eHEALTH Magazine
ASIA’S PREMIER MONTHLY MAGAZINE ON THE ENTERPRISE OF HEALTHCARE VOLUME 10
ISSUE 10
OCTOBER 2015
EDITOR-IN-CHIEF: Dr Ravi Gupta EDITORIAL TEAM HEALTH Senior Assistant Editor: Garima Pant Senior Correspondent: Anshuman Ojha Correspondent: Romiya Das
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Contents
OCTOBER 2015 | VOLUME - 10 | ISSUE - 10
10
Cover Story
In vitro Diagnostics
Surging Ahead
The demand for sophisticated diagnostic techniques and increasing acceptance of personalised medicines are the emerging areas attracting the companies to plunge into IVD market, writes Anshuman Ojha of Elets News Network (ENN)
24 Medical Printers
Medical Printing – Improving the Healthcare Domain
Exclusive Feature
30 Blood Banks
Every Drop Counts
Exclusive Feature
40 ELISA
Vouching for Holistic Tests Kits 6
OCTOBER / 2015 ehealth.eletsonline.com
Exclusive Feature
Downtime is your laboratory’s worst nightmare! Unplanned downtime causes disruption to laboratory workflow and is detrimental to patient care which can damage a laboratory’s reputation. An interruption in your testing will result in the outsourcing of your workload and will mean an increase in costs and a delay in reporting patient results. Your clinical chemistry analyser is an integral part of your laboratory so ensuring you have the highest quality instrumentation is essential in avoiding any unnecessary downtime. The RX series of clinical chemistry analysers has been developed by Randox laboratories to meet & exceed the growing needs of clinical laboratory testing. Robust hardware combined with intuitive software guarantees real
cost savings and consolidation. The highest quality reagents & instrumentation guarantees unrivalled performance, giving you complete confidence in results. Intuitive, easy-to-use software allows real time results for rapid diagnosis & treatment ensuring the best in patient care, while not trying your patience. We offer astonishing flexibility through our world leading, extensive dedicated test menu allowing routine chemistries, specific proteins, lipids, therapeutic drugs, drugs of abuse, antioxidants and diabetes testing to be run on a single platform.
Unrivalled clinical chemistry testing Acetaminophen Acetic Acid Acid phosphatase Adiponectin Albumin Aldolase Alkaline Phosphatase Alpha-1 Acid Glycoprotein Alpha-1 Antitrypsin ALT ALT (GPT) Ammonia Amphetamines Amylase Apolipoprotein A-1 Apolipoprotein AII Apolipoprotein B Apolipoprotein CII Apolipoprotein CIII Apolipoprotein E ASO AST (GOT) Barbiturates
Benzodiazepines Beta-2 Microglobulin Bile Acids Bilirubin (Direct & Total) Calcium Canine CRP Cannabinoids Carbamazepine Ceruloplasmin Chloride (Non-Direct) Cholesterol Cholinesterase Cholinesterase (Butyryl) CK-MB CK-NAC CO2 Total Cocaine metabolite Complement Component 3 Complement Component 4 Copper Creatinine (Jaffe) Creatinine Enzymatic CRP
CRP Full Range (0.3-160mg/l) CRP High Sensitivity Cystatin C Digoxin Ecstasy EDDP Ethanol Ferritin Fructosamine G-6-PDH Gamma GT Gentamicin GLDH Glucose Glucose/Fructose Glutamate Glutamine Glutathione Peroxidase Glutathione Reductase Glycerol Haptoglobin HbA1c/Hb HDL Cholesterol (Direct)
H-FABP Homocysteine Hydroxybutyrate (Ranbut) IgA IgE IgG IgM Iron Lactate LAP LDH LDL Cholesterol (Direct) Lipase Lipoprotein (a) Lithium L-Lactic Acid Magnesium Malic Acid Methadone Microalbumin Myoglobin NEFA Opiates
Pancreatic Amylase Phenobarbitol Phenytoin Phosphorus Potassium (Non-Direct) Rheumatoid Factor Salicylate sLDL Sodium (Non-Direct) Superoxide Dismutase Theophyline TIBC Total Antioxidant Status Total Protein Transferrin Transthyretin (Prealbumin) Triglycerides TxB Cardio Urea Uric Acid Urinary Protein Valproic Acid Zinc
Learn more at
A global market leader in the in vitro diagnostics industry for over 30 years Randox Laboratories India Pvt. Ltd., Plot no. 191 to 195 & 246 to 250, KIADB Industrial Area, Bommasandra, Jigani Link road, Bengalura - 562 105, Bangalore T: +91 80 2802 5000 F: +91 80 2802 5012 E: therxseries@randox.com Product availability may vary from country to country. Please contact your local Randox representative for information.
therxseries.com
Start-up
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55 Augmenting Home Healthcare Market 56 80 Bedded Multi-Specialty Hospital In GK-I Product Launch
57 Enhancing OT Safety NEWS Buyers Speak
19 Accredited Labs Needed for Quality Healthcare
Dr Raman Sardana, Head, Infection Prevention and Control, Coordinator, Indraprastha Apollo Hospitals
22
48 International News 50 Company News 53 Government Desk 54 Hospital News 58 Pharma Buzz
Surge for Sensitive Reagents
Dr Deepak Sanghavi, Deputy Chief of Lab, Metropolis Healthcare Limited
34 Streamlining Lives
48
Dr Reena Bansal, HOD , Blood and Transfusion Medicine, Saroj Super Specialty Hospital
36 Access to Safe Blood
R N Makroo, Director and Senior Consultant, Department of Transfusion Medicine Transplant Immunology and Molecular Biology, Apollo Hospitals
38 Accreditation Uplifts Healthcare
Dr K K Kalra, CEO, National Accreditation Board for Hospitals (NABH) and Healthcare Providers
Industry Speak
18 Cost-effective Technologies Needed
Dr Th Dhabali Singh, Managing Director and Senior Consultant Pathologists, Babina Diagnostics, Imphal
57
20 Need for Regulatory Body
Zoya Barar, Founder and MD, Core Diagnostic
Spotlight
42 Injecting Well-Being
Dr M K Aggarwal, Deputy Commissioner (UIP), Ministry of Family Health Welfare
44 The Smart Healthcare Offering
Soo In Cho, Global President, Health and Medical Equipment Business, Samsung Electronics
46 Technology Transforming Healthcare
Dr J Sivakumaran, Chief Operating Officer, Kovai Medical Center and Hospital Limited, Coimbatore
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editorial
Paving Way to Optimal Healthcare Revealing a diverse facets of the Indian healthcare, a plethora of statistics has revealed some realistic outcomes of the industry. Indian healthcare providers indicated that US $1.2 billion has been used on IT products and services in the year 2015, an increase of seven per cent over 2014. This includes hospitals, as well as ambulatory service and physicians practices on internal services, software, IT services, data centre, devices and telecom services. IT services, which include consulting, implementation, IT outsourcing (ITO) and business process outsourcing (BPO), will be the largest overall spending category throughout the forecast period within the sector. On the flipside, there is an 83 per cent shortage of specialist medical professionals in community health centres (CHCs). This data, according to the Rural Health Statistics 2015, released by the Ministry of Health & Family Welfare, brings to fore the dire need of increasing presence of medical practitioners in the CHCs as they constitute the secondary level of healthcare and provide specialist care to patients referred from Primary Health Centres (PHCs). Another research report estimates that India faces an acute shortage of two million beds, followed by a jarring dearth of two million doctors and four million nurses. These statistics point to the alarming need for improving the existing healthcare infrastructure in the country, a cause religiously pursued by eHealth magazine through its publication, portals and even events. In continuation with our efforts, eHealth Magazine presents 5th Healthcare Leaders’ Forum, Bengal (HLF) in Kolkata, December 2015. The objective of Healthcare Leaders’ Forum, Bengal is to bring forward the Healthcare Technology initiatives taken to facilitate quality care in the Eastern part of India. The summit will aim to provide a vibrant platform for the innovators, investors and to engage private companies with the East region healthcare service providers. It will also be a conglomeration of bigiwgs of the industry to exchange knowledge and best practices with each other for better healthcare system in Eastern India. Through this engagement, a road map will be developed to change the paradigm for healthcare delivery in East by showcasing high potential healthcare initiatives, deliberating on challenges and identifying opportunities through public private partners.
Dr Ravi Gupta ravi.gupta@elets.in
OCTOBER / 2015 ehealth.eletsonline.com
9
Cover Story
In vitro Diagnostics
Surging
Ahead
The demand for sophisticated diagnostic techniques and increasing acceptance of personalised medicines are the emerging areas attracting the companies to plunge into IVD market, writes Anshuman Ojha of Elets News Network (ENN)
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In vitro Diagnostics
D
iagnostic tests are playing an increasingly important role in the provision of healthcare. Approximately 80 per cent of the information that physicians use to make medical decisions is produced by clinical laboratories and diagnostics are now seen as critical inputs into overall quality of patient care. Whereas clinical assay output a generation ago consisted of basic blood chemistry and infection tests, the modern clinical laboratory has grown to offer a large array of diagnostics for immunological, cardiovascular, cancer, chromosomal/gene, and pharmacogenomic markers. Many of these tests are still based on classic techniques such as cell culture, staining, and microscopy, but advancements in molecular biology technologies over the past several decades have driven the rapid growth of molecular diagnostics.
reagents and kits segment accounted for the largest share of approximately 79.3 per cent of the IVD product market, and is expected to grow at a CAGR of 6.4 per cent during the forecast period. Growth in this segment is mainly attributed to the increasing demand for diagnostic tests and launch of new reliable, specific, and faster detection reagents.
IVD Market – By Technology Based on technology global IVD market may be segmented as immunoassays, clinical chemistry, point-of-care, molecular diagnostics, haematology, coagulation, microbi-
market is segmented into diabetes, infectious diseases, oncology, cardiology, HIV/AIDS, autoimmune diseases, drug testing, nephrology, and other applications. Infectious diseases generated the highest revenue for current and forecast period mainly due to rise in the incidences of infectious diseases. HIV/AIDS application market is the second largest revenue generating applications segment and would remain the second largest through 2020. The oncology segment is expected to grow at the highest CAGR of 9.6 per cent during the forecast period, owing to the increasing number of cancer patients across the world.
The global in vitro diagnostics market was valued at US$ 47.30 billion in 2013; it is expected to reach US$ 62.63 billion in 2017, at a compound annual growth rate of 7.3 per cent
Market Dynamics The global in vitro diagnostics market was valued at US$ 47.30 billion in 2013; it is expected to reach US$ 62.63 billion in 2017, at a compound annual growth rate of 7.3 per cent. The market is segmented by product, technology, application, end-user, and region. IVD Market – By Product The IVD market, by product, is segmented into reagents and kits, instruments, services, and data management system/software. In 2014, the
Cover Story
ology and other clinical techniques. Point-of-care (PoC) is the highest revenue-generating segment in the overall IVD techniques market. Molecular diagnostics is the fastest growing technique in the in the overall IVD techniques market due to its ability to detect the primary cause of the disease accurately. It also represents the latest major technological additions to the clinical lab and remains the most dynamic and fastest growing product spaces. The reach of molecular diagnostics and its utility in many forms of clinical testing has contributed to growth in other IVD segments, such as histology, microbiology, and blood bank testing.
IVD Market – By Applications On the basis of applications, the IVD
IVD Market – By End-users Hospitals, laboratories, academics, point-of-care testing and others are the end-users of global IVD market. Laboratories generate the highest revenue followed by point-of-care for global end-user market. Rise in the number of laboratories in Asia-Pacific regions and increased awareness about healthcare and its benefits are contributing towards the growth of laboratories market, which in turn drives the global IVD end-users market.
IVD Market – By Geography In 2014, North America commanded the largest share of the global IVD market, followed by Europe, Asia-Pacific, and the RoW. North America accounted for the largest share of 43 per cent of global IVD market in 2014. The large share of this region can be attributed to the presence of advanced technologies, superlative opportunities for molecular diagnostics in genetic testing and cancer screening, established distribution channels in the region,
OCTOBER / 2015 ehealth.eletsonline.com
11
Cover Story
In vitro Diagnostics
In vitro diagnostics is an indispensible tool in modern medical practice in order to diagnose and treat diseases promptly and effectively. Technical advancements and rising healthcare awareness are key factors contributing to the growth of IVD market worldwide. Clinical chemistry segment is expected to lead in terms of market size among all other segments of IVD. Molecular diagnostics market is anticipated to witness highest growth rate in which oncology segment is expected to grow the highest owing to increasing number of cancer patients across the globe. IVD market tends to be driven by rising incidence of chronic lifestyle diseases in emerging economies, growing ageing population rising adoption of Point-of-Care (POC) testing and personalised medicine”, says Dr Anju Gomber, Senior Consultant, Microbiology, Sri Balaji Action Medical Institute, New Delhi.
and the presence of a large number of leading market players. The United States is a prime market due to the availability of government funds, expansion of molecular diagnostics for genetic disorders and cancer screening, and easy access to IVD tests through diagnostic service providers and major leading companies headquartered in US. On the other hand, Asia-Pacific is the fastest-growing region in the global IVD market, mainly driven by the increasing demand for IVD tests from large patient population, increased spending capabilities of consumers on healthcare, improving healthcare infrastructure in the region, and increasing investment by leading players and respective government agencies in the region.
