asia’s first monthly magazine on The Enterprise of Healthcare
volume 10 / issue 3 / March 2015 / ` 75 / US $10 / ISSN 0973-8959
Haematology Analysers & Reagents
eHealth Magazine
State-of-the-art Automation is Here
Mri Systems Maternal & Infant Care Equipment Blood Filters
asia’s first monthly magazine on The Enterprise of Healthcare volume
10
issue
3
March 2015
President: Dr M P Narayanan
Partner publications
Editor-in-Chief: Dr Ravi Gupta
Editorial Team Health Sr Correspondent: Anshuman Ojha education Sr Editor: Shitanshu Shekhar Shukla Project Manager: Seema Gupta governance Sr Assistant Editor: Nirmal Anshu Ranjan Sr Correspondent: Kartik Sharma, Nayana Singh, Souvik Goswami, Gautam Debroy SALES & MARKETING TEAM: Health North: Sapna Choudhary, Mobile: +91-9910998066 West: Douglas Digo Menezes, Mobile: +91-9821580403 South: Vishukumar Hichkad, Mobile: +91-9886404680 Subscription & Circulation Team Manager Subscriptions: +91-8860635832; subscription@elets.in Design Team Creative Head: Pramod Gupta Deputy Art Director: Priyankar Bhargava Sr Graphic Designer: Om Prakash Thakur Sr Web Designer: Shyam Kishore WEB DEVELOPMENT & IT INFRASTRUCTURE Team Lead – Web Development: Ishvinder Singh Sr Executive – IT Infrastructure: Zuber Ahmed Executive – Information Management: Khabirul Islam event team Manager: Nagender Lal Assistant Manager: Vishesh Jaiswal administration Head Administration: Archana Jaiswal Editorial & Marketing Correspondence eHEALTH - Elets Technomedia Pvt Ltd, Stellar IT Park Office No: 7A/7B, 5th Floor, Annexe Building, C-25, Sector 62, Noida, Uttar Pradesh 201301, INDIA. Phone: +91-120-4812600 Fax: +91-120-4812660 Email: info@elets.in ehealth does not neccesarily subscribe to the views expressed in this publication. All views expressed in the magazine are those of the contributors. The magazine is not responsible or accountable for any loss incurred, directly or indirectly as a result of the information provided. ehealth is published by Elets Technomedia Pvt. Ltd in technical collaboration with Centre for Science, Development and Media Studies (CSDMS) Owner, Publisher, Printer - Dr Ravi Gupta, Printed at Vinayak Print Media D - 249, Sec-63, Noida 201 309, UP, INDIA & published from 710 Vasto Mahagun Manor, F-30, Sector - 50, Noida, UP. Editor: Dr Ravi Gupta © All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic and mechanical, including photocopy, or any information storage or retrieval system, without publisher’s permission.
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Contents
14 Haematology Analysers & Reagents
28- Clinical Logistics are Saving
State-of-the-art Automation is Here 23 Blood Transfusion: A Doubleedge Sword
Transfusion of blood products is a double-edged sword, which should be used judiciously. Though blood transfusion can be life-saving, it can also lead to certain adverse reactions
Buyers Speak
19-EMR: Need of the Hour
Dr. B.K. Murali, MD, Hope Hospital & DrMHope Softwares Private Limited
He future appears limitless as researchers and medical technology manufactures continue to strive toward increased image quality, physicians work towards better diagnoses, and patients anticipate speedier, more comfortable, and less costly MRI exams
Mother-Child Care Equipment Market Smiles Ahead Prenatal, fetal and neonatal care is gaining importance every year with increasing awareness, demand and affordability for the latest, improved and technologically advanced equipment that are available worldwide
guest column
12-Do We Wait 138 Years for the
Outcomes of Draft National Health Policy 2015? Dr. Nomal Chandra Borah, CMD, GNRC Hospitals
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36- ‘Make in India’ Key to Growth
46-Trends in Cardiology
Dr. Vishal Rastogi, Senior Consultant Interventional Cardiologist, Fortis Escorts Heart Institute (FEHI)
41- Direct Radiology Systems are
47-Affordable Hi-end Technology
Kiran Phuri, Director Marketing, Medx Technologies
Dr. Shubham Sogani, CEO, House of Diagnostics
56-Technology and Healthcare Delivery
Dr. Dharminder Nagar, MD, Paras Healthcare
57-Technological Advancements and Emerging Trends
Dr. Rakesh Gupta, Chairman and Medical Director, Sarvodaya Hospital and Research Centre
here to Stay
53- Technological
Advancements and Emerging Trends
Shashank ND, Founder & CEO, Practo
62- Health Information Exchange is for 360 Degree Patient Care
Dinesh Samudra, CEO, Palash Healthcare Systems
Case Study
30-Developing and Deploying Software for the Social Sector
60-ASHA Soft – The Online
exclusive interview
Payment and Monitoring System for ASHAs
10-Government Reaches Out To
NEWS
Communities
50
Manoj Kumar, Executive Vice President and Chief Executive Officer, Ricoh India Limited
James Mazarello, CEO, Rosalina Instruments
Dr. Rajeev Boudhankar, VP, Kohinoor Hospital
MRI Future – Faster Workflow, Shorter Exam Time, More Patient Comfort
34- IT Infrastructure – The
Backbone of Indian Hospitals
54-NICU Offers Quality HealthCare
38
Patients’ Lives
Bhavesh Y Bhatt, GM, Maquet Medical India Private Limited
Dr. Jagdish Prasad, Director General, Health Services, MoHFW, Govt. of India
18-Pharmaceutical Industry -
Technological Advancements and Emerging Trends
Nakul Pasricha, VP, Authentication Solution Providers Association and COO, PharmaSecure
20-Focusing On the Universal
22-Company News 49-Government Desk 58-International News 59-National News Product Launch
64 - Laura M – Next Generation Urine Analyser
Healthcare Needs
65 - Carestream Unveils its
26- Blood Transfusion and
Product Showcase
Dr. Stephen Oesterle, Senior Vice President – Medicine and Technology, Medtronic plc
Leucoreduction: Need of the Hour
Chetan Makan, VP and GM, Haemonetics
Innovative Radiology Solutions at IRIA 2015
66-Staying Fit or Staying Healthy
editorial
Remedy Short of Malady? Finance Minister Arun Jaitley’s maiden Union Budget does talk about sops to the healthcare sector, but going by the reaction from the Industry, they probably expected more off the rather ‘reformist budget’. The Budget proposes an allocation of `33,150 crore for the healthcare sector, apart from rolling out Atal Innovation Mission, an innovation promotion platform involving academics, entrepreneurs and researchers, at an estimated cost of `150 crore. The government has also proposed to raise the limit of deduction in the health insurance premium from `15,000 to `25,000 and from `20,000 to `30,000 for senior citizens. The increase in health insurance premium will enable people to go for quality healthcare, which is a huge concern in the country. Some of the other key announcements include a proposal to set up AIIMS in five states — Jammu & Kashmir, Punjab, Tamil Nadu, Himachal Pradesh and Assam. Bihar will also have a second institute modelled on AIIMS. Besides, three new National Institute of Pharmaceuticals Education and Research in Maharashtra, Rajasthan and Chhattisgarh, and one Institute of Science and Education Research to be set up in Nagaland and Orissa each. The move will go a long way in addressing the issue of shortage of doctors and skilled professionals. While the increase in allocation for healthcare is a welcome move, Mr Jaitley could have done more. Even after the proposed hike in the government spends, it remains lowest amongst the BRIC nations. The funds may also fall short to achieve the ‘Healthcare for All’ goal by the end of the next five-year plan. Also, the budget leaves the import-dependent MedTech industry, which could have given impetus to the ‘Make in India’ campaign, completely untouched. The healthcare sector was expecting announcement of tax holiday for medical technology companies desirous to set up new manufacturing facilities, and announcement to set up medical technology manufacturing hubs with singlewindow clearance to provide ease of manufacturing. Similar is the story of the pharmaceutical industry, which looks disappointed with no major announcements coming its way. There is also a lack of announcement of initiatives to boost the bulk drugs industry, which is facing stiff competition from China. As if that was not all, the increase in Service Tax rate to 14 percent from the 12.36 percent is also sure to have an adverse impact on patients and hospitals. But as they say, reforms and stimulus don’t go together. Let’s accept the fact.
Dr Ravi Gupta ravi.gupta@elets.in
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Face to Face
Government Reaches Out To Communities Around nine lakh ASHA workers have been trained to provide healthcare facilities to every 1000 population, says Dr Jagdish Prasad, Director General, Health Services Ministry of Health & Family Welfare, Government of India in conversation with Nayana Singh of Elets News Network (ENN)
Please brief us on the latest healthcare initiatives in the rural and semi urban space in India. The Government of India is running its National Rural Health Mission (NRHM) since 2005, the purpose of which is to encourage health coverage in the rural areas and make available health services till the community level. ASHA workers have been appointed for this purpose. Around nine lakh ASHA workers have been trained to provide healthcare facilities to every 1000 population. We have also taken measures to train the sub centres, PSC, CSC and district hospitals. These initiatives have achieved significant results. Infant mortality has been successfully brought down to 40 per 1000 population, maternal mortality rate a n d total fertility rate have also
Dr Jagdish Prasad Director General, Health Services Ministry of Health & Family Welfare, Government of India in conversation
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Face to Face
been successfully controlled. States such as Kerala, Tamil Nadu, Goa and Maharashtra have made significant progress and their health standards are far better as compared to many European countries. However, there is a lot to achieve as far as the rural health standards of people are concerned.
The availability of doctors at the village level or the sub centre level is still a concern. What are the steps you are taking to address this problem? In order to fill up the vacancy of having adequate number of doctors in the rural areas, we have introduced telemedicine to reach out healthcare services. The ANMs present at the sub centres have basic knowledge of medicines and they can help the patience to communicate with doctors sitting at tertiary care in hospitals. We are planning to attach a medical college in every district and we want the medical colleges to make a complete development plan of the district, sub district, CSC, PSC and sub centers. We are also planning to give hands on training to the doctors working in the district hospitals. Thus, by the use of Information Technology, we will be able to cater to all the healthcare needs in the rural apace. The Bill and Millinda Gates foundation has covered 800 villages in Bihar. Through the system of telemedicine, people from these villages can reach out to the doctors. Kits have also been made available so that the body temperature, blood pressure, ECG, auscultation (sound of the heart and lungs) can be sent to the doctors through telemedicine and thus the patents can be treated. We are also running health programmes in schools of the districts in which health cards of the students will be made. If any student has any disease or defect, it will be detected and treated. We have
provided a fund for this and this fund will help doctors treat patients free of cost. Some states have already done this. The introduction of health cards for students will ensure that we have healthy children in the society. We have launched National Rheumatic Heart Programme in the country in which we are trying to teach children, parents and teachers that symptoms such as sore throats, joint pain can be the indications of rheumatic heart diseases. Similarly, we have identified 35 diseases and provided doctors who will visit the schools and make health cards of students and treat them in case they are suffering from any disease.
How are you developing awareness regarding healthcare in these areas? We are introducing health education in schools in which health education will be imparted to students studying in between standard three to 12. In this curriculum, students will learn everything about non communicable diseases, communicable diseases, prevention of these diseases, trauma prevention, right dietary plans, how to detect diseases in their early stage etc. This will be a compulsory subject so that all the students can learn this and also teach their parents. The Government of India has already prepared the syllabus for this and the book is also ready. We hope to introduce this book in the coming session. Thus, we hope that this initiative will help us cure the non-communicable diseases such as diabetes, hypertension, cardiovascular diseases, cancer etc, which are causing almost 57 percent of deaths in the country. We have also launched a screening programme for cervical cancer, breast cancer and for mouth cancer. These can be cured if they can be treated early. We have decided to help the 50 medical colleges where there is a nucleus of cancer treatment. We will
provide them a fund of `45 crore so that they can upgrade the institutes. Besides, GoT will provide funds for developing state cancer institutes.
Are there particular challenges that you are facing? Uneven distribution of human resource is a big challenge for us. We have more than eight lakh doctors available to us in the AYUSH system. They should be allowed to work so that the gap which is felt at the lower levels can be filled up.
How are you planning to adopt IT to develop the health sector? Besides telemedicine, we are planning to introduce tele education, which will help medical students to learn from the best professors who deliver lectures in the best institutes. This will also address the problem of lack of professors. The Medical Council of India has to give its permission for the same.
What is your opinion on making healthcare more affordable for everyone? In order to make healthcare services affordable, the public healthcare system has to improve. We have formed an act under which we are trying to regulate the prices charged by private hospitals so that they cannot charge exorbitant from patients. If this gets implemented in all the states, healthcare expenses will be so high.
What is your vision for a healthy India? Prevention of diseases should be our priority as most of the diseases can be prevented. Regular health checkups are also very important. Our traditional ways such as Yoga, meditation should be adopted in our daily routine to keep us healthy. Taking care of our diet and regular exercises is equally important to prevent the lifestyle diseases.
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Guest Column
Do We Wait 138 Years for the Outcomes of Draft National Health Policy 2015? Dr. Nomal Chandra Borah, CMD, GNRC Hospitals, Guwahati
F
ederal approach missing, regional imbalances remain unaddressed in National Health Policy 2015 An evidence-based prescription from the North-East – relevant to North, East, West and South – to rectify the inadequacies of centrally-formulated, nationally-imposed and regionallyirrelevant policy formulation and implementation process. Let us first consider pieces of evidence that illuminates aspects of the state of health of the nation and its care that the Draft Policy attempts to address. Life expectancy in India has risen by five years in the past decade, according to the Union ministry of health and family welfare. This is due to better immunization and nutrition, coupled with prevention and treatment of infectious diseases. Though India will remain a young country overall, the population of the elderly will touch 12-13 percent by 2025 and 17 percent by 2050, according to the World Health Organization (WHO). The longer lives of our people today, however, are often being led under the debilitating shadow of health conditions resulting from our present lifestyles and longer life-spans. The causes of fatality, and often, disability, today are lifestyle-triggered conditions such as hypertension which leads to coronary artery disease and stroke.
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Our lives are longer, but not healthier. A prosperous nation cannot be built by unfit, unproductive people. Apart from primary, preventive and promotive healthcare, India must cater well for secondary and tertiary healthcare, if we have to pursue a brighter destiny for this country and her population. Given this situation, one would have expected the draft policy to be farsighted and pay significant attention to the emerging burden of healthcare due to demographic and lifestyle changes, and the consequential importance of secondary and tertiary care – all the more so as Section 2.7 explicitly acknowledges that non-communicable diseases and injuries now account for 50.9 percent of the nation’s burden of disease and that National Health Programmes offer very limited coverage and scope of treatment for non-communicable diseases. To address this emerging burden, the nation must be prepared to provide affordable, accessible specialist care to our population. Let us allow statistics to further illuminate how inadequately prepared we are to provide care in the present situation, leave alone the future – due to lack of skilled manpower – the foremost requirement for healthcare. The statistical construct below also highlights how acute the regional imbalance is.
Guest Column
Let us take a condition, say, epilepsy and the specialists who treat it – neurologists. If diagnosed early and treated, 80 percent epilepsy patients can lead a productive life. Lack of treatment, however, results in arrested intellectual growth, rendering individuals incapable of contributing significantly to society for the rest of their lives. The population of approximately 55 million people in North-East India carries a burden of prevalence of epilepsy greater than 300,000 individuals and annual new incidences numbering over 27,500. Now, nearly 99 percent of these individuals do not receive proper medical attention. This is not surprising, considering that there are just 12 (yes, twelve) neurologists catering to the entire population of 55 million in North-East India – a ratio of 1:45,83,333. In developed nations, this ratio is around 1:18,000 – more than 255 times higher. Similar is the situation in specialisation after specialisation – cardiology, oncology, nephrology, hepatology, pulmonology, and the like. Considering that our population-todoctor ratio or patients-to-bed ratio is typically one-fourth those found in the developed world, the situation in specializations is literally more than 60 times worse! Even if we accept a ratio far lower than the developed countries, the gap remains formidable, though surmountable if we innovate. Even if we wish to have, say, three specialists for 25-odd key specialisations for every one-million of population, this would mean a requirement of around 3,750 specialists, of whom 150-odd would be neurologists. Given that we have 12 neurologists at present in the North-East, this means a required increase of 138 neurologists – almost twelve times over what is available at present. But here is the catch: the entire country today is producing just 50 neurologists, approximately, annually – of which only two are produced in the North-East. Typically, at least one of them is from outside the North-East and will not be available to
serve the people of the region once he or she qualifies. This means that at this rate of addition of skilled manpower – one specialist per year – it will take 138 years to bridge the gap (on the basis of the entirely unrealistic assumption that there is no further growth of the population!). Do note that neurologists are required to not only treat epilepsy but several other conditions in people of all age groups. Ominously, the prevalence of such conditions in the population is multiplying rapidly on account to present-day lifestyles; and, the above situation repeats itself in specialty after specialty. Policy to deliver healthcare to the country must address this ironic, tragic situation. The situation has manifested itself in such an acute form due to lack of region-focused, innovative, visionary, locally-relevant health policies for creation of skilled manpower pools in the regions. This is hindering the process of creation of a resource pool comprising adequately trained manpower – without which availability, accessibility and affordability of necessary healthcare for the people will forever remain a mirage and never become a reality. While the National Health Policy has expressed the intent to address the issue of creation of qualified manpower pool, it fails to acknowledge the scale of the gap, the consequent dimensions of the challenge and the urgency to respond. Regional realities, requirements and methods to cater to these requirements can best be understood and addressed by regional drivers of innovation in public interest. In the absence of such platforms and mechanisms, a centrally-driven agenda will only perpetuate the scarcity of skilled manpower, continuing the economic benefits enjoyed by some vested interests today, from the shortage of skilled manpower. Considering the scale of the challenge as demonstrated by the statistical formulation above, the speed with which the challenge must be addressed is significantly higher than possible
through the methods outlined in the draft national health policy – which ascribes no role to the states in the creation of pool of skilled manpower. The challenge can only be addressed by adopting what may be termed as the federal method of formulation of policy to create skilled manpower pool, implementation and regulation of such policy. The federal method of policy formulation and implementation would entail providing adequate role for state governments, state universities, statespecific social entrepreneurs and public-private partnerships. State representatives – public and private – should be given their seats and their say at the policy-making table – specifically regarding creation of the pool of trained manpower, and provided the freedom and authority to formulate state-specific policies in pursuit of locally-relevant objectives – in accordance with the federal mode of transforming India espoused by our Prime Minister Narendra Modi. The state governments, universities and other stakeholders should be empowered to design and develop curriculum and the mechanism to monitor its quality – to create the required number of specialist clinicians who can take care of the conditions that are responsible for 50.9 percent of the healthcare burden – as identified by the draft policy itself. In the absence of the above, we Indians from the North-East, and perhaps many others from the North, East, West and South, will need several lifetimes before we can benefit from the outcomes that the policy proposes to deliver. Meanwhile, the region will continue to lag behind in health and Human Development Index parameters, remain economically backward, a hotbed for militancy and a burden on the nation, which is attempting to soar towards its destiny. Is that the overall outcome national policymakers are seeking from the Draft National Health Policy 2015, and other such policies being centrallyformulated and nationally-imposed?.
