Asia’s premier Monthly Magazine on ICT in Education Volume 10
Issue 9
September 2015
PRESIDENT: Dr M P Narayanan EDITOR-IN-CHIEF: Dr Ravi Gupta CONNECTING TECHNOLOGIES, TRENDS & BUSINESS
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Contents
10
SEptember 2015 | VOLUME - 10 | ISSUE - 09
Cover Story
Revitalising Healthcare Infra – Synergising Well-Being for All Indian healthcare infrastructure is in a state of paradox. While certain urban centres have five-star deluxe facility hospitals with a state-of-the-art medical technologies; there are areas which don’t even have the basic access to primary healthcare
36 Focus – mHealth
Adding Pace to Healthcare Delivery Given the fast increasing reach of mobiles in India, the healthcare industry is coming up with innovative models of integrated care processes, thus giving the whole concept of healthcare delivery a patient-centric turn
22 Viewpoint
Building Bricks of Well-Being Dr Sunil Kr Khetarpal COO, Shalby Hospital, Indore
47 Spotlight
Reaching the Unreached Rahul Mullick Head-ICT & Supply Chain, India Programs, Bills & Melinda Gates Foundation
6
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editorial
Bridging Infra Gaps in Healthcare There is a dire need to create an infrastructure to provide basic healthcare facilities to the teeming millions. The current issue of eHealth will highlight the policies and private sector initiatives that can help create infrastructure void. According to a recent PwC report, part of the problem is the shortage of manpower and physical infrastructure needed to provide better healthcare. The ratio of doctors per 1,000 people is just 0.6. In Brazil and China, it’s 1.8. And India has only 1.3 hospital beds per 1,000 people—significantly lower than the guideline of 3.5 beds defined by the World Health Organisation (WHO). There is a growing need for healthcare-sector players to focus on improving the reach, quality, and affordability of healthcare. Though India is expected to become the third-largest in APAC in terms of total healthcare expenditure, with the largest CAGR expected in healthcare expenditure by 2020 at 19.8 per cent, a lot more is desired. The private sector is expected to continue to increase its share from the current 65 per cent as more investments pour into private primary care services, diagnostic services and hospitals from within the country and international investments. However, there are significant challenges to be addressed both in terms of accessibility of the healthcare services and quality of patient care. But these challenges also present a significant opportunity for the private service providers along with the government that is also playing an important role in facilitating this evolution. To look at a few recent government programmes, Ministry of Health and Family Welfare announced its initiative to establish National Medical College Network (NMCN), wherein 41 government medical colleges are being networked in the first phase riding over National Knowledge Network (NKN) with the purpose of eEducation and eHealthcare delivery. One National Resource Centre and six Regional Resource Centres have been identified for promoting technologies like remote patient monitoring to aid the healthcare sector. Our cover story of the current issue looks at the scope and the future of synergising infrastructure while bridging the gap in the country. In further initiatives to boost the healthcare sector, two National Centres of Ageing have been proposed to be set-up during the remaining period of the 12th Five Year Plan. Administrative approval has been issued to AIIMS, New Delhi and Madras Medical College, Chennai. Besides clinical service, these centres will also undertake activities related to training, education and research. The charges for patient care will be at par with the rates applicable to other patients treated at the Institutes. India needs and will continue to see growth in private-sector healthcare delivery despite investments made by the government in public health, as there is an underserved population for which the government needs to develop healthcare access. Needless to say, the healthcare sector holds promises for exponential growth in the foreseeable future.
Dr Ravi Gupta ravi.gupta@elets.in September / 2015 ehealth.eletsonline.com
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Cover Story
Revitalising Healthcare Infra Synergising Well-Being for All
Indian healthcare infrastructure is in a state of paradox. While certain urban centres have five-star deluxe facility hospitals with a state-of-theart medical technologies; there are areas which don’t even have the basic access to primary healthcare. Although various state governments are taking initiatives to improve the health infrastructure, various health experts share with Prathiba Raju of Elets News Network (ENN) on how a major revamp is necessary 10
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Cover Story
H
ealthcare in India exuberates a wide disparity among all levels, while at one end it is heading towards advancements in innovative healthcare, at the other end, it lacks basic infrastructure in the medical facilities. To bridge this gap, a major revamping of the healthcare infrastructure is needed which includes upgrading the Primary Healthcare Centres (PHCs), preventive health measures, pre-natal care, vaccinations and counselling on the importance of hygienic practices, and sanitation at all urban, rural centres and secondary care hospitals in taluka
and district hospital levels. There has to be increased participation of private sector for infrastructure and capacity development. Drawing the concern of the healthcare infrastructure, Pranab Mukherjee, President of India, recently informed in a conference, “A developing country like India needs a universally accessible, affordable and effective healthcare which can be acquired only by having a robust healthcare infrastructure, trained and motivated personnel, and better access to medicines and equipment.” Considering that India’s public expenditure on health is meagre, Mukherjee said that a significant
Pranab Mukherjee, President of India: A developing country like India needs a universally accessible, affordable and effective healthcare which can be acquired only by having a robust healthcare infrastructure, trained and motivated personnel, and better access to medicines and equipment.
rise in health urgently required.
expenditure
is
Govt and Private Sector Synergy The healthcare infrastructure is in a juncture where the synergy between the state governments and private sector is crucial. As the Government of India has informed that they would increase healthcare expenditure to 2.5 per cent of the Gross Domestic Product (GDP), various state governments are trying to improve the health infrastructure. This alone cannot meet the infrastructure capacity, the private players also need to fit in the shortages existing in the current healthcare system. “Improved healthcare infrastructure is definitely the need of an emerging economy like India and private players have been major contributors. Though the various state governments have come up with the programmes, private players have facilitated the government to reach to the grassroot levels,” says Amol
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Cover Story
Naikawadi, Joint Managing Director, Indus Health Plus (P) Ltd, Pune. “Many organised private infrastructure sector are making inroads in tier II and tier III cities. They give opportunity to not only increase the penetration of quality health services but also be the growth driver in these regions,” said Naikawadi. Informing the government should come up with investment-friendly policies in the health sector, Dr Sunil K Khetarpal, Chief Operating Officer, Shalby Hospital, Indore said, “Easy loans from banks to set up private hospitals, diagnostic centres and pharmaceuticals can change the face of healthcare infrastructure in India. In the developed market, health insurance companies can compete with each other. They can also negotiate with hospitals for the quality of services offered to the patients. Eventually, a better competitive market will reduce costs and result in better services.” Despite making rapid strides in the last decade in various aspects of healthcare, the country still faces basic healthcare challenge like scarcity of beds, proper doctorpatient ratio, lack of essential drugs, alignment of hospitals with physicians more closely and a well integrated hospital information system and data management is yet a miss.
Gaping Gaps in Healthcare As a country we face an acute shortage of over 64 lakh skilled human resource in the health sector, the physician density of India per
Our country faces acute shortage of over 64 lakh skilled human resource in the health sector, the physician density of India per 10,000 populations stands poorly at 6.5. India’s nursing and midwifery density of 10 per 10,000 of population is not even half the global average of 28.1. The worst indicator is the density hospital beds per 10,000 populations, which stands at nine against a global average of 30 10,000 population stands poorly at 6.5. India’s nursing and midwifery density of 10 per 10,000 of population is not even half the global average of 28.1. The worst indicator is the density hospital beds per 10,000 population, which stands at nine against a global average of 30. In the WHO ranking of the world’s health systems, India stands at
Nilaya Varma, Partner and Head of Government and Healthcare , Infrastructure and Government Service (IGS), KPMG in India: India’s poor health infrastructure brings to light the country’s struggle of providing sustainable access to healthcare to its populace. While on one hand, we have advent of several major hospital chains on the other hand, the insufficiency in the total bed capacity, lack of human resource are major causes of concern.