Market Trends The global IVD market has evolved over the years with launch of number of innovative techniques having applications across multiple therapeutic areas. A new range of condition-specific markers and tests with advances in genomics and proteomics and increasing investment in emerging countries are creating new opportunities for this market. There are multiple trends shaping the future of the IVD market: Point-of-care (PoC) testing: Pa-
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tients would rather get tested in a doctor’s office or when they’re in a medical clinic than have to get tested in a hospital. The move of testing to the PoC is driving growth in the market. Need for speed: Medical diagnostics are getting pushed to deliver faster. This can be best seen in the explosion for raid and minimally—invasive diagnostic tools. Emerging markets demand: Some emerging markets are now able to pay for diagnostic devices where they weren’t able to just a few years back. Beyond other in vitro tests, in India alone, there are 100 million malaria tests per year. Lab-on-a-chip: It is a technology through which bodily fluid samples
can be analysed on a small, disposable plastic chip. While lab-on-a-chip often is associated with point-of-care diagnostic testing, it also is likely to play a larger role in the traditional laboratory setting. In order to meet the growing capacity and maintain their revenue flows, labs will need to develop more innovative, lab-on-a-chip technology and better connectivity solutions that will require less materials, less reagent, fewer sample volumes, less labour, less time, and less cost. Mobile diagnostics: The use of mobile technology to better manage chronic diseases, diabetes in particular is likely to increase in the coming years for two key reasons. Ageing population: Many countries are seeing a marked ageing in their populations. As this occurs, new tests and diagnostic technologies are necessary to cope with the changes. However, inadequate reimbursement and stringent regulatory approval framework are restraining the growth of this market.
Market Share The global in vitro diagnostics market is highly competitive with the top five major players, Roche Diagnostics, Siemens Healthcare, Johnson & Johnson, Danaher Corporation, and Abbott Laboratories, governing ~58.9 per cent of the total market share in 2014. New product development and
Growth Drivers
l Rising incidences of chronic lifestyle diseases l Growing ageing population l Rising adoption of point-of-care testing l The high demand for personalised medicines is a potential area that encourages companies to invest in the IVD reagents and devices market l Increase in disposable income and awareness leading toward increased prognostic testing for conditions like diabetes and cardiac problems. The middle- and high-income families are becoming more health conscious, which is increasing the demand for preventive healthcare. Many companies offer annual check-ups to the employee. This is another driving factor for the in-vitro diagnostics market, especially for the biochemistry and immunology markets
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Cover Story
In vitro Diagnostics
Expanding Horizons What are the current trends of IVD market and how fast is it growing? The in vitro diagnostics (IVD) market was valued at US$ 50 billion in 2012 and expected to reach nearly US$ 70 billion by 2017 according to a report by Research and Markets. There are multiple trends driving the growth of the in vitro diagnostic market, like many countries are seeing a marked ageing in their populations. As this occurs, new tests and diagnostic technologies are necessary to cope with the changes. Patients would rather get tested in a doctor’s office or when they’re in a medical clinic than have to get tested in a hospital. The move of testing to the Point-of-Care (PoC) is also driving growth in the market.
What are some interesting applications in the IVD market? On the basis of applications, the in vitro diagnostic market is segmented into diabetes, infectious diseases, oncology, cardiology, HIV/AIDS, autoimmune diseases, drug testing, nephrology, and other applications.
launch is the most preferred strategy acquired by leading market players followed by agreements, partnerships, collaborations, and joint ventures and mergers and acquisitions. Market players adopt these strategies to access new technologies, expand their product portfolio, enter into growing markets, and/or to increase their market share. In addition to the top market players, companies such as Alere Inc.; Becton, Dickinson and Company; Biorieux; Bio-Rad Laboratories; Hologic, Inc.; and Qiagen N.V. primarily focused on mergers and acquisitions to accelerate their global product offerings. Companies such as Arkray, Inc. and DiaSorin S.p.A. adopted expansions as the dominant strategy to sustain their growth in the
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a combination of technological improvements, cost pressures, reimbursement changes, rapid growth in molecular diagnostics and increasing interest in the genomics testing. Recent advances in molecular diagnostics technologies, including sequencing, PCR and microarray, are enabling greater sensitivity and precision in nucleic acid measurements, further expanding manufacturers’ offerings. Graeme McNeill Global Manager - RX series Randox Laboratories Ltd The oncology segment is expected to grow at the highest CAGR of 9.6 per cent between now and 2020, owing to the increasing number of cancer patients across the world.
What would you say is the general state of the IVD industry as we come to the end of 2015? The in vitro diagnostic industry is experiencing a revival fuelled by market. This increased competitiveness is expected to drive innovation in the market and thereby help the industry to solve existing challenges and meet the needs of end-users.
Emerging Fields Major strategic developments take place in the field of cancer diagnostic technologies which exhibits highgrowth potential in the near future. Dominant market players such as Roche Diagnostics, QIAGEN N.V., Siemens Healthcare,
Which types of technologies and products do you see as being the most successful in this new IVD environment? According to Simba Information, it is important to design and manufacture products that are right for the target audience and then to use scientific methods to prove that the products have a positive effect on patient care. Evidence-based medicine is becoming more critical for product success as advances in medical technology create increasingly sophisticated and thus more costly new tests.
and Abbott Laboratories, Inc. introduced several tests for cancer diagnosis in order to keep pace with the industry. The molecular diagnostics technology is also gaining popularity, primarily due to the increasing demand for personalised medicines.
In vitro Diagnostics
Indian Market
Restrains
l No reimbursement of tests being performed at a standalone lab. In the Indian insurance market, none of the participants provide reimbursements for diagnostic tests. Though some insurance providers such as Axa and ING Vysya provide facilities like free annual check-ups, their policies do not include expenses for diagnostic tests performed otherwise. Diagnosis thus completely becomes an out-of-the-pocket expenditure for a patient. Hence, many people delay or refrain from using better diagnostic facilities l There are no regulations required for the manufacturing of the in-vitro diagnostic products either. This has resulted in high fragmentation of the market with many unknown manufacturers selling low-quality instruments and reagents. There is no assurance of the quality and performances of the reagents and equipment to the end user. Lack of regulations allows manufacturers to sell cheap reagents at half the price of a quality product l The difference in prices is mainly driven by the quality of reagents used. Many spurious reagents and equipment are available and used in the market. This hampers not only the creditability and quality of the test performed, but also the market for quality products’ manufacturers The high demand for personalised medicines is a potential area that encourages companies to invest in the IVD reagents and devices market. Becton, Dickson and Company; Hologic, Inc.; Qiagen N.V.; DiaSorin S.p.A.; and Biorieux are some of the growing diagnostics companies focusing on the growth of their molecular diagnostics business predominantly through mergers and acquisitions. In addition, biomarkers are also facing emerging trends in the market that uncovers new growth opportunities for IVD companies. For instance, in June 2011, Qiagen NV acquired Ipsogen S.A. to leverage its
Cover Story
Opportunities l Potential opportunities for outsourcing l Convergence of new technologies l Increasing investment in emerging countries l Need for delivering healthcare services at unconventional locations broad range of assays covering 15 biomarkers for the prognosis, diagnosis, and monitoring of blood cancers. The acquisition enabled Qiagen NV to develop its business in molecular assays for profiling and personalised healthcare. The demand for sophisticated diagnostic techniques and increasing acceptance of personalised medicines are the emerging fields attracting the companies to plunge into IVD market.
Indian IVD market is one of the fastpaced and growing markets in the world. This is one of the focus markets for most of the organisations connected with it. The Indian in vitro diagnostics (IVD) market is valued at `3,000 crore, and is expected to reach `9,000 crore by 2018 growing steady at a CAGR of 20 per cent. IVD covers a diverse range of products from individual reagents to testing systems that consist of reagents, instrumentation, and software. Also included are accessories such as dedicated software as well as control and calibration materials. This remarkable growth can be attributed to increased healthcare awareness, desire to undergo preventive health checkups, availability of disease specific tests, corporate setups promoting health focus of employees, and drift from manual to semi-automated and automated equipment. It is estimated that India has around 100,000 diagnostic labs, out of which around 30 per cent are completely automated, 40 per cent are semi-automated, and 30 per cent are manual. Increasing development in the corporate hospital infrastructure, evolution of automated instruments and emergence of new concepts like near patient testing, hospital laboratory management and customer relationship management has augmented the growth of Indian IVD market. Lifestyle and communicable diseases are no longer restricted to urban centres, but are spreading to rural areas as well. As a large portion of rural areas do not have even the basic healthcare facilities, several cases remain undiagnosed. Certain statistics state that only one-third of the rural population has access to diagnostic centres. Most patients visit health centres outside the village for diagnosis and treatment. Nearly half of these pub-
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Cover Story
In vitro Diagnostics
Growing at a Constant Rate What are the recent developments and trends in vitro diagnostics market?
l Work flow automation through integrated systems for chemistry and immunology tests l Role of Next Generation Sequencing (NGS) in cancer diagnostics and therapy management due to reducing cost of automation and testing for personalised healthcare solutions l Role and awareness of pre-analytics solution increasingly felt by labs of various sizes to reduce pre analytic errors in sample handling l Increased awareness and use of workflow solutions for complete urine analysis including sedimentation Ganga Mohan, Executive President l Use of Nucleic Acid testing to - International Business, Agappe improve the blood safety from Diagnostics Switzerland GmbH HIV, HBV and HCV viruses l Microbiology lab automation on (PCR) as a nucleic acid testing for the rise to improve the quality and blood screening turnaround time for various microl Genome Based Diagnostics bial tests
Few noteworthy applications in the IVD market?
How has the IVD market performed this year?
lic sector units don’t have treatment facilities for major chronic ailments.
These changing disease patterns, rising incidence of diseases, higher healthcare spending, and untapped markets create abundant opportunities for IVD manufacturers. Even hospitals are looking to reach out to patients in tier III cities and rural areas. IVD companies will not find it easy going in the unorganised and frag-
l Use of Polymerase Chain Reaction
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growth has remained steady with 14-15 per cent l MNCs’ are targeting the tier II customer segment through their “Go to Market” strategy
Which types of technologies and products do you see as being the most successful in this new IVD environment?
l Chemiluminescent based products, compact system using Nephelometry for special protein detection, Real Time PCR for Molecular Diagnostics, Next-Gen Sequencing, Spectroscopy for blood cell counting / haematology disorders.
How has the IVD industry evolved over the years?
l Adaptation of new technologies by Indian labs, like Positive: Urine analysis automation; Negative: NAT for blood screening l Another thing that surprises me is the healthcare spending by the government as against the total budget.
l The in vitro diagnostics market
mented IVD market. The major reasons for the market fragmentation are the low entry barriers (leading to the mushrooming of laboratories) and the complete lack of standardisation. Less than 300 laboratories in India have accreditation, and due to the absence of legislation, standardised procedures and instruments are unavailable. Another significant concern for market participants is the inadequate insurance coverage. Responding to the demand for quality healthcare, most corporate laboratories have introduced cost effective and convenient patient care packages.
Industry Speak
Cost-effective Technologies Needed Increasing competition makes laboratories to lookout for cost-cutting technologies and superior products to deliver good quality and faster results, says Dr Th. Dhabali Singh, Managing Director & Sr Consultant Pathologist, Babina Diagnostics, Imphal, in conversation with Anshuman Ojha of Elets News Network
What is the market size and rate of growth of the IVD market? With a compound annual growth rate (CAGR) of 18.1 per cent during the period, the IVD has emerged as one of the fastest growing markets in the Indian healthcare industry. The Indian In vitro Diagnostics (IVD) market is poised to grow from US$ 331.7 million in 2009 to US$ 900.2 million in the year 2016. This kind of healthy growth rate can be attributed to the rapid growth of many diagnostic laboratory chains, improvement in corporate hospital infrastructure, and the use of automated and semi-automated equipment on a large scale. Currently, the ratio of the market share of equipment and reagents is estimated to be 40:60.
What recent trends have documented in the IVD market? A large portion of the Indian IVD market comprises of professional diagnostics,
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which includes clinical chemistry, haematology, immunoassays, microbiology, histopathology and cytology. However, point-of-care (POC) diagnostics, molecular diagnostics and tissue diagnostics like immunohistochemistry (IHC) and in situ hybridisation (ISH) segments have seen significant growth following the global trend.
What has evolved in the IVD application market? One of the most interesting developments is the biochip-based in vitro diagnostics. Biochip facilitates an assortment of multiple tests on a single chip, which brings in an increased efficiency in testing. Some interesting applications envisioned include a wide range of DNA applications, biosensors, microfluidics-based systems, proteomics, cancer diagnostics and gene expression profiling.
How did the IVD industry perfom this year? The IVD market continues to grow as expected. With increasing competition, laboratories are on the lookout for cost-cutting technologies and superior products to deliver good quality and faster results. The “reagent rental system� ensures that labs do not incur heavy capital expenditure
and the vendors are also assured of sales of reagents for the lease period. An area of concern is the after-sales service. There is a need for wide network of regional sub-distributors to provide better after-sales service. For smaller laboratories or for those in smaller markets, the vendors ought to come up with reagents in smaller pack sizes.
Which types of technologies and products do you see as being the most successful in this new IVD environment? In the new IVD environment, immunochemistry, point-of-care (POC) testing, molecular diagnostics, tissue diagnostics, self-monitoring blood glucose systems and haematology are seen to be successful.
Over the years, the trends you have seen in IVD industry? Despite the huge Indian IVD market, domestic players have traditionally shied away from foraying into the market in a big way. This has been somewhat surprising. We believe this mind-set needs to change because there is a real need to offer cost-effective alternatives. The present technologies need lots of customisation as per local needs, local technical support and infrastructure.