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Haematology Analysers & Reagents
State-of-the-art Automation is Here
In the near term, information technology will play a growing role as an adjunct to technological developments in haematology analysers.
C
linical haematology analyser analysis is one of the oldest and most important sectors of clinical laboratory analysis. Haematology analysers are indispensable diagnostic tools and continue to sustain a strong position in the global healthcare industry. They include analysers, flow cytometers, coagulation analysers, and slide strainers. Haematology analysers are computerized and highly specialized machines that determine the presence, count, and types of cellular elements in a blood sample for disease detection and monitoring. They are also used to determine non-cellular parameters of the blood such as haemoglobin and hematocrit. Samples of blood can be processed alone, in batches, or continuously in a haematology analyser. In haematology analysers and reagents market, leading players are adopting the strategies of new product development, geographic expansions, agreements, acquisitions, and joint ventures. Market players adopted these strategies to access new technologies, expand their product portfolio, enter into growing markets, and to increase their market share.
Market Dynamics The global haematology analysers and reagents market is expected to reach US$ 3.13 billion by 2019, at CAGR of 5.2 percent from 2014 to 2019. Technological developments in high throughput haematology analysers, integration of basic flow cytometry techniques in modern haematology analysers, increasing adoption of automated haematology instruments by diagnostic laboratories, technological advancements, and developments in the high sensitivity point-of-care (POC) haematology testing are some of the key factors that are fuelling the growth of the haematology market. However, slow adoption of the advanced haematology instruments in the emerging economies, haematology product recalls, and high cost of haematology analysers are some of the key factors hampering the growth of this market.
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As of 2014, North America holds the largest share of 44 percent of the global haematology analysers and reagents market, followed by Europe. However, the AsiaPacific market is expected to grow at highest CAGR of 9.4 percent from 2014 to 2019. A number of factors including developing healthcare infrastructure, large patient population, increasing funding/investment toward the development of haematology products, and growing focus of both international and domestic players on the
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Haematology Analysers & Reagents
Growth Factors A number of factors such as development of the high throughput haematology analysers, integration of basic flow-cytometry techniques in modern haematology analysers, increasing adoption of automated haematology instruments by diagnostics laboratories, technological advancements, and developments in high sensitivity point-of-care (POC) haematology testing are propelling the growth of the global haematology analysers and reagents market. On the other hand, slow adoption of the advanced haematology instruments in the emerging economies, haematology product recalls, and high cost of haematology analysers are restricting the growth of the global haematology analysers and reagents market.
Technology Advancements
Asia-Pacific countries are stimulating the growth of the haematology analysers and reagents market in the AsiaPacific region. The Indian haematology analysers and reagents market in 2014 is estimated at `671 crore. Reagents constitute 60 percent of the market.
Major Players Sysmex Corporation (Japan), Beckman Coulter, Inc. (U.S.), Abbott Laboratories (U.S.), HORIBA, Ltd. (Japan), Siemens AG (Germany), Bio-Rad Laboratories, Inc. (U.S.), Mindray Medical International Limited (China), Nihon Kohden Corporation (Japan), and Roche Diagnostics (Switzerland) are the key players operating in the global haematology analysers and reagents market.
Sysmex Corporation Beckman Coulter, Inc. Abbott Laboratories HORIBA, Ltd. Siemens AG Mindray Medical International Limited Nihon Kohden Corporation Roche Diagnostics
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Haematology analysers utilize various technological solutions in order to recognize cell types in a blood sample and to count them individually to generate a complete blood count (CBC) with differential. Manufacturers have developed finely tuned haematology analysers that achieve good levels of precision and accuracy in cell counting through the examination and identification of thousands, not hundreds, of cells in each sample analyzed. The challenge of reporting precise results for immature cells using manual methods is exemplified with manual reticulocyte counts, which routinely have a CV of approximately 25 percent. Manual methods, even for immature cell counts, are being replaced with precise, reliable automated haematology systems that provide faster reportable results within the first aspiration. At the highest level of haematology laboratory automation are scalable, configurable automation systems dedicated to shepherding lavender (EDTA) top tubes through the following analytic determinations: CBC, 6-part white blood count (WBC) differential, nucleated red blood cell (NRBC), reticulocyte count (RET) and immature retic fraction (IRF), automated immature platelet fraction (IPF), and automated smear preparation and staining. These on-demand tests are standardized assays that meet performance goals, decrease technologist handson time, eliminate batch testing, and provide results faster to physicians. When this testing is supported by a haematology-specific middleware product, clinical laboratories are automatically reporting up to 85 percent of their test volume without any operator intervention. Nowadays, haematology automation platforms offer more than CBC testing from a single EDTA sample. Laboratories that have incorporated HbA1c testing on high speed haematology lines are performing >90 percent of assays from lavender top tubes with minimal technologist intervention. Auto validation of HbA1c results can run as high as 90 percent. Further process improvements are
Haematology Analysers & Reagents
coming to the forefront of haematology, such as pre- and post-analytical sample sorting/archiving and automation of digital smear review. Now, these newly formed EDTA work areas can manage traditional haematology testing as well as the HbA1c traditionally tested in the chemistry department. • Automation: pre-analytical One area of haematology testing that was late to become automated was reagent preparation. Haematology technologists frequently have been frustrated about the time and effort required to change 20L cubes of diluent. Recent additions to automated haematology lines address this concern by including units that utilize concentrated reagent which is diluted using an in-lab water supply. This approach minimizes the time and effort required to prep the analysers prior to the highest volume run of the day and enables laboratorians to avoid interruptions in testing due to the need to frequently change diluent in high-volume testing settings. • Automation: clinical decision making The latest haematology technologies automatically provide results to the physician on immature cell population characteristics that can reflect the state of leukopoiesis, erythropoesis, and thrombopoiesis in the bone marrow through analysis of peripheral blood. • Automation: standardization Today, both small and large integrated networks and other entities having multiple haematology testing sites can achieve standardization of sample and data management. Haematology testing systems for these multi-lab operations provide the following for standardization, thereby eliminating discrepancies that may occur when a patient is tested at different laboratories: identical technology platforms; quality control procedures; calibrators and controls; and reagents. • Automation: post-analytical Sample processing after analysis also flows differently with complete automation of haematology testing. The presence of immature granulocytes in the peripheral blood typically triggers a sample for manual smear review. New haematology analysers now report these automatically in the WBC differential as immature granulocytes, reflecting the presence of metamyelocytes, myelocytes, and promyelocytes in the sample. • Automation: staff shortages Automation in the haematology lab may play a significant role in addressing anticipated staff shortages in a number of locations.
Rising popularity of automated haematology analyzers: Automated instruments enable faster processing of samples and generate results much faster than manually operated ones. Automated haematology analyzers are also more efficient and cost-effective. Increase in aging population is a key driver of this market: The number of older adults is increasing at a fast pace worldwide. As older people are susceptible to many age-related diseases, they require access to medical therapies that depend on accurate diagnostic test results. Haematology analyzers play an important role in the early detection of diseases. High cost of instrument: The report identifies the high cost of the instrument as a major challenge in the market. Modern automated haematology analyzers come are portable with advanced features, making it difficult for small vendors to gain from investing in them.
The latest haematology technologies automatically provide results to the physician on immature cell population characteristics that can reflect the state of leukopoiesis, erythropoesis, and thrombopoiesis In the near term, information technology will play a growing role as an adjunct to technological developments in haematology analysers. There is a tendency for new haematology analysers to employ increasingly more detectors than the older models, for improved specificity in cell classification and for more accurate flagging of abnormal blood cells. In other words, blood-cell analysis will become more multi-dimensional, and this multitude of cellular information will rapidly expand. Moreover, a more detailed look into the characteristics of a certain cell can possibly yield more information than just WBC, such as data associated with cellular activation pathways and apoptosis or other cellular processes. It is even conceivable that information that is connected to certain disease states will be available. Thus, advanced information technology could be useful for unveiling information that is “hidden” in signals that register, but currently are used only for cell counting and classification.
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Exclusive Interview
Pharmaceutical Industry- Technological Advancements and Emerging Trends Every brand owner requires authentication technologies for different needs, says Nakul Pasricha, Vice-President, Authentication Solution Providers’ Association and COO, PharmaSecure
C
ounterfeiting is increasingly becoming a global phenomenon and the pharmaceutical industry is not spared from the clutches of this peril. It has become a major issue and an increasing focus of attention by various organisations such as the US Food and Drug Administration (FDA) and various Government authorities across the globe. In fact, the European Parliament has made the battle against falsified medicines one of its top goals. Governments across continents are formulating and implementing stricter laws to counter this menace. As the old adage, prevention is better than cure, holds true even today, the pharmaceutical companies and the brand owners need to educate themselves on the latest advanced authentication technologies and solutions. The advanced technologies and solutions should be put in practice in order to empower the consumers to identify an original medicine from a fake one. Every brand owner requires authentication technologies for different needs. It is his sole responsibility to identify the amount of risk and then shortlist the correct technologies to alleviate it. At various instances, a single technology may not be useful. So, the Authentication Solution Provider may suggest using more than one technology to counter the threat. Advancement in anti-counterfeiting technologies: Advancement in nanotechnology has enhanced the security of various authentication technologies. We are developing and adding
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nanostructured components like gratings and fluorescent nanopatterns to make holograms impossible to reproduce, making counterfeit goods easier to recognise. Advancement in digital (serialisation) authentication technologies: With close to one billion mobile subscribers in India, but only about 30 percent of them using smartphones, it is important to have a solution that is easily accessible for consumers across the country, in both rural and urban areas. Serialisation is one such solution. Using this solution, unique alphanumeric or numeric codes are generated and applied via direct printing or labels on to medicine packages, with a consumer being able to SMS this code to a gateway and verify its authenticity. As each code on each package is never repeated and almost impossible to guess randomly, this becomes a low-cost, scalable effective solution to deter counterfeiting. In addition, this solution can also be used to connect with patients with chronic
illnesses and help them better understand and manage their ailments. PharmaSecure has been providing this solution in India for several years already, having protected more than 1.2 billion packages, or one for every Indian citizen. Integration of anti-counterfeiting technologies: Schreiner, another German company, has devised a new Pharma-Comb label that aggregates overt features, such as holograms, color-shifting security inks, guilloche patterns with more covert elements, including certain voiding effects, and LaserSecure – a sophisticated method incorporating special pigments that only become visible via a dedicated hand-held reading device. The combination can be customised to specific manufacturer requirements, resulting in personalised authenticity protection for pharmaceuticals. The Pharma-Comb label has another builtin security feature: detachable label parts. When detached from the substrate, the message “peel-off part has been removed” becomes visible on the bottom label. Other security features embedded in the detachable label part make authentication checks possible even after the label has been appended to a patient’s medical records. Solutions such as security holograms can complement other technologies like serialisation and track and trace, delivering a powerful combined offering for brand protection. Such integration enables brand owners to select the right mix of various technologies to keep the counterfeiters at bay.
Buyers Speak
EMR: Need of the Hour Please comment on healthcare market in India visa-vis the global market. India does not have Electronic Medical Record (EMR) concept. The EMR concept can be seen in sumptuous clinics or hospitals with dozens of doctors, and not with general hospitals or primary healthcare centres or small private practices. However, in bigger private practices where computers are used at least for billing, there is a motivation to use EMRs for patient care. Though, there are some hurdles in their adoption. The patient identifier is something given to a patient as a card which the patient has to remember, otherwise it is difficult to locate the history. Given many Indians do not always use their last names, demographic look ups overwhelm administrators. Also, providing an ID is not required for getting healthcare. To improve the usage of EMR or Electronic Health Record (EHR) in India the push needs to come from one class of sources - the payers. Individuals do not have enough sway in this matter that leaves out the government and insurers. Insurance is not good and has very little usage in India. If the government mandates an ID and managing patient history, usage could improve a lot.
Please tell us about your current operations in India and your expansion plans. Our current operations are to provide an ERP using latest technology with a detailed EMR to hospitals globally.
What are your views on the price sensitivity of the Indian
Dr B.K.Murali Managing Director, Hope Hospital & DrMHope Softwares Private Limited, Nagpur
market and how does your hospital counter this problem?
Please comment on emerging trends and new technologies.
Indian healthcare IT Industry in general happens to be price sensitive. Hence, the key requirement is that the solution should be cost competitive. Other than that it is also necessary that the solution should have interface with third party applications. It should offer ease to use for end users and it must conform to global standards of healthcare.
SaaS based cloud applications and accreditation ready ERP are the trends in the market. Today’s healthcare market is more than ever influenced by a number of external factors that are reshaping the way in which care providers deliver medical services. Driven by the current economic climate and increasing stress on the sector to be more efficient, cost savings are only some of the pressures faced by the sector as a whole. More informed and opinionated, today’s patient is seeking better healthcare delivery, driven by consumer demand for more comfort and faster and more efficient services.
What are your views on government regulation or any other challenges faced while operating the Indian market? Government regulation to make EMR compulsory and HL7 compliant software will help standardise various software in the market. It must conform to global standards of healthcare.
For more information visit: www.hopehospital.com
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Exclusive Interview
Focusing on Universal Healthcare Needs In India, there is a need for favourable policy environment, bringing in regulatory clarity and providing incentives to increase competitiveness of medical devices companies in a transparent and healthy manner, says Dr. Stephen Oesterle, Senior Vice President - Medicine and Technology, Medtronic plc Please comment on medical technology market in India visa-vis the global market The medical equipment and devices industry, valued at US$ 2.5 billion contributes only six percent of India’s US$ 40 billion healthcare sector. Moreover, it is growing at a faster annual rate of 15 percent than 10-12 percent growth seen in the healthcare sector in its entirety. A rise in the number of hospitals and the increased requirement for healthcare facilities creates a need for sophisticated devices and equipment, which can provide accurate treatment to individuals. The key drivers for growth of medical technology sector in India are economic growth leading to higher disposable incomes, increased public spending and focus of government on healthcare, increased private investment in healthcare, and increased penetration of health insurance.
On current operations in India and your expansion plans Established in 1979, Medtronic has been directly represented in India for over 35 years. Its business region extends to South Asia that includes India, Bangladesh, Sri Lanka and Nepal. The company has more than 1000 employees covering the length
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and breadth of the region. The focus in this region remains on increasing awareness and accessibility to therapies and for this, we have Indiacentric programs like Healthy Heart for All and Shruti.
What percentage of your company’s global annual revenue comes from the Asia Pacific market? Please elaborate. Asia Pacific is a very prominent market for us. In the last fiscal year its contribution was close to about 16 percent of the total revenue – which includes South Asia, China, ASEAN region, Australia and Japan. It includes some of the largest emerging markets like China and India and some developed markets like Japan and Australia.
What are your views on the price sensitivity of the Indian market, and how does your company counter this problem? Our strategy is to focus on addressing what we call, the universal healthcare needs. We address these needs through three core strategies: therapy innovation, globalization and economic value. We have set up R&D centers here to find solutions and devices that will
help increase economic value to the patients and clinicians and therefore make healthcare more accessible for the people. We understand kidney disease is a problem of many in India and so we are concentrating on the development of a new dialysis system that will benefit this large population who are underserved for treatment. Less than 10 percent of the kidney failure patients today are able to get any treatment due to scarcity of resources and the capital intensive hemodialysis centers required. I would also like to stress here that our goals for therapy adoption and access are consistent with the government’s goals – to make affordable, quality therapies accessible to more and more people. So we are focused on partnering and collaborating with the Indian government to make this happen here in India.