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a low 112th position, whereas its neighbouring countries Sri Lanka stand at 76th position and Bangladesh 88th position. “India’s poor health infrastructure brings to light the country’s struggle of providing sustainable healthcare to its populace. While on one hand, we have advent of several major hospital chains, on the other hand, the insufficiency in the total bed capacity and lack of human resource are major causes of concern,” said Nilaya Varma, Partner and Head of Government and Healthcare, Infrastructure and Government Service (IGS), KPMG in India. Varma also emphasised that the health gaps need to be addressed for an effective foresight. Designing
Cover Story
a competent policy framework, pertinent regulation and a push from the top are required to realise national health goals to build a robust healthcare infrastructure in the country. As per a study conducted by Pricewaterhouse Coopers (PwC) report, ‘The Future of India: The Winning Leap’, in order to meet the desired outcomes in terms of hard and soft infrastructure capability, the healthcare delivery system will need to add 3.6 million beds, three million doctors and six million nurses over the next 20 years. “In order to meet the deficit of bed, doctor and patient ratio an investment of around US$ 245 billion is needed. Such an investment would not only put fiscal pressure, but would be difficult to implement considering the nature and scale of
Amol Naikawadi, Joint Managing Director, Indus Health Plus (P) Ltd, Pune: “Many organised private infrastructure sector are making inroads in tier II and tier III cities. They give opportunity to not only increase the penetration of quality health services but also be the growth driver in these regions.” new additions. For instance, over the last decade roughly 100,000 hospital beds have been added annually. If India continues to maintain this rate, it will fall short of the Winning Leap target by 1.6 million beds by 2034. The country needs solutions that can help maximise reach and efficacy and are cost-effective by a quantum margin,” the report stated. As per analysts, a stronger regulatory framework will help to enhance efficiency and fill the necessary gaps; the healthcare
Dr Sunil K Khetarpal, Chief Operating Officer, Shalby Hospital, Indore: “Easy loans from banks to set up private hospitals, diagnostic centres and pharmaceuticals can change the face of healthcare infrastructure in India. In the developed market, health insurance companies can compete with each other. A better competitive market will reduce costs and result in better services.”
market is expected to grow at a steady pace during the next decade. The industry should concentrate on non-metro urban market, government sponsored health insurance programs and implementing IT in the healthcare domain.
Health Insurance- a key factor Good quality healthcare should be a right, not a privilege. A proper health insurance would be a game changer, as it would help the common man avail medical treatment at good facilities. Health insurance would be an aid for nearly 40 million people who are burdened by out of pocket expenses. Analysts feel the buzz on the Insurance Bill and universal health cover has helped raise awareness on health insurance in India. In terms of the gross written premium, the industry has crossed `20,000-crore mark in 2014 and is expected to grow impressively in the coming years. “High out-of-pocket expense is an indication of low health insurance coverage in India. Less than 15 per cent of population has some form of health insurance coverage. There is immense potential for the health insurance segment and there is an urgent need to ramp up the health insurance coverage in the country,” Dr Khetarpal said. Four years ago, amongst the BRICS nations, Russia’s out-ofpocket expenses stood highest at 87.9 per cent, closely followed by India (86%), China (78.8%), Brazil (57.8%), and South Africa (13.8%). On the other hand, these expenses in the developed economies of US and UK were comfortably poised at 20.9 per
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Cover Story
cent and 53.1 per cent respectively. Lack of awareness and tendency to postpone the decision to buy health insurance are the main reasons for low health insurance coverage in India. “The health insurance has become one of the most promising segments today and is expected to grow significantly in the next few years. There are innovative offerings and schemes from the health insurance companies to attract the insured. As spending on healthcare in India is expected to grow double in a couple of years, health insurance segment is likely to become the biggest contributor in the non-life segment,” said Puneet Gupta, a Star Health Insurance consultant. The health insurance industry is dominated by four public sector entities –National Insurance, New India Insurance, Oriental Insurance, and United India Insurance, which have 60 per cent market share. The rest of the market shared by 17 private sector players, of which four are standalone health insurance players - Star Health, Apollo Munich, Max Bupa and Religare Health. Among the private players, ICICI Lombard continus to be the largest private sector non-life insurance company, with a market share of around 10 per cent. Apart from insurance, the advancement of IT in healthcare has given a facelift to the healthcare sector.
Abhijit Gupta, Founder and CEO, Praxify Technologies: “From struggling to get decent broadband bandwidth to set up heavy resource driven server infrastructures, India has come a long way in IT initiatives. With the advent of cloud and mobility, and the growing demand of ubiquitous access, IT has started playing a strong role of an enabler in the medical infrastructure today.” infrastructures, India has come a long way in the past two decades. With the advent of cloud and mobility, and the growing demand of ubiquitous access, IT has started playing a strong role of an enabler in the medical infrastructure today informed Abhijit Gupta, Founder and CEO, Praxify Technologies. Several health experts feel that the new mobile and cloud-enabled
applications imply a lot of backend infrastructure readiness from IT right from secured access, wireless connectivity, proper bandwidth utilisation, to providing security to devices and data. “Lot of experimentation is going on in the various modules available with various service providers. The hospitals are customising the modules at their end as per their
PwC report states that clearly defined policy related to incentives, tax rebates, institutional loan interest waiver scheme, land acquisition, SEZ status approval and removal of red tape-ism in attracting big private service providers to set up large super specialty and multi-specialty facilities as well as medi-cities is needed to achieve robust healthcare infrastructure
IT- the game changer The use of Information Technology (IT) in healthcare is on the rise and it is projected to grow by leaps and bounds in the coming years. The IT in healthcare is empowering health domain with more affordable, accurate and accessible healthcare than ever before. And it’s just the beginning. “From struggling to get decent broadband bandwidth to set up heavy resource driven server
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Tech-health: Doctors do direct video conferencing with patients
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Cover Story
needs. The challenge lies in bringing along the medical fraternity i.e. the clinicians and nursing personnel, who are not exposed to IT and find it difficult to acclimatise their working from real paper to virtual tablet,” said Dr H S Chhabra, Chief of Spine Services and Medical Director, Indian Spinal Injuries Centre, Vasant Kunj. Dr Ashendu Pandey, CEO, CK Birla Hospitals, said, “CK Birla Hospitals have invested substantially in the implementation and will keep on investing in technology which will help in redefining healthcare practices in eastern India.” With technology being the new buzz word in healthcare industry, doctors too take help of apps and smart phones. For example, the mHealth apps and software help the doctors to keep track of the patients. “Mobile-enabled collaboration platforms can ensure real time patient and staff engagement before, during and after hospitalisation.
Dr H S Chhabra, Chief of Spine Services and Medical Director, Indian Spinal Injuries Centre, Vasant Kunj: “Lot of experimentation is going on in the various modules available with various service providers. The hospitals are customising the modules at their end as per their needs. The challenge lies in bringing along the medical fraternity i.e. the clinicians and nursing personnel, who are not exposed to IT and find it difficult to acclimatise their working from real paper to virtual tablet.”
With exponentially increased use of IT and advances in mobile technology, healthcare delivery is all set to go beyond the physical confines of a hospital and empower patients to access healthcare anywhere, anytime,” said Chandrashekhar B C, Head of Product Management, CSC Asia, Middle East and Africa. He also added that IT should also be taken to tier II and tier III cities and to the grassroots levels via video conferencing, spreading useful medical apps in villages
In the WHO ranking of the world’s health systems, India falls lowly on the 112th position, whereas its neighbouring countries Sri Lanka stand in 76th position and Bangladesh in 88th position
A unqualified person treats a patient
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as smart phones are widespread.