Buyers Speak
Accredited Labs Needed
for Quality Healthcare Dr Raman Sardana, Head, Infection Prevention and Control, Coordinator Laboratory Services, Senior Consultant Microbiology, Indraprastha Apollo Hospitals talks about the requirement of regulating the laboratories to Romiya Das of Elets News Network (ENN) What is your overview of the IVD industry in India? Past one decade, people have turned more conscious about their well-being and awareness. Coupled to this, there is a general economic affordability which has escalated expenditure on their own healthcare. Even the corporate world desires their employees free of lifestyle diseases and more fit people in the work culture, laying more stress upon preventive health-checks and changes in the life-style pattern. The Indian IVD market is valued at more than US$ 500 million and is expected to surpass US$ 1.5 billion by 2018 growing at a CAGR of 20 per cent as mentioned by MarketReportsOnline.com. The growth in healthcare insurance sector is another aspect to the growth of the industry, along with home collection for tests. Looking at the overview there are hospital based labs and many corporate stand alone labs are growing with the outreach to the people. We are also looking at rapidity of response, which asks for more and more IVDs to be available. Also, the contribution of people’s willingness to spend has assisted to the growth of IVD sector. As insurance companies set in to cover healthcare, they desire to bring more and more people under this umbrella and are dependent upon IVDs for knowing the current health status and prognostic interpretation. The successful labs and diagnostics centres are getting the best technologies in India as fast as possible at the same level as the
best centres in the world. Technicians working with IVDs in India are trained in-house by the people who have been trained elsewhere outside India or people who are providing IVD kits. But, there is a lag phase in acquiring a technology and putting it to great use. There is no formal education program in majority of the technical institutes in India which can cater to recent advances in equipment and technology.
What are latest technological advancements in this domain? There is a thrust on more and more automation in the West. Whatever we are doing in IVDs on the clinical side should be standardised, uniform, the results should be reproducible and accurate (as near to the actual value). People in the west have moved from technician-based structure to automation and we see this trend coming to India as well. There is some amount of semi-automation that came up about two decades back, now we see more automated machines com-
ing in. People want a single link or control over all the equipments. There is a surge in point of care testing though the equipments and reagents used require stringent quality control. Not many people are aware that they have to carry out quality checks. Also, faster and diagnostic tests are being sought to lessen the burden of prolonged stay.
What are your views on industry regulatory requirements? There is the mushrooming of many laboratories at every nook and corner of a city and these labs do tests at a minimal cost. Majority of the cost is incurred on running IVD tests on strict protocols, though it won’t come at lower price for the patients. The standardised labs cannot perform tests below a certain price which is their incurring cost. There is a large population which even if can afford, would opt for a lab with lower price. Here the regulatory can help in a way that every new lab which opens its operation should be registered. It should be told to follow a base minimum a quality programme. Labs should be encouraged to undergo National accreditation (NABL) that would improve quality tremendously. There are many public sector units which say that they would ask their employees to get themselves or their beneficiaries to get tested only by accredited labs. Such riders are important to encourage labs to undergo the accreditation process. Thus, accreditation should be a voluntary effort with some kind of incentivisation.
Where are we lacking? The basic challenge is that we are not manufacturing our own kits. We are not customized to Indian healthcare, Indian genetic makeup and Indian biochemical parameters. Today, we use reference range which has been set by West. The country lacks trained manpower who can work on imported IVDs. Most of our distribution systems are not tuned to keeping the same parameters which are required for the storage or transportation of IVD kits.
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19
Industry Speak
Our country needs a regulatory body to keep a tab on the mushrooming of labs that lack appropriate criterion for establishing such centres, informs Zoya Barar, Founder & MD, Core Diagnostics in coversation with Romiya Das of Elets News Network (ENN)
B
rief us about Core Diagnostics presence In Vitro Diagnostics (IVD) domain. Core Diagnostics is a high-end diagnostic lab. The focus is on innovation in the diagnostic segment and bringing in the best technology across the world to India and making high super specials technology accessible for patients here.
How do you perceive Indian IVD industry with other developed countries across the globe? In Vitro Diagnostics (IVD) is a large spectrum in which pathology diagnostics there are two types of tests one is routine and other is the esoteric diagnostics, which is high in demand. If we compare India with US our total market is US $ 2 billion out of which only 100 million caters high-end diagnostics. We have a good market when it comes to routine diagnostics while the high-end ones we don’t have enough players. There is a need for consolidation, but there is enough opportunity for the same. For instance, if somebody needs to go for a blood test they don’t have to go beyond their colony as there is
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Need for a a Regulatory Body enough access. The high-end space as of now is building up, three years back there was nothing available. There were some labs that were sending samples up to Stanford or University of California, Los Angeles (UCLA) or somewhere else for a second test or opinion, but nobody was offering it in our country. As of
now, there are enough people who can afford high-end diagnostics. Taking only 10 per cent of the 100 billion population (100 million that is one third of the US market) and that 10 per cent can afford anything, they can sit on a plane go to America and get treated. So why is there nothing available? There is enough market
Industry Speak
size. The market is very exciting on the high-end side there is growth and investors are very positive about this space. The future is very bright for this industry.
What are the latest state of innovation and trends heading the IVD industry? There are a lot of interesting things happening, there is next genome sequencing which gives a lot of options to both cancer patients and patients with rare disorders. This sequences all your genes and tells you which treatment or lifestyle will work for you. There are also diveres algorithms and informatics which are availavle. On the pathology side there are 30-40 inputs easily available even if you don’t go into high-end diagnostic space. There is a good opportunity for organisations on the diagnostic side even on the other parts of IVD to create a platform that integrates all the information and gives a solution. And I personally feel that is the next big thing.
What are the challenges faced and how did you overcome them? Hiring has been a continuous challenge for the company. I believe we have less talent pool available in this arena compared to rest of the world. Keeping people motivated and ensuring that they stay with you is quite a challenge.
Therefore, it is quite a task to firstly identify people, getting them join the organisation and making them stay. On the government side, I will separate pathology from rest of the IVD sector as it has lots of challenges in devices, pharma etc. We do not face many challenges due to our present lax regulatory environment. There is a need to have a regulatory body. At present anyone even from a non pathology background can open diagnostics establishment.
From the patients perspective why would they opt for labs like yours than multi-speciality hospitals? How do you face the competition? We are not in competition with any multi-specialty hospitals instead we have tie ups with 100 such hospitals across the country that are sending us work. The kind of work we do they cannot do in-house. For example, certain hospitals lack technology, volumes, expertise etc. We have contracts with various hospitals such
There is a need to have a regulatory body. At present anyone even from a non pathology background can open diagnostics establishment Technically, they will need just the machines and they can start printing reports and nobody can question because there is no regulatory body. There is an accreditation body and now we are National Accreditation Board for Testing and Calibration Laboratories (NABL) accredited but even that doesn’t cover everybody. It is a voluntary accreditation and there is no compliance need for it. A lot of labs are mushrooming in every nook and corner and we have no idea what are they are doing. A patient is not aware of who is actually giving an authentic report.
as Medanta, Max, Artemis, Narayana Health in Bangalore, Saifee hospital in Mumbai.
What are your company’s expansion plans in the upcoming years? Beyond Delhi and NCR we are present at 57 more cities. Out of country, we have expanded and have operations in various neighbouring countries such as Nepal, Bangladesh, Sri Lanka and UAE. We are picking up samples from these countries and bring it back here. Geographically, we are growing month over month. In terms of test menu, we started with 30 tests and presently we are close to 1000 tests. Core diagnostics started with oncology, but now we are doing expert diagnosis on the reproductive, infectious diseases. As far as the technology is concerned, we are constantly upgrading and adding a couple of equipment that we didn’t have initially. This year we will be introducing two or three unique platforms, not available in the country today, which will reduce the cost significantly and offer advance test that other diagnostics centers are not offering.
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Buyers Speak
Surge for Sensitive Reagents The rising demand for technologically advanced diagnosis instruments and increased spending capabilities of consumers on healthcare provides huge potential for IVD market, says Dr Deepak Sanghavi, Deputy Chief of Lab, Metropolis Healthcare Ltd, in conversation with Anshuman Ojha of Elets News Network (ENN) On recent developments and trends in vitro diagnostics market The IVD market is segmented as follows: biochemistry, immunology, haematology, urine analysis, molecular diagnostics, and microbiology. Manufacturers are launching newer products with better technologies, such as multitasking reagents and wider range application equipment. For example, many labs are now buying a combined biochemistry/immunology analyser, which allows both types of tests to be performed using a single instrument; this reduces cost and labour requirement. This trend is similar in all the IVD market segments. There is huge demand for more sensitive reagents, such as chemiluminescence, is increasing in metros, tier I cities, and even beyond these tiers. These reagents give more accurate results. The demand for reagents also has been influenced by epidemics in the country. Like in 2007, the demand for reagents that test chikungunya or in 2009 the reagent for swine flu was at peak. The latest trends include automation, remote data acquisition, enzyme linked fluroscence assay, direct access testing, rapid accurate quantification at point-of-care.
On Indian in vitro diagnostics market According to study conducted by F&S, the Indian IVD market contributed around one per cent to the global IVD market in terms of revenue in 2005; and is likely to reach three per cent of the global IVD market by 2010. The Indian IVD market is expected to witness
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growth in revenues from US$ 281.5 million in 2009 to US$ 900.2 million in 2016.
On types of technologies and products being the most successful In vitro diagnostic industry shows promising signs and especially in cancer, genetic, molecular biology testing segments. An important factor in cancer is early detection, which helps to ascertain the stage, genes and protein expression have distinct link to tumour aggressiveness and therapy sensitivity. Precision medicine, quantification, multiplexing, targeted therapy; highly precise identification of markers is now the goal of cancer testing. Microarrays, digital PCR, mass spectrometry, LCMS, tissue microarrays, next-generation sequencing, this high-end equipment are revolutionising the in vitro diagnostics industry.
On some of the market surprises encountered Over the years the IVD industry is growing with increase in demand. Today, some multinational companies in India have started manufacturing the equipment, developing kits which will be cost effective and the benefit can be passed down to the patients. “Make in India� campaign a government initiative, will allow manufacturing in India. For eg LCMS, a metal detecting equipment, which helps in identifying multiple metals from a single sample, this saves lot of time and cost effective, smaller machines like plasma protein synthesiser can cater the needs of smaller lab, which in turn can switch from manual method to automation. The other factor driving the growth of the industry is the demand generated from tier III cities and towns, which increase the potential to tap these markets.
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HEALTH IT – Medical Printers
With most promising breakthroughs happening in the medical printing front, the diagnostic imaging, 3D printing offers endless possibilities Elets News Network (ENN) explores the expanded range of diagnostic imaging and the technological advancement of printing in healthcare domain
Medical Printing
Improvingthe Healthcare Domain
D
igitisation helps to administer tedious work of managing multiple printing devices for different medical images and administration of various output sheets such as films and papers. It acts as boon for Indian diagnostic industry, as it might help to lower the high print cost of the medical imaging, as it stands as a challenge. From the time Wilhelm Roentgen’s discovered X-rays in 1895 medical imaging has gone through continuous innovations – computed tomography (CT), magnetic reasonance imaging (MRI), nuclear imaging and ultrasound playing a transformative role in enhancing
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healthcare. In 1970s, with the advent of computer based image processing the medical imaging experienced the digital revolution, but it was not until 1993 with the introduction of Digital Imaging and Communications in Medicine (DICOM) 3.0 that the transition to a unified imaging platform for picture archiving and communication system (PACS). DICOM enables the integration of scanners, servers, workstations, printers and network hardware for multiple manufacturers into PACS. Even though file rooms are shrinking and darkrooms no longer exist, prints are essential when there is a need in reviewing images for diag-
There is a requirement of digital infrastructure to carry data says V Balakrishnan, Executive General Manager - Marketing & New Business Development at Konica Minolta Business Solutions India Private Limited in conversation with Bhawna Satsangi of Elets News Network (ENN) What are the IT innovations you are doing in healthcare? Healthcare has been on connectivity of processes and systems. And how do we come up with devices which can directly print on digital imaging on to our digitised processes. We also have our sister company completely that focuses on healthcare. Konica Minolta has multiple divisions - we come from business technology solution distribution
HEALTH IT – Medical Printers
India lacks a stable data transfer network to implement certain solutions, it is required to be more open in leveraging technology and focus on creating the digital infrastructure to carry data nosis, by general practitioners and surgeons to specialists such as neurologists and orthopedists to discuss the condition with patient. To improve productivity and lower the cost, the medical industry has transitioned to
Private Players Drive the Change that takes to our 70 per cent global turnover. We have a medical health division that is credited with one product which called the AeroDR. This product allows one to take digitised images. When going for an X-ray the first thing that crawls the mind is the amount of exposure to radiation the body gets because the process itself is such, they not able to pin point the particular area and throw more exposure than what is required. In AeroDR we have a process where the results can be seen in less than 30 seconds and you see the digital image and you have a radiation exposure less than 50 per cent than a normal procedure. Minolta’s technologies and imaging is what we leverage. We are able to pinpoint
the area we are able to give far lesser radiation exposure and we can see the digital image in less than 30 seconds.