What are your views on government regulation or any other challenges faced while entering or operating the Indian market? The government’s focus is on regulating the industry to promote transparency. At the same time, it has allowed foreign investment in the industry to encourage growth and
Exclusive Interview
now also automatic route for FDI. Medical devices form an integral part of healthcare and the treatment of these chronic and non-communicable conditions that afflict the larger part of the population. In India, there is a need for favourable policy environment, bringing in regulatory clarity and providing incentives to increase competitiveness of medical devices companies in a transparent and healthy manner. It is important to have clear and strong regulations and this requires strong government/ private sector partnership to strike this balance. The Indian government has shown very positive signs on their willingness to partner in these ways and we are very hopeful of positive outcomes here.
On emerging trends and new technologies Some of the innovations in the pipeline are products such as Resolute Integrity, Onyx, DFSin the area of stents, new balloons and IVUS/FFR collaborations in other geographies, Corevalve and EvolutR (heart valves), new surgical innovation (fusion, surgical valves). We also have products like Performa, ACRT, MRI, Tyrx, Micra, Linq, arctic front and phased RF, across our cardiac rhythm and heart failure. Another product, which we have developed keeping India in mind is the Seeq patch, which runs using cellular technology. Patients with cardiac arrhythmia are unlikely to
be diagnosed by the conventional holter monitoring, or an ECG since the likelihood of symptom-ECG correlation is very low. This device monitors a patient for a long duration, and hence has a higher chance of providing a diagnosis to patients with cardiac arrythmia.
What are your company’s offerings? Medtronic’s businesses are structured under four key business groups: Cardiac and Vascular Group (CVG), Covidien Group, Restorative Therapies Group (RTG) and Diabetes Group. The Cardiac and Vascular Group offer therapies for cardiac rhythm disease management (CRDM), coronary and vascular diseases and structural heart diseases along with endovascular and peripheral therapies. The primary offerings under this group include pacemakers, implantable defibrillators, heart valves, aortic stent graft systems and coronary angioplasty technologies. T h e Covidien Group that includes
early technologies, advanced surgical technologies and general surgical products, medical supplies, respiratory and monitoring solutions, and venous solutions. The Restorative Therapies Group comprises of therapies for spine conditions, neuromodulation, and ENT and surgical technologies. The primary products sold include those for spinal conditions and musculoskeletal trauma, neurological disorders, urological and digestive disorders, and ear, nose, and throat conditions. The Diabetes Group is one of the leaders in advanced diabetes management solutions, including integrated diabetes management system, insulin pump therapy and continuous glucose monitoring systems.
A rise in the number of hospitals and the increased requirement for healthcare facilities creates a need for sophisticated devices and equipment
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Company News
Practo Invests US$ 30 Million to Expand into 35 Indian Cities
Hindustan Syringes to Partner with WHO
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ealthcare startup Practo Technologies has big plans to expand into 35 Indian cities, and more than six international locations by March 2016. The firm already has its presence in India, Singapore and Philippines, and also has registered growth in these markets. The US$ 30 million investment plan of the company to realise this expansion dream is one of the largest investments by any Indian healthcare technology company into Digital health, globally. Existing investor Sequoia Capital led the round with participation from Matrix Partners. Avnish Bajaj, MD at Matrix India will join Practo’s Board of Directors. “We are on a mission to improve human longevity by simplifying healthcare. Over the next 12 months, we will expand to 35 cities in India and several more international locations to help hundreds of millions of consumers around the world find the best doctors and make better healthcare decisions,” told Shashank ND, Founder and CEO, Practo. According to Shailendra Singh, MD at Sequaio Capital, since their very first investments in Practo in 2011, the company has come a very long way with a hard working and committed entrepreneurial team. The company has raised it to a level of being a market leader in online healthcare in India. He expressed his company’s commitment to Practo’s goals and aspirations to transform access to healthcare in India, leaving a positive impact on society.
industan Syringes and Medical Device (HMD) will partner the World Health Organisation (WHO) in a campaign to prevent deaths and serious infections caused due to re-usable syringes and unsafe injection practices. The WHO campaign aims to completely eliminate the practice of using re-usable syringes and replace it with auto-disable (AD) syringes. As per WHO, the use of auto disable (AD) syringes could deliver a net savings to US$ 850 million worldwide from reduced treatment cost of HIV, hepatitis B and C. The campaign would benefit Hindustan Syringes and Medical Devices Ltd (HMD) as it is the world’s largest manufacturer of AD syringes. “Syringes should be a life giver, not life taker. It is a very fulfilling moment for my company and an emotional one at personal level, as thousands of people unnecessarily lose life in our country due to unsafe injection practices,” said HMD Joint Managing Director, Rajiv Nath.
HelioScreen to Enter Indian Market, Announces Partnership with C.L.A.I.M.S Private Limited
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elioScreen, has announced their partnership with C.L.A.I.M.S Private Limited to enter the Indian market. The two companies will be attending the Home and Personal Care Ingredients (HPCI) exhibition and conference in Mumbai from 4th-5th March, 2015. Partnering with C.L.A.I.M.S Private Limited, a clinical research organisation which provides specialised clinical research and sensory evaluation in the area of skin care, hair care, and body care, the French company will explore the Indian market for offering their solutions during their visit to India. Dr. Dominique Lutz, CEO, HelioScreen, said, “As we did shortly in South-Eastern Asia, we decided to be present in India as we consider the country a very strategic market. As increasing disposable incomes continue to change the spending habits of the
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sizeable population, and awareness for new formulations grows, India has the potential to become one of the major consumption markets for personal care products.” Helioscreen is a laboratory providing services for testing any products (cosmetics, textile, clothes etc.) in regard of their properties for UV /sun protection by means of In Vitro testing. With their profound involvement in R&D, the expert laboratory formed 15 years ago by Dominique Lutz has conceptualised a very particular kind of ‘robot’ which is considered as a performer in UV protection as it ensures consistency during In Vitro testing. All over the world, there is a great debate about the evaluation of the sun protection for cosmetic products.
Blood Filters
Blood Transfusion: A Double-edge Sword Transfusion of blood products is a double-edged sword, which should be used judiciously. Though blood transfusion can be life-saving, it can also lead to certain adverse reactions
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he past fifty years has seen a significant, paradigm shift in the provision of allogenic blood products. Half a century ago, most of the blood transfused was whole blood. However, since the 1960s, whole blood has been separated into its various components such as RBCs, platelets, and plasma. The latter has been further subjected to various manufacturing processes so that individual plasma proteins can be purified and made available to specific patients with specific
plasma protein deficiencies. Until recently, little attention had been paid to the leukocytes present in various blood components. However, it has been shown that the removal of leukocytes from various blood products can minimize the risks associated with these contaminating leukocytes; the most common among which are: Nonhemolytic febrile transfusion reactions, human leukocyte antigen (HLA) alloimmunization and platelet refractoriness observed in
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Blood Filters
multi-transfused patients, and transmission of leukotropic viruses. Although the terms, leukoreduction and leukodepletion are used interchangeably in literature, leukoreduction technically implies removal of leukocytes by gross removal method, whereas, leukodepletion connotes removal of leukocytes with the help of certain specific filters or devices.
Market Dynamics The global blood industry has experienced strong growth in recent years and growth will remain solid though 2018. The key driving forces impacting the blood industry include the cost of collection and processing, technological advances, an aging population, demand for plasmaderived therapeutics, and changes in the incidence of diseases and surgical procedures and catastrophes requiring blood transfusions. The global blood market consists of more than blood collection. It includes blood typing and testing for diseases, blood storage and processing, blood transfusions, blood management and safety issues, synthetic blood products, the blood products market, the blood testing and typing products market, the plasma and blood collection equipment market and the synthetic blood products market. The blood products market is a good example of the larger market in microcosm. In 2012, worldwide demand for non-infected blood exceeded 200 million pints. Of this, red blood cells (RBCs) comprised 105 million units. Through 2018, global demand for RBCs is expected to reach 140 million units. The market for blood and blood components continues to expand as a result of ongoing technology advancements/new product introductions and indications, expansion of health coverage in the US via healthcare reform and continued strong promotion of blood
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donation by collection agencies. The United States is the single largest global market for blood products. While some countries such as India and the Philippines set prices for blood and blood components, in many of the developed nations, including the US, there is no uniform, fixed price for blood. Rather, the cost varies from country to country and region to region, with even nearby centers often charging different prices and fluctuations often occurring. The effective management of blood supplies is a critical issue for the blood industry, which continues to be challenged with a growth in demand that exceeds any increases in supply. The US may be the single largest consumer, but demand is high and continues to grow in other developed countries such as India, China, Japan, and Germany as well. India has a population of one billion and has a huge burden of patient population requiring multiple transfusions. As per the National AIDS Control Organization, there is a requirement of 8.5-9 million units of blood in our country annually,
India has a population of one billion and has a huge burden of patient population requiring multiple transfusions.
and this includes the existing Thalassemic population requiring regular transfusions and the rapidly growing size of the hemato-oncology patients requiring different types of blood component support. A majority of them become alloimmune to various red blood cell, platelet, and HLA antigens during the course of their transfusion therapy. This leads to various immunohematological problems in managing the blood component support to these patients, especially the platelet transfusion support in refractory patients. Therefore, transfusion of leukoreduced blood components assumes a lot of significance in these patients.
Recommended Leukoreduction Strategies for Developing Countries
Blood Filters
The effective management of blood supplies is a critical issue for the blood industry, which continues to be challenged with a growth in demand that exceeds any increases in supply.
of this technique is that it cannot prevent HLA-alloimmunization and CMV-transmission.
Modification of the component preparation technique
Selective pre-storage leukofiltration for patients on regular transfusions
• According to an article Leukoreduced Blood Components, adopting a buffy coat method of component preparation generally gives a log 1 leukoreduction and to a great extent can minimize the febrile non-hemolytic transfusion reactions. A thorough quality practice can be achieved if leukodepletion is done in the top and bottom bags, with the help of certain dedicated equipments such as automatic component extractors. The blood components prepared with this method can give the desired therapeutic benefits to a majority of patients, even on regular transfusion therapy, where transfusions become troublesome due to repeated FNHTRs. However, the limitation
• The packed red cell selective prestorage leukofiltration policy can be adopted for patients on regular transfusion therapy such as, thalassemia major patients, with skillful inventory management and active coordination between the transfusion therapy clinic and the blood bank. Platelet concentrates can be pooled and leukofiltered for a select group of hemato-oncology patients in the blood centers, prior to the storage. This strategy can achieve 3-4 log leukoreduction, however, it requires dedicated technical manpower for stringent quality control and skillful inventory management, along with active coordination with the treating units.
Harvesting blood components through aphersis technology • Blood components harvested, through Apheresis technology, are generally 3-4 log leukoreduced, and provide better therapeutic benefits than the random donor products. This can be of great help to the patients’ refractory to platelet transfusion with HLA alloimmunization, as the desired component can be harvested in sufficient quantity from an HLAmatched donor. However, the cost of the consumables act as a limiting factor for its utility at large, but it is the best option for those who can afford it. Mobilization of resources through philanthropic organizations for the benefit of poor patients should also be pursued. Since the advent of transfusion medicine, many technological advances have made the collection of blood products safer and more efficient. Ongoing research, however, is underway to improve several aspects of blood component collection and administration. Advances in DNA technology are changing the understanding of blood group antigens and HLA serotypes and allowing blood centers to solve compatibility problems among alloimmunized/refractory patients. Within this rapidly evolving ecosystem, those who choose to commit to understanding current opportunities and threats will be positioned for a strategic advantage. While industry conditions vary somewhat by market, there is an advantage to having a global understanding of the industry. Emerging trends are rapidly expanding to new regions and impacting business elsewhere. In addition, research advances, clinical trial findings, and technology advances do not know international boundaries. They are shared nearly instantly from region-to-region.
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Exclusive Interview
Blood Transfusion and Leucoreduction: Need of the Hour “We filter the water we drink, but why not the blood we transfuse” is the common refrain one hears from practitioners in India, as they continuously endeavour to improve the safety of the blood components transfused says, Chetan Makam, Vice President and General Manager, Haemonetics What is Leucoreduction? The terms leucoreduction and leucodepletion as used interchangeably, depending on the standard followed is a US or EU standard of permissible amounts of WBC’s in the final blood component. US Standard < 5x106 WBCs/unit; EU Standard < 1x106 WBCs/unit. A common misconception is that when the whole blood is spun down into its components and some of the WBC’s are segregated into the buffy coat, that this is a leuco depleted product. In reality, this process provided a 1-log reduction in the WBC’s, whereas the standards call for a 5-log reduction.
Why should we Leucoreduce? Leukocytes are unnecessary contaminants in unfiltered blood products and have been reported to be responsible for a variety of adverse reactions, including alloimmunization, febrile non-hemolytic transfusion reactions, immunosuppression and transmission or reactivation of intracellular virus, i.e., cytomegalovirus. Leukocyte reduction has been demonstrated to be clinically effective in reducing the incidence of these transfusion-related complications which can significantly decrease the cost of medical care producing considerable cost reduction for hospitals.
What patient groups are indicated for providing Leucoreduced blood components?
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Leucocyte reduced blood components are often provided for specific patient groups, however, a growing number of hospitals are now providing all blood components leucoreduced. The reasons for this are - growing evidence supporting the benefits of leucocyte reduction for surgery and ICU patients, recommendations of governing bodies, and adoption of Universal Leucoredution in many countries.
Are there countries with 100 per cent Leucoreduction? In India, only about six percent of the approximately 8.5 million units of blood collected is leucoreduced, compared to 100 percent in many countries such as UK, France, Germany, Switzerland, Austria, Scandinavia, Spain, Portugal, Netherlands, Belgium, many other countries are targeting 100 percent leucoreduction or Universal Leucoreduction (ULR). In US around 80-90 percent of the blood is leucoreduced. Transplant patients, cardiac surgery patients in the ICU, patients in NICU, oncology patients and thalassemia patients who require multiple transfusion as the primary recipients of leuco reduced blood in India today. While some progressive centers and hospitals that cater to a sizable medical tourism population have adopted near 100 percent leucoreduction, most centers either leuco reduce blood on the clinicians demand or not all.
Filtration of blood can happen at different points along the blood supply chain namely, at the patient bedside, just prior to transfusion, in the lab on demand or as a practice of keeping a small inventory for the patients in critical care or at the time of processing the blood into components, usually at centers that have adopted 100 percent leucoreduction (ULR). Decisions about when and where to leukoreduce are based on cost considerations, convenience and patient benefits. The timing of when to filter the blood components is also important.
Filtering platelets Laboratory and bedside filtration both have advantages. Laboratory filtration at the time of collection prevents the accumulation of bioreactive substances released by stored leukocytes that have been associated with patient reactions. An advantage of bedside filtration is that specific leukocyte reduction filters consistently will reduce the level of the anaphylatoxin C3a, which is associated with proinflammatory and immunomodulatory effects.
Filtering red blood cells When RBC units are leukocytereduced prior to storage, a decrease occurs in the concentration of substances (e.g., serotonin, histamine, acid phosphatase and elastase) that are released by leukocytes and platelets during storage.
Exclusive Interview
Clinical Logistics are Saving Patients’ Lives This remarkable statement is a quote from a newspaper post by Ole Thomsen, CEO of Healthcare in Central Denmark Region
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n the post, Ole Thomsen cites a study revealing that mortality is 9 percent higher in overcrowded hospital wards compared to wards with a normal state of occupancy. According to Ole Thomsen, this problem can be solved with a clinical logistics solution. Regional Hospital Horsens has substantial and positive experiences from using INSIGHT clinical logistics for more than five years. “Clinical logistics enables hospitals to optimize the staff capacity to the current patient situation and avoid that single wards are put under too much strain”, Thomsen says. In his experience, clinical logistics used to involve telephone calls and handwritten notes that became quickly outdated in a busy hospital environment. “With clinical logistics, we immediately find the answer in the system which always conveys a real time overview of the occupancy of the different departments. This way we avoid patients waiting unnecessarily”, Thomsen says.
Clinical logistics is a key to an efficient hospital Hospitals are always looking for ways to improve workflows and operational efficiency so that throughput increases without compromising quality or safety in treatment. Jørgen Schøler Kristensen is a medical doctor, holds a doctorate in haematology and is working as Chief Medical Officer at the Regional Hospital Horsens in the Central Denmark Region. He strongly agrees with the views of Ole Thomsen on
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INSIGHT clinical logistics. In an article in the Journal for Danish Health Care, he points out that: “The efficient hospital” is characterized by stringent logistics and coordination”. As Jørgen Schøler Kristensen puts it “this is one – if not the - essential key to securing fast and efficient high quality patient flows. Add to this that the working environment of the staff is improved at the same time.” According to Jørgen Schøler Kristensen, logistics is an important lever in the development of future healthcare because we need to treat ever more patients in a shorter time span. At the same time more patient flows are growing ever more complex and the organizations handling the patient flows are getting larger. This demands efficient and well coordinated workflows alongside maintaining – preferably improving patient safety and overall quality.
