

Can hospitals like Avantika hope to grow to a size of a tertiary healthcare center? It is not easy in current times.

What are your expectations from the new government? My expectation from the government is that healthcare policies should be applied only after getting feedback from the end users—the patients, the doctors, the para-medical staff, etc. Also, there should be a gradual transition phase of about three years, not like the current set up — where we are told to upgrade our facilities on a short notice.

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Offering Healthcare

to One and All Dr H S Kukreja, Director, Kukreja Hospital, talks about the challenges in bringing healthcare to the low-income people in a conversation with ENNâ&#x20AC;&#x2122;s Rajesh K Sharma Please tell us about Kukreja hospital.

On an average, how many cases do you see each day?

It is a 50-bed hospital of which 40 beds are registered with the government and 10 beds are reserved for emergency situations like epidemics. We have Gynaecologists, Orthopedics, Pediatrics and General Practitioners as well. Kukreja Hospital offers comprehensive healthcare facilities to all strata of society. We cater to the needs of the lower and middle classes, and the economically weaker sections of the society.

We have different OPDs for each department. In each OPD, we see five to six new patients daily. So, on the whole, the number is about 50 to 60 patients daily.

You said you cater to the lower and economically weaker sections of the society, but your website also talks about medical tourism. Can you please explain?

We had planned to offer Laparoscopic surgery to foreign tourists. It is economically feasible in India, and we can do it at very reasonable rates. We are working towards it.

Any plans to take it up in the future? Definitely, medical tourism is the future. India can provide affordable medical services and quality doctors as well. However, I am afraid whether it would be successful. Ours is a small hospital of just 50 beds. This does not inspire confidence in people. People trust large hospitals. Earlier, we were planning to target smaller countries like Sri Lanka in order to offer services like laparoscopic surgeries. Later, we realized that it would be difficult to sustain our services in the midst of bigger hospitals.

In your opinion, does technology help lower healthcare costs and make it accessible to more people? Definitely, the need of the hour is to move towards newer and modern technology. However, it depends on finance. Ours is not a high-end hospital, it is a middle-class one. We also want to go in for modern technologies, but our financial constraint limits it. It is the need of the hour. While in Delhi about ten percent of the population

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“Even today, people in India are not aware of a thing like immunisation, which is a very basic and necessary thing”

has access to the latest medical technology, in India, barely one percent of the patients might have it. The majority of population doesn’t have any access to the latest healthcare technologies. Our main aim is to cater to those people who do not even get the most basic facilities.

But the government has taken many healthcare initiatives under the National Healthcare Mission programme to bring healthcare to the poor with the aid of technology. It has, but I don’t think that it is working, because people are not aware of it. Also, the poor people are not so educated, that they can tell you exactly what their ailment is, what their problem is, and what they need. It is difficult for them. Even today, people, in India, are not aware of a thing like immunisation, which is a very basic and necessary thing.

So you feel that the benefits of technology in healthcare have not touched the lower sections of the society? Not at all. And it is out of their reach as well. If you want to provide the latest technology, and the most modern form of treatment to the lower sections of the society, they will not be able to afford it. They cannot even afford the medicines.

How should this challenge be met then? The government needs to help the private hospitals, because everything is becoming more expensive. Licenses are becoming more difficult to procure. While accreditation of hospitals by the National Accreditation Board for Hospitals & Health care Providers (NABH) is a good thing, to get accredited, certain conditions must be met. This means more investments. If we give more facilities, then definitely things will be more costly. In a small hospital like ours, people cannot afford the extra costs. Also, insurance is another area that needs improving. While the rich having private insurance coverage get a refund for their expenses, the poor that come under government insurance schemes have to run from pillar to post for reimbursements.

Can you shed some light on the latest technologies that you are planning to install at Kukreja Hospital? We will start lipid, and also install a dialysis unit because we are getting lots of cases of renal failure now-adays. The contracts have been signed, and the units should start functioning within two months.