What are the challenges faced by the healthcare sector in India presently? See, the challenge is more of an opportunity for us. The government has its own challenges in providing better healthcare delivery. The private sector that has stepped up into the sector is driving the change. That is constant to both. I think it can get faster if we focus more on creating the digital infrastructure that is required to carry data. Today, we are not able to think of implementing certain solutions in India because we not have stable data transfer network. We should be far much open to leverage technology. If someone is getting operated in the district hospital you can have a panel of experts
digital imaging and achieving over the past two decades. Presently, the printing needs are more diversed than ever before with an expanded range of diagnostic imaging modalities, cameras in the operating room and the digitisation of information in the pathology laboratories to ophthalmology departments. With the expansion of digital imaging there is a need to identify medical printing solutions that meet a facility’s comprehensive needs efficiently and cost-effectively. As medical facilities seek to update their printing with latest technologies it is important to identify specific printing needs and review printing options. There are various technological trends driving the growth of the digital printing market such as WiFi, networking with organisations going for greener environment with lower power consumption and bio
sitting miles away looking into the operation helping the doctor.
Are you focusing on the government sectors? It is very limited, because of the way we are structured in terms of our sales channels which is predominantly partners. We have few of our partners focusing on government. Most of them are generic barring the ones who address government because most of them operate from particular territory or geography so they need more able to leverage more opportunities in this domain.
How about the positing of colour printing as it is considered pricey by Indian market? Indian market is different from others. Even though colour printing devices are less than 80 per cent in A3 and less than four per cent in A4. Colour is about how do we sell and that is one area where we have a very large market share. Konika Minolta is known for colour.
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HEALTH IT – Medical Printers
3D Printers – The Next Big Thing 3D printing is a thriving market with full of innovation and experimentation. With the advancement in the technologies after digital printing, now 3D- printing is revolutionising the healthcare world. 3D-printing also popularly known as addictive manufacturing, it has moved beyond being a primary technology. It is a process of converting digital designs into solid three-dimensional objects. 3D printing has the potential to impact millions through variety of medical solutions particularly surgery and the treatment of otherwise intractable health conditions. 3D- printing is used to produce customised robotic exoskeletons that enable the paralysed to stand and walk providing high quality, customised implants, human tissue and select organs. The increase in tapping 3D printing by healthcare industry is projected to grow at a CAGR of 25
The increase in tapping 3D printing by healthcare industry is projected to grow at a CAGR of 25 per cent globally from 2015 to 2020 and it is expected to reach US$ 2.13 billion as stated in MarketsandMarkets degradable material used in printers are becoming essential, increase in the trend of electronic transactional communication for instance pathology lab reports, increase in need for electronic content, etc, also printing more visual content with the rise in
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per cent globally from 2015 to 2020 and it is expected to reach US$ 2.13 billion by 2020 as stated in MarketsandMarkets report. The global 3D printing medical device market is segmented into 3D printing equipment, materials, and service & software. Further, 3D printing equipment market is categorised into 3D printers and 3D bioprinters. This innovative technology is hugely adopted by dental laboratories to increase scalability and precision in the manufacture of medical devices. It is revolutionary aspect for the medical industry as it saves time, saves more lives and improves the efficiency of the surgery as well. It provides great hopes for bioprinting like 3D printing human cells. The technology still is in its nascent stage but has achieved great strides in the past few years. Leveraging technology both in printers and printing materials have helped
multimedia communications and multimedia devices. “As many healthcare organisations are interested in transforming their present workflow, high investments act as a deterrent since existing medical imaging solution requires high
make the creation process more affordable, more accessible and much faster. The healthcare industry was an early adopter of 3D printing technologies with its potential to develop fully customized and personalised tools, devices, implants, models etc. There has been a swift implementation of 3D printing in healthcare industry. From the ability to create exact replicas of anatomy to work from before committing to complex operation to more subtle application like creating specific casts for immobilization after an injury the impact of 3D printing is substantial. There is also research being conducted on the possibility to replicate complex organs sustaining in human body with 3D printers. The technologies potential may in the manufacturing industry but it has variety of uses, immensely benefitting the healthcare industry.
upfront investment, skilled resources and an elaborate IT requirement. Ricoh keeps in mind the affordability and easy access of healthcare facilities for the patients and customer satisfaction. We are enthusiastic about our rapid growth and increased
HEALTH IT – Medical Printers
visibility in the country. Nowadays, customers are looking at partners that can develop a n d provide customised solutions. 360 degree framework has enabled Ricoh to emerge as onestop business solutions provider for increasing the workplace efficiency of enterprises through IT automation and process integration, said Manoj Kumar, Managing Director and CEO, Ricoh India told Elets News Network (ENN). For the patient care medical grade printers that meet certain regulated safety and performance standards may be used such as compliance with Underwriter’s Laboratory (UL) regulations for special power supplies and groundings to protect against shock in case of contact with fluids. It must comply with the highest International Electro Technical Commission (IEC) standards. Dr T B S Buxi Chairman, Department of CT scan and MRI, Sir Ganga Ram Hospital says, “Medical imaging plays several roles like provision of media for primary diagnosis by radiologist, for sharing information with referring physicians and for archival of medical image for future reference. There are two popular printing technologies: Photothermographic laser imaging and direct thermal imaging.” He further added, “In photothermographic laser imaging, laser light is absorbed by silver halide crystals forming clusters which form latent image centres. Silver behenate diffuses into these latent image centres
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For the patient care medical grade printers that meet certain regulated safety and performance standards may be used such as compliance with Underwriter’s Laboratory (UL) regulations for special power supplies and groundings to protect against shock in case of contact with fluids and is reduced to metallic silver in the presence of developer leading to optical density on the film. In direct thermal imaging, thermal resistive head delivers controlled amount of heat to the film. Silver behenate is reduced to metallic silver leading to optical density on the film. Three major companies which include Carestream, Agfa and Fuji provide medical imagers which
differ in resolution and image production rates.” Moving with the market needs and trends the industry has made a paradigm shift to 3D from the 2D world. S Karthikeyan, National Manager CR and Imager Sales says, “Medical imager is essential for all Hospitals andDiagonostic centre having CR, DR , MRI or CT for printing of images. In the past decade there has been a steep demand in the number of modalities such as CR, MRI and CT which has resulted increase in demand of printer too. Medical Imager Sales in India has been growing in double digit at the rate of 10 per cent in the last few years since there was always a preference from doctors to view images on film which has helped maintain printer sales. Digitisation of the X-ray process from Conventional (Analog ) to Digital (CR/ DR) too has contributed to growth of Imager Sales.”
Blood Banks
Every
Dr p Counts Human blood, the life stream of human beings has no alternatives. The need for reliable and safe and uncontaminated blood is still inaccessible for many. The country dwells on a pathetic state where transmission of infectious diseases through blood transfusion is prevalent. It is a call for an immediate remedy to invigorate the blood banks sector, writes Prathiba Raju of Elets News Network (ENN)
I
ndia requires 12 million units (one unit is about half a litre) of blood every year and the supply is at nine million, there is a dearth of three million unitsa gap of 25 per cent. Adding to this shortage of blood, the fragmented blood banks industry, lack of trained personnel and outmoded screening tests disorders like sickle cell anaemia, thalassemia and haemophilia that require repeated blood transfusions makes the deficit more appalling. As per the National Health Profile data released by the health ministry recently, India has a total of 2,760 licensed blood banks, with the state of Tamil Nadu, at 304, possessing the highest number, followed by Maharashtra with 297 blood banks and Uttar Pradesh (240). India’s north-eastern states have the lowest number of blood banks with Assam, Nagaland, Mizoram and Manipur having 76, 6, 10 and five blood banks respectively, the data shows. Among the total number of licensed blood banks in India, 1,564 are run privately and 981 by the government.
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“Blood banks are extremely fragmented in India with too many centres; most are hospital-based. Though the blood policy was adopted by the parliament there has been very little work done after that to implement what is enshrined in the policy. What we need is radical changes – moving to centralised blood collection and processing and provision of these units at all hospitals without any pre-condition of replacements,” said Dr Aseem Kumar Tiwari, Associate Director and Incharge, Department of Transfusion Medicine, Medanta -The Medicity Hospital, Gurgoan. As per expert medical practitioners, maintaining a safe blood supply is a challenge in many countries particularly for a country like ours. Reliable blood means safe blood donors, safe blood transfusion practices and rational use of blood.
Safe Blood-A Dire Challenge Right from blood transfusions for thalassaemics and haemophiliacs, surgeries after accidents has been a nightmare for few patients, for 10-year-old Aditya, whose parent face a tough time to arrange two unit of ‘A negative’ blood as he suffers from thalassemia and requires regular blood transfusion. “My child and many like him are not safe. Despite stricter testing norms, they are still at risk. For each and every transfusion hunting a safe blood is still a dream,” says Arpita Gupta, mother of Aditya, and also a member in Thalassemics India, a patient group. Thalessemic patient between the age of one to five years needs one unit of blood every month, between the age of five to ten-two units every month are needed, between the age of 10 to 15-three units are needed every month. An adult thalassemic needs four units of blood every month.
Blood Banks
Annually, unsafe transfusion causes an estimated 8-16 million Hepatitis B infections, 2.3-4.7 million Hepatitis C infections and around 1.6 lakh HIV infections. “Safe blood transfusion is one of the key life-saving interventions that should be available for patients in need. Yet, equitable access to safe blood still remains a major challenge in many countries. Providing safe and adequate supplies of blood and blood products should be an essential part of every country’s national health care policy and infrastructure,” informed Dr Edward Kelley, Director of Service Delivery and Safety at WHO. National Aids Control Organisation (NACO) informs that access to safe blood is mandated by law, and that is there primary responsibility. The specific objective of the blood safety programme is to ensure reduction in the transfusion associated with HIV transmission to 0.5 per cent, while making available safe and quality blood within one hour of requirement in a health facility. However, there is a serious mismatch between demand and availability of blood in the country: against 12 million units/ year requirement, the availability is only nine million units/year. Another concern is that voluntary blood donation is 52 percent. NACO is committed to bridge the gap in the availability and improve quality of blood under National Aids Control Programme III (NACP – III). “Safety during blood transfusion should be considered priority but many blood banks which are operat-
ed in grass root levels are not aware of it. Many women get infected during the pregnancy while the blood is transfused. It is mandatory to check blood for HIV before it is banked. There is no possibility of infection if blood is checked and banked properly,” Kouslaya Periaswamy, founder Positive Women’s Network (PWN) told Elets News Network (ENN). Assuring the safety of the blood transfused from one vein to another is a rigorous process and it should
start from screening of the donors which includes testing, careful quality control of donated blood.
Voluntary Donation – In Paltry State Blood is an intrinsic requirement for healthcare and proper functioning of the health system, however everyday hundreds of patient struggle to get blood on time. The procurement of blood on time still depends on the patient relatives and not with the service provider.
“We do not have a proper VBD programme that can run throughout the year to take care of the demands. There have been efforts to improve the VBD but vested interests have marred the progress. The madness to commercialise blood banking is ruining the very concept of VBD,” said N K Bhatia, Mission Jan Jagriti Blood Banks, Delhi. Ironically India is among 51 countries to sign the “Rome Declaration” on “Achieving Self-Sufficiency in safe blood and blood products based voluntary non-remunerated donation”. But voluntary blood donation (VBD) is still very low and the majority of the blood donors are family donors or replacement blood donors. Experts stress that only awareness and more sensitisation and enhanced blood donation camps can match the shortage. “The best way to guarantee a safe and adequate supply of blood and blood products for transfusion is to have a good supply of regular donations by voluntary unpaid blood donors,” says Dr Margaret Chan, WHO Director-General. Indian Red Cross Society (IRCS), which contributes 10 per cent blood of the total requirement in the country, says that they start a motivational programme for youth and make them lifelong blood donors. “IRCS is already in the activity for over 50 years, we motivate the youth an the safest donors as they are free from disease or medical issue like blood pressure. IRCS play auxillary role for the government to get more donors,” said Vanshree Singh, Director, Indian Red Cross Society. According to an NGO, who run
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Blood Banks
blood bank a universal donor card for volunteers would help the VBD. For example, if a donor donates blood in Delhi but he or his family is in need of blood at Bengaluru, there should be a system in place where the donor card he carries be given equal recognition in the other parts of the country. Under the current system, blood donors are issued donor cards by blood banks where they donate the blood at, and they can only approach that bank in case of an emergency. As per estimates, four in a population of 1000 persons in India are blood donors. Although VBD is still very low and the majority of the blood donors are family VBD and replacement blood donors, the technology like bar coding, scanners and deep freezers are trying to enhance the quality of the donated blood.
Enhancement through Technology Blood banking needs a balance between safety and efficiency. Technology like bar coding, scanners makes routine tasks easier to perform. The sector has only recently accepted the use of ICT. “Technology helps in traceability and it can checks status of stocks, alerts expired stocks, quarantine management, inventory being sent to storage centres will help in better and effective stock utilisation and supply chain management. With all records available for audit and analysis, better planning and resource allocation can be made. Technology also helps in predictable outcomes and is monitored efficiently. The blood chain stakeholders consist of different players operating in silos bringing them into one umbrella,” informed Dr. Rasika Dhawan Setia, Senior Consultant Department of Transfusion Medicine & Hematology, New Delhi. “Bar coding system provides a unique number of the donor blood so it can be easily traced. Nowadays patient wrist
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bands have a bar code which helps to store the data of that individual, chances of mix-up clerical errors are reduced. In blood bags we have the sampling pouches in which the first 15 ml of blood gets collected and sampling is done from which reduces the mix up and bacteria contamination. Deep freezers have chart recorder it is connected to data loggers information connected to central computer, which can be accessed through mobile phones,” she added. Odisha government has started e-blood banks, an integrated blood bank automation system. These banks help with the real-time updates on
India is among 51 countries to sign the “Rome Declaration” on “Achieving SelfSufficiency in Safe Blood and blood products based voluntary nonremunerated donation what type of blood is available in the state blood banks. “This web-based mechanism interconnects all blood banks of the state into a single network and includes elements of acquisition, validation, storage and circulation of various live data and information electronically regarding blood donation and transfusion service. The system developed by Odisha government is a success,” said Pramod Kumar Meherda, Mission Director, National Rural Health Mission, Government of Odisha. While the state government are trying to imbibe new technologies a five-member team has developed a mobile app and a website to match people who need blood with those willing to give it, instantly.