IT for better logistics Jørgen Schøler Kristensen is of the view
that “The efficient hospital” demands tools and processes, which both support and contributes to the further development of good communication, coordination and overview during the execution of daily clinical work. In his experience, INSIGHT clinical logistics is that kind of tool. The system has two main user interfaces: • Firstly the large interactive screens places strategically in the departments • Secondly the browser based interface ”Anywhere” which is accessible on all PC’s, laptops and so on. The Anywhere is also available for mobile devices. On the interactive large screens, the clinical staff is at any given time presented with a full overview of patients, staff, treatment activities, surgeries, test results and so on - in real time. The staff is at any given time able to edit informations and changes are instantly (in under one second) visible
Exclusive Interview
to all staff on both interactive large screens and Anywere. Jørgen Schøler Kristensen points out that this is key to enhancing cooperation among staff as well as between departments and the systems’ incorporated webcams and chat functionality supports communications. Finally tracking is used making it possible to know where ones colleagues are at present. And Ole Thomsen wants clinical logistics to go further. He explains: “The vision is that the overview that Clinical Logistics provides today on large touch screens will ultimately be in the pockets of the healthcare professionals, where it is constantly within reach”.
Logistics is of great value One of the departments where INSIGHT clinical logistics has had a tremendous impact on the execution of the daily operations is the surgical ward. Jørgen Schøler Kristensen explains that the work flow in the surgical ward consists of a vast number of serial actions involving staff from a number of different departments. The serial nature of the workflow has the distinct consequence, that delays and errors propagates on to the subsequent actions of the surgical flow. And Ole Thomsen adds: “Whenever a patient is in surgery, the doctors are easily and efficiently able to communicate with the staff outside the operating theatre by updating an electronic touchscreen. This is relevant in many cases, for instance if a member of the surgical team is running late or an additional specialist is needed for surgical assistance. The staffs outside the operating theatre stays updated and able to effectively plan the next activities via the status changes conveyed to them from the operating theatre. “This makes sure that the patient has a good and safe course of treatment all the way from layering to anaesthesia, surgery and recovery”. Ole Thomsen explains how clinical
over the hospital.”
The results in short
Bhavesh Y Bhatt General Manager - Maquet Medical India Private Limited
logistics is also of high value in the emergency departments where there is a large flow of patients. “We get an overview of the incoming patients and are able to prioritize the patients who are in the greatest need of acute care. At the same time we are able to see which doctors and nurses are attending to each patient and make sure that the right staffs are assigned to the particular patient,” Thomsen says. “Furthermore the system provides us with a detailed overview of the individual patients’ flow. This makes us able to stay ahead and be prepared for the next step”. Jørgen Schøler Kristensen points out the differences from before to after implementation of an IT-system for clinical logistics: “Before the implementation of an IT-system for clinical logistics, the overview of the surgery programme for the day only existed on a large piece of paper, which was manually updated with acute surgeries and other changes during the day. Changes and other new information had to be communicated by phone and only the staff in the OR theatre had knowledge on how far along the ongoing surgery was. Today the complete real time overview of the programme for the day is available on the interactive large screens and staff are able to edit infomation during the day which is instantly available in all screens all
Jørgen Schøler Kristensen points out, that several actions have been taken to describe and measure the gains from implementing a joint IT-system for clinical logistics in the Central Denmark Region. “Both qualitative and quantitative studies show that clinical logistics provides better overview, improves communication and supports efficient coordination and in effect optimizes the collective workflows. At the same time all users of the system say that the system has resulted in a higher quality of treatment and has improved patient safety”, he says. The same conclusions were reached in a Medical Technology Assessment carried out by the Centre for Public Health. Finally the one evaluation done of the system in an Emergency Department was carried out by Regional Hospital Horsens. The evaluation showed an increase of production of 19 percent in the course of 18 months from the system implementation. Ole Thomsen sums up the reason for Central Denmark Region to implement a joint IT-system for clinical logistics: “This way the healthcare regions are constantly working on improving work flows in hospitals and making them more flexible. Because we do not believe that time heals all wounds”.
INSIGHT INSIGHT Clinical Logistics supports workflows throughout the hospital. The unique and user-friendly design makes the system preferred by healthcare professionals. The integration of multiple platforms, including mobility, and the adherence to integration standards (HL7) makes the system the preference among IT professionals. The author is Bhavesh Y Bhatt, General Manager - Maquet Medical India Private Limited For Further information, please contact on b.bhatt@maquet.com
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Case Study
Developing and Deploying Software for the Social Sector Client: Jan Swasthya Sahyog (JSS) Hospital Project: Hospital Management and Information System (HMIS) Testimonial: Dr Yogesh Jain, Co-Founder, JSS Hospital Vendor: ThoughtWorks Industry: Healthcare IT
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Case Study
“When we started to work with clients in the social sector, our strategy was that we are a global technology company, and this is the value we bring to the sector. Today, after a few years of working with clients in this space, even how we approach the problem is different. Although technology is still the largest part of what we do, we also look at the other aspects that need to be in place to make that technology successful.” Pradipta Kundu, Client Principal, ThoughtWorks Supporting a truly ambitious mission Jan Swasthya Sahyog (JSS) is a voluntary, non-profit, registered society of health professionals running a low-cost health program in the rural areas of Bilaspur, Chhattisgarh. For 14 plus years, they have been providing healthcare services through a community health programme in a rural health centre, which includes a 55-bed hospital. They operate village outreach centres in three other villages that are not easily accessible. The team at JSS researches ways to minimise the cost of healthcare and influence policy makers. They also advocate for the poor in various areas of public health. Patients at JSS typically wait one full week to see a doctor – in spite of the outpatient department accommodating 300 patient visits per day, including emergency cases. Many of these patients live on site during this time. They sleep in corridors and cook on makeshift wood-burning stoves, while waiting patiently in 47°C temperature. The cost of transportation and the opportunity cost of lost wages for patients and their families are not insignificant. And yet, they choose to make the long journey to JSS because they have the utmost faith that they will be cured there. The staffs at JSS feel the burden of these expectations. They wanted a Hospital Management and Information System (HMIS) that would make their processes more efficient. Apart from benefits like improved documentation and effective decision and advocacy support, an Electronic Medical
Record (EMR) coupled with an HMIS could help save time - their most constrained resource. Patients themselves would benefit the most, as they would be able to receive treatment hours or even days sooner, allowing them to return to their homes and jobs that much quicker.
Developing an integrated, flexible and infrastructure-appropriate solution Jan Swasthya Sahyog had tried to put a system like this in place a few times in the past, with little success. They deployed a number of siloed applications in registration, billing, and laboratory, but nothing came close to what they had in mind. As a result, their staffs were skeptical about new companies offering solutions and products. JSS started working with ThoughtWorks in December 2012. Since then, an open source, integrated HMIS and EMR has been developed that aims to meet the needs of hospitals like JSS in low-resource settings - one that can manage information across different departments, allow for the hospital’s unique workflows and processes, and be hosted and operated at the hospital site (requiring no Internet dependency). Several software releases have been deployed till date - the final features and modules should be released by mid-year. Registration, billing, laboratory, radiology, pharmacy, the outpatient department, and the inpatient department are already using the new system.
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Case Study
“There are many criticisms of technology, indicating that it can take away the human element of health care. ThoughtWorks has shown us how technology can help, and still remain very human”. Dr Yogesh Jain, Co-Founder, JSS Hospital Harnessing the benefits of an intuitive and adaptable system There are a number of visible outcomes from these early releases, almost all relating to the improved efficiency of care delivery. The system can be used on a variety of devices at the point-of-care, including mobiles, tablets, and laptops, with minimal staff training required due to the system’s intuitive design. Earlier, individual laboratory report generation went on until past 6 p.m. on a daily basis. The lab technicians and assistants now complete their daily workload by 4:30 p.m., no matter how many patients there are, even as their daily patient caseload has increased from 120–150 to 180–200 patients per day. In the past, the team could only run their electrophoresis machine once a week, in an area of the country where the incidence of sickle cell anemia is high. After the laboratory system came online, they are able to run the machine three times per week, thanks to the extra time available to lab staff. Time savings have also been deployed to bring previously outsourced tests in-house, saving patients both waiting time and money. Time spent searching for existing patients’ files or redoing previous tests like x-rays has drastically reduced. Staff can go through their patients’ history, pull up past prescriptions, and more, within five minutes. The same task used to take them up
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to a few hours, especially when patients had forgotten to bring their JSS registration card with them or if the quality of their physical reports had deteriorated. Similarly, time previously invested in hand-counting and reporting patient visit numbers, disease incidence, etc., is now redeployed into direct patient care activities like patient counselling because of automated report generation.
Ensuring adoption success through better development and deployment There is something very rich happening at the intersection of developers and end-users at JSS, something core to Agile software development philosophy. Through a combination of constraint and desire, developers are working sideby-side with the end-users of the software, and as a consequence, the software is much richer for it. For example, doctors requested a “my patients” tab so that they could review their cases for the day. The development team has been very Agile in what they plan for – securing wins where this new digital system can provide functionality that the previous paper-based one could not, thereby increasing physician buy-in. Moreover, working with JSS inspired ThoughtWorks to go beyond being just a software solution provider. Apart from traditional solution delivery and train-the-trainer training, the
team got involved in other areas like: • owning and handling the solution completely, including thinking through future design (e.g., integrating with a community health worker system) • setting up servers, upgrading operating systems, procuring hardware, and training the local IT staff • working with the staff directly to help them overcome their fear of using new devices and a new system • facilitating business process reengineering, helping establish new processes and managing the transition from one to the other If the software development team had not taken on this ownership – the responsibility to make the software work – the deployment would not be at the stage where it is today. There are many tried and tested models out there for technology deployment in a traditional corporate environment. Software in the social sector space is at a juncture where one is trying many new things. For this to work, both parties need to realize that something is being ventured for the first time and have the mind-set that this experimentation is part of the process. To introduce something so substantial into a hospital while not disrupting the actual flow of operations in spite of low computer literacy has been a challenge but also wonderful.
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IT Infrastructure The Backbone of Indian Hospitals The healthcare sector has been a bit conservative from the perspective of IT usage, but realised that IT can really add value to the business, says Manoj Kumar, Executive Vice President and Chief Executive Officer, Ricoh India Ltd India stands for promises and opportunities, and has leapfrogged to become a formidable power in the global economic scenario. Transforming healthcare dynamics of the country will support the advancement of the economy which has already grown to one of the fastest growing economies in the world. Yet today, India finds itself lagging behind peers on healthcare infrastructure and healthcare outcomes. The Indian healthcare sector faces shortage of infrastructure, with 0.7 beds per 1,000 persons as compared to other large developing economies (Brazil with 2.6 beds, and China with 2.2 beds per 1,000 persons). There is dearth of human resources for healthcare, with 0.6 doctors and 1.3 nurses per 1,000 persons. Indiaâ&#x20AC;&#x2122;s overall healthcare expenditure is only 4.2 percent of its GDP compared to an average of 8.5 percent globally, and lower than other emerging countries such as Brazil (9.0%), China (4.6%) and Russia (5.4%). Further, the government investment is even lower at 1.3 percent of the GDP, and most of it is either on manpower cost, running health programs
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or building infrastructure. IT has become a business enabler for multiple industries such as banking, manufacturing, telecom, logistics, and aviation. The healthcare sector has so far been bit conservative from the perspective of IT usage, but has started realising that IT can really add value to the business. According to IDC report, only two percent of Indiaâ&#x20AC;&#x2122;s IT spend is focused towards healthcare. However, healthcare is expected to be one of the fastestgrowing verticals in IT spending. As the healthcare industry starts to enter this phase of transformation, technology providers will need to
Hospitals currently manage large volumes of data, and technology will help manage this data, turning it into intelligence in order to improve efficiencies of businesses
provide a consultative approach to deliver business solutions and not focus on selling their technologies. The technology solution needs to be simple and user friendly with focus on patient-centric care.
IT and hospital management IT has the potential to transform the current healthcare scenario in India and improve the quality of life of its citizens. Some of the areas where applications of technology solutions for Indian healthcare industry can play a vital role are creating health awareness and influencing behaviour, overcoming infrastructure gaps, building skill-sets, focusing on patient-centric services, and improving decision-making powered by big data analytics. With growing need for personalised medicine, healthcare delivery is combining sciences of diagnostics, medicine and behavioural economics. IT can be put to use in increased awareness and promoting a behavioural transformation- mass dissemination of healthy practices, running ICT programmes on digital media (diet plans, exercising, reducing use of tobacco, etc.), apps for healthcare monitoring, auto
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reminders for medicine, healthcare call centers. Healthcare providers can also leverage IT in improving healthcare access and overcoming infrastructure gaps – hospital information system (HIS), mobile medical units. Telemedicine, teleradiology, telediagnosis are still at very nascent stage in India. Nevertheless, a lot of development is being stimulated. IT has also been playing a key role in building skill-sets and continuing knowledge update through online training courses for medical staff (including clinicians, nurses, paramedics, radiologists, pathologists and general duty staff). Sharing content digitally, such as tutorials, journals, videos, presentations, whitepapers, online CMEs has been made easy by IT applications. IT has been an enabler of patient-centric services, such as Electronic Health Record (EHR) for g e t t i n g treatment at any center across India, surveillance, controlled instrumentation, improved 4As – access, awareness, attitude and affordability.
Hospitals currently manage large volumes of data, and technology will help manage this data, turning it into intelligence in order to improve efficiencies of businesses. Whether it is connecting patient care history through simple data mining tools, or facilitating phases of research in the life sciences space, technology will play a big role. Even for diagnosis, IT serves as the backbone and is involved at every step from tracking the samples via barcode, which ensures that specimens are tied to patients correctly through the entire process, to performing statistical quality control on results and deliver reports securely and swiftly to our customers. Without sophisticated IT applications, preserving patient privacy and delivering accurate results can be challenging. One of the most important aspects of IT infrastructure application is also the database technology in health care to maintain patients’ records. These medical records exist in a wide range of health care settings, and effectiveness of databases for their management depends greatly on
the environment. In addition to databases, management also needs automated machines which can deliver efficient and related data in order to draw proper conclusions. These automated machines have the capability of generating conclusion based results for the management. These systems are not only for the evaluation of the patient, but can also be used to provide data related to administration at regular intervals.
Powering hospitals for a successful transformation IT deployment can transform the functioning of key areas of hospital operations. One of the key barriers for IT adoption in various hospitals is the perceived challenge in integration of multiple platforms that are running in the hospital. Other reasons include unavailability of appropriate hardware and software, financial assistance and support in implementation. Ricoh globally recognises healthcare as a focus area and has a strong history of delivering technology solutions. The firm comes up with a unique solution for hospitals named “Hospital in a Box”. The objective is to set up an IT system that adds real value by being quick to deploy, and easy to adopt. The benefits of this solution includes reduced administrative cost, increased profitability and enhanced customer satisfaction, with streamlined workflow, improved productivity, better inventory management, and better decision making. The solution offers a perfect mix of hardware, software and services based on the hospital’s requirements. Additionally, it provides manpower training, 24x7 helpdesk, customer relationship management (CRM) and digital marketing.
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‘Make in India’ Key to Growth We can reduce the cost of imports and India can save crores in taxes and private hospital money, says James Mazarello, CEO, Rosalina Instruments Tell us more about the company. We started as a company catering to pharmaceuticals to repair services and maintenance sophisticated analytical and biomedical equipment in 1988. We had experience on quality assurance equipment for cancer treatment and concentrated on dosimetry. We slowly took up to servicing of larger equipment till we were capable handling independent portfolios from foreign companies. We have now branch into three division analytical equipment, medical equipment and industrial and defense equipment our concentration has been on cancer treatment equipment since last 25 years.
Please share your views on the “Make in India” campaign There’s never been a better time to “Make in India” than now as it is high time to self motivate and not wait for the government to take the first step. It completely changes the thought process to a higher level and high quality of products that need to be delivered. Foreign companies have cooperated with local entrepreneurs for faster development of both the companies and proper utilisation of resources. Government should identify and encourage micro development programs for such purposes; Grameen bank is one such example.
On hazards of radiation in hospitals
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Core Linac’s has not changed much in treatments, though they have adapted to the latest technologies that have evolved, but this has benefited the patient to a lesser extent. Quality treatment also means keeping the hazards away.
On new products
The two most important points in delivering accurate and precision treatment is the amount of dose and the point to which one imparting the dose. There are two major aspects in radiation monitoring. Firstly, radiation to personal working in the environment, radiation to common people who are prone to such environment where radiation exist and radiation to the patient themselves who are being treated (this falls in both categories). The second aspect is the radiation treatment itself. Delivering quality radiation treatment is the sole responsibility of the hospital where the patient is being treated. In radiation treatment consulting the radiation oncologist and a proper advise is of utmost importance and it is here that safety of the patient comes into picture, delivering the correct amount of dose to the diseased tissue and protecting the healthy tissue has been a great dilemma to all both in India and the world.
We have produced the 0.65 cc Ion chamber, which is the heart of the quality assurance system. The product has to be imported and costs about `1.2 lakh to 1.5 lakh. We have supplied about a 1000 chambers to various hospitals across India of various sizes. These were wholly imported from abroad. The cost of each chamber averaged about `1.2 lakh, the basic system of quality assurance for any hospital will cost about `80 lakh to nearly a crore. Quality treatment independent of the LINAC the hospital plans to procure should be made economical to the patients. Make it in India, cost will be low and patients will be benefited. Blue prints have been laid for many products in this range and it will take some time before we can come out with many products. We are also trying to collaborate with some American, German and Swedish companies to join hands with us, if this collaboration succeeds then it will be much faster. We can reduce the cost of imports, and thus save crores of tax payers’ money and avoidable expenses by private hospitals.