Need for a push The ever-growing population and increasing disease burden have made our country to work on fast paced health reforms. The healthcare infrastructure needs huge investments. The private sector has ample business opportunity to establish their presence and expand their operations market share in the healthcare delivery market in India either by partnering with the different state governments or by pursuing a pure private model. “The Centre and different state governments need to facilitate the private sector by helping to improve the investment climate in the respective states. They need to place clear policies and guidelines in the healthcare sector, which will enable to attract large private investments in the healthcare industry, viz, leveraging state specific PPP models, encouraging private hospitals participation in semi-urban areas,” Naikawadi informed. Defining the way ahead, the PwC report listed that clearly defined policy related to incentives, tax rebates, institutional loan interest waiver scheme, land acquisition, SEZ status approval and removal of red tapism is attracting big private service providers to set up large super specialty and multi-specialty facilities as well as medi-cities is need of the hour.
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Industry Speak
Innovating Care Solutions Dr Adheet S Gogate, Partner & Head, Philips Healthcare Transformation Services, India, discusses the digitisation of hospital information system becoming more patient-centric to deliver better care services, in conversation with Romiya Das of Elets News Network (ENN) How do you see the Healthcare infrastructure market in India vis-a-vis global market? India’s healthcare infrastructure development market is more or less similar to those in mid-sized economies. Driven by factors such as rising standards, expectation of better ambiences in the enduser spaces, it is also constrained by patchy construction quality, questionable labour quality and productivity, poor fits and finishes, high variability across cities and locations, regulatory uncertainty. Few other challenges come in the form of disproportionately, high property prices, especially, in the strategic locations that are important for hospitals. With complex regulations, healthcare infrastructure development is more challenging, costly and risky than it needs to be.
Please throw some light on Philips contribution in enhancing healthcare infrastructure? Philips recognises that the world of healthcare that we are entering is fundamentally different from the world that we have lived in. Earlier healthcare was paternalistic, physician centred and with poor data management. Tomorrow’s healthcare is going to be patientcentric, empowered and comprising rich data. The change is happening at varying paces, but its direction
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is undeniable and will deeply transform how care is provided, for instance, earlier to get registered as a patient in a hospital required them to visit multiple counters, to make a card, to plan insurance, to make payments, to get an appointment and so on. This process represented how hospitals are organised in their department of records, management, cashier, booking clerk etc. However, it is not about how the patient wants the healthcare. We at HTS are working with hospitals redefining their experience easing the patient’s comfortability by regular interaction with their care providers. We work with both new hospitals and older ones looking to transform their systems. For instance, we are working with one 50-year-old hospital helping them thoroughly revamp their infrastructure. Some of our recommendations were seen as radical in reducing beds and increasing intensive care and theatres. Our rationale was simple, in the future, admission to hospital will increasingly happen purely for interventions or surgeries, and not for basic medical conditions. Hence, the entire space
allocation needs to be changed to enable more intervention, more critical care and less oldfashioned ‘lying in’. For example, hospitals then had beds assigned by departments in some wards, you had only surgery patients; in others only ENT patients and so on. But this is inefficient as one department may be empty and another may be full, turning away patients. In our estimation, running inpatient beds enables more efficient usage of capital and scarce talent – something that has significant impact on reducing prices. These require new m i n d -
Industry Speak
sets, processes, infrastructure and resources. In other areas, we are working with our customers to bring technology to patients that enable them to diagnose illnesses faster or manage their own chronic diseases most efficiently. A decade ago, managing diabetes meant testing your blood sugar every month. At present, one can not only measure it daily, but you can upload it to the cloud. One can correlate this data with when medications were taken, caloric information of food, tracking of movement and exercise, monitoring of ECG’s and scores of other data, to give a rich picture of overall wellness and illness. In this environment, patients, with help from their devices and caregivers, will have tremendous visibility into managing their illness far better than they ever have in the hanging. Working with doctors and patients to make this happen is what we are focusing on. The goal is to improve overall system outcomes which are the core of transformation.
What are the policies or regulations required to build a robust healthcare infrastructure? This is quite a complex subject, but we need to change our mindset quite fundamentally. We need to shift our focus from infrastructure to outcomes. I say that because having infrastructure may be necessary, but it is not sufficient. Going forward, the nature of infrastructure required may itself need a change. We may no longer need so many PHC’s for instance, if we have effective telephonic primary care, we may need better telephony bandwidth, reliable power and drug availability. In such an environment, should we really be obsessed about how many PHC’s we have? At the highest levels, our overall policy must be directed towards ensuring
better outcomes - what that means in terms of infrastructure is transient and keeps changing. We need to stay abreast of trends and technologies.
How helpful do you think is the adoption of PPP model to improve healthcare infrastructure? Basically, a good Public-PrivatePartnership (PPP) model is one that combines the strengths of the public sector (usually legal standing, trust, ability to deploy resources) and for those of private enterprises (innovation, efficiency, performance orientation, focus on financial
imaging being expensive, private players cannot achieve sustainable financial results. To close this gap, we have designed and developed a PPP model by which private clinicians and technology providers can deliver these services to the poor as a contracted government service provider.
How do you see the health technology evolving in the coming years? At present, the technology operates in silos and provides pieces of diagnostic information or therapy. In the near future, informatics and
A good PPP model is one that combines the strengths of the public sector and for those of private enterprises to deliver a service that would not have been possible by either type of agency on its own sustainability & profitability, competition) to deliver a service that would not have been possible by either type of agency on its own. If the PPP developing agency has established a good understanding of a healthcare problem and its root causes and has determined that a mix of private and public skills are essential, then you are off to a good start. The key to success is to make sure that both parties are incentivised and accountable for clear goals – and that these goals are critical to overall success. We have several good PPP’s in India. Ambulance service such as 108 is commendable example where PPP’s can work well, get the public sector to pay for it and have competing private agencies run it efficiently, professionally and to continually improving standards. We are already working with governments to bring the PPP idea into diagnostic imaging. There are opportunities in poor areas where
digital technology systems will stick together. Patient data will go from being a jigsaw to a composite picture. This ‘full picture’ will have dramatic impact on patient care.
To emerge ahead in the healthcare landscape by 2020, care providers have to move beyond traditional care and get onto a ‘patient centric care’ delivery model. Please elaborate. As mentioned above, with so much information, insight and planning, patients will be far more knowledgeable of their disease than ever before. They will also own their data. Earlier, patients could not even interpret the most basic results such as diabetes. But all this is now transforming. For chronic diseases, it will be a game changer. It will have deep implications, even the role of surgeries and interventions for maintaining health will change
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Buyers Speak
Call for Structured Patient Information Integration India needs to boost implementation of IT to create a well structured healthcare where there is an interpretation of paperless, seamless environment where all the data is available right from where the patient walks in at any entry point for any through hospital information system, says Dr Jagdish Modhe, Head of Imaging Department, PD Hinduja Hospital, Mumbai in conversation with Romiya Das of Elets News Network (ENN) How do you see the healthcare infrastructure market in India compared to the global market?
How does RIS, PACS technology affect healthcare IT and your opinion on your current service provider? Did it meet all milestones?
The Indian healthcare infrastructure market needs to go a long way. The international market such as US and Europe is well structured and they importance to IT in terms of medical records are electronically stored. Unfortunately, in India not much importance is given to Healthcare IT. They feel that it is sort of nonrevenue generating thing for them and refrain from investment in this domain. There are few private and public hospitals in the country that have gone into full-fledged IT structure.
What are your views on HIS, RIS, PACS in India? We are moving towards paperless, seamless environment where all the data is available right from the patient walks in at any entry point for any through hospital information system. This information is captured where any services rendered for instance when X-ray, CT scan or MRI is done it helps avoiding the mistakes regarding personal information. This forms the base of your records. The same information is transferred through the Radiology Information System (RIS) to the modality. With the advent of technology, all the images
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captured, they are transferred to the reporting or picture archiving and communication system (PACS) station. In this reporting station the soft copy report is viewed. The advantage here is time is saved and the different processes can be done sitting at one place. The system helps making the reports of the patients (with repetitive visits) easily available the reports of the tests done six months or year back, to compare with the present diagnosis. Therefore, it is easier to make the comparative reports. Also, with the digital signature procedure helps us to save time from manually signing the reports.