“Bloodline Android app can be downloaded from the Google Play Store or register with Bloodlinelabs.com to join the network. Once a request is placed, Bloodline runs algorithms to match potential donors based on location and blood group and notifies only them. The app is a hit in Chennai and Bangalore,” said Arun, member Bloodline. The mobile app helps to contact patients to spot willing donor with apt blood group. Instead of outdated list of regular donors who may or may not be available,” he added. “Government will explore the possibility of establishing a mechanism where people can check online the availability of required blood groups in blood banks across the country. The government has taken steps for expanding the infrastructure in blood banks across the country for the benefit of common people,” Health Minister J P Nadda inform parliament.
Centralised Blood Banks Needed Blood banking and transfusion medicine sector needs to transform, all stakeholders must join hands to advocate uniform pricing and highest safety standards for blood and components along with safe transfusion practices, inform experts. “The emphasis should be on adopting IT in blood banking. Blood banking system in India is decentralised, while in Western countries it is centralised. Therefore, we see that blood banks have varied practices of blood manufacturing and using different technology. As the technology advances, the cost of blood components go high,” Tiwari added. For a safe, source and ethical supply of blood, blood products, appropriate and rational clinical use of blood are important as its a responsibility of every government, informed RN Makroo, Director, Department of Transfusion Medicine, Apollo Hospitals, New Delhi.
Buyers Speak
Streamlining
Lives Indian blood banks industry needs efficiency in manpower, adequate infrastructure and financial base needs to be addressed says Dr Reena Bansal, HOD, Blood & Transfusion Medicine, Saroj Super Specialty Hospital, Delhi while in conversation with Prathiba Raju, Elets News Network (ENN)
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Buyers Speak
How much of blood shortage does India faces annually, what are the causative factors? India has a population of 1.28 billion and has a huge burden of patient population requiring multiple blood transfusions. As per the recent data released by National AIDS Control Organisation (NACO), there is a requirement of 12 million units of blood annually in India. However, it is able to collect only nine million units per year with around 25 per cent shortfall. Blood and blood components are widely used in treating patients with deficiencies related to blood and are used in deriving numerous biopharmaceuticals (antibodies, blood factors, and others). Especially with season of dengue we see sharp rise in the demand of blood. However, certain infections like HIV and AIDS continue to take a toll on the population across the world, fuelling the demand for blood products. We can undermine various causative factors responsible for shortage of blood in India like lack of awareness among masses, ageing population, changes in the incidence of diseases and surgical procedures.
Can you give an overview of the current status of the blood banks industry in India? The blood supply depends on three types of donation - voluntary, replacement for used blood and professional donors. In India professional blood for money was banned by Supreme Court in 1999. So, almost 60 per cent of the total blood collected in the country is through voluntary blood donation. There is no alternative product that can replace human blood, and the supply depends entirely on voluntary donations, which never fully meet the demand. Fuelled by a greater awareness and acceptance of blood transfusion as a safe option, increasing efforts to make quality blood available, stringent regulatory and healthcare policies
adopted across the world, the global market for blood banking and blood products is expected to touch US$ 36 billion in current year and US$ 43 billion by 2018.
What are some of the major challenges that the blood banks industry is currently facing in India? The blood banks industry in India is highly decentralised and lacks many vital resources like manpower, adequate infrastructure and financial base. The major issue, which plagues blood banking system in the country, is fragmented management. The standards of services and quality vary from in each state and city. Despite we follow hospital based system, many large hospitals and nursing homes do not have their own blood banks and this has led to proliferation of standalone private blood banks.
For safe and quality blood and blood products, well-equipped blood centres with adequate infrastructure and trained manpower is essential The blood component availability and utilisation is extremely limited. There is a great demand of trained healthcare professionals in the field of transfusion medicine. For quality, safety and efficacy of blood and blood products, well-equipped blood centres with adequate infrastructure and trained manpower is essential. Upgrading them as part of modernisation is bound them to raise costs, making them economically unviable. The control on pricing deters the industry from implementing latest
technologies as the cost implications would be high is a major challenge.
Which states lacks and excels in voluntary blood donation and why? States like Maharashtra, West Bengal witness high rate of voluntary blood donation whereas states like Bihar, Meghalaya, Assam has lower rate of voluntary blood donation due to lack of interest and awareness and fewer number of female blood donors.
What should the central and state government do to regulate the unlicensed blood donation? Every blood banks needs to be licensed before starting its operations, therefore, strong regulatory regime i.e. licensing is important to ensure compliance to minimum requirements in terms of structures and some processes. Guidelines for obtaining the basic licensing for blood banks needs to be reviewed in every two years. The Central Drug Standard Control Organisation, the regulatory body which is responsible for licensing and monitoring blood banks in the country should regulate a mechanism to keep a check on smallscale blood banks that do not adhere these guidelines.
How IT could help? Blood transfusion is more prone to error by virtue of the process involving a chain of events done at different locations, by different personnel, happening simultaneously or in series. Some errors can be life threatening. Proper use of IT technologies like bar coding, online storage of donors data, web based blood banks information management systems can play a crucial role in reducing any chances of human error and efficient utilisation of blood products and lesser chances of wastage. With the help of coding and scanning technology the chances of miss-reporting can be reduced to a great extend.
OCTOBER / 2015 ehealth.eletsonline.com
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Buyers Speak
Access to Safe Blood As winds of doubts loom large when it comes to transfusion of safe blood. R N Makroo, Director & Sr Consultant, Department Of Transfusion Medicine Transplant Immunology & Molecular Biology, Apollo Hospitals, Delhi lists out the efforts required to streamline the blood banking sector and imbibe safe transfusion practices, while in conversation with Prathiba Raju for Elets News Network (ENN)
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an you give an overview of the current status of the blood bank industry in India?
We have roughly 2,650 licensed blood banks in the country, which are working under various controls viz under government, charitable organisations and hospital based. As per National Aids Control Organisation (NACO) 70 per cent of the blood is collected via voluntary blood donors (VBD) but unfortunately majority of them are one time donors. The concept of regular repeat VBD is very little, only four to five per cent do the donation repeatedly. The blood transfusion services in India is primarily hospital based transmission services.
Why does the country face a dearth in VBD? The concept of regular VBD is not growing up like the developed world. In West, people feel responsible for there fellow human beings. Many feel that nobody is doing it then why should I do it. But our country fellow man are good in responding on crisis situation may be it’s a earthquake or calamity thousands of people come forward to donate blood but it doesn’t work like that. Blood has its own shelf life it can be stored only 42 days with latest technologies. We need regular, replenishing blood. Some of the blood components like platelets can be stored for a week; plasma can be stored for a year.
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Buyers Speak
of the drug and cosmetics to be in place. The government should also make sure that all the blood transfusion, which takes place are done in a safe manner. Among the various states the Karnataka is the only state, which has made the NAT testing compulsory. Hope others follow it as safe blood is a concern for all.
How can technology like bar coding, scanning technology, deep freezers help the sector? How far would web based blood banks information management systems help?
What are the challenges in the blood banks sector? A wide gap prevails in the demand and supply of blood. Our country faces high disease burden that is 2.5 million with HIV, 15 million HCV and 43 million HBV. With miniscule repeated voluntary donors, disintegrated blood transfusion centres, testing technologies like immunohaematology, infectious markers, low blood component preparation, lack of trained manpower are major challenges. Moreover there is no haemovigilance – how safe is the blood transfused. Blood is not a tonic there are risks attached to it and before transfusion there should be a tracking system. Transfusion is a vital services in the healthcare delivery system. A successful blood transfusion depends on many factors a cohesive and comprehensive national policy is necessary.
Providing safe blood transfusion where does India fall? Safe blood donation consists of three factors safe blood donors, safe transfusion practices and rational use of blood. For safe blood donors we need
At each and every step a set of safety assurance needs to be done for blood transfusion. Technology would be a helping hand in this foray voluntary blood donors, where we have a huge gap. Testing technologies means not just testing for infectious markers. Presently many hospitals just carry ELISA screening test. But we have to do Nucleic Acid Test (NAT) for HIV/ HBV and HCV. Both tests are complimentary to each other to improve the blood safety. As of now only one million blood units undergo NAT out of the nine million units collected.
What are your expectations from government? Although our country has a national policy for the blood banking sector in place there is a need to have the amendments
Implementation of various technology in the sector is necessary. Actually for every unit of the blood transfused from one vein to another vein there is a need to access the quality. At each and every step a set of safety assurance needs to be done and the technologies definitely helps to track them along with appropriate donor selection. Few measures like the donors being grouped and patient’s screening for red cell antibodies before the transfusion is a must. In case if some patient has red cell antibodies which is clinically significant then we need to provide an antigen negative blood for those patients so it will prevent transfusion reactions. Especially for patients who need multiple transfusions like thalassaemics and haemophiliacs.
How has the transfusion and blood banking evolved in Apollo Hospital and its uniqueness in this platform? Apollo hosptials has been a forerunner in the quality of blood transfused. We were one of the first centres in the country to start the Hepatitis C antibiotic screening and Hepatitis B core antibiotic testing in 1996 and the test for Hepatitis C testing became mandatory in 2000. We started to do one leukoreduction in 1998 and we started doing three lock leukoreduction 2006 onwards. NAT testing for each unit of blood was started in the same year. We have 100 per cent blood components.
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Buyers Speak
Accreditation Uplifts Healthcare Accreditation provides quality and safety of healthcare services informs Dr K K Kalra, CEO, National Accreditation Board for Hospitals (NABH) and Healthcare Providers, Delhi, while in conversation with Prathiba Raju for Elets News Network (ENN) Why is the NABH accreditation important for the blood banks? There are lot of hazards still prevalent in the blood transfusion services. Blood transfusion should be made safe as it is a patient safety issue. Getting license from ‘Drugs and Cosmetics Act’ is a must and it is the first step, which will cover the minimum requirements of any hospital, clinic or a blood bank. Though NABH accreditation is not mandatory it has a set of standards, which ensures management, accommodation, personnel, equipment, process control, performance improvement, document control, records, internal audit and management review. From proper screening of donors, testing and how the blood is collected. The NABH accreditation is a risk-reduction activity; it complies with standards and is intended to reduce the risk of adverse outcomes and improve patient safety. Accreditation assures high quality of healthcare and patient safety.
How many hospitals/blood banks are under NABH accreditation? When it comes to hospital accreditation we grant it for each and every department like laboratories blood banks and radiology department. Hospitals which are accredited under NABH are 315 this includes private, public hospitals. But nowadays we give stand alone accreditation for blood banks too under NABH Blood Bank Program. Out of 2060 blood banks in the country, 74 are accredited but many are yet to come forward. Accreditation in our country as on date is voluntary and it is not made compulsory. Quality can be up to the mark when its a volunteer process as each healthcare organisation approach us in there own interest.
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Although selling blood and paying donors is illegal, a vast illegal market proliferates. How to tap them? We do not have a role in controlling people who indulge in selling blood or paying blood donors directly. But we have few standards which deals with ethical practices and we definitely take action against any hospital or blood banks which are into unethical practices. The healthcare organisations be it hospitals, blood banks once receive the accreditation are under constant surveillance. The validity period spanning for three years we have check in first three months and before three years and do surprise inspection in-between. They need to submit monthly quality indicator data to the NABH secretariat. Apart from this, each month we take out a draw from all accredited hospitals and conduct surprise assessment to ensure the maintenance of quality standards in accredited healthcare organisations.
What factors NABH consider while assessing a blood bank hospital? NABH standards address most of the
processes in healthcare delivery system. They are related to safety viz medication use, infection control, surgery and anaesthesia, transfusions, restraint and seclusion, staffing and staff competence, fire safety, medical equipment, emergency management and security. These standards also include specific requirements like the hospital needs to tell a patient about the outcomes of the care provided to the patient and its outcomes. Out of the 311 hospitals accredited Andhra Pradesh stands first with 46, Delhi second with 43, Karnataka 28. While Bihar, Himachal Pradesh the north eastern states like Mizoram, Manipur do nothave any accreditation.
How will accreditation of healthcare sector help the public? Accreditation offers an assurance to the patients that particular hospital or blood banks offer quality healthcare, addresses patients rights. It strengthens quality, treatment, risk reduction and patient safety efforts. It provides quality manpower. Now even the health insurance companies are also considering to empanel only NABH accreditation. Out of ten chapters, five focuses on patients and their concerns. We organise seminars and workshops to familiarise the healthcare industry with added advantages and benefits of NABH accreditation. We also ask them to display there logos to the public and make them aware the NABH accreditation provides quality health. Moreover NABH wants the healthcare delivery system to operate in more systematic and professional way.