Delta Discover 4
TM
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MRI Systems
MRI Future: Faster Workflow, Shorter Exam Time, More Patient Comfort The future appears limitless as researchers and medical technology manufacturers continue to strive towards increased image quality, physicians work towards better diagnoses, and patients anticipate speedier, more comfortable, and less costly MRI exams, writes Anshuman Ojha of Elets News Network (ENN)
M
agnetic resonance imaging (MRI) technology has gained impetus from the keen interest shown by technology developers and manufacturers who wish to make it more patient friendly. It has become one of the preferred diagnostic imaging methods for imaging the central nervous system, particularly for detecting brain tumors, spine lesions, imaging blood vessels, and stroke affected areas of the brain. The global magnetic resonance imaging market is a shifting, capital equipment market that is saturated with numerous players developing innovative technologies. Given their
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impressive safety and efficacy as well as non-invasive nature, MRI systems have seen continued adoption since they were first introduced to the healthcare market. Rapid advances in the field imaging along with the development of MRI safe technologies have greatly expanded the potential of therapeutic applications. The US market will be driven by physician adoption of new systems, especially high-field devices, as a result of acceptable safety profiles for high-field strength devices and the decreasing cost of equipment. The global MRI systems market will more than double in value from approximately US$ 4.1 billion in
2013 to over US$ 9.2 billion by 2020, representing a Compound Annual Growth Rate (CAGR) of 11.8 percent, according to market research firm Reportstack. Closed systems with high field strengths dominate the market due to their high clinical significance and higher image resolution. Technological advancements such as the introduction of MRI-compatible pacemakers and digital broadband scanners drive the growth of the MRI market. Aging population in developed countries and increasing cases of chronic diseases in developing economies accelerate the market growth from the demand side.
MRI Systems
The use of MRI technology is expected to dilate globally owing to its significance in modern medical diagnosis for diverse biomedical applications. MRI systems for neurology and brain disorders command the current market, while cardiac MRI and breast MR systems are gaining momentum, due to rising cardiac and breast cancer cases globally. With its ability to image anatomically and functionally, MRI has found its way into surgical applications as well as in diffusion and perfusion imaging. It is being combined with other modalities such as PET, SPECT and ultrasound to achieve new heights of image clarity. The overall MRI markets in Japan are expected to experience growth through 2020, including low-field
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systems, which are declining in many other countries globally. China will experience growth during the forecast period, although low-field systems will grow at a small CAGR of one percent. In India, the low-field strength MRI market segment will decline slightly at a negative CAGR of 0.6 percent through 2020. In France there is no market for low-field MRI system sales, although the market for mid- and high-field systems is expected to undergo significant growth in the coming years. MRI is one of the fastest growing market segments in the country, and will be valued at over US$ 181 million by 2020. Valued at just US$ 30 million in 2013, the high-field MRI market in UK is one of the smallest in Europe, due to poor reimbursement and slow
adoption of advanced systems. In Brazil, cost and reimbursement remain the top concerns of practicing radiologists who must base diagnostic strategies on cost-effectiveness to a greater degree than their counterparts in US or EU. As a result of this slow market growth, many US and EUbased companies often overlook the Brazilian market, focusing on greener pastures in Europe and US where profitability is easier to achieve and maintain. This leaves radiologists in Brazil with limited options in terms of new technology, which in turn slows progress in the country and ultimately hurts patient outcomes.
Indian Market The market of diagnostic MRI systems in India will see a growth of 15 percent CAGR over the next five years. The increased potential offered by new diagnostics tools, such as functional MRI, weight-bearing MRI, and diffusion of new clinical applications of this technology among physicians and patients are fueling the growth. Improved clinical outcome for patients has allowed the modality to reach tier-II and tier-III cities, avoiding the patients to travel many miles for an MRI scan. The Indian MRI systems market is estimated at `1190 crore in 2014. About 356 units of diagnostic MRI systems were sold. On the basis of technology, Indian diagnostic MRI systems market may be segmented as 0.2-0.5 T MRI, 1.5T MRI, 3T MRI, and refurbished MRI. Though 3T systems have an edge over 1.5T systems in terms of image quality, clinical applications, and certain other aspects of MR imaging, the versatile good system with multiple channels and coils on 1.5T system can equally provide great imaging. Nowadays, more and more manufacturers were flouting higher field MRIs of 3T to upgrade. However, in India it is not financially viable to invest in 3T machines as
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Direct Radiology Systems are here to Stay
Indian radiology market for ages has not seen a major transformational change, but now it is taking place and is evident in technology, products design and features, says Kiran Phuri, Director Marketing, Medx Technologies Please share more about your company We come to the Indian radiology market with a strong team of eminent engineers that have more than two decade of experience with them. This is our strength and with their in-depth understanding of the market and their expertise in creating innovative solutions, we at Medx Technologies have we have designed and developed latest technology products which are in line with international specifications. Currently, we have a complete range of high frequency general X-ray systems, mobile X-ray systems and mobile C-arm imaging systems, which are way ahead in terms of technology comparing to the existing products being marketed by competition.
Kindly share your views of the latest trends in radiology market in India? Indian radiology market for ages has not seen a major transformational change, but now it is taking place and is evident in technology, products design and features. Specifically talking about X-ray imaging there would be over 40,000 low frequency systems currently in use and many of them would be over ten years. With new technology the market potential and growth is too high as most of the age old systems and old technology systems may be replaced with newer technologies in the next five years. So with the ongoing changing trend we
see a big opportunity in the Indian Imaging radiology market.
What are the key segments that your products focus in radiology? In the past, the X-Ray Imaging market in India did not witness any major changes in technology and almost things were stagnant with low frequency systems being the basis of Imaging. The major shift came in 2008 when digital Imaging became affordable, and since then we have seen a change and this digitation process has brought about a change in the basic Imaging technology as well. With the need of better imaging quality, high frequency X-ray systems have been gaining major acceptance in the new sales. The latest trend in X-ray Imaging of-course has been digitisation using CR but is now changing pace towards Direct Radiography (DR) Systems. To be in line with future market requirements, at Medx we have a range of DR solutions from the affordable series to the highest end technology products to meet a variety of customer needs. For high end imaging requirements, Medx Technologies has collaborated with a few European and US companies to get technology from them and produce affordable systems in India.
What are the unique features that you have introduced in your imaging products?
At Medx Technologies, our main focus has been in developing high frequency generators, which are more stable to Indian power supply conditions and are future ready for digital radiography solutions (DRS). We have been quite successful in doing this as we can boast that our high frequency generators have been working past three years without any voltage stabilizer requirements and a single day breakdown in the worst parts of the country where electricity is not stable. Our dream to provide affordable technology is the basis of our product designs. We try to develop and create new technologies keeping in mind the vision to make it affordable. With some of our products released, we can surely say that we offer some higher end solutions at nearly 40 percent lower cost than similar spec products available from the international market.
What are your business plans for this year? We already have a basket of products to offer which range from the lowest end mobile X-ray to 50kW high frequency systems. This covers 80 percent of the general market demand in India. For 2015, we have a lineup of new products which are currently undergoing necessary certification and would be commercially released soon. In the next six months we are releasing high capacity X-ray systems with 65kW and 80KW, range of high-end digital radiography solutions, and higher end C-arm imaging systems with cardiovascular imaging capabilities.
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MRI Systems
the cost is double of a 1.5T system. The manufacturers have now wisely developed robust 1.5T systems capable of everything a 3T could do and at a marginally higher cost. Using parallel imaging technology these systems can produce equally good images and also take lesser time as compared to earlier systems. The future of MR imaging lies in high-field MR systems but equally in low field systems, which are patient friendly and targeted to specific body parts and diseases. Public-PrivatePartnership (PPP) may also play a huge role in providing accessibility to patients residing in remote parts of the country. There is a constant increase in the number of hospitals, day centres and private clinics all over India and to cater to this growing need, there will be immense demand for diagnostics in the country.
Major Players The MRI market is dominated by GE Healthcare, Siemens, Philips, Toshiba and Hitachi — all had something new to offer. Here is a look at some of the latest innovations in MRI systems.
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most scans nearly completely silent. Additionally, the SIGNA Pioneer features Total Digital Imaging, which enables improved image quality and increases signal-to-noise ratio by up to 25 percent. With MAGiC, Panagiotelis explains, one can get six different image contrasts from one composition, taking a total of approximately five minutes, one-third of the time normally required. “We can actually go back after the scan and change the contrast,” Panagiotelis says. “Let’s say you made a mistake; you can simply move the contrast of the image you got and optimise the contrast. We think there will be a huge interest in MAGiC as it’s a real answer to the needs of the customer today.” Both the SIGNA Pioneer scanner and the MAGiC technology are pending FDA approval and have not yet received the CE mark. Two other systems GE will introduce in 2015 are the SIGNA Explorer and SIGNA Creator, the latter an entry-level, value-segment system.
Philips Healthcare GE Healthcare At RNSA, GE Healthcare unveiled its new SIGNA Pioneer 3.0 Tesla MRI system that comes with a new imaging technique called MAGiC, which, according to Ioannis Panagiotelis, GE’s global CMO, may reduce imaging times by up to two-thirds. “Our big thing was the return of SIGNA, which we first introduced in 1983, with four new systems,” Panagiotelis says. “It was always associated with leadership and innovation and this is a vision we want to bring back for MR.” The scanner features an enhanced version of GE’s SilentScan technology, which originally was only available for neuro scans, but now makes
Philips has introduced Ingenia 1.5T S, a new addition to the Ingenia and dStream family specifically designed for medium- to large-scale hospitals that serve large patient volumes with high-performance MR imaging. It includes mDIXON XD, which provides fat-free imaging and four contrasts in one sequence in virtually all applications and anatomies, including subtractionless MR Angiography, whole body imaging, and even combinations of fat-free and motion-free imaging simultaneously; and O-MAR, a solution for excellent image quality, even for patients with orthopedic metal implants. “What makes Ingenia 1.5T S unique is that it addresses the root causes in a holistic way, delivering ‘first time right’ imaging for high productivity
MRI Systems
and a superb patient experience,” says Annemarie Blotwijk, director of MR marketing for Philips Healthcare. “mDIXON XD and O-MAR improve MR speed and robustness to make MR more accessible to patients and new applications. It strengthens Philips’ Premium IQ solution, which aims at delivering more diagnostic information in the available time slot.” Philips has also introduced new quantitative techniques in body and cardiac imaging to make MR a more definitive diagnostic solution, including MR elastography for the assessment of liver fibrosis and T2 or T1 mapping for cardiac disease assessment. “Today, MR is already crucial and established imaging modality already today, but our customers see a huge potential to increase the impact of MR even more,” Blotwijk says. “The future of MRI is in delivering faster, more definitive diagnosis, shortening the time to diagnosis with more definitive outcomes. This will be achieved by making MR procedures extremely fast and reliable and by making MR more patient friendly. It will also require more quantitative data and provide intelligent data analysis tools to provide definitive answers and enable personalised treatment plans.” At RSNA, Philips demonstrated the concept study of an MRI coil that is not only fully digital, but also features an integrated power supply. This allows a data-only connection of the coil, significantly speeding up the workflow. “In the future many MRI developments will be based in the software domain, arising from the coupling of digital data acquisition, reconstruction and post-processing,” Blotwijk says. “We believe that meaningful innovation starts with collaboration, which is why we developed a high-end reconstruction framework with a plug-and-play environment for new and custom reconstruction algorithms that also
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supports a graphical programming interface for our clinical research partners.”
Siemens Healthcare “Considers MRI a young modality because its potential is so limitless, and the company’s latest products have focused on improving speed and clinical use”, said Stuart Schmeets, Senior Director, MR Marketing, Siemens Healthcare. “The efficiency of healthcare has evolved, making the diagnosis faster, and some of the buzz in the industry has been, ‘How can we increase speed for MRI?’” Schmeets added. “It is about collecting more information in less time and completing complex diagnoses.” At RSNA, it unveiled its 1.5T Magnetom Amira MRI system, which was designed to speed up scans to as little as 10 minutes, while saving energy when the scanner is not in use. According to Schmeets, the system allows for 20 percent shorter exam slots, accommodates more patients per day, makes MRI expertise accessible to every technician, reduces the number of rescans with standard procedures, and minimizes complexity and maximizes efficiency for each MRI exam in an institution. Siemens also introduced its new, FDA-cleared 24-channel version of the Magnetom Skyra, Siemens’ advanced wide-bore 3T MRI system. “The new configuration of the Skyra joins the previously available 48-channel version and has a lower cost entry point for customers looking to perform advanced clinical applications,” Schmeets says. “We have a tremendous customer feedback programme and that helps drive our R&D and where we are headed.” Additionally, Siemens has in the pipeline its new, 510(k)-pending SEE it solution for prostate MRI exams, which will enable users to perform noninvasive prostate MRI without an endorectal coil. According to Schmeets,
MRI has the highest sensitivity and specificity for assessing prostate cancer as it can rule out the presence of life-threatening cancer with more than 89 percent certainty. “Powerful coil technology and unique applications help to streamline processes and maximise system utilisation,” Schmeets added. Siemens continues to make use of its Day Optimising Throughput MRI exam software, which provides intuitive protocol management designed to produce quality exams in less time, with the potential to shorten exam time up to 20 percent.
Toshiba Medical Systems Toshiba introduced the Vantage Elan MR system, a 1.5T MR system, designed to help providers save time, money, and space. Josh Emperado, Toshiba’s senior manager for MR market development, says the Vantage Elan magnet and couch fit in a footprint of 23 square meters and it offers the lowest total cost of ownership. “The buzz we hear in the industry is about making the whole exam much more comfortable and patient friendly,” Emperado says. “At the same time, MR technology is complex, and we need to make it easier for the customers. Our new system is quieter, more comfortable, and we’ve streamlined the process so that patients spend the least amount of time possible and customers can perform them easier.” Among its features are Toshiba’s standard Pianissimo noise-reduction technology that’s designed to help put patients at ease, a single set of coils that does’t need to be readjusted for multiple exam types, and noncontrast imaging techniques allowing for safer exams. “Toshiba puts customers first with an MR system that delivers productivity, reliability, and high image quality, but can fit into the budgets of small community hospitals,” says Nancy Gillen, vice president marketing
MRI Systems
and business development at Toshiba America Medical Systems. “We think hospitals of all sizes should be able to offer their patients the very best in imaging to enhance patient care and outcomes.” Toshiba’s MR series also offers an upgradable solution to its existing Superb Micro-Vascular Imaging technology, which enables the visualisation of micro-vascular flow without the use of contrast.
Hitachi Medical Systems The mandate around Hitachi’s MRI systems in 2014 dealt with several industry trends that shaped the direction of its newest products. “MRI continues to move from qualitative to more quantitative assessment—such as techniques to visualise certain biomarkers and then map those over traditional anatomical images,” says Shawn Warthman, MRI marketing director for Hitachi Medical Systems America. “Our new MRI platforms needed to meet diverse market segment needs. Like all imaging modalities, MRI is focused a lot on workflow enhancements, continuing to push exam times closer to 15 minutes from the norm of 30 minutes.” At RSNA, Hitachi introduced new software designed to improve image quality, workflow and new clinical applications for its customers. These include a new k-space parallel processing scan method, improved fast spin-echo imaging, new fat suppression sequences, improved tuning and prescan set up, noncontrast tissue perfusion, white matter lesion detection, breast spectroscopy, and cardiac wall motion analysis. Key features in Hithachi’s Echelon
Oval 1.5T system include 74-cm oval bore, a 63-cm wide mobile patient table, and workflow-integrated technology with integrated coils and on-gantry monitor.
Trends One of the emerging trends in the global MRI systems market is the intense competition among the vendors. The leading vendors provide an extensive range of advanced instruments globally and the low-key vendors also deliver a wide range of products to suit the needs of their customers.
Growth Drivers One of the major drivers in the market is advance in technology, which results in the availability of efficient and inexpensive devices. Advances in technology enhance the quality of the output by improving field strength, which results in a better signal and improved image quality. Technological innovations in the healthcare industry have resulted in the development of customised equipment as per the needs of the patients. This impressive growth will be driven by continual design developments, cost reductions, reimbursement improvements and the rapid uptake of less expensive MRI systems in emerging markets.
Challenges One of the major challenges in the market is the growth of the used and refurbished MRI systems market. Many local vendors are exporting and importing used and refurbished MRI systems. Used and refurbished MRI systems are available at half the price of new ones, and the vendors also provide a warranty period of a couple
of years on them. However, current economic factors remain the greatest threat to new innovation in the next five years, despite numerous advancements in MRI system capability. Healthcare providers are calling on manufacturers to develop both cheaper and better technology, meaning suppliers’ success will depend on the development of MRI solutions offering improvements in cost, efficiency and workflow, while also enhancing clinical diagnostics. Despite the need for replacements, hospitals do not always decommission MRI systems at the end of the products’ manufacturer recommended lifecycles, which negatively affects sales in developed markets as new system purchases are delayed or abandoned. The Indian MRI market will be fueled by the rapid uptake of less-expensive MRI systems that will allow access to healthcare in more remote areas of these price-sensitive economies. With increase in average income, growing demand for healthcare, and higher standards for care, emerging markets are expected to see a rise in MRI diagnostic procedures, as the technology offers safe and valuable insight into patient conditions and is a powerful, irreplaceable decisionmaking tool for physicians. In a time of rapidly changing environments due to regulations, financials, competition and technology, medical imaging will be a focal point of successful providers. The difference between successful providers and those that struggle will come down to the people who make up the organization and can utilize the resources and create an organization that is informed and flexible.