How important is medical insurance in making healthcare affordable? Healthcare insurance is very important today. A hospital cannot survive without medical insurance today. But sadly, not many people have insurance now-adays, not even the rich. As for the poor, they don’t have faith in it. The process for claiming insurance from LIC is so complicated that people get frustrated. In recent times, though health insurance has improved, but till the process for reimbursements for health insurance improve and the insurance companies ensure that there are no unnecessary hospitalizations and no malpractices, it will not grow. The insurance companies need to be strict with erring hospitals and individuals, blacklisting those found erring. At the same time, genuine cases must be reimbursed immediately, so that people gain confidence in insurance.

What are your expectations from the new government? The new government should ensure an environment for a hassle-free running of businesses, minimizing of corruption. India has a lot of capacity to grow and a corresponding capability as well. In healthcare, transparency needs to be introduced. Most government policies create room for corruption rather than removing it. Take for example, CGHS. Why should a patient be bound to go to a particular hospital? He should be able to go to any hospital of his choice. All hospitals approved by the DGHS should be empaneled. The process of applying for empanelment for a hospital is itself fraught with corruption. If corruption is dealt with, things will improve. Secondly, the charges laid down by the CGHS panel are unrealistic. Everyone, even the policy makers and the government know that the prices are very low. This creates room for corruption, as the doctors then keep adding more procedures to a case to raise the charges.

june / 2014 ehealth.eletsonline.com

special focus

Scope, a Hope for

the Down and Out A small hospital in a high-income locality, Scope Hospital makes its services available to the rich and the poor alike. Its Director Dr Tarun Kumar explains to ENNâ&#x20AC;&#x2122;s Rajesh K Sharma how the hospital makes it happen Can you tell us something about Scope Hospital? Ours is a 25-bed hospital, with a fivebed ICU with ventilators. We also have a well-equipped operation theater.

What medical services are available in your hospital? We have Laparoscopic Surgery, Dermatology, Pediatrics, Orthopedics and many other departments. We provide all types of surgeries except transplants and Cardiothoracic Surgery.

What kinds of patients do you cater to? We mostly serve middle-class patients in Indirapuram and Ghaziabad. In addition to this, we have started a special OPD for the poorer families at just Rs 20.

How many patients do you deal with in a single day? Since we started, we have been getting about 20 patients for our OPD. Overall, we get around 70 patients daily.

What are the technologies that you have implemented in the hospital? We provide all basic facilities like Surgery, Gynaecology, Orthopedics and ENT. My specialty is Laparoscopic Surgery. We do all kinds of laparoscopic surgeries here, except Bariatric Surgery. In orthopedic surgeries,

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we have performed Total Knee Replacement (TKR) Surgery, hip transplant, knee transplant. In addition, we also do Trauma and Neurosurgery. Since, ours is a very small hospital, we do not do CT scans and MRIs due to shortage of space.

What prevents you from performing Bariatric Surgery here? Bariatric Surgery is a very expensive surgery, costing nearly Rs four lakh. Patients wanting Bariatric Surgery

prefer to go to the bigger hospitals. Also, if I start performing Bariatric Surgery here, I need to look at how many patients I can expect, since this is an expensive surgery. Bariatric Surgery requires teamwork between different disciplines like gastroenterologists and endocrinologist, which we donâ&#x20AC;&#x2122;t have.

Do you think technology is helping bring down the costs in healthcare? Yes of course, every new technology is

beneficial to the patient if it helps in bringing down the costs.

Are you planning to implement any such technology in your hospital? In the future, yes. The government is pushing to introduce a central repository of patient database. Please share your opinion on this. This is a good thing. But how long can the patient information be stored? Every hospital stores the patient information for five years. But, since we see a lot of patients, holding the information for long is not possible for us.

What are the challenges that a small hospital like yours faces when it wants to grow? We are a 25-bed hospital, and if we want to grow, we need to provide more facilities like CT scans, MRIs and blood banks which require more space. While space is limited n Delhi-NCR region, smaller hospitals in Tier II and III cities are able to provide such facilities. However, in Delhi-NCR region, due to the Supreme Court ruling against nursing homes in residential areas, such an opportunity is not present to us. The government did provide us some relief in the form of increasing the FAR (Floor Area Ratio) from 10 percent to 25 percent. While the government says we canâ&#x20AC;&#x2122;t run these companies in residential areas, we tend to think otherwise. We feel that we are giving facilities to patients. If a patient develops a serious problem, then he can go to a nearby hospital, instead of going to a bigger hospital elsewhere. We provide primary care to patients in such cases.