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PREPARE SAMPLES
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Centrifuges and Sample Storages
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ELISA
Vouching for Holistic Tests Kits
Majority of the end-users are opting for multiplex proteomic arrays, as a result of which ELISA products have largely been restricted to laboratories seeking cost-effective technology options, writes Anshuman Ojha, Elets News Network (ENN)
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nzyme-Linked Immunosorbent Assay (ELISA) is one of the few assay formats that has managed to command widespread popularity, in terms of reproducibility, performance, and validation, particularly in a rapidly changing life sciences and drug discovery market. Adherence with stringent quality control and validation requirements has ensured minimal high-cost failures. The advent of proteomics led to a significant expansion in the availability of protein targets for assay development, thereby
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fostering the development of kits for large family of proteins as well as for proteins in unrelated, niche research segments. Majority of the end-users are opting for multiplex proteomic arrays, as a result of which ELISA products have largely been restricted to laboratories seeking cost-effective technology options. On the other hand, the commoditisation of ELISA products has enhanced price-related pressures for manufacturers, particularly from bulk purchase customers. With the advent of proteomics which largely expand the availability of protein targets for assay development, the ELISA instruments and reagents market is challenged. The multiplex technology as well as multiple-analyte quantification microarray tech-
nique restricts the further popularity of ELISA products. However, favourable reputation of ELISA kits as a trusted technology for research markets, continued use in secondary validation for select targets by multiplex customers, and developments in the field of biomarkers resulting in the availability of new targets is expected to ensure revenue generation in the ELISA market. The cost-effective ELISA products are preferred by laboratories and researchers that focus on less number of analytes and high sensitivity of assay.
Market Dynamics The global ELISA market is projected to reach US$ 165 million by 2020, driven by its continued use as a secondary validation technique, and increasing investments in research related to immunology and medicine, according to a report by Global Industry Analysts. Demand for ELISA products, in the short to medium term, is expected to come largely from small sized laboratories
ELISA
dealing with less number of analytes and high sensitivity of assays. Development of automated platforms for running ELISA will further encourage market growth by offering improved performance, productivity, sensitivity, and flexibility to adapt a range of assays/protocol. The United States represents the largest market for Research ELISA worldwide. AsiaPacific ranks as the fastest growing market led by medical tourism and demand for cost effective biochemical screening technologies.
Market Trends ELISA kit manufacturers boast that they perform a tremendous amount of validation and quality control with stringent requirements on each kit, ensuring that costly failures are kept to a minimum. With an extremely high level of inter- and intra-assay reproducibility, quality ELISA kits provide validated, publishable results for academics and proven consistency for large studies by pharma firms. Despite the technology’s solid reputation, the ELISA market has seen minimal growth over the past five years as researchers adopt newer technologies, especially the multiplex proteomic array platforms. Many studies that previously employed single-analyte ELISAs for target detection and quantification are now utilising proteomic arrays for the convenience of multiplexing capabilities. The ELISA, however, has assumed a new complementary role serving as the benchmark technology to multiplexing and other new assays, demonstrating that these product markets may be sustainable simultaneously. Researchers tend to use multiplex platforms to measure many targets at a time in a small number of samples and then switch to the ELISA technology to carefully measure many different samples for a selected target. Additionally, researchers who do not need the advantages of multiplexing, lack the funding to purchase
Talking about the advantages of ELISA kits, Aseem Kumar Tiwari, Associate Director and Incharge, Department of Transfusion Medicine, Medanta-The Medicity Hospital, Gurgoan says: “Fourth generation ELISA kits is better than the third-generation ELISA kits since it detects both antibody and antigen. The good news is that Chemiluminescence, which is superior to ELISA is also bringing in fourth-generation kits. But the combination of ELISA/ Chemiluminescence and Nucleic Acid Test (NAT) is the ideal testing strategy. There is absolutely no debate that NAT adds to safety. However, if it is more cost-effective it would be used more widely. RDTs have limitations and should be avoided as far as possible.
expensive array instrumentation and reagents, focus only on a few analytes, or require high assay sensitivity, continue to use ELISA kits. While the trend toward multiplex proteomic arrays has accounted for a declining growth rate in the overall ELISA market, unless newer platforms dramatically decrease in price and improve on sensitivity levels, the ELISA will continue to maintain a role in research. Interestingly, ELISA providers have reacted to newer technologies in different ways. Determined to take
advantage of the trend toward multiplexing, several companies have stalled expansion of their ELISA kit portfolios over the past five years in favour of focusing resources toward the development of multiplex or other new assay types. Other providers vehemently defend the complementary role of ELISAs to proteomic arrays and continue expansion of their ELISA lines while building multiplex assay portfolios as well. Smaller companies without the R&D budgets to develop new multiplex assays have sought niche markets to penetrate to circumvent heavy competition. In general, new ELISA product introductions attempt to serve a different market sector than multiplex assays currently reach. Companies that continue to bring unique ELISA products to the market are experiencing market share growth; companies abandoning ELISA product development are generally experiencing stagnant-to-negative growth for their ELISA lines, contributing to an overall decline in market revenues. Developing unique ELISA products and targeting niche markets appear to be successful strategies for overcoming both market erosion by newer technologies and increasing commoditisation. Furthermore, companies with the resources to develop portfolios for new assay types may reap the benefits of diversification, including expansion of their customer bases and increased exposure for other product lines. Nevertheless, the overall ELISA kit segment is likely to experience the greatest erosion by proteomic array technologies, as the ELISA development components segment caters to price-sensitive laboratories unlikely to switch exclusively to more expensive technologies. The percentage of total research revenues generated by kits is expected to decrease as the percentage of revenues generated by development components increases.
OCTOBER / 2015 ehealth.eletsonline.com
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Spotlight
Injecting
Well-Being India would reach 90 per cent immunization coverage by 2020 and the mission Indradhanush would help to achieve this target, informs Dr M K Aggarwal, Deputy Commissioner (UIP), Ministry of Family Health Welfare, to Prathiba Raju of Elets News Network (ENN)
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an you give us an outline of the current immunisation level in India ?
As per the latest estimate and various survey points, currently, 65 per cent of the children in India receive all vaccines during the first year of their life. We want to increase this data rapidly, as this data was available at 2009, it stood upto 61 per cent and since 2012
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it is at 65 per cent. It has increased in a very slow pace. We need to rapidly increase the immunisation coverage. The public should also understand that if it is full immunisation coverage the child has to get one shot of BCG (Bacillus Calmette Guerin), three shots of DPT (Diphtheria, Pertussis and Tetanus Toxoid DPT 1,2,3) or pentavalent. And, one shot of measles vaccine and three drops of OPV (Oral
Polio Vaccine). If these are completed at the age of one year we can then call it full immunisation.
After implementation of “Mission Indradhanush� is there any change in the reach of the immunisation? Mission Indradhanush flagship programme was launched in December, 2014. It has strengthened the routine immunisation program and focuses on all those who are left out from the benefits of the vaccination cycle thereby providing complete immunisation and taking it to the grass root level across the country. The first round of the mission, conducted about four months ago, was a huge success. We were able to cover about two million people who were partially immunised and left with full immunisation. This meant that we have achieved more than the 50 per cent of our target in 201 districts. Phase II will be starting in October 2015 and continue upto February 2016 for few other medium priority districts. It will be an ongoing process. Our aim is to provide complete immunisation to 90 per cent of the children by 2020.
Spotlight
We had focused on 201 districts, out of which, 82 districts were from four states of Uttar Pradesh, Bihar, Madhya Pradesh and Rajasthan. As nearly 25 per cent of the unvaccinated or partially vaccinated children of India are in these districts from four states. In the second phase 297 districts will be targeted.
Do you think the target of complete immunisation to all the children by 2020 is achievable? If yes how?
same from the media for the routine immunisation programme. We are expecting an unbiased story because public perception usually changes by media views and media should be very accurate as far as possible in reporting on immunisation.
At times there are issues were children die of vaccine as well. Your comments.
Definitely it is achievable. Mission Indradhanush is not just a campaign but the program also simultaneously strengthens the immunisation program in the rural areas. We are also conducting campaigns for system strengthening like capacity building of the doctors and health workers. The health
All the vaccines are licensed by Drug Control General Of India (DGCI) after being screened through all the protocols and scientific evidence. Vaccines are time tested and tried. Before being introduced, these vaccines undergo a scientific and a step-by-step method. World over this is the practice. We have a national technical advisory group which has got experts across the fields like community medicine, virologist, epidemiologist,
workers are identifying the area were children are partially immunised and include them in the micro plan of immunisation. Everytime we do not have to conduct a campaign to cover those children but we have to just have follow-up with the parernts for the second round of vaccination. So these efforts would reflect in the national average. If we can able to eradicate polio we can achieve full immunisation too. Polio eradication campaign had very positive impact. We expect the
pediatrician, pathologist and the committee examines the issue from aspects like burden of disease, economic viablity, safety of the vaccines and then put up a recommendation, which goes to a larger organisation. It is a pool of experts who see to it. Yet, there are deaths because vaccine is a biological product, like any drug, it can have some consequences. If you see our infant mortality rate is 42 at present. This means 42 children are dying in the first year of their life. This might occur due to different causes like
diarrhoea, fever, pneumonia or at times they are ascribed to vaccine. But we are not sitting silent on the issue. We have a National Adverse Event Following Programme , where we follow adverse cases that detect the cause of the death and investigate it. After investigation we find that very few cases are ascribed to vaccine. It might be coincidental or a program error and we take the corrective action accordingly. So far, we have done causalty survey of about 663 cases and they are uploaded in the health ministry’s website.
What are the IT advancements made in the routine immunisation sector? We have got national cold chain and vaccine logistics management information system, where we have 26,000 cold chain
points across the country. At every cold chain point we have different types of freezers, temperature monitoring to keep the vaccine safe. All these cold chain points are mapped and we have detailed information of the cold chain technician who monitors it in the district, state and centre level.We also have national Mother and Child Tracking System (MCTS), where we have a call centre established to the care givers like Auxiliary Nurse Midwives (ANMs) and Asha workers so that they can directly interact with the parents.
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Spotlight
Technology Transforming Healthcare Technological innovations in the healthcare platform are making it baby steps into the country. More innovations like digitalisation, connectivity and data security will bring growth to the industry, informs Dr J Sivakumaran, Chief Operating Officer, Kovai Medical Center and Hospital Limited, Coimbatore in conversation with Prathiba Raju, Elets News Network (ENN) How well regulated is the healthcare industry? What are the reforms needed? Healthcare industry is still in the growing stage. Required regulations are not in place. Through NABH, authorities are trying to bring some framework to regulate and bring quality delivery. Though we can be proud to have more number of JCI and NABH accredited hospitals, still we have a long way to get stabilised and establish as a regulated industry. Hospitals need to develop a culture of sharing and reporting data to improve.
What can be done to make health services more affordable? This is a double edged sword on the
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healthcare administrators. Providing state of the art technology is essential for differentiating from the competition and attracting the patients but to match with the market price is a challenge. This can be managed to some extend by scaling up the volume. Reaching the population with technology will make them mentally prepare to pay little more,
when the market price is not viable. Introduction of technology wherever possible will make the cost affordable to some extent.
How technology helps in the healthcare services? Technology plays a very vital role in the healthcare services. Right from billing to the PACS, technology has become the part and parcel of healthcare services. Nowadays, patients can view their medical records from anywhere to have continuity of services. Telemedicine has now expanded from mere opinion to monitoring ICU patients from a command center to the remote locations. From a rural area, a patient can get expert opinion for further treatment, at an affordable cost. The high ICU expenses could be managed with local hospital charges, but still the patient can get specialists’ treatment. Indian doctors are successfully managing ICU beds in abroad – thanks to telemedicine and technology.
Spotlight
What according to you should be done to change the healthcare service delivery with the ICT intervention? The tax policies on hardware and software investments by hospitals either need to be exempted or lowered down to make everyone to use the ICT intervention. Government can mandate to have certain hospital activities to be done only through ICT to have more transparency and accuracy.ICT will reduce the healthcare delivery cost and at faster rate. Over a period, hospital can build its own evidence-based medicine. This will reduce the cost of treatment, reduce hospital stay and result in patient satisfaction.
How KMCH IT system boost inhouse operational efficiency? What are the areas in which you are leveraging innovative IT solutions and how it helps the patients? The hospital performances like occupancy, discharge, admission, collection, surgery and procedure details could be viewed in mobile. The dash board system throws lot of managerial information for taking suitable decision in time. Right from appointment system to discharge processes can be efficiently handled by the professions with the help of IT system. Equipment tracking and billing system, hand wash compliance system, vital parameters tracking system are in pipeline to enhance our operational efficiency. We constantly engage the IT team to study and simplify the process for easy usage. Starting from alerts on abnormal results, gender based lab procedures, integrating equipment, helps to standardise the process thereby reducing errors.
What are the challenges you are facing today as digital data is exploding? How do you see the role of Big Data analytics and what are its key advantages? A good IT system requires reasonable investment. When the operation expands, more and more investment is needed to meet the requirements. Apart
from investment getting skilled man power in this domain is also a challenge. When more and more operational decisions are depended on IT, a good team to understand and customise the need within the time frame, is a challenge. Due to heavy attrition of paramedical staff, a dedicated training team is needed for training and re-training IT, to get better results. Bringing the paramedical staff to the required standard itself is a challenge. With converting our process digital; data security, privacy and accessibility are the key challenges. KMCH is having a research foundation that adopts villages and does various research activities. It does various clinical tests and collects data for trending various disease pat-
Do you think mobile based healthcare have potential in India? How mobility devices and telcos aiding remote healthcare monitoring?
terns with these villagers. This will be further analysed and published by epidemiologist for the benefit of researchers. It has tied with giants like IIS Bangalore, IIT Chennai, SASTRA universities for various collaborative studies. Again IT plays a very vital role in collating and analysing a huge data. The results of these data throw very vital information for the society at large. We are too early in India to talk about Big Data in healthcare. Even before discussing about Big Data, we need to understand the context of Big Data in healthcare.
rural health. But M2M in India is still in infant stage. When two machines talk to each other without human intervention, it is M2M. The transmitted results in areas like patient care, patient monitoring will be very exciting and useful. One of the vital advancement of healthcare industry transformation is this technology with the use of a tiny sensor. KMCH has already developed and deployed Apps for cardiac care patients from the time we pick the patient from home until he reaches the secondary or tertiary care hospital with all vital data recorded and published for the treating doctor.