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Buyers Speak
Trends in Cardiology
T
his is the Golden Era of Cardiology. No other field in medicine has seen so many advances as in this field and itâ&#x20AC;&#x2122;s just the beginning. The death rate of acute heart attacks has halved in past two decades. The focus is now shifting to prevention, early detection and minimally invasive treatment of the disease.
Trends in cardiac imaging There is already a discernable shift from diagnosing disease at a later stage, after symptoms occur, in asymptomatic diagnosis. Patients at high risk can now be selected on the basis of risk profiles and screened in the doctorâ&#x20AC;&#x2122;s office. An important recent development is the realisation that the vast majority of heart attacks are not due to progressive atherosclerosis, but to sudden rupture of non-occlusive, vulnerable plaque. CT angiography is now widely being used in the emergency department to distinguish noncardiac chest pain from those acute heart attack patients in whom the initial ECG is non-diagnostic. Cardiac MR is also very helpful in diagnosing structural diseases of the heart with greater accuracy.
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Dr. Vishal Rastogi Senior Consultant Interventional Cardiologist, In charge - Heart Failure Clinic, Fortis Escorts Heart Institute (FEHI), Gurgoan
anti-platelet agents, which are being used in the treatment of acute heart attack patients and in patients who undergo angioplasty. Their usage has reduced cardiovascular death, stent thrombosis and urgent target vessel revascularization. Dabigatran, apixaban and rivaroxaban are very exciting addition for stroke (paralytic attack) prevention in patients suffering from atrial fibrillation, a form of irregular heartbeat.
Trends in drug treatment of disease
Trends in interventional cardiology
After the publication of courage trial, which showed that in patients with stable angina, drug treatment is equally effective as angioplasty or bypass surgery, more and more patients with stable coronary artery disease (CAD) are being managed medically. Newer drugs such as ivabradine and ranolazine are very effective in control of symptoms. Ticagrelor and prasugrel are novel
Today, most type of diseases can be treated by less invasive catheter based interventions obviating the need for more complex surgery. Transcatheter Aortic Valve Replacement (TAVI) has made life very comfortable for high surgical risk patients with aortic stenosis. Moreover, till now, mitral valve leakage repair was strictly a domain of surgeons. Recently, a percutaneously applied clip called
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MitraClip has allowed lots of patients avoid high-risk surgery. Multiple long blockages are now increasingly being treated by angioplasty because newer medicated stents have shown excellent long-term safety and efficacy. Another milestone in the treatment of coronary artery disease is the advent of Biodegradable Scaffold, also known as vanishing stent - a device that keeps the artery open till it heals and then gradually dissolves to leave behind a normal, natural artery. One of the most important innovations for management of CAD patients is cath table assessment of significance of blockage by fractional flow reserve (FFR). It is a simple and accurate guide to tell us whether a blockage needs fixing or can be left on medications.
Trends in heart failure As the survival in patients with CAD is improving, the number of patients suffering from heart failure or weak heart is also increasing. Management of these sick patients is very difficult and these patients require frequent hospital admission. However today, along with medicines, various devices like implantable cardioverter defibrillator (ICD) and cardiac resynchronization therapy (CRT) have allowed these patients to live longer with good quality of life. Now definitive treatment such as cardiac transplant and artificial heart is also widely available. Now the distinction between a cardiologist, a surgeon and an imaging expert is blurring and a new approach called the heart team approach is necessary to properly evaluate and treat the patient. For more information visit: www.fortisescorts.in
Buyers Speak
Affordable Hi-end Technology Please comment on MRI machines market in India visa-vis the global market. India is the second most populous country in the world with over 1.2 billion population. As expected, it also has a very high disease burden. This in turn represents the huge market and the large prospect for the healthcare industry. The Indian MRI market has witnessed strong growth over the last few years and will continue to do so over the next five years. Southern India tops the list in terms of installations whereas in future bulk of the demand will come from West followed by North. Buying behaviour of MRI depends on the budget and the type of population catered by the institution. Therefore, the latest and advanced 3T MRI is not afforded. An increase in healthcare infrastructure boosts the demand for MRI equipment installation, also increasing the demand from hospitals and imaging centres. Increased health insurance coverage and disposable income fuels the affordability among the patients, leading to increase in health insurances and per capita disposable income. Medical tourism is opening up new avenues for growth for this market. Greater budgetary allocation towards health sector will see better infrastructure in state run hospitals. The duty structure should be decreased for such equipment. Both doctors and patients are increasingly becoming
more aware of the benefits of MRI test. Higher currency fluctuation squeezes the profit margin of the players. Currency fluctuation affects this market as this market sees heavy imports (for both first-hand and refurbished equipment). Highly capital intensive MRI equipment demand high service charges, which in turn is passed on to the patients resulting in lack of affordability amongst patients. Lack of regulation in the medical community on MRI referral fees further hampers the affordability of patients for this modality. Looking into the rapid developments in technology such as faster scan times and higher imaging quality, higher and more sophisticated machinery makes it possible to even detect small lesions <5mm. The advancements in MRI Physics are decreasing the use of contrast administration for MRI. The latest advancement of PETMRI makes it a highly sensitive tool to detect any cancer anywhere in the body at very early stages, without giving any radiation from the machine unlike the PET-CT Scan. This makes this innovation of PET-MRI the safest way and most comprehensive way to study and deal with cancers. It has helped in decreasing the time for cancer imaging and diagnostics, further decreasing the time gap between Dr Shubham Sogani CEO, House of Diagnostics
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Buyers Speak
diagnostics and treatment, helping patients fight cancer and time, as cancer is a fight against time. Right treatment at the right time may cure cancer. It gives the doctor the correct extent of cancer and helps him make the right decision. Lesions which are missed on a regular positron emission tomography (PET) scan are picked up using the MRI Scan, thus complementing the findings of a regular PET. It is safe as no radiation exposure from the MRI (unlike CT scan) completely removes the untoward side effects and harms from CT scan during a PET-CT. This technology is now being used for cancer screening and also can detect cancer anywhere in the body in just one examination which lasts for about 45 minutes only. The Indian market is becoming increasingly more susceptible to refurbish MRI equipment because of cost advantage - about half the cost of new equipment. MRI equipment are penetrating more because of the various tie ups between government and private companies. As per latest trend MRI equipment is installed through PPP model. Teleradiology is emerging as a tool for reporting MRI images to counteract the lack of good radiologists especially in remote and rural India.
Please tell us about your current operations in India and your expansion plans. We are mainly concentrated in the Delhi - NCR Region with the largest number of MRI scanners installed under one brand. We have the highest end PET-MRI (a high end 3T MRI with PET Scanner) at Indraprastha Apollo Hospital, a 3T super-magnet MRI installed at Hargovind Enclave in East Delhi, 1.5T super-magnets installed at Hargovind Enclave, Saket, Faridabad centers, Open cum standing and weight bearing MRI installed at Hargovind Enclave in Faridabad and Apollo New Delhi.
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We have 8 MRI’s installed in Delhi/ NCR Region itself and six diagnostic centers being run and managed by us. With Delhi market maturing and the demand for MRI’s rising we expect to further expand our portfolio in Delhi -NCR and also are targeting other nearby markets with such fully equipped centers. Today we do diagnostic tests at rates which are lower than those being charged by government hospital also as we cater to large volumes.
On the price sensitivity of the Indian market, and how does your hospital counter this problem? The Indian market is very price sensitive and patient’s affordability is a major challenge in diagnostics and treatment. We are now offering 50 percent discount on the prevailing market rates on all tests done at our centres in Hargovind Enclave, Saket and Faridabad. An MRI test prescribed by a doctor on a 3T MRI for instance, which costs Rs 18,000 at any private hospital, costs between Rs 7,000 to 9,000 at our centres. This has resulted in a large patient flow to our centres and we are now handling a good volume of patients.
On government regulation or any other challenges faced while operating the Indian market? The main challenge faced by the healthcare industry is the huge costs of infrastructure. Government should look into subsidising the costs by removing VAT, service tax and excise applicable on all goods and services which are directly supportive to healthcare industry such as on equipment and consumables. This in turn will greatly decrease the burden of costs on patients making it more affordable to them. Lack of regulation in the medical community on medical referral fees further hampers the affordability of patients
for diagnostics and treatment.
On emerging trends and new technologies. The new technologies in the space of MRI are PET – MRI, which is a ground breaking innovation that has changed the way doctors are approaching and treating cancers. Also its use in cancer screening for people who wish to rule out any and all types of cancers by just one test makes this advancement truly a medical marvel. The 3Tesla MRI with high power of a 3Tesla magnet gives better quality images and resolution are far better, making even the minute lesions visible. Silent MRI decreases the noise inside a MRI machine. While open MRI is recommended on claustrophobic patients. Standing weight-bearing MRI has given a new dimension to spinal and joint problems, which get exaggerated in standing and weight bearing positions.
What are your Hospital’s offerings? We are one of the healthcare institutions that offers discounts on all diagnostic tests, including 3T MRI, 1.5T MRI, open cum standing weight-bearing MRI, CT Scans, PETCT scans (at Rs.9,999), laboratory investigations besides all general tests such as X-Rays, ultrasounds, bone densitometry, mammography, OPG, PFT, EEG, EMG, ECG, etc. We offer a comprehensive whole body cancer screening check up using the PET-MRI at Indraprastha Apollo Hospital in New Delhi using the high end PET-MRI. Affordability is the key for all. The manufacturers have to sell affordable products without compromising on quality, Government has to provide subsidy to the service providers to make investigations such as those of MRI affordable for patients. For more information visit: www.houseofdiagnostics.com
Government Desk
Centre to Unveil New National Health Policy Soon
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new health policy will be soon introduced by the Centre with special emphasis on AYUSH - Ayurveda, Yoga and Naturopathy, Unani, Siddha, and Homeopathy system. The new policy will redefine the role of AYUSH, giving adequate importance. AYUSH system, with its long history of use at various stages of civilisation would be made an integral part of the healthcare arrangements at all levels, right from the primacy health centres to the top. According to Union Minister, Shripad Naik, there can be a revolution in healthcare if strengths in AYUSH system of medicine are properly utilised by prompting, supporting and spreading awareness about it. On the other hand, the Central Government has approved a sum of Rs 54,351.02 lakhs for allocation to all States and Union Territories for mainstreaming AYUSH under the National Rural Health
Mission (NRHM) during the current year 2014-15. Under NHM and NRHM, engagement of AYUSH doctors and paramedics are being supported, provided they are co-located with existing District Hospitals, Community Health Centres and Primary Health Centres with priority given to remote PHCs and CHCs. States and Union Territories engage the AYUSH doctors as per local preference. States and Union Territories utilise funds for appropriate stream of AYUSH, as per their requirement. Under the scheme, Manipur recruited 95 AYUSH doctors for co-located health facilities, 72 AYUSH doctors under Rashtriya Bal Swsthya Karyakram (RBSK) and 59 paramedics and pharmacists. Co-located AYUSH health facilities in Manipur are available at seven district hospitals, 17 community health centres; one, at other than community health centre above block level but below the district level, and 72 primary health centres.
NUHM to be Implemented In Karnataka by March
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he National Urban Health Mission (NUHM) will finally be implemented in the first week of March. As a part of the initiative, 13 Urban Public Health Centres, including eight in Bengaluru will be brought under the scheme. According to Health Minister, U T Khader, the objective of the NUHM was to address the health service needs of slum dwellers, migrant and vulnerable sections in urban areas. Towns and cities having a population of more than 50,000 would be covered under the scheme, he added. Some of the existing healthcare facilities now identified under the Urban Public Health Centres would be revamped with modernisation of infrastructure and deployment of medical staff, nurses and paramedics. There would also be the need to muster for medicines and diagnostic equipment. Programmes such as delivery of healthcare, environmental sanitation and supply of safe drinking water will be taken up under the Mission.
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Mother-Child Care Equipment Market
Smiles Ahead
Prenatal, fetal and neonatal care is gaining importance every year with increasing awareness, demand and affordability for the latest, improved and technologically advanced equipment that are available worldwide
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remature and congenitally ill infants are born as a result of advanced maternal age, induced fertility, labor treatments, poor prenatal care, and lifestyle preferences such as smoking, drinking, and obesity. Various disorders such as anemia, bronchopulmonary dysplasia, intra-ventricular hemorrhage, hyperbilirubinemia, and transient tachypnea are diagnosed at birth. Thus, proper prenatal care, balanced nutrition, and appropriate medical care are necessary for a healthy pregnancy and birth. Maternal and infant care equipment are used to monitor, evaluate and treat diseases in the prenatal and postnatal stage of infants. Prenatal, fetal and neonatal care is gaining importance every year with increasing awareness, demand and affordability for the latest, improved and technologically
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advanced equipment that are available worldwide. Premature birth has been one of the leading causes of neonatal death globally, that kills more than one million newborns every year. There are approximately 15 million premature babies born every year across the globe that require urgent medical attention and intensive care, which creates the demand for maternal and infant care equipment. Prenatal, fetal and neonatal care equipment are also required for numerous other applications, such as treatment for hypothermia, jaundice management, fetal and neonatal monitoring, respiratory assistance and others. Growing awareness, low cost equipment, and replacement market are some of the factors driving the growth of neonatal equipment industry.
Maternal & Infant Care Equipment
Global Market
Increasing demand for improved and technologically advanced equipment such as double walled closed incubators, highly portable fetal dopplers will add to the growth of the market.
The global prenatal, fetal and neonatal equipment market was valued at US$ 6.63 billion in 2014 and is expected to grow at a CAGR of 6.1 percent from 2014 to 2019, to reach an estimated value of US$ 8.92 billion in 2019. Some of the major prenatal, fetal and neonatal equipment available in the global market are ultrasound and ultrasonography, fetal dopplers, infant warmers and incubators, phototherapy equipment, and respiratory assistance and monitoring devices. Among these, respiratory assistance and monitoring devices are the largest sub-segment with over 40 percent share of the neonatal equipment market. North America dominates the global prenatal, fetal and neonatal equipment market, with more than 28 percent share in 2014 in terms of revenue, followed by the European market (25%). Major factors contributing to the leading position of the North American market are high incidence rate of premature births, increasing age of maternal population and high level of awareness, demand and affordability for various prenatal and neonatal care equipment in the region. Asia-Pacific is expected to show the highest CAGR of 7.8 percent during the forecast period from 2014 to 2019 in the global prenatal, fetal and neonatal equipment market. The key factor responsible for the growth of the prenatal, fetal and neonatal equipment market is increasing incidences of premature births worldwide. Africa and Asia are the largest contributors towards the premature newborns, with Africa exhibiting highest
One-Touch Wireless Health Tracker!
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Maternal & Infant Care Equipment
incidence rate of premature births. However, the US exhibits the second highest incidence rate of premature births with 10.6 percent of all births in the region in 2005. Increasing age of maternal population is also leading to a number of complications that require various prenatal, fetal and neonatal care equipment. Rising awareness levels along with increasing affordability of the population especially in the emerging economies will help the growth of this market in future. Increasing demand for improved and technologically advanced equipment such as double walled closed incubators, highly portable fetal dopplers will further add to the growth of this market.
Indian Market Indian neonatal equipment industry is experiencing spectacular growth for the past few years as many new entrants are emerging in this market providing better healthcare facilities, thus, leading to increased competition. The Indian neonatal equipment market was valued at `201 crore in 2014. The market grew at an average rate of 25 percent over the past three years. New and technologically advanced equipment in the prenatal, fetal and neonatal equipment market will further provide growth opportunities
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The Indian neonatal equipment market was valued at `201 crore in 2014 to this market in future. Leading multinational companies, medium sized corporate, importers, and small companies are operating in this field; however, the market is dominated by multinational companies in premium segments and medium sized
companies in low cost segments. The neonatal mortality rate in India is amongst highest in the world and skewed towards rural India. Non-availability of trained manpower along with poor health infrastructure is one of the major hurdles in ensuring quality health and neonatal care. Despite a decline in Infant Mortality Rate (IMR), neonatal mortality is more or less static. It is therefore essential that neonates are provided utmost care at the first month of life so that neonatal deaths on account of asphyxia, infection, and preterm births could be prevented. The neonatal mortality constitutes about 75 percent of infant deaths in the country. Under the National Rural Health Mission, several initiatives have been undertaken to accelerate the pace of reduction of child mortality. Growing wealth, increasing mortality rate (IMR), increasing demand for private healthcare, reforms from governments, and active participation of social organizations in neonatal healthcare programs are some of the factors driving the growth of this industry.