We have one of the longest experiences, we started with 2009 and recently in February this year we revamped the technology. Very few people understand about the entire HIS, RIS and PACS process in India. It is a solution unlike buying CT scanners or other equipment. It is important to design work flow depending on the environment of the hospital. The key is how all these are integrated. We are satisfied with the solutions provided to us by Agfa Healthcare. They are the focal point connecting us with other solution providers as well.
What are the unique challenges of Hinduja Hospital? What we lack in our hospital is digitisation of medical records. It is easy for a new hospital to start with EMR as they don’t have any previous records. The challenge for us to integrating or digitising previous records and converting thirty year old reports is not an easy task. Therefore, integrating the previous records (inpatient and outpatient), lab reports is quite a task.
Industry Speak
ICT: Changing Healthcare Dynamics Information technology acts as an enabler in medical infrastructure, says Abhijit Gupta, Founder & CEO, Praxify Technologies in an interview with Romiya Das of Elets News Network (ENN) How has IT evolved in the Indian medical infrastructure? With the advent of cloud and mobility, and the growing demand of ubiquitous access, IT has started playing a strong role of an enabler in medical infrastructure. CIOs are looking at providing accessibility, efficiency and productivity improvements for their clinicians and patients by enabling them with better mobility enabled workflow applications. These mobile and cloud enabled applications imply a lot of backend infrastructure readiness from IT, - right from secured access, wireless connectivity, proper bandwidth utilisation, to providing security to devices and data.
Do you see a shift in perception among users vis-à-vis IT applications in healthcare? Consumerisation of IT with the advent of mobile apps, has led to a significant shift in perception among users. Today convenience and speed take higher priority in healthcare IT too, as with other domains in the market. Nowadays, a lot of doctors and patients use WhatsApp to share clinical images, questions and notes for effective and realtime communication.
What are the products offered by your company? Praxify offers a myriad of products for the healthcare enterprise built on top of a common platform – its
clinical workflow mobile apps, underlying health IT investments, the value chain in terms of outcomes and better patient care. Praxify’s care coordination and patient engagement apps enables an health enterprise to cater to the growing demands of their patients and improve carerelated insights by analysing more complete data from new patientcentric sources. The products we offer are Electronic Health Record (EHR) for ambulatory (Outpatient) and acute care (Inpatient), EHR for acute care (Inpatient), computerised physician order entry (CPOE) to minimise medication errors and increase compliance with various regulatory requirements like NABH, JCI, Electronic Medication Administration (eMAR) to keep a track of what medicine given and missed while improve qualityof-care. eVisits - keeps patient’s engaged via video conferencing from within EHR and save clinician time, improve patient satisfaction immensely and reduce cost. Branded Patient App and Portal is a fully integrated cloud hosted Patient app and portal completely branded for the hospital to take patient engagement to completely different level theory services like appointment booking, medical record access, results access, bill payments, booking other services like home sample pick up etc.
Patient care coordination – Take care of the patients before they walk in to your hospitals and after they walk out to ensure better outcome of care provided, improving treatment protocols, tracking compliance and providing timely interventions.
How have Indian hospitals fared in terms of adapting health IT as compared to other countries? Every country in the world goes through an evolution of healthcare IT adaptation. At one end of the spectrum, Indian hospitals have been spending a lot of effort in automating basic workflows from billing, revenue cycle, administration, etc., and at other end of the spectrum, only few corporate hospitals in India have taken leaps and bounds in implementing ICT in healthcare in various workflows for physicians, nurses, and patients. Indian hospitals are poised to leapfrog with adaptation of health IT with easier and scalable models of cloud and mobility.
What is the company’s vision upcoming years? Praxify sees itself positioned as a thought leading company, catalysing the revolution of the change in healthcare, fueled by the advent of digital technology. We plan to grow globally and fuel predictive analytics, which will change healthcare outcomes for a better generation.
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Viewpoint
Building Bricks of Well Being The upcoming years look positive but also challenging for the global healthcare sector amidst rising demand, continued cost pressures, lack of or inadequate care facilities, and rapidly evolving market conditions, says Dr Sunil Kr Khetarpal, COO, Shalby Hospitals, Indore on prevailing scenario of healthcare infrastructure with Romiya Das of Elets News Network (ENN)
A
s the urban spaces are gaining a population influx, it has become a common sight to witness metropolises suffocating for spaces be it in public mobility, housing; the healthcare sector too is facing a crunch in providing suitable infrastructure in its hospitals. It is imperative for the urban planners and policy makers to comprehend the nuances of healthcare infrastructure. There is a large capital requirement for building a new hospital in Indian cities. Any new venture requires an innovative thinking and has to be planned meticulously with a professional approach. The biggest challenge for our country today is to provide better healthcare delivery at affordable price or free healthcare services to the economically weaker section.
Financial constraints The challenges of the public healthcare providers thus create an opportunity for private healthcare provider to manage cost efficiency at micro level without compromising the quality of care. In addition, changing demographics, disease profiles and the shift from chronic to lifestyle diseases in the country has led to increased spending on healthcare delivery. High equipment and its maintenance costs, increased material cost, increased manpower cost, inadequate funding for capital improvements are the key challenges to startup a hospital from a financial perspective. Other challenges for running a hospital includes increased operating cost, reimbursement by government agencies, empanelled organisations and insurance companies or third party administrators (this includes delayed payment and deductions whether justified or unjustified), decreased footfall in OPDs and bed occupancy, achieving and maintaining quality standards and accreditation, competition from other providers. A sound financial planning is the key to address this challenge. It is important to be capitalist in approach and looking for optimal resource with a quantified approach.
Implementing reforms A comprehensive study report prepared by Mckinesy and Company in 2002 on “Indian Healthcare – Inspiring Possibilities Challenging Journey” for CII has outlined the healthcare reform scenario and
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role of government and private players in incorporating healthcare reform measures and implementation in 11th and 12th five year plan. The draft 12th five year plan defines the government’s strategy to implement ‘Universal Health Coverage’ which is a major challenge to meet. In the UHC model, all citizens should be entitled to a comprehensive package of healthcare services, and have access to public health and accredited private facilities for attaining services such as diagnostics, medicine, vaccines or surgeries as an entitlement, without having to pay at the point of use. This will widen the scope of access to quality and affordable healthcare to the citizens of the country where 70 per cent of healthcare expenses in India are incurred by people from their pockets, and 70 per cent spent on medicines alone which further leads to impoverishment and indebtedness. As a result of high OOP payments, 40 million Indians are pushed into poverty each year. There has to be strong political will and commitment to address the issues of accessibility, availability and affordability of healthcare to the citizens of the country and optimally maintaining a balance between the cost and quality. India needs to focus on preventive health, early detection and management of diseases, develop a short-term and long-term public private partnership strategy, increase efficiency through better and optimal utilisation of resources, and strengthening the systems and processes. The healthcare reforms should address aspects of
Viewpoint
based framework that will include a larger spectrum of standards, including diagnosis, procedure, laboratory coding and clinical standards. A major concern for the Indian healthcare industry is that, while the tertiary healthcare segment seems to be powered with IT usage, primary healthcare continues to look grim, something that can only be altered with stringent government regulations and mandates in effect.
Cost-effective products and solutions in medical technology has always been an issue due to lack of innovation. Due to limited number of options, there is a great demand supply gap in the market. India has destitute manufacturing base for healthcare technology. This is due to absence of any incentive schemes to attract local or foreign investors to set up a production base in India. The overall growth remains small due to low penetration of products.