There is a huge potential for mobile based healthcare services. Earlier to monitor the fetal heart rate, the pregnant mother has to come to the hospital. But now a cordless fetal monitor could be attached with the mother’s belly and she can lie at home comfortably. Advanced mobile technologies help patients shift healthcare from tradition hospitals to home. For example many healthcare apps like monitoring blood pressure are available in Play Store. With government coming up with Smart Cities and penetration of 4G mobile helathcare apps will play a major role in
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International News
Philips and Dutch Radboud University introduces New Digital Health Prototype
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oyal Philips and Radboud University medical centre have launched a connected digital health prototype, which allows diabetes patients and their healthcare providers to manage complexity of diabetes self-care. The system securely connects devices and collects, integrates and analyses patient data from connected consumer and medical devices, electronic medical records and personal health data. Both organisations will use the new digital health prototype to focus on patients living with diabetes type I, in the first phase. The system, including a mobile patient app and online community, will collect and connect data
from electronic medical records, multiple personal health devices such as wireless glucose meters and activity monitors, comprising patient selfreported data. The app, through a smartphone or tablet, provides patients with continuous access to important parameters such
as blood glucose levels, insulin use and nutrition, offering coaching guidance at home and on the go. “I am excited that we are providing people with diabetes the tools to connect all of their relevant health data and devices. Our system allows sharing of data and experiences in one community, where they can collaborate with fellow patients and their care teams in a secure environment,” said Jeroen Tas, CEOInformatics Solutions And Services, Philips Healthcare. The secure online community, including enrolled patients and healthcare professionals, can interact through private messaging or shared posts within a healthcare organisation’s clinical guidelines.
Cantel Medical buys Medical Innovations
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antel Medical, a US based company, has acquired Medical Innovations Group Holdings, for US$ 79.5 million in cash. UK-based medical device firm Medical Innovations provides endoscope storage and transport systems in the UK and other countries. The acquired business will allow Cantel Medical to expand its infection prevention and control (IP&C) solutions in the gastrointestinal (GI) endoscopy market. “We are continuing our strategy of driving sustainable growth through the expansion of our global presence, the introduction of new products and the execution of strategic acquisition”, said Jorgen Hansen, President and COO, Cantel Medical. Medical Innovations produces infection prevention solutions such as CleanaScope shortterm scope transport system and SureStore long-term endoscope storage system. In addition, the firm markets single-use endoscopy consumables, mobile cart systems and patient transport solutions.
Physio-Control to purchase HeartSine
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hysio-Control has reached an agreement with HeartSine Technologies to acquire the Northern Ireland-based automated external defibrillator (AED) manufacturer, the companies announced. The two privately held companies recently completed due diligence. Financial details of the transaction are not being released. The combination creates one of the
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world’s largest AED solutions providers. “With Physio-Control and HeartSine now united in our lifesaving missions, we will be able to offer a tremendous range of AED solutions to our global customers and partners,” said PhysioControl CEO Brian Webster. The companies share a strong scientific and technical focus with important, often parallel histories. The pioneer of direct current defibrillation,
Physio-Control has partnered with leading emergency medical systems since the 1960s and commercialised the first home use AED, the LIFEPAK 100, in 1986. “This is very good for HeartSine and our distributors. Our teams share a strong clinical focus, and together we have exciting opportunities ahead for technical, scientific and marketing collaboration,” said HeartSine CEO Declan O’Mahoney.
Company News
Lifetrenz offers Doctors a Primary Care Platform for Free
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he Ministry of Health and Family Welfare, Government of India, published the Standards for ‘Healthcare IT (HIT) & Electronic Health Records (EHR)’ back in August 2013, and in March 2015 announced the intent to form a regulatory body NeHA (National E Health Authority) to regulate and mandate the Use of these Standards by Healthcare providers. Bangalore based dWise Healthcare IT Solutions, a Healthcare IT product and platform developer, has launched a Primary Care Platform under the brand ‘Lifetrenz’, that is fully compliant to the Government approved HIT & EHR Standards. The Lifetrenz Primary Care Platform provides doctors a Practice Management Solution with EHR absolutely free for life time. Lifetrenz also provides an appointment management system integrated to its patient portal“MyLifeTrenz.com”, where patients can book appointments online with doctors for free. Lifetrenz EHR system provides doctors with ‘Clinical Decision Support’ which helps them with suggestive Alerts and Notifications of Contraindications, dose adjustmentsand best practice protocols, apart from access to longitudinal patient health records. The EHR system also helps the doctors to provide patients with individualised context based patient education content. DWise Healthcare CEO, Joseph Alexander says, “Our experience of buildingONC-MU2 Certified Inpatient and Ambulatory EHR products for the US market, led us to build an EHR platform for India as well. We have several hospitals using our Hospital EHR platform in India. However, over 80 per cent of healthcare incidences
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that occur are managed at the Primary Care level, and unless Primary Care doctors use EHR systems, patients are not going to have their Longitudinal Electronic Health Records. If EHRs have to become a reality in India, then we need to ensure it’s feasible for Primary Care Clinicians to afford and use EHR systems. This led to our decision to provide a PMS and EHR free to Doctors, and encourage adoption by providing other benefits like Multisite Practice and Online Appointment Management”. The Lifetrenz Platform provides Patients with a free Mobile App, which gives them access to Standards Complaint Longitudinal EHR and context
based patient education content. They can export their Health records in the CCDA (Consolidated Clinical Data Architecture) format, which is an internationally supported standard for interoperable health records. Patients can also book appointments with their doctors on the App. Doctors can offer Chat consult and Tele-consult to their patients for a fee, and the platform manages the payment collections for these services. Dr Pramod Jacob, who is the Chief Medical Officer at dWise Healthcare, is an alumnus of CMC Vellore, with a MS in Medical Informatics from OHSU, USA and has worked with EPIC systems in the US. He says “In the 12th Five year plan, the Planning Commission talks of Universal Health Coverage. The government wants the
private sector to provide Primary Care delivery, and will reimburse them for the services. To achieve this, EHR adoption by primary care providers would become imperative”. Further he states that “Adoption of EHR by doctors would require systems to be extremely user friendly. Doctors would expect usage of the system to be faster and easier than manually writing out prescriptions. Doctors would like to see returns for the effort to electronically input clinical records on these systems, which is what the Lifetrenz Primary Care Platform will provide.” The Lifetrenz PMS provides doctors a Dashboard with live clinical analytics and reports. It also allows doctors to set notification of any disease outbreak in the country, a region or in their city. The platform also provides Doctors their own social Media tool to post and discuss case studies. The Lifetrenz Product team has also ensured Gamification on the App, to ensure Doctors earn rewards for EHR adoption. The Chief Business Officer of dWise, Wing Commander C K Babu, Retd says, “We have over 1200 Doctors and more than 300,000registered Patients with their Health Records already on our EHR platform. On the new Primary Careplatform, we expect to expand the number of Doctors to 100,000 in the next 3 quarters, and we believe providing the platform to the doctors for free will facilitate this process.” He further adds “Patients especially in the tier I and II cities expect transparency and more from their healthcare providers. Access to their Health records and better patient engagement by providers have become essential to manage patients’ expectations.”
HEALTHCARE LEADERS FORUM
Company News
The Lifetrenz PMS is a great patient engagement tool for Doctors. The platform sends out SMSs of various reminders to the patients on behalf of the doctor, and also sends out emails with individualized context based patient education content links. Patients with the Lifetrenz Mobile App can message/communicate with their doctors and even chat with them, if the doctor so wishes. The App also allows patients to place refill requests of prescription to their doctor. Sreejith P, the chief architect of Lifetrenz Primary Care Platform says “The
primary challenge in building the Platform was to ensure “High Usability with High Functionality.” EHRsystems can be high on functionality but doctors’ adoption and acceptanceof these systems depend on the usability of the system. The feedback received thus farfrom our physician users have been highly positive both for usability and functionality.We have managed to incorporate every functionality that can be envisaged in the Lifetrenz Primary Care Platform, but at the same time,doctors find the product highly user friendly.”
Doctors can download the Lifetrenz PMS and HER product from the URL www.myliftrenz.com/Practiceand it takes just 10 minutes to setup their practice and see the first patient on the platform. The Medical Council Registration is mandatory for a doctor to register and use the product. This is dWise Healthcare IT’s genuine effort to provide the platform to India to harness 21st century healthcare, as they are convinced that this is the only way to keep track of the health of India, with its more than 1.2 billion population.
Transasia buys Lumora
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ransasia Bio- Medicals Ltd has completed the acquisition of Lumora Ltd., a Cambridge, UK based patented molecular technology company for about `250 crore. This makes Transasia one of the global companies with its own patented technology for the `35,000 crore global markets for molecular testing. The company has been providing reliable, accurate and affordable diagnostic solutions for over thirty five years now. Through its overseas subsidiaries in eight continents, Transasia Group has been meeting the needs of doctors and patients worldwide in over 100 countries. In India, Transasia services over 20,000 laboratories in span over 200 towns and cities performing blood tests for over 20 crore people. The acquisition will see ERBATransasia Group add advanced molecular diagnostics testing to its comprehensive suite of clinical testing products and make them available worldwide for testing of diseases such as HIV, respiratory diseases, dengue, malaria, etc. Global market
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for molecular tests is estimated to be about `35,000 crore per year. Along with the specific diagnostic technologies, the Transasia Group will have the opportunity to further commercialise Lumora’s patented technologies such as BART, RapidMag, and other sample preparation technologies. In addition, Lumora, has a number of ongoing commercial partnerships which will continue following the acquisition. “The ERBA-Transasia Group is an excellent home for Lumora’s technology. The company has a strong global presence and is well established in a number of key market segments.
With the acquisition of Lumora, and its novel technology, the Group is now well placed to expand the utility of the technologies globally”, said Dr Laurence Tisi, CEO, Lumora. “The acquisition of Lumora enhances and completes our existing portfolio of instruments and test kits, to make ERBA- Transasia a global IVD leader. Lumora has a strong portfolio of molecular technologies which will help us develop molecular testing for emerging country specific diseases such as HIV, TB, malaria, dengue, etc,” said Suresh Vazirani, Chairman and Managing Director, ERBATransasia Group.
Government Desk
Linking Rural Health through ‘Sehat’
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n order to provide better healthcare facilities in rural areas, the government has launched a telemedicine initiative “Sehat” through which people can consult doctors via video link. Launching the programme “Sehat”, Union Minister for Information Technology and Telecom, Ravi Shankar Prasad said: “The Digital India program is to transform India into a digitally empowered society so as to share the fruits of development with every section of the society especially those living in rural India. He said digitally empowered rural women can truly address the issues of structural imbalances and poverty.” Quality and affordable healthcare is one of the emerging needs for citizen in rural areas, Apollo and Medanta hospitals will join hands with Common Service Centre (CSC) in every panchayat and design a workable solution. They will provide tele-consultation services are being extended to 60,000 CSCs across the country.
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entre is considering to channelise all the unclaimed amounts in various government investments towards the healthcare of senior citizens, Union Finance Minister Arun Jaitley informed.
Common Service Centres will also provide diagnostic services and promote sale of generic drugs through collaboration with Ministry of Health – by setting up of the “Jan Aasudhi Stores”. “With the availability of teleconsultation, diagnostic facilities
providing healthcare to senior citizens. The programme is under consideration,” Jaitley said. He spoke at a function organised by Kerala government Karunya Benevolent Fund, “The state governments
‘To Channelise Unclaimed Funds for Elderly Healthcare’ “In fact, I am currently working on a programme we have approved last year where all the unclaimed amounts in various government investments are now to be taken over and used for
across the country have expanded public healthcare but the number of doctors are still inadequate. We have about 5,00,000 doctors short still,” Jaitley said. Jaitley also hailed the role of the private
sector medical institutions in providing “very high quality healthcare” across the country. “In fact, it is now universally accepted that even though private healthcare is very costly, compared to what it is in the developed world, we are still much better off,” he said. Chief Minister Oommen Chandy said the state government has made available lifelong unlimited treatment benefits to haemophiliacs from the Karunya fund irrespective of their above the poverty line (APL) or BPL status.
and generic drugs stores – we can redefine the extension of affordable and quality healthcare to the citizen especially in rural India and hope that this will become a game changer not only for India but also exemplary for other countries across the globe,” Prasad added.