Exclusive Interview
Technological Advancements and Emerging Trends in Healthcare Single health account of the patient linked to their families, storing their medical information securely and providing helpful information timely, will help people live a healthier and longer life, says Shashank ND, Founder & CEO, Practo
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ealthcare is perhaps one of the few industries yet to be completely disrupted by technology. It bothers me that millions find it difficult to search for an efficient doctor than a movie hall. It is easier to get a joke on your email than getting your own healthcare records. We talk of Digital India and making access to good healthcare a fundamental right yet millions in India and billions around the world struggle for it every day. How are we going to solve the problem? Even if you look at people with access to healthcare, their experience is not much better. They have no way of finding the best doctors other than asking a few of their friends who may or may not know great doctors. Their medical history (if they were diligent enough to actually have one) is stored in fat files that need to be lugged around every time they want to see a doctor and even when they do; it is so cumbersome for doctors to go through them. They simply order more tests which make the file even fatter and leave your health not much better. Why cannot your healthcare information and history work for your benefit? Surely, in an era where keyboards can predict your next word and cars are driving themselves, your healthcare data can (and should) do more than just compile in a file (fat or thin or digital)
and twiddle its thumbs. There has to be a better and easier way of doing this. I envision a world where technology will help consumers find the best doctors with a few clicks. Generating, accessing and storing health records would be entirely done digitally. Patients will have a single health account linked to their families that will store their health information securely and providing helpful information (prescription reminders for instance) in a timely manner (prescription reminders to take medicines) to help people live healthier, longer lives. Practo Ray software automates and simplifies clinic management so that doctors can focus on treating the
patients. With Practo Tab, doctors can provide a superior patient experience in the clinic as well as have offline access to all their digital records. The possibilities from here on are endless. For instance, finding the best doctor on Practo from thousands of doctors listed across the various countries we operate in and securely sharing your health information with the doctor with a single click, will make it extremely easier (and for the first time practical) for the patient to consult a doctor irrespective of geographical distance. This will make people in every corner of India (and around the world) getting access to the best healthcare they can. It will also make healthcare industry become a global integrated entity working to improve patient care. The good news is that things are changing rapidly. Doctors and healthcare providers want to improve patient healthcare experience but so far, all the technological change had been focused on large medical devices and creation of medicines (which is obviously important). But the next phase of innovation will be centered on improving patient ability to make more informed healthcare decisions and making all the magic of modern medicine accessible to consumers easily, transparently so that they can live healthier longer lives.
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Buyers Speak
NICU Offers Quality Healthcare Preterm births are the underlying cause for the fetal and neonatal care products and services market across the globe. Please comment on neonatal infant care unit market in India vis-a-vis the global market. Preterm birth poses a grave challenge to perinatal and maternal care, and is the major reason for neonatal mortality. Around 28 percent of the four million annual neonatal deaths that occur worldwide are directly attributed to preterm birth. This percentage of neonatal deaths is different for various countries, depending on their respective degree of neonatal mortality. The primary reason for such pronounced differences is the cause of neonatal death and the stark measure of healthcare inequities between low and high resource settings. According to the National Institute of Health (USA), the increased adoption of preterm equipment has enhanced the survival rate of premature babies.
Tell us about your current operations in India and further expansion plans. Kohinoor Hospitals is planning to have 500 self-sustained beds by 2020. At present, our hospital project has envisaged having 210 beds by the end of this year.
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quality care for which he is ready to pay a reasonable price. At our hospital we have, right from the project stage, gone in for a Green Hospital, which cuts our operational costs in terms of savings costs for electricity, water, etc. These savings are passed on to the patients. Additionally, we have different classes of admissions so that we can take care of all sections of society. For the poor, we have tied up with some NGOs who sponsor certain operations at very low costs- paediatric cardiac interventions. Our experience is that patients are ready to pay reasonable tariff if you provide them with quality services and counsel them about the costs rationally.
What are your views on government regulation or any other challenges faced while operating the Indian market?
What are your views on the price sensitivity of the Indian market, and how does your hospital counter this problem?
The problems with regulation are illustrated by Indiaâ&#x20AC;&#x2122;s medical tourism industry, which according to government sources will be worth `9,500
Indian market is very price sensitive; however with increasing awareness, education and disposable incomes, the Indian consumer is asking for
Dr Rajeev Boudhankar Vice President, Kohinoor Hospital, Mumbai
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crore in 2015, and as much as `54,000 crore in 2020. Almost 75 percent of the medical imaging equipment (worth `18,000 crore in 2011) that serves this industry is imported, and the value of imports themselves grew at a compounded rate of 16 percent in 2010-2014. A part of the problem is corruption and inefficiency. There is no national
Buyers Speak
body to oversee the procurement and provision of generic medicine, which currently originates from local manufacturers known to operate their plants in unsanitary conditions.
What are the various upcoming trends and new technologies? Time has come when challenging conventional constraints in healthcare can change the scenario in India. I agree with the Mckinsey report, which says that disruptive technologies deployed together have the potential to bring affordable healthcare to millions in the coming decade. The healthcare sector needs to be liberated from the institutional and human shackles that inhibit the transformative power of technology. Despite facing severe challenges, the Indian healthcare sector could become one of the most fertile test beds for technology innovation around the world. India’s myriad healthcare shortfalls are well known, and facts are the most troubling. Furthermore, poor access to clean water and sanitation compounds are other problems, as does a lack of awareness of preventive measures, which traps many in a cycle of debilitating malnutrition and disease. Finally, affordability alone will not solve the problem. Healthcare operates through a funnel of awareness and promotion, prevention, diagnosis, treatment and compliance. Trained and appropriately incentivised human resources are required across the entire funnel, but India doesn’t have enough of them. The ratio of practising doctors and nurses to the population has fallen to 1.4 per 1,000 in India, far below the World Health Organisation (WHO) norm of 2.5. This means conventional solutions will not make a dent. Those who are trained and want to work are not willing to practise in poor, rural communities. And those who are willing, they are either not trained or not certified, or both.
Would you like to suggest any other thing? Some of the new technologies are helping smallest infants progress faster in the Neonatal Intensive Care Unit using new devices to personalise the nutritional needs of premature babies, and help smallest infants with head shape and sleep cycles. Several new technologies being used in the USA are also making it easy for the smallest babies to gain more weight and being healthy. Doctors have begun routinely using a device known as the Pea Pod to measure the body composition of the infants. It looks like a mini Magnetic Resonance Imaging (MRI) machine. It is heated, and the baby is placed inside for approximately three minutes. Using an air displacement method, the machine senses change in pressure and can determine the percentage of body weight that is fat and the percentage that is lean body mass. With this information, health care workers can then personalise the baby’s nutritional supplements to help with appropriate weight gain.
The Pea Pod is important in helping the NICU team facilitate a healthy weight gain in the smallest infants by calculating the amount of lean mass and body fat in the infant on a daily or weekly basis. At the same time, some hospitals in the USA conduct ongoing studies of breast milk composition, using a device that analyses the percentages of fat, protein and carbohydrates in breast milk. To date, health care workers have performed hundreds of analyses of breast milk. The information from both analyses, ultimately leads to weight gain, better neurological outcomes and shorter hospital stays for babies in the Neonatal Intensive Care Unit (NICU). Cedars-Sinai is currently the only hospital in the United States with the new technologically advanced mattresses. Together, these new technologies are helping reduce the babies’ stay in the NICU and sending them home to their families, where they belong. For more information visit: www.kohinoorhospitals.in
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Buyers Speak
Technology and Healthcare Delivery Please comment on healthcare market in India vis-a-vis the global market. The Indian healthcare industry can be termed as the sunshine sector, with its increasing revenues, investments, FDIs and technology advancements. In comparison to our global counterparts, we now also have destination and specialised tertiary care hospitals providing low-cost treatment and care to patients from all over the world. With the estimate of growing US$ 100 billion by 2016, one can be certain that with public and private partnerships the gap of healthcare infrastructure, medical professionals shall be abridged. In my opinion the important aspects to be learnt and incorporated from the global market are â&#x20AC;&#x201C; government expenditure and support to healthcare along with structure in planning the same. Today with production companies being opened in India, and Indian hospitals opening their units abroad, we see recognition and a positive future for ourselves.
Please tell us about your current operations in India and your expansion plans. At present, Paras Healthcare has three commissioned hospitals at Gurgaon, Patna and New Delhi. By the last quarter of 2015, we shall also be commencing Paras in Darbhanga. By 2020, Paras Healthcare aims to establish healthcare facilities at tier-II and tier-III cities. Five years from now, it will have a bed strength of 1500 and revenue of `800-1,000 crore.
What are your views on the price sensitivity of the Indian market, and how does your hospital counter this problem? The mission of Paras Healthcare is
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to provide affordable specialised tertiary care healthcare facilities to the common man. To give access and approach to healthcare you have to suit the pocket of the community at large. With around 70 percent of the population making expenses out of pocket, majority still in cash, hospitals have to streamline their costs. One should not view price sensitivity as a hurdle. In fact, it is a challenge, which forces you to utilise your resources, optimise your processes and ensure that we deliver quality healthcare services.
What are your views on government regulation or any other challenges faced while operating the Indian market? The government support to the private sector to establish specialised tertiary care centres is in adequate, despite the fact that today 70 percent of the healthcare facilities are provide by private players in India. High custom duties, slow government approvals and low primary health coverage are all hurdles. Also, closure of many PPP projects takes time. The government policies need to be more defined, timeline oriented and robust to suit the finances and the ground realities of a private player. Projects like universal healthcare coverage and healthcare for all should be realised into reality.
Please comment on emerging trends and new technologies. The two most significant emerging trends in India are dual disease burden, gaping reality of the gap between healthcare infrastructure and manpower. The first forces us to understand the changing paradigm of diseases and the second asks for more policies, government inclusion and
Dr Dharminder Nagar Managing Director Paras Healthcare, Gurgoan
Public-Private-Partnership (PPP). In view of technology and healthcare delivery, today we are going through a metamorphosis. We are open to all types of healthcare models. The concepts of telemedicine, paperless healthcare, healthcare at home (from bench to bedside and online doctor consultation and second opinions) are just few examples that make us realise that the Indian Healthcare industry is exceptionally dynamic. It is time that the Indian healthcare fraternity accepts its digital transformation and incorporates the same. A model that saves time, cost, resources and is more convenient should be selected. A comprehensive inclusion all over the country shall transform the entire industry and its interface. Doctors who are hesitant, professionals who are sceptical should accept evolution. We need to make sure that we have the resources and the capability to accommodate technology at its introduction and not at the end of its market life cycle. For more information visit: www.parashospitals.com
Buyers Speak
Technological Advancements and Emerging Trends Please comment on healthcare market in India visa-vis the global market. Healthcare has evolved tremendously in the last two decades. India had been lagging behind in providing medical care to its population and it had to look upto western countries for providing advanced and tertiary healthcare. But in the last few years, several operators in the tertiary segment have come up to provide excellent quality oriented healthcare to both, Indian as well as international patients. Now-a-days in India, we have a huge inflow of international patients for medical value tourism. Indiaâ&#x20AC;&#x2122;s primary competitive advantage over its peers lies in its large pool of well-trained medical professionals. Also, Indiaâ&#x20AC;&#x2122;s cost advantage compared to peers in Asia and Western countries is significantly low as the cost of surgery in India is one tenth of that in the US or Western Europe.
Please tell us about your current operations in India and your expansion plans. Currently, we have our tertiary care centre in Sector 8, Faridabad and another secondary care centre at Sector 19, Faridabad. We also have two peripheral satellite clinics and an institute to train nurses and paramedics. We plan to expand at peripheral level by putting
What are your views on government regulation or any other challenges faced while operating the Indian market?
Dr Rakesh Gupta Chairman and Medical Director Sarvodaya Hospital and Research Centre, Faridabad
up peripheral centres at Palwal, Mathura and Hodal.
What are your views on the price sensitivity of the Indian market, and how does your hospital counter this problem? I believe that the Indian market is acutely price sensitive i.e. majority of treatments are carried out in the value segment and this applies more to elective procedures. But in cases of life threatening situations, or highly advanced procedures where scarcity of skilled deliveries is there, price doesnâ&#x20AC;&#x2122;t matter.
Government is playing a leading role in transforming the Indian healthcare industry. With most of the comprehensive reforms in the twelfth five year plan, government is set to play the role of stewardship for the Industry. If an organisation, like ours follows all rules and regulations, there are no challenges as such. However, finding proper and demographically suitable manpower seems to be a challenge at times, leading us to start our own nursing and paramedics institute to develop skilled resources focused on precision and advance healthcare treatment.
Please comment on emerging trends and new technologies. We live in an era of rapid technological advancement and great interconnectivity in terms of communication that enables professionals in the Indian healthcare industry to provide patients with the most advanced tertiary care treatment possible. It enables us to achieve greater efficiency improved outcomes and provide world-class care to our patients. For more information visit: www.sarvodayahospital.com
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International News
Medtronic Gets FDA Approval for VenaSeal Closure System
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edtronic, an Irish medical technology firm has received approval from the US Food and Drug Administration (FDA) for its VenaSeal closure system. The company has developed a minimally invasive procedure to close lower superficial extremities such as the great saphenous vein in patients with symptomatic venous reflux. Medtronic aortic and peripheral vascular business endoVenous franchise general manager, and vice-president, Sandra Lesenfants, said, “The FDA
approval of the VenaSeal system strengthens our endoVenous portfolio, providing physicians and their patients with a nontumescent treatment option. The VenaSeal System, together with our Venefit procedure, provides physicians and patients with leading treatment options.” The VenaSeal procedure is the only non-tumescent, non-thermal, and non-sclerosant procedure approved in the US, which uses a specially formulated medical adhesive that closes the vein.
Siemens Provides Imaging Technology for Neighbors’ Health System
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iemens has partnered with Neighbors Emergency Center to offer its imaging technology. Under the deal, Siemens will provide its imaging equipment for all new facilities of the Neighbors Emergency Center, which are expected to open in new Texas markets and other states. Bruce McVeigh, CEO, Neighbors Emergency Center, said, “It is currently a common practice for many ER facilities to purchase refurbished equipment. This contract with Siemens creates a standardised, state-of-the-art package of new radiology and imaging equipment for all of our Neighbors Emergency Centers, as we strive to be a leader in the free-standing emergency center market.” Siemens will supply its new CT, overhead X-ray, and ultrasound equipment for each new facility of the Neighbors Emergency Center.
Illumina Introduces New NeoPrep Library Prep System
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S-based Illumina has introduced a new NeoPrep Library Prep System, which claims to simplify the library preparation and offer quality sequencing-ready libraries for next-generation sequencing (NGS). The NeoPrep System has been developed for use with the Illumina portfolio of library preparation kits, supporting the commonly used NGS applications on all Illumina sequencing systems. The new system comprises NeoPrep desktop instrument, disposable library cards and reagents, and provides an efficient and complete workflow, together
with Illumina sequencers and the BaseSpace computing environment. Illumina life science business general manager, and senior vice-president, Kirk Malloy, said, “Illumina is enabling the broadest-possible adoption of NGS across research, clinical, and applied markets. “It makes NGS accessible to any lab by radically simplifying the library preparation process, creating a seamless workflow of Illumina solutions for library preparation, sequencing, and data analysis.” The system is said to be the first commercially available product, which
ResMed Acquires US-based Jaysec
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esMed has acquired Jaysec, a provider of Internet-based software solutions for the home medical equipment (HME) industry. Headquartered in Knoxville, Jaysec’s products assist HME providers resupply their patients and communicate with referring medical providers. “Jaysec’s products streamline key HME business practices such as resupply,
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allowing home medical equipment providers to focus on delivering quality care for their patients,” said Raj Sodhi, President, ResMed’s Healthcare Informatics Global Business Unit. Jaysec offers an automated resupply solution - GoJaysec - that uses
performs library preparation, quantification and normalisation in a single and selfcontained instrument. The system provides quality DNA and RNA libraries from starting amounts four to ten times lower than those required for equivalent manual assays, by precisely manipulating droplets within the tightly controlled library card environment. Users can prepare up to 160 libraries per week, by creating 16 libraries per run, noted Illumina. interactive voice, text and secured email communications to direct patients to a self-serve portal for easy authorisation of HME resupplies, including CPAP masks and accessories. This targeted, periodic communication automates the resupply process. The portal offers a cost-effective solution while reducing the administrative burden for the HME.
National News
Healthcare Goes Hi-tech with Patient Details on Tablet & Smartphones
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Delhi-based healthcare at home has asked their nurses to carry Tablet computers or Smartphones with proprietary applications. Over the past three years, a clutch of professional home healthcare companies have started in the country, and in the process they are not only making nurses more high-tech, but also opening up more career paths for them and creating specialisations in a profession. The nurses get their visiting
schedules and patients’ addresses on their tablets a day in advance, says Charles Walsh, who, along with Gareth Jones founded this service in India with the Burman family, the promoters of the Dabur group. The Walsh-Gareth duo co-founded Healthcare at Home Ltd in UK in 1992. The Indian company, which is unrelated to the UK one, started operations in April 2013. The nurses also have access to a patient’s health records, clinical history, hospital discharge summary, lab and imaging reports, along with a detailed care plan that provides information on the medicines and equipments required during a home visit. The tablets are also equipped with GPS to help track the location of the nurses.
India Needs Many Hospital Management Professionals by 2020: IIHMR
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y 2020, India will require lot many hospital management professionals, reveals a recent study by Institute of Health Management Research (IIHMR). “With the role of private hospitals expected to go up, we see a huge demand for healthcare managers. The private healthcare industry is likely to grow seven-fold from the present US$40 billion to US$280 billion in 2020. A big part of it would come from the corporates,” said Biranchi N Jena, director, IIHMR. At present Telangana and Andhra Pradesh seek a demand of around 2000 healthcare professionals, but it would increase to 10,000 by 2020. IIHMR has recently tied up with Netherlands-based Maastricht University’s Faculty of Health Management and Research (FHML) to provide global exposure and quality facilities to its students.