Government Mandate Necessary
Technology Aided Growth and Challenges
Manpower Crunch punches Healthcare
While the US healthcare has norms to safeguard a patient’s right by keeping his medical history confidential, in India, there are no such mandates. Though the Indian healthcare industry is rapidly growing and is set to cross `1.3 trillion by 2020, the country is still working on putting together a set of regulatory framework for the healthcare industry. There is greater underutilisation of IT in clinical healthcare per se. The Medical Council of India (MCI) guidelines mandate hospitals to keep prescription records for three years, preferably on a computer which promotes use of IT in healthcare. However, keeping electronic medical records (EMR) remains a guideline and is not mandatory. EMR is also valid in the court of law. The Ministry of Health and Family Welfare (MoHFW) has proposed to set up National ehealth Authority – NeHA for development of an integrated HIS in India. It will also be responsible for enforcing laws and regulations relating to privacy and security of patient health information and records. Under this project, a uniform system of EMR for hospitals is developed that will maintain the records of treatment, identification, healthcare providers, cost of treatment, standard of healthcare availability and quality of treatment etc. The proposal is underway and its successful implementation will be an important step towards improving quality of patient care and data management. The government also plans to build a broad-
With the rapid development and advances in technological sciences, medical technology has played a strategic role in improving healthcare delivery towards better healthcare outcomes. Innovations in medical technology, enhances the quality of care and safety. The CII and Delloite study has revealed that despite a strong growth in medical technology market in India, there has been low penetration of technology. Considering heart disease as a major killer in the country, India’s pacemaker penetration is one per cent of the western market at 18,000 pacemakers per year against the requirement of a million pacemakers. There is a need to expand the market. Healthcare costs are rising dramatically, largely because of tremendous advances in diagnosis, treatment and prevention of diseases. Equipment like CT scan, MRI, ultrasound, mammography, simulator and linear accelerator etc required for diagnosis and treatment, need huge investment. Nowadays, the hospitals are planned and designed as super specialty hospitals manned and managed by super specialist. Tertiary care hospitals require huge investments in terms of infrastructure and equipment. In contrast to its vast presence in urban area, distribution of medical technology in rural area is a major challenge and the disparity resulting in poor or inadequate healthcare in those areas.
Manpower planning is an important element for hospitals. Itdepends upon the size of the hospital and specialties it is going to cater. As per World Health Report, India tops for shortage of healthcare workforce in the world, with 53 out of 57 in the ratio of healthcare personnel per thousand populations. The Indian Healthcare system suffers acute shortage of doctors, nurses and paramedics. India has seven doctors and 17.1 nurses per 10,000 populations which is much below WHO recommendation. Situation is worse in rural areas where thousands posts of doctors are vacant in PHCs and CHCs. Certain states are experiencing an acute shortage of health personnel. Inequalities in the distribution of health workers are highest for doctors and dentists and have a significant effect on health outcomes. As India is striving to achieve universal health coverage by 2020, the realisation of this goal remains challenged by the current lack of availability and inequitable distribution of appropriately trained, motivated and supported health workers. There are 387 medical colleges in the country—181 in government and 206 in private sector. India produces 30,000 doctors, 18,000 specialists, 30,000 AYUSH graduates, 54,000 nurses, 15,000 ANMs and 36,000 pharmacists annually. Although the production of health workers has expanded greatly in recent years, the problems of imbalances in their distribution persist.
hospital management such as regulatory or legislative reforms, reduce operating costs, supply chain management and value-based purchasing, alignment of hospitals with physicians more closely, well integrated Health Information System (HIS) and data management, ethical and best service practices to avoid penalties, hiring one or more primary care physicians, regular training and education of staff to reduce adverse events and healthcare associated infections.
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Exclusive Interview
Medical Mall for Patients India has an availability of complete inequitable infrastructure. You find surplus in some pockets while you find it completely deficient in certain areas. To engage optimum healthcare, a suitable infrastructure is vital, says Dr Garima Singh, CEO, Saket City Hospital while speaking with Romiya Das of Elets News Network (ENN) How does Health Information System enable us to serve our patients better?
the hospitals to report. In India, there is no policy barring a few. It helps the country when you put across the demographic profile to rank in the world index. In the current scenario, every hospital claims to be the best. Are you educating the patient and is it reliable? Is there any data to prove that? So, the government needs to ensure the credentials of the doctors. Thirdly, making hospital land available. The basic criteria must be why a hospital in a particular area is needed, and if so, what specialities should be there. It should be driven by the community.
Health Information System (HIS) is extremely vital in different ways. From the time when the patient comes in for the first consultation, either in the OPD or in the emergency, all these records are registered. The medical records are retained to maintain the condition of the patient. From there, the admission formalities are done through a system along with other facilities. So, the entire system is geared to understand whether the patient is moving. It determines the acuity of care which is required and it determines our response to them. Labs, radiologythese are all integrated to the unique patient identity.
Can you elaborate on how technology is implemented by Saket City Hospital for patient management system? Each institution has its own set of policies. We have our own HIS that has been developed with a third party and which we have instituted right across the system. All our billing, radiology patient flows - are managed on the HIS, which has been developed by Akhil Systems.
Do government regulations or policies need to be changed or made better for the benefit of the hospitals to create a better infrastructure? The government needs to understand
What are the upcoming projects of Saket City Hospital?
that each of the institutions are running at a particular level of cost and the cost of providing care is going up for two-three different reasonsone is the rising salaries to beat the inflation. The cost of acquiring manpower is increasing year-byyear. With the dollar strengthening and most of the equipment, consumables and drugs coming up from abroad, we are losing leverage. It’s an erosion of the profitability. On the other hand, CGHS and other government hospitals are not increasing their prices. Appropriate pricing for services of discounted business through CGHS, ECHS and all need to be looked at very seriously. Making certain clinical outcome indicators mandatory for
In the first phase, we will be going from 230 to 300 beds, which is a one year plan. In two years plan, we will have additional 700 beds going upto a total of 1000 beds. It will be our highend facility dedicated to the western philosophy completely. We will probably have investors coming on board to partner with us in the new expansion phase. Apart from these, we are going to have a dedicated research and development centre. The idea is to get the best of minds together at one place. For instance, you have a doctor in Malaysia and a patient from India flies down there to be operated by him and you want to have an outpost here. It is a data concept and it is an office clinic, almost like a medical mall. We are planning a space for this, which has an additional 400 beds.
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Industry Speak
Structuring Modern Hospitals Sanjay Jaiswal, Founder & MD, Airox Technologies Private Limited, says Airsep Oxygen Generator uses state-of-the-art technology that customises Indian weather condition to provide purified oxygen in conversation with Romiya Das of Elets News Network (ENN) How do you see the healthcare infrastructure market in India compared to global market? India’s per capita expenditure on healthcare is very low compared with developed countries such as US (per capita healthcare expenditure of US$ 4,700 in 2010), the UK (US$ 1,700), Japan (US$ 2,800), etc. This is primarily on account of low disposable income and low government spend, the Indian government expenditure on healthcare is amongst the lowest, accounting for 4.2 per cent of the total GDP. At present, the general public meets around 78 per cent of their total health expenditure. There are fundamental differences between the markets in India relative to the developed markets. India has tremendous growth prospects in healthcare. The market in India is quite nascent, so the regulations, standards, and different parameters of how the health system is set up are in their infancy and are being created. That’s a big difference compared with the western world. Also, there is tremendous amount of price sensitivity in this market, so the point of affordability is absolutely paramount, having a product [priced], or pricing the service, at a very affordable rate is absolutely critical.