Does a small hospital like yours face a perception issue when patients compare it to bigger hospitals for similar treatment?

We do face perception challenges from patients who feel we may not be able to perform certain procedures. But, if we provide a good treatment to the patient and he is cured, then the perception changes Yes, we do face perception challenges from patients who feel we may not be able to perform certain procedures. However, if we provide a good treatment to the patient and he is cured, then the perception changes. All these things depend on the doctor and the staff. The patient will feel that he can get the same treatment at a lesser cost here, and doesnâ&#x20AC;&#x2122;t need to go to a bigger corporate hospital.

Are you empanelled on CGHS? No, to be empanelled on CGHS, a hospital needs to be a 100-plus bed hospital. Also, a lot of smaller hospitals are moving away from CGHS empanelment because their charges are very less, and most have pending payments running in crores.

What kinds of ailments do you treat more commonly?

We treat all kinds of ailments, right from viral infections to seasonal infections. Last year, we treated a lot of dengue and typhoid patients. Besides that, we also get a lot of hypertension cases, as stress levels are quite high now-a-days.

What are your expectations from the new government? The government should increase the number of beds in government hospitals as well as the quality of their healthcare. Patients always complain about the absence of doctors from the hospitals, when in fact the doctors are present, but the workload is immense. For a hospital like Scope Hospital, the government should decrease the criteria for the number of beds for a CGHS empanelment. It should also release the CGHS payments in a timely fashion.

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launch pad

Key to timely and appropriate treatment

rrhythmia refers to abnormal rhythms of the heart which in turn causes the heart to pump blood less effectively. The common symptoms of cardiac arrhythmia are dizziness, shortness of breath, light-

headedness, rapid heartbeat, heart palpitations, chest pain, blackouts, visual problems, and fainting. Since different patients suffer from these symptoms at different frequencies; they are unlikely to be diagnosed by the conventional Holter monitoring that monitors the heart for 24-48 hours, or an ECG. The above mentioned tests allow the doctor to look at the heart’s activity at rest and at

one point in time. But abnormal heart rhythms and cardiac symptoms may come and go. So to record your heart rate and rhythm during a symptom there is a device called as the External Loop Recorder (ELR). An ELR has capability to monitor a patient’s heart for a long duration (7-30 days), and hence has a higher chance of providing a diagnosis to patients with infrequent symptoms.

All-in-one Mobile Healthcare Solution

PL Medical Technologies Private Limited introduces a new revolutionary all-in-one home health and wellness monitoring mobile device – BPL LifePhone Plus, making better healthcare practices easy for the public, anywhere, anytime. The device will serve as a proven way to improve wellness at reduced costs through self-management and will facilitate a hands-on prevention solution among hospitals, physicians, caregivers and patients. The device will also be an add-on to the rural healthcare practitioners who extend their services in the remote parts of the country. Comprising of a personal healthcare device and a mobile phone app, BPL LifePhone Plus is an efficient healthcare solution that allows the patients to monitor their electrocardiogram (ECG), blood glucose, pulse rate, activity and the amount of calories burnt, and obtain feedback through remote monitoring from the physicians.

JUNE / 2014 ehealth.eletsonline.com

Total Power – Hydraulic fitness machine

he new Universal CF frame is the optimum addition to the operating table for surgery with the intra-operative use of a mobile C-arm. Professionals are able to securely position your patients and also benefit from an exceptionally large x-ray window. The radiolucent carbon fiber frame can be mounted to all MAQUET or tables via the leg plate interface. Three different types of positio¬ning elements open up entirely new possibilities to the sur¬gical team. Radiolucency is optimally ensured in the prone position as well as the supine or lateral positions with a mobile C-arm, 3D scanner or O-arm. Universal CF frame can be flexibly converted for use in surgical procedures in orthopedics, neurosurgery, traumatology, general surgery and vascular surgery. The Universal CF frame is particularly suitable for surgery on the spine, the pelvis or vessels of the abdominal cavity. The four SFC pads for the prone position can be accurately positioned at 3 levels: It is best suitable for 3D C arm and O arm for best artifact free picture quality.