‘Figure-1’: Now in India
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medical photo sharing application ‘Figure 1’ that enables healthcare professionals upload images and scans to aid diagnosis, is now available in India. The app allows the doctors and the students to connect, discuss and share content related to the field of medicine. The app launched in 2013, is available in 48 countries and the images are viewed more than 1.5 million times a day. It is the most popular app with the healthcare professionals in the US and the UK. ‘Figure 1’ hopes to gain traction among India’s 2.3 million healthcare professionals. “Medicine is a visual field and there’s so much to be learned from medical images. ‘Figure 1’ is a privacy-conscious way for Indian healthcare professionals to view, share, and talk about a wide variety of medical findings,” said Dr.
Joshua Landy, a Critical care medicine specialist who developed the concept while seeing patients in an Intensive Care Unit (ICU) in Toronto, Canada. The company has worked with the Indian lawyers to ensure the platform complies with the country’s privacy laws.
The app protects its subjects by autodetecting and blocking faces and also gives users the option to blur parts of a photo that might give away patient’s identity. The app can be downloaded from the App Store and Google Play.
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Case Study
ASHA Soft - The Online Payment and Monitoring System for ASHAs
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Naveen Jain, Mission Director, National Health Mission, Rajasthan
ince the inception of National Rural Health Mission (2005), Accredited Social Health Activist (ASHA) component has played an important and critical role in the implementation of NRHM activities. The ASHA programme was introduced as a key component of the community process intervention and over the period of eight years, this programme has emerged as the largest community health worker programme in the world and is considered of critical importance in enabling people’s participation in health. ASHA is a community, whose role is to generate awareness on health issues and it also acts as an interface between community and health services. In Rajasthan, it is known as ASHA Sahyogini, as it works jointly between Department of Medical Health and Department of Women and Child Development. ASHA is selected by Gram Panchayats and works with the help of Anganwadi Centres. Before it starts functioning, it has to undergo intensive induction training. To reduce the Infant Mortality Rate (IMR) and Maternal Mortality Ratio (MMR), to ensure better health services and to prevent other diseases, at present, approximately 47000 ASHA Sahyoginis are functional in the state. ASHA Sahyoginis are paid incentives against providing various health services to pregnant mother and child and also for providing health services to the community. The roles and responsibilities of ASHA include the functions of a healthcare facilitator, a service provider and a health activist. It coordinates as a bridge between health and WCD in delivering key services and message for Child and Maternal health. Besides, ASHA Sahyogini also renders important services under National Disease Control Programme (NCDC) such as malaria, TB, leprosy, cataract and many more health provisions. ASHA are paid incentives against 26 types of
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activities and that also at different time period and from various channels. These complexities in their payment system cause various problems for ASHA’s payments. Because of not being paid on time, ASHA’s were getting de-motivated to render proper services to the community. Getting payment for every activity on time is a challenge, which has been acting as disincentive to them. To ensure their timely and seamless online payment, ASHA software popularly known ‘ASHA Soft’ has been conceptualised. It is a unique initiative by the NHM, Rajasthan. The software has been developed in a very short time span because of the keen interest shown by the authority to solve the major problem of ASHA’s delayed and partial payment, which was being faced at grass root level. ASHA Soft is an online system which facilitates the user to capture beneficiary wise details of services given by ASHA to the community, online payment of ASHA to their bank accounts and generate various kinds of reports to monitor the progress of the programme.
Objectives To ensure their timely and seamless online payment, ASHA Soft has been conceptualised with objectives to monitor the performance of each and every ASHA every month. To identify the gap area and need assessment
Case Study
for rendering better services at community level. Assessing the quality of services in remote and vulnerable areas, it would be easier to assess the service delivery of ASHA in remote areas and marginalised community. Further, timely payment of incentives to ASHAs will maintain their motivation level. Methodology, the software has been developed by NIC, Rajasthan state unit and the NHM core group constituted for this purpose under the directions of the Mission Director, NHM, Rajasthan. Master data for each and every ASHA was created constituting their personal profile including their educational qualifications, level of trainings, any other skills etc. All the concerned functionaries have been oriented and trained for their responsibilities. Directions and circulars have been issued to states, districts, blocks, PHC officials. A detailed manual has been prepared and circulated to all data entry points and various stake holders. Training for filling up the claim form has been done in all the districts up to PHC and ASHA level. For online payment, Bank of Baroda has been selected, which provides services without any additional charges.
ASHA Soft Analysis Report From the analysis of first month’s payment disbursement through ASHA Soft, various patterns related to ASHA’s functioning have emerged. The pattern of payment draws a picture of ASHA programme all over the state. For instance, it was found that in most of the district in Rajasthan, the majority of services rendered belong to monthly meeting and routine activities of ASHAs followed by maternal health, immunization services and family planning services. There is a very negligible proportion of National Health Programmes such as TB, leprosy, cataract and malaria (Fig 1).
Implementation Process This online payment process has been implemented all over the state from 26th December 2014. The payment process includes steps where ASHA would prepare their monthly claim form (self appraisal forms). ANM will verify their claim form (self appraisal forms). Verification and entry of data would be done by IA or Data entry operator or PHC or ASHA Supervisor. ASHA wise data entry would be done of self appraisal form and line listing. Sanction of payment will be done by MOIC with assistance of accountant or LHV and release of payment through digital signature of the CM and HO by the seventh of every month. The payment will be transferred to ASHA’s bank account. ASHA will receive SMS on their mobile regarding the transfer of payment.
Figure 3 brings out a clear picture of the ASHA’s functioning in the state. In terms of rendering services under child health, there is a clear correlation with the level of training received under sixth and seventh module and the amount of services provided. Similarly, the analysis from the payments of month January shows improvement over the December report. The temporal analysis of these two months shows the impact of persuasion to all districts after December performance. As evident from figure 4, the level of best performing ASHAs have gone up and there is a sign of healthy competition in the competent ASHAs of all the districts. Thus, the knowledge of the ASHAs on the nature of activities and job responsibility is the pre-requisite for effective service delivery. Awareness among ASHs about their responsibilities is the most crucial factor, which has been now possible to link with performance through ASHA Soft. It is critical that through ASHA Soft Rajasthan is going to witness a new dawn in the field of its community health.
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Exclusive Interview
Health Information Exchange is for 360 Degree Patient Care The health information exchange is a point that connects a healthcare provider to all information needs with respect to its hospital and patient records, says Dinesh Samudra, CEO, Palash Healthcare Systems Please share with us the latest product that you have launched for the healthcare sector? We have launched an exclusive service for the healthcare Industry. All the healthcare institutions currently maintain the patient records in their own premises and there is one information set which is present with the patients. There is no centralised location where all the information is available for a better treatment programme. So we have created a portal where we have attempted to get the healthcare providers, consultants and patients together to interact with each other and thus meet the challenge of carrying and multiplying the medical records. The Health Information Exchange is a point that connects a healthcare provider to all information needs with respect to its hospital and patient records. The elimination of the need of a physical health record of the patients for the hospital and consulting doctors empowers them to get access to patientsâ&#x20AC;&#x2122; data anytime anywhere thus ensuring that the hospital delivers a 24x7 services to its patients. A direct advantage of this info being readily available is improvement in speed of delivery of care, quality and safety becomes better and brings down the cost for hospitals to keep themselves connected to their patients roundthe-clock. The SWARM Health Information Exchange has three
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16. The main impetus of technology in the healthcare holds immense promise and will gain more grounds if the healthcare providers adopt and implement healthcare information management systems this will help them streamline their process, become quality oriented and will be able track the flaws in the entire system and take better care of the patients by just one simple solution that weaves hospital, consultants and patients together.
components that are interconnected Consulting Connect, Palash Practice and Palash Fingertips. These will operate across administration, doctors and patients for simplification of processes, effective compliance and improved health outcomes.
What are your reflections on the Union budget presented for 2015-16 for healthcare sector? The budget clearly indicates that the Government of India has a focus on healthcare and education. This government and the budget clearly indicate their intention on measures to improve the healthcare infrastructure and delivery in India. There have been some announcements to increase the adoption of health insurance and we hope that many such measures will follow as we move forward in the financial year 2015-
Please share with us your projections of growth and expansion for 2015-16 financial year? Last year was a great year for us and we booked orders worth US$ 2 million and 150 percent growth in profits, so we are looking at becoming a US$ 100 million company in the next five years. We are aggressively working towards our global presence. Currently we are in 16 countries with focus on Middle East, Africa and South East Asia markets. We have also started our work operations from London, UK recently and are looking to foray and expand our presence across European markets from our London location. We already have our presence in the US market through one of our partners, and we aim to expand our presence even across pockets in the US and maybe go independent in two year or so in that market.
Company profile
Medicare Gas Pipeline Services India is developing country and termed as a potential healthcare industry, Indian healthcare has suddenly started gaining a momentum by experiencing a new wave of opportunity, says Rajesh Mate, CEO, Medicare Gas Pipeline Services Please comment on medical technology market in India vis-a-vis the global market
Please comment on emerging trends and new technologies.
India is developing country and termed as a potential healthcare industry, Indian healthcare has suddenly started gaining a momentum by experiencing a new wave of opportunity. We now have capability of offering world class facilities at lesser cost than developed countries.
We have a sound infrastructural base that is well-equipped with advanced technology machines and equipment. Build over a large space, our infrastructural base is divided into various sections to assure smooth production. To enhance the production capacity without compromising with the quality, we continually upgrade the production machines. We boast of an experienced team of engineers, technicians, and other allied workers that is well-versed with the production. Their industrious efforts lead to provide unbeatable products and services thereby offering utmost level of satisfaction to the clients. They always keep themselves abreast with the everchanging market requirements to fulfill the prevailing market needs.
Please tell us about your current operations in India and your expansion plans. Medicare Gas Pipeline Services was established in the year 2007 as a designing, planning, supplying, installation, manufacturing, exporting, trading, commissioning unit and service provider of central medical gas pipeline systems along with basic supply systems, accessories, equipment, nurse call systems, ICU and operation theatre products. We have been successfully catering to hospital industries with oxygen, nitrous oxide, medical / surgical air supply system and vacuum system etc. Today, we are well-reckoned as one of the prime service providers for medical gas pipeline services in India. Currently we are engaged in big hospital projects at Maharashtra, Gujarat and Rajasthan.
What are your views on the price sensitivity of the Indian market, and how does your hospital counter this problem? Indian market is very price sensitive. Need to provide high quality state-of-the-art MGPS facilities at affordable cost. Providing tailored systems and services at very economical rates is our first priority. Quality is the prime concern of the organization that is maintained at every level of production. As, we are a quality cautious company, we conduct stringent quality tests starting from the procurement of raw materials to the finished product. Furthermore, our quality control unit keeps a strict vigil on the production process to assure the development of flawless products.
What are your company’s offerings? • Offering a comprehensive range of products and services • Backed by a qualified and experienced team • Timely delivery of the products • Products are manufactured in conformance with the highest national / international standards • Reasonable charges
Your major customers in 2014? • SMBT Hospital, Nandi Hill, Ghoti Road, Nasik, Maharashtra • Medipulse Hospital, Jodhpur, Rajasthan • MGM Hospital, Aurangabad, Maharashtra • Patni Health Care, Thane, Mumbai, Maharashtra • MIT Hospital, Aurangabad, Maharashtra • LBS Hospital, Bhopal, Madhya Pradesh • Vedant Hospital, Thane, Maharashtra • KLS Hospital, Vile Parle, Mumbai, Maharashtra.
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Product Launch
Laura M - Next Generation Urine Analyser
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ransasia Bio-Medicals Ltd. has launched Laura M analyser - the next generation Urine Analyser with high-throughput that is capable of measuring all routine parameters in urine along with Microalbumin and Creatinine. It is produced by ERBA Lachema, the Czech Republic subsidiary of the ERBA â&#x20AC;&#x201C;Transasia group. Objective evaluation of the urine samples by Laura M instrument helps to eliminate any subjective interpretation and operator bias of the color reaction of the diagnostic pads, contributing to accurate diagnosis. Urine Analysis is recognised as an integral parameter for diagnosis. With the advent of latest technology, urine analysis is now done either through visual detection with the help of urine strips or automation. Urine chemistry strips are mainly used for routine testing, treatment monitoring and preventive medicine. There are different types of urine chemistry strips available in the market, providing high diagnostic specificity and sensitivity. Majority of labs, hospitals are moving towards automation in urine analysis to provide quality and costeffective results. Hence, automated analysers providing objective evaluation of urine samples are gaining momentum due to their ease of operation and faster turnaround time. Objective evaluation by using a reader helps to eliminate any subjective interpretation of the color reaction and thereby contributes to accurate diagnosis. The continuous loading analysers offer added advantages
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over strip readers such as higher memory, LIS, throughput, QC, etc. On the other hand, sedimentation analysers are proving to be more efficient to those laboratories where the sample load is quite high. Major features of Laura M include smooth workflow management that provides continuous loading with very high throughput of 600 tests per hour and results in 60 seconds. It also gives a provision for LIS interfacing. The product has an efficient data management system with internal memory capacity of 2000 measurements. Laura M carries a large colour user friendly touch screen, hygienic disposal of used strip by waste container, an in-built thermal printer that flags all abnormal results. It also has multiple sensors to detect strip at different stages preventing any operator error. The Urine Analyser has the flexibility to interchange between different metric systems for units of measurement and set the critical values, as per laboratory practices. The strips are protected against the common concentration of Ascorbic Acid (200-800mg/dL), ensuring no interference with measurement of Glucose, Blood, or Nitrates on the strip. DekPHAN Laura and MicroAlbuPHAN Laura are routine 10 and 2 parameters specialised Microalbumin and Creatinine test strips respectively. All PHAN range of strips has a uniform incubation period of 60 seconds. For more information visit: www.transasia.co.in
Product Launch
Carestream Unveils its Innovative Radiology Solutions at IRIA 2015
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nhanced product features of four recently launched systems ensure faster diagnosis and treatment for patients, improve efficiency for hospitals. Carestream Health India that
develops new radiology products and advanced IT systems for the healthcare industry has unveiled state-of-the-art radiology systems and solutions at radiology conference, IRIA 2015 in Cochin.
It has launched four innovative products and solutions - Carestream Vita Flex CR System, DRX Revolution System, DryView 6950 Laser Imager and MPS. Carestream Vita Flex CR is a complete plug and play CR solution. It delivers excellent image quality and can be positioned virtually anywhere in a healthcare facility. This new flexible design enables it to operate vertically as well as horizontally, so it can process CR cassettes sitting on the floor, or on tabletop or even from the back of a van. Second product, the DRX Revolution is a digital X-ray machine on the wheel. It provides wireless access to high-quality images in as less as five seconds. It features a collapsible column that improves visibility during movement and positioning and provides the ability to easily maneuver the system in tight spaces. The DryView 6950 is a high quality, high productivity medical printer designed to produce rapid output of high-resolution images for all imaging modalities including mammography. In addition to CT, MR, CR, DR and other modalities, this new laser imager will also support output of full-field digital mammography (FFDM) and CR mammography images. It can deliver a maximum film density of 4.0, which is preferred for mammography. While MPS - managed print solutions allows customers to focus on their core business. For more information visit: www.carestream.in
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Product Showcase
Staying Fit or Staying Healthy â&#x20AC;&#x153;Sound mind in a sound bodyâ&#x20AC;? is a simple yet a powerful statement that is packed with significant meaning.
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he first step in staying fit is to be staying healthy. Without knowing the status of health and working to staying fit could become dangerous. Also, it is equally dangerous to do those exercises that could possibly harm your body based on your disease conditions. To stay healthy, one should ensure that their body vitals are in desired range. If not, immediately seek professional advice. Seek professional advice on your fitness regime, as it is important to know what works and what does not. Also, for people with health conditions, it is important to have your fitness regime set based on your health.
AMI B.O.L.T: Creating a new vision in Indian Healthcare
Ecosystem AMI B.O.L.T, a wireless healthmonitoring product of American Megatrends, is one such solution that can help individuals monitor and record the key vitals parameters at place, any time. AMI B.O.L.T. is one of a kind portable lifestyle health device that seamlessly integrates with iOS, Android and Windows phones to measure and record vitals at the comfort of your home. It is a portable mobile device with dimensions similar to smartphone and it does not need AC outlet to operate. The device can be carried anywhere and is simple to use. Everyone can use it and one can easily measure vitals in the comfort of their home. Also, clinicians and paramedics can measure vitals in
rural areas without carrying heavy medical equipments. Security forces & soldiers working in remote areas can measure vitals with ease. AMI B.O.L.T is a cloud-enabled solution. With AMI B.O.L.T your health vitals can be stored in your personal health cloud. Trend monitoring and graphical reporting is built on mobile and cloud platforms to get a snapshot at any given point in time. Healthcare organisations like Astermed City, Portea and several others are using B.O.L.T to assist their customers to manage and maintain healthy life. AMI B.O.L.T helps you to keep a tab on your health. Life is precious and we have one opportunity to live it to the fullest. To make the best out of this life, we need to stay healthy.
To know more about AMI B.O.L.T, please visit : www.amibolt.com
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6th Annual
2015
eINDIA.eletsonline.com
11th
INDIA’S PREMIER ICT EVENT
High Efficiency Leucocyte Reduction Filter Protect patients from microaggregate and leucocyte-related transfusion complications with bedside high efficiency leucoreduction filter sets.
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