Please elaborate on Airsep Oxygen Generator? How does it contribute in enhancing health infra? Airsep Oxygen Generator is onsite oxygen production system for hospitals. The air is taken from the atmosphere which gets purified through different driers and filters. Medical grade oxygen is then separated through purified air through molecular sieve which is
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centrally connected to hospital oxygen supply. Like magnet, molecular sieves strongly attract certain type of molecules which have positive and negative electric poles. For this reason, nitrogen, carbon dioxide, carbon monoxide, hydrogen sulphide, hydrocarbons, water etc. are absorbed and oxygen passes through. For this reason CO2 and CO in our system does not exceed 100 & 2 PPM respectively which is far less than 300 & 5 PPM that is found in cryogenic oxygen. Besides this, our system offers benefits over cryogenic and cylinder oxygen such as saving 50 – 70 per cent on hospital oxygen consumption bills, our system is far safer than cryogenic and cylinder oxygen, it saves space as the compact system can be installed on terrace or in a room. It does not have heating transmission, evaporation and leakage problem which is major problem with liquid oxygen. Moreover, one can never be assured about cylinder filling. The manpower, stock maintenance, billing etc. are overheads which reduce with our system.
What are the unique features of Airsep Oxygen Generator? To maintain 4.5 bar pressure and consistent purity at Indian conditions with such high Indian temperature, humidity and atmospheric pressure one requires state-of-the-art Technology. Ours is only proven product which works in Indian atmospheric condition with more than 150 installations across India. The Zeolite that separates oxygen from air is developed by core team of Airsep Corporation in the USA, which is not available with any competitor. Our PSA process is unique and cannot be
duplicated. Due to this, robust process and our service team with 35 dedicated engineers and spare parts inventory of almost 3 crore, we can guaranty minimum 20 years life of our system. These things make us the market leader in India with more than 90 per cent market share in Indian private hospitals.
What are your business plans? With our tag line ‘Oxygen for Modern Hospital’, major corporate groups are already our customers and we want other key hospitals in India to incorporate this system. We have 80 employees and 20 distributors across the India to achieve our goal. We are also launching ETV (Electric Tracking Vehicle), a German technology in India which will be major revolution in Indian hospital industry. This technology is a modern way of transporting hospital material within hospital which reduces manpower, electricity cost, improves workflow and transports goods such as surgical instruments, pharmaceuticals, IV bags, blood bags, lab specimens, reports etc.
Industry Speak
Connecting Networks for
Healthcare Providers Ajay Deshpande, CTO, Rakya Technologies Private Limited, talks on automate hospital management and healthcare workflows during the golden hour of the patients in conversation with Romiya Das of Elets News Networks (ENN) The Indian healthcare industry is rapidly evolving, how has this affected the software or IT needs of hospitals? The primary catalyst behind the evolution of the healthcare industry in India is the growth of the Indian middle class, as the expectations of the patients are increasing. We see this pattern spreading to even places which were once considered as remote. This is adding a burden on the hospitals and the administrators. It is becoming imperative for hospitals to upgrade to good IT systems. Healthcare providers are looking for solutions that will relieve them of this administrative stress to deliver better healthcare services.
What are the challenges faced by the Indian healthcare providers? In addition to the usual issues related to their occupation, healthcare providers are faced by another set that are related to running a hospital. The primary one is decreased patient satisfaction. Patients expect more from every touch point from their hospital experience. Then healthcare providers face administrative stress arising from issues like compliance, resource pilferage, managing finances. Further, many of these hospitals are built by one person or a small set of people. What works for a smaller setup seldom works when the numbers escalate. Thus, they simultaneously discover scalable models while striving to keep
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their level of service high. Adopting IT and automating the workflow in hospital management is not a solution for all the problems, but will help streamline a majority of the processes. This in turn will help the healthcare providers concentrate on their core services.
How have Indian hospitals fared in terms of healthcare IT adoption as compared to other countries in Asia and globally? We all know that Indian hospitals have not fared too well in the adoption of the best of breed technologies. The adoption is concentrated in the urban parts. India as a whole did not have good infrastructure in communication, transport and other basic amenities. Thus, the hospitals have been waiting for the basic infrastructure to be available. However, with the mobile revolution in India, we have leapfrogged many countries in communication.
How is Rakya Technologies helping end-users? Rakya builds products that automate hospital management and healthcare workflows aiming to save lives by using technology in the needy hours of the patients. The company has already helped more than 150 hospitals transition from ‘pen and paper’ based workflows to IT based hospital. Rakya is among the providers of advanced endto-end technology solutions for hospitals in India. We provide ‘Electrical earthing
to electrifying the hospital’ solutions to healthcare providers. At present, Rakya’s software is instrumental in managing the various cross functional domains of many hospitals. Our endeavour is to partner with the hospitals to provide them with solutions as they grow.
What developments are likely to occur in the healthcare IT landscape in India in the near future, how is your company preparing for it? The healthcare market in India is on the cusp of a significant change. Some research predicts that India’s healthcare market will be US$ 70 billion by 2018. Another recent research estimated that there will be a need for 1.54 million more doctors to cater the country’s needs. With the economic engines in semiurban and rural areas surging ahead, a large part of this growth story will be happening in these areas. One of our key focus areas has been to get a deep understanding of the way hospitals run in the semi-urban and rural areas. We intimately understand the problems they face, their infrastructure needs. We expect to grow significantly in these areas and are well prepared to meet that growth. We plan to replicate our success from our current clientele into new ones. We are also investing in building the next generation products that will help healthcare providers embrace Cloud and Mobile Computing.
Industry Speak
HIT: Window of Opportunity There is a requirement of enabling the IT system to boot various innovations in the healthcare domain, discusses A Arvind Kumar, CEO, Attune Technologies while talking to Romiya Das of Elets News Network (ENN) How do you perceive the Indian healthcare IT market and what are the drivers that are influencing this market in India? There are three drivers, firstly the health insurance penetration. Earlier, health insurance penetration was not big. There are two kinds of schemes - Below Poverty Line (BPL) mass insurance scheme, where government pays health insurance premium to health insurance companies, to provide free treatment to the people in private and public hospitals. In the states like Tamil Nadu and Uttar Pradesh, every year the premium touches up to `750 crores. The revenue from the insurance companies to the hospitals is something else. The hospital revenue contribution from insurance company is significantly on the rise, making the hospital operations more complex. More people are getting health insurance. The second driver is private equity venture funding in healthcare space. Many hospitals, radiology centres are getting funded, which is used to scale up their present infrastructure or setting up multiple centres. This increases the need of enabling IT systems. The third driver is the government. The central government smart city initiative and united healthcare mission initiatives are boosting the healthcare sector as well.
How do you perceive the Indian healthcare IT market? The Indian healthcare IT market is fragmented because there are lot of significant opportunities in the small and medium-sized hospitals; it is not explored much by the corporates. Having a cloud platform helps in managing a large number of customers centrally. So, one side there are drivers like health
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insurance penetration, private equity venture money and government push, on the other hand, the cloud industry is evolving very fast.
What are your current operations and vision for upcoming years? We have customers in South East Asia, Malaysia and Sri Lanka apart from Eastern Africa. We also have two products: one is installed at small hospitals in small labs and another is for mid market and mid-level customers. Apart from these two products, we use Internet-of-Things (IoT) for healthcare through which we are connecting all the devices of healthcare on one platform. The other one rolled out mobile first for handicapped customers. There is a four billion dollar market opportunity that we are going after.
What are the functional areas where health IT can make a difference? For hospitals, the first functional area is to bring a change in the process management because hospitals are
struggling with that. So, automation in terms of billing efficiency and the ability to integrate with insurance companies and provide them appropriate billing information is necessary so that they pay out their claim. There are multiple health insurance policies coming in from multiple companies. So, hospitals find it difficult to deal with the billing. Another automation that will add very large value is admission and discharge process. Many hospitals make patients and their relatives run pillar to post during both the process. The moment you automate, a lot of time is saved, also helping to save a huge amount of money. Labs should adhere strict timelines, as several hospital labs do not give test results on time. The logistic time that is required for the samples to be sent out and process and the results available also need to be calculated when we give commitment to the patient. That needs to be monitored as part of the turnaround time.