PGI Soon to Become e-Hospital
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he Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, will soon acquire the tag of becoming an e-hospital, Union Health Minister, JP Nadda informed. Nadda said the institution was on course to realise the Prime Minister’s dream of digital India. “The online OPD registration was already in place and the process to automate its diagnostic services and payment facilities are under process. These facilities would save a lot of time and effort of the patients,” he added. “We are expanding the network of our medical colleges in a big way by upgrading 58 district hospitals to medical colleges. As many as 20 state cancer institutes and 50 tertiary cancer care centers are being set up,” the health minister said. OCTOBER / 2015 ehealth.eletsonline.com
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Hospital News
Dr Agarwal’s Eye Hospital Adopts Cloud-based IT Solution from Dell Fortis Healthcare to add 500 Beds Every Year
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ortis Healthcare would be looking at adding around 300-500 beds a year as “bolt-on” activities to add more beds and clinical programmes to the existing healthcare facilities. The company will be focusing on improving its performance and implementing technologies including robotics for patient care. “Under the bolt on initiative, we will add more number of beds to the existing facilities rather than setting up a new hospital. We will be adding 300 to 500 beds every year, which is a 10 to 15 per cent hike in bed capacity each year,” said Bhavdeep Singh, CEO, Fortis Healthcare, without disclosing the investments. The company will be adding new medical programmes such as oncology and cardiology programmes in multiple hospitals across the country. The company has also made a decision to invest into robotics surgery, which it has not done so far, as part of bringing in more technology. Elaborating the future plans he said, “At some point we will look at growth opportunities, but I think there is enough to do within the four walls of Fortis.” The company is looking at running a better, leaner organisation. The company would also explore opportunities like using drones for patent care and faster transportation of materials including a bag of blood or similar consignments. While it has conducted a few trial runs of this with some dummy materials and there has to be a proper system and regulations in place before taking it forward, said K R Balakrishnan , director - Cardiac Sciences, Fortis Malar Hospital.
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ell Services has been selected by Dr Agarwal’s Eye Hospital as its strategic partner to help define the chain’s technology roadmap to drive operational efficiencies and improve productivity. Through the partnership, Dell will provide Dr Agarwal’s Eye Hospital a complete cloud-based IT solution that includes Enterprise Resource Planning (ERP) and Hospital Information System (HIS) components to harness the power of Software-as-a-Service (SaaS). Dell will also provide global best practices and deep local business insight to help the hospital chain achieve its aggressive expansion plans to establish a separate line of optical businesses across India. “We were looking for a technology partner to support our goal of being a global leader in eye care and found a perfect partner in Dell Services with their best-in-class healthcare domain knowledge and deep IT expertise. We believe that Dell’s expertise will help us respond to changing technology and business needs, both in the short and long term. We were impressed by how Dell’s solution could modularise our IT while enabling operational excellence and higher patient/customer satisfaction, which is the end goal of any healthcare provider,” said Dr Amar Agarwal, Chairman and Managing Director, Dr Agarwal’s Eye Hospitals. “We are proud to partner with Dr Agarwal’s Eye Hospital, a pioneer in eye care specialty in India, on its transformation journey. Our cloud-based healthcare solution brings in the best-of-breed combination of HIS and ERP to help Dr Agarwal’s Eye Hospital provide efficient, information-driven healthcare in an affordable way. We are very excited about this partnership,” said Veera Raghavan, Executive Director and Global Practice Head, Healthcare & Life Sciences, Dell Services.
Start-up
Augmenting Home
Healthcare Market Increasing chronic lifestyle diseases in India and access to professional and affordable healthcare at home, has given Portea Medical in Bengaluru a buzzing start-up in home healthcare services
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oncept of professional, accessible and affordable home healthcare in India was virtually non-existent before the advent of Portea Medical in 2013. Few players who existed, were “momand-pop” stores which offered an unsophisticated “bedside attendant” service with neither the standards, reliability, accountability, medical knowledge nor the overall professionalism that underpins home healthcare in more advanced nations such as US and UK. Portea has enabled an effective continuum of care for hospitals and their patients that was not easily available, previously, in India. “Prior to Portea, a family needed to go to several doctors and different locations to cater for geriatric care, basic primary care, post operative care, routine check-ups, and requirements such as diagnostics or medical equipment. We have consolidated the management of all of this and become an active co-participant in the healthcare needs of a family. We don’t handle emergency care and refer or assist
our patients requiring this to hospitals,” Meena Ganesh, Co-Founder & CEO, Portea Medical told Elets News Network (ENN). In three years Portea presence is across 24 cities in India and four cities in Malaysia. With nearly 3,000 staffs handle 60,000 visits per month. It has become the largest and fastest growing player in home healthcare services. “Home healthcare in the country is a very people intensive and execution-oriented business. Ensuring consistent quality across so many cities is a challenge. Portea has addressed this by using a proprietary app and tech platform that displays SOPs for each procedure, allows for clinician monitoring and supervision, and collects all the relevant health-related data to ensure that we have a complete record on the patient’s health,” Ganesh said. Portea clinicians have access to the Portea app, through which they can access the patient’s medical history, check for specific instructions from the patient’s consulting specialist; provide real time update of there vital parameters via patient health record (PHR). The firm currently uses America Megatrends’s smart diagnostic tool called BOLT which collects patients BP, temperature, and pulse oximetry in a passive manner. This
data is then uploaded into data collection architecture. “We are in the process of creating predictive analytics, which will allow us to proactively intervene when we see a patient’s health indicators in a worrisome direction. We have also just launched a patient (customer) app with just three taps; managing appointments, track health records, subscriptions and payments; enabling cashless transactions with Portea wallet; avail offers, and earn through referrals,” she said. Confident about the home healthcare sector Meena informs that the market is growing with US$ three billion annually and opportunity is huge and attractive. Talking about venturing in healthcare start up Meena says, “In any economy, a dominant majority nearly 90 per cent of the new job creation happens in new ventures and not in old ones. This is of special significance for India where start-ups have contributed to creating millions of blue collar and white collar jobs, directly or indirectly. The entire startup ecosystem today in Bangalore and in India is very conducive to entrepreneurship. What started off in a small way in the late 90s, has inspired many entrepreneurs and I am proud to have been a part of these revolutionary changes. I hope that millions of other ventures bloom in India in the coming years.”
OCTOBER / 2015 ehealth.eletsonline.com
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Start-up
80 Bedded MultiSpeciality Hospital in GK-I To provide a doctor friendly environment that enables medical practitioners for better healthcare services to their patients, Dr Shivani Sachdev Gour along with Dr Vishal Dutt started SCI International Hospital
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he posh New Delhi neighbourhood of Greater Kailash-I, gets an 80-bedded SCI (Surgical Centre of India) International hospital equipped with integrated healthcare facilities to all sections of the society, maintaining high standards of ethical practice and professional competency.
SCI International Hospital commenced in April, 2015 provides comprehensive super-speciality services in Urology, IVF, Mother & Child Care and Advanced Laparoscopy procedures. It has three sets of wellequipped modular operation theatres with HEPA (High-efficiency particulate arrestance) filters to regulate the air flow and minimise the infection. Hospital has one minor operation theater, Labor Delivery Rooms (LDR), 10-bedded well-equipped ICU and 15-bedded neonatal intensive-care unit (NICU). Well qualified ex-
(in a month) has well qualified and trained doctors present round the clock to manage emergency cases with 24 hours ambulance service by the hospital. Each ward is managed by adequate number of qualified and experienced nursing staff, who provides high standard nursing care to the patient. With self investment through bank loans, the infrastructure of the hospital is gradually setting a benchmark for mid segment hospitals in a way ahead of similar size centres. The five storied hospital, at present has 49 operational beds
There was a great need for international level hospital offering minimal access surgeries, urology, mother and child along with fertility services and others like Orthopaedics, ENT etc. We are offering at affordable prices and this is an endeavour in that direction - Dr Shivani Sachdev Gour
perienced and reputed consultants in all specialties are working in the hospital. The health centre is equipped with sharing, single private, executive, super deluxe and twin room suite centrally air-conditioned. The health centre with patient inflow of 200-250 patients
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and rest will be functional in a month’s time. As of now, the hospital runs three centers two in South Delhi and One in Noida with collective bed strength of 100. The hospital plans for expand its operations in Delhi and NCR soon. For more information visit: http://www.scihospital.com/
Product Launch
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hromophare F-Generation lights combine revolutionary reflector technology with newest LED technology called as ’Hybrid- LED’for reflection and glare-free light. In contrast to other technologies, the light is mixed in the reflector within the light head to generate a light with outstanding spectral properties. Newest generation LEDs save energy and produce almost no heat. Color-cast shadows in the surgical field are reduced to a minimum. With Operon D-Series OT tables, Stryker brings many firsts to India. Operon boasts of being world’s first 567 kg standard operating table, first sensor recognition of modules, largest height adjustment range on a standard operating table and first carbon fiber table top incorporated into a general purpose table. Berchtold Operon line of surgical tables is designed to provide improved workflow, flexibility, quality and safety in conjunction with latest industry leading technology. Special features like capability to support heavy loads and maneuverability, Operon series is equipped for all eventualities. Its flexibility makes it suited for all kinds of minimally invasive, bariatric, spine and orthopedics surgery. Smart and intuitive OT tables are designed to meet a wide range of patient positioning. Its modular structure also allows adaptation to the patient’s body size. It allows surgeon to operate while sitting or standing as table height can be adjusted up to 440 mm. For optimum fluoroscopy, the tabletop can be moved longitudinally. Rajesh Babu, Head of Institutional Business, Stryker India said, “With Berchtold lights and OT tables portfolio we endeavour to elevate the standards
from a small spot to a very wide field. All this has been achieved with a full 160,000 Lux shadow-free illumination.” New Berchtold lights and tables are a generation ahead of all others and fully equipped to meet surgeon and patient requirements during a surgical procedure. Chromophare F-Generation lights are equipped with free color selection feature that allows choosing between daylight quality illumination at the standard 4,500 k or lower or higher color temperature as per the surgical situation. With an estimated lifespan of 40,000 hours for the 104 LEDs and upgradeable design of the suspension system, the Berchtold LED F-Gen is designed to minimise maintenance and offer easy upgrades. In OT, it is critical for lights to be movable with ease throughout the life of the theatre. High quality and durable suspension systems in Berchtold lights allow seamless movement during the surgery. Unrestricted rotation of light head around its axis provides flexibility and ensures more freedom of movement. Offset mounting of lights and pendants provide the best free moving space and unhindered operating space. The relatively ‘weightless’ lights are easy to maneuver and can be positioned as per surgeon’s comfort and preference. Flexible lights can be combined with each other in any way and with camera system and monitors. They can be attached to the ceiling or wall. Berchtold OT lights not only have an obvious high performance, but are also equipped with high quality and durable suspension system. IP53 certified these lights are fluid resistant and capable of withstanding the rigours theatre environment.
Enhancing OT Safety for overall patient care in India. Good quality OT lights and tables are critical for a better working environment to surgeon in an OT which in-turn reduces error and enhance patient outcomes. Our Chromophare F-Generation Hybrid LED combines a patented one piece reflector system with LED light engines. Hybrid-LED uses all the benefits of a reflector to create the homogeneous and shadow-free light combined with the latest generation LED elements. As a result, there is an exceptionally slim light head with no moving parts internally, yet able to achieve large focal range,
OCTOBER / 2015 ehealth.eletsonline.com
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Pharma Buzz
Sun Pharma to acquire InSite Vision
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un Pharma has announced its one of the subsidiary entering into an agreement and plan of merger with InSite Vision Inc. (InSite Vision). Under this agreement the subsidiary has offered to acquire InSite Vision. InSite Vision focuses on developing new specialty ophthalmic products, including three late stage programs. Jerry St. Peter, Vice President and Head of Sun Pharma’s US Ophthalmic Business said InSite Vision will bring with it a pipeline of three latestage clinical candidates, validated drug delivery technology and a track record of achieving USFDA approval for ophthalmic products.” Kal Sundaram, CEO of Sun Pharma’s North American Business said “This potential acquisition is a part of our overall objective of transitioning to a specialty company. Besides dermatology, we have identified ophthalmics as one of the key segments for establishing our branded presence in US.”
Dr Reddy’s Inks Commercialisation Deal with Hatchtech
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r Reddy’s Laboratories has signed a commercialisation deal with Hatchtech, an Australian pharmaceutical company for developing an innovative prescription head lice product, Xeglyze Lotion. The exclusive rights for this product are applicable for the territories of the United States, Canada, India, Russia and the CIS, Australia, New Zealand and Venezuela. Hatchtech had announced that it will be filing its New Drug Application for Xeglyze with the US Food and Drug Administration (FDA). If approved, the product will be marketed in US by Promius Pharma. As part of the agreement Dr Reddy’s will pay Hatchtech an upfront amount of US$ 10 million, up to US$ 50 million based on pre commercialisation milestones and an undisclosed amount based on post commercialisation milestones, linked to achievement of annual net sales targets.
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GSK Pharma’s `1,000 crore Manufacturing Unit in Karnataka
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harmaceutical company GalaxoSmithKilne will be setting up Rs 1000 crore manufacturing unit in Vemgal, Karnataka, whose foundation stone was laid by Chief Minister Siddaramaiah in the presence of UK’s Minister of State for Trade and Investment Francis Maude. Siddaramaiah, Chief Minister of Karnataka said, “GlaxoSmithKline Pharmaceuticals Limited’s state-ofthe-art plant in Kolar district is yet another major investment by a multinational company in Karnataka which hopefully, will prompt other companies to come and invest in the State.” The unit is said to be operational by 2017, and will make more than eight billion tablets and one billion capsules in the areas of gastroenterology and anti-inflammatory medicines for the Indian market. The facility will be built on a 50acre site in Vemgal, Karnataka. The factory
is expected to employ of 300 people in the region once in operation. Annaswamy Vaidheesh, Managing Director, GlaxoSmithKline Pharmaceuticals, India said, “GSK has been at the forefront of serving the healthcare needs of India for more than 90 years. We fully support the government in their efforts to increase access to affordable medicines to improve healthcare and we are very excited to begin work on what will become our largest manufacturing facility in India. With this new facility, GSK Pharma aim to further strengthen its commitment to helping the patients in India to improve their health and well-being.” The factory will be built in partnership with international and local design and construction companies. The facility will also include a warehouse, site infrastructure, employee welfare centre and utilities to support the manufacturing and packing of the medicines.
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