Is it the right time for the public and private sector of India for optimising their business outcomes and improving healthcare scenario in the country? Window of opportunity exists in the healthcare IT. As the cloud-based technology, infrastructure connectivity is getting bigger and better. Also the central government initiative viz eHealth, smart cities and digital health initiatives are boosting IT in healthcare. So, this is really the time to lead for in terms of healthcare IT adoption in the country and go from where we care today. All the parts are aligned to change the landscape.
Industry Speak
Need for Patientcentric Infrastructure Chandrashekhar B C, Head of Product Management, CSC Asia, Middle East and Africa elaborates CSC’s wide portfolio of software products to build a robust healthcare infrastructure while talking to Romiya Das of Elets News Network (ENN) The Indian healthcare industry is rapidly evolving. How has this affected the software or IT needs of hospitals? Delivering a great healthcare experience has become a key focus area for healthcare providers today. Creating great healthcare experiences, will make it a necessity for hospitals to go beyond traditional basics of IT, and embrace IT enabled clinical care and collaboration platforms. Fundamental to this is an integrated information infrastructure with a thoroughbred EHR at its core. Over this information infrastructure purpose built, mobile enabled collaboration platforms can enable near real-time patient and staff engagement before, during and after hospitalisation that can significantly improve a patient’s perception of the experience. This information infrastructure will also facilitate operational and patient experience analytics which can help executives identify and respond to the constantly evolving client needs, expectations and perceptions. With the exponentially increasing use of the internet and advances in mobile technology, healthcare delivery is all set to go beyond the physical confines of a hospital and empower patients to access healthcare anywhere, anytime.
What are the products offered by CSC? CSC offers a wide portfolio of software
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products to meet the needs of large hospitals or rapidly growing hospital chains across the globe. Our flagship product for Asia, Middle East and Africa (AMEA) is the Enterprise Management HIS, designed to meet current and future IT needs of a growing healthcare enterprise in emerging markets. It enables complete automation of the healthcare process in the hospital and enables fluid stakeholder collaboration across the healthcare enterprise. Hospitals can also opt to use our mobile care platform to enable medical record access on the move and our patient engage portal solution to offer services on the web to their patients. CSC also offers Ultragenda- a cutting edge planning and scheduling platform for hospitals.
What are the policies and regulations required to build a robust healthcare infrastructure? A robust healthcare infrastructure should be designed to support the continuum of care for the patient across providers and care settings with information captured in a standard and reusable manner and exchanged securely and without ambiguity. The regulations should be defined around the following objectives: Identify an individual uniquely – Healthcare providers should capture approved unique patient
identifiers e.g. Aadhar number on patient registration to ensure unique identification internally and externally when the data is shared. Store, handle and communicate information without ambiguity – Healthcare systems should progressively adopt standards of information capture e.g. SNOMED CT and communication e.g. HL7 to ensure that what is captured is transmitted and interpreted elsewhere as the same thing. Adequately secure storage and communication – Access to information should be restricted to authorise users and any communication over public channels such as the internet should be encrypted to at least AES 128 bit level. While regulations are necessary to implement the ultimate purpose, they should be defined initially with periodic goals or targets in mind and refined over time based on the industry’s ability or inability to conform to these regulations. CSC Healthcare is continuing to work with the UK department of Health to create its national healthcare infrastructure. Our Indian government has also embarked on its journey to implement these standards in India and has entered into license agreements with the IHTSDO to make SNOMED CT freely available for vendors in India to adopt.
Exclusive Interview
Need for Transparent Ecosystem Dr N K Pandey, Chairman & Managing Director, Asian Institute of Medical Sciences, Faridabad talks about the need for more transparency in the imported hospital equipment in conversation with Romiya Das of Elets News Network (ENN) How do you see the Indian healthcare infrastructure in compared to global infrastructure? Indian healthcare infrastructure is still at a nascent stage. Our expenditure on healthcare is poor. India currently spends approximately 4.2 per cent of its GDP on healthcare, with just one per cent being contributed by the public sector, amongst the lowest globally. We stand in league with Bangladesh, Uganda and other African countries and are not even at par with other developing countries. Presently, the basic problem is that the good quality healthcare is restricted to big towns. To create a better healthcare infrastructure we need to focus at district level, providing secondary level hospitals, and the big players should also move from metropolitan cities to tier II, III and IV cities. There is a need of a basic infrastructure – may be 50 to 100 bedded hospital facility with at least secondary care and for rest the superspecialty care the patients can look for
bigger setups in the metropolitan cities. Further, even in the smaller regions or cities the land price has escalated. Most of the medical colleges are moving towards the rural areas due as the land price subsides. The government needs to help the people who have got the will to take healthcare infrastructure to the next level. A single window is required in order to accelerate the infrastructural development
What does the Indian Healthcare Infrastructure lacks? Healthcare, in India, is traditionally seen as a social sector, with less government focus and low budget allocation. The healthcare sector in the country is in urgent need to get the right policy framework and infrastructure impetus. Granting infrastructure status may not only help the sector receive investments, but also bring down the cost of healthcare delivery. Further in India, we have a fragmented industry with multiplication of resources. For instance purchase of expensive equipment. If I buy one the second and third hospital will buy the same. Whereas in overseas they look into the demand and they create a regional centre and everything will be referred there. So, splitting of resources doesn’t happen and if the resource is created it is utilised by everybody. Our manufacturing of medical equipment is at very basic level. The most what we are doing is importing things from China and assembling it with no quality. We have not grown beyond that. If we look at any big equipment, we are depended on major manufacturers who are manufacturing outside and we have no control on their cost input. The government should bring
more transparency in the imported hospital equipment so that the common man is less burdened.
What are the regulations required to build a robust infrastructure? There is a need to deregulate than to regulate. What needs to be regulated is the patient safety. This can be achieved by bringing in standard of care such as monitoring pollution levels, looking at various compliances etc. The new private players are setting up infrastructure meeting NABH standards. Further, beyond just doing accreditation what is required is to segregate the basket – as all accredited hospitals fall in one basket, scaling their forte at various levels that differentiation need to be brought in.
What are your hospital’s expansion plans? We had a major investment from American PE firm a year and half ago. Thereafter, we have commissioned a basic tertiary care hospital in East Delhi and are in process of commissioning 200-bedded tertiary care hospital in Moradabad. As we are maxed out on the capacity in our present location, we are planning for a 100-bedded secondary care facility in Greater Faridabad and Palwal. We are in the process of getting all the approvals in place and the construction is likely to start within 3-4 months. We are also exploring multiple growth opportunities in states like Bihar, Jharkhand, Madhya Pradesh and Jammu & Kashmir. To augment these growth plans, we would be approaching the market soon for second round of funding.
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Buyers Speak
Skilled Resources for Optimum Healthcare There is an increase demand at the domestic and international level for cost effective healthcare, says Dr H S Chhabra, Chief of Spine Services & Medical Director, Indian Spinal Injuries Centre, Vasant Kunj, in an interview with Romiya Das of Elets News Network (ENN) How do you see the healthcare infrastructure market in India compared to global market? Healthcare industry in India is experiencing a growth owing to the factors such as strong coverage, expanding services and increase in expenditure by public as well private players. Additionally, factors such as rise in income levels, growing population of elderly people, changing demographics, disease profiles and the shift from chronic to lifestyle diseases has further made the healthcare as one of India’s largest sectors - both in terms of revenue and employment. According to a data released by the Department of Industrial Policy and Promotion (DIPP), the hospital and diagnostic centres attracted foreign direct investment (FDI) worth US$ 2,793.72 million between April 2000 and January 2015. Taking into account the requirement of 600,000 to 700,000 additional beds over the next five to six years in the country, experts view it as a potential opportunity for the growth of the sector by more than US$ 25-30 billion.
What are your views on Hospital Information Systems in India? Hospital Information System in India is in growing phase, it has picked up pace in metropolitan cities and tier I cities. The hospitals are customising the modules at their end as per their needs and the service providers are working towards offering solutions to
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the newly arising queries of hospital managers. The challenge lies in bringing along the medical fraternity i.e. the clinicians and nursing personnel, who are not exposed to information technology to acclimatise their working from real paper to virtual tablet.
There is a dire need to come up with better policies and establishment of PPPs to address the issue of manpower shortage What policies or regulations do you think are required to build a robust healthcare infrastructure in the country? According to Central Bureau of
Health Intelligence (CBHI), there are over 381 medical colleges. The medical education infrastructure in India has total admissions of 43576 per annum. Despite, there exists a shortage of manpower due to lack of opportunity, management and facilities. Additionally, the country is in dire need to come with better policy regulations and establishment of PPPs in order to manage the problem of manpower shortage. The government also needs to increase on healthcare from one per cent to at least 6 per cent in order to bring the sector in a comparable position with that of the western countries.
What are your upcoming projects? Upcoming projects of HIS at ISIC are to manage patients’ crowd in OPD, ticket generation machine through Kiosk Machine where the patients will generate ticket themselves. We are also planning for blog postings through our intra-portal. To make bar code interfacing for each and every service, item and document and putting up of classified ads (for internal circulation only). Lab reports will be available on the web making it easily available to the patients to view and download. We will be integrating PACS with HMS to document entire data at one place. We are creating paperless environment through Google App built-in forms to send and receive thorough email.
Exclusive Interview
Evolving State of Health IT Tirupathi Karthik, CEO, Napier Healthcare in conversation with Romiya Das of Elets News Network (ENN) talks on the role of mobile technology in healthcare delivery, and why healthcare providers will soon start to spend more on healthcare IT How do you perceive mobile technology in healthcare? How is Napier contributing in this domain? The healthcare industry is moving towards the provision of what I refer to as ‘ubiquitous health’—healthcare is to be delivered wherever it is required. Mobile technology is a key enabler of information access and communication between care providers and care recipients who are separated by physical distance, the better to see through this vision of ubiquitous health delivery. In line with what the healthcare industry needs, Napier makes certain that all its products are developed to be mobile-enabled from day one. By definition, all Napier solutions have mHealth (mobile health) features and capabilities built in. So there is no need for the purchase and implementation of a separate piece of software or licence to take advantage of what we see as an essential component of healthcare delivery in the 21st Century.
Please elaborate on Napier’s referral management system. The cloud-based and mobile-enabled Napier Loop addresses the most common problems we see in transitions of care, specifically in patient referral management, using the old world tools of paper-based letters by physicians, faxes and phone calls, and requiring the patient himself to approach the doctor he has been referred to. Such a process not only wastes a lot of time and money (the patients’ as well as the physicians’), it also leads to a great number of referrals never being completed. What the Napier Loop does is serve as a platform on which patients can be referred between physicians with ease, speed and security. With each referral is the treatment history of the given patient, along with his accurate detailed medical records, during his passage through the physician network. The visibility into key patient information and the channels for collaboration this platform offers physicians can only enhance patient care, boost treatment success rates, and help keep patients under the watchful eye of physicians who know their conditions best.
How do you see health technology evolving in the coming years? Hospitals and other healthcare providers will increasingly be called upon to provide more price transparency, and in turn will ask their technology providers for greater price transparency too. This would actually be a good opportunity for healthcare technology providers to show that they offer higher value than their customers have assumed all these years. Our research shows that the healthcare industry
as a whole only spends two to three per cent of its revenue on IT. This is a very small sum compared to what other industries are spending on IT. With greater price transparency, healthcare providers can see for themselves more clearly just how much value– particularly in terms of productivity gains and revenue quality–healthcare IT delivers, and be persuaded to invest more in it.
What are your company’s expansion plans? We are a global company with a significant presence in Singapore, where our headquarters is located; India, home to our development center and elite squad of implementation and services specialists; and, the US, which is one of our larger markets. We are also growing our business in the Middle East and Africa, and expect to make inroads into Australia and New Zealand, China and Europe in the next 12 months. We fully appreciate that every geography comes with its own set of challenges. So we invest a lot in preparation for our entry each time. Basic operational, legal, language and cultural issues aside, we also expend a lot of resources on building a solutions portfolio that matches the needs of the healthcare industry. In the last 18 months, we rolled out five new product lines—each served a pressing business or industry need, based on our market research. As those products continue to yield high returns for our customers, we shall carry on developing new futureproofed solutions for other segments of the healthcare industry.
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mHealth
Adding Pace to
Healthcare Delivery Given the fast increasing reach of mobiles in India, the healthcare industry is coming up with innovative models of integrated care processes, thus giving the whole concept of healthcare delivery a patient-centric turn. Romiya Das of Elets News Network (ENN) explores the emerging trends and the gateway of opportunities leading to the growth of the mHealth industry
M
obile devices are making a huge difference in people’s lives across the globe. Internet-enabled smartphones and tablets provide access to information and a channel of communication to the users. By the year 2020, India will have 1.4 billion mobile subscriptions, states a recent Ericsson Mobility Report. Mobile technologies for healthcare or mHealth is escalating its presence in health services and information addressing various healthcare issues. It has led to the transformation of the healthcare services across the world rendering the growth of mHealth market. The continuous growth in coverage of mobile networks, advances in mobile technologies and
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applications, increasing lifestyle diseases, and growing awareness among patient population in emerging economies are some of the factors expanding the mHealth market globally. “In the next five years, mHealth will take over 15-20 per cent of the physical consultations especially those of follow-up consultations and reviews. Improved internet speeds and mobile devices that will increasingly support monitoring vitals such as pulse, blood pressure will provide impetus to further growth”, says Anil Kumar, CEO of SmartRx. “We are seeing that roughly 70 per cent of the discharged patients from the hospitals we have tied-up are choosing to receive post-discharge instructions and
care through mobile which is their first brush with mHealth. They are receiving instructions for their diet, nutrition, do’s and don’ts, reminders etc. through mobile,” he added.
Dynamics of mHealth Industry The major portion of the mHealth device market is collectively commanded by BP, blood glucose and cardiac monitors. The large share of these monitors can be attributed to the increased affordability of mobile compatible devices, integrated of innovative technologies in monitoring equipment and the increasing lifestyle diseases such as diabetes, stroke, COPD, ischemic heart to name a few. Within the mHealth services, diagnostic, monitoring and treatment
mHealth
services collectively hold about 74 per cent of the market. The rapid growth of mHealth services market is attributed to the rise in government initiatives, increasing the mHealth awareness programmes in rural and semi-urban areas.
Indian market: In 2014, India showed its might in the smartphones domain with companies launching a plethora of affordable devices, and is on the verge of surpassing the global market leaders to become the world’s largest smartphone market. In a recent study, conducted by Wipro and the Internet and Mobile Association of India (IAMAI), found an increase in the consumer demand for mHealth in India. With mobile technology playing a significant role in the provision of healthcare services globally, the Indian mHealth sector is predicted to lead revenue opportunity worth `3,000 crore by 2017, as reported by PricewaterhouseCoopers (PwC). Changing disease profiles, increased adoption of smartphones, advancements in mobile technology and a greater focus on health and wellness are certain factors contributing to the growth of the mHealth in India. Dr Nitisha Rai, Executive Director, HITLAB, New York says, “The future of healthcare in India is going to be through mobile phones wherein people will have ‘handheld clinics’ which will not only revolutionise the healthcare system, but also benefit people with better services.
Global Scenario: The global mHealth market in 2014 was valued at US$ 10.5 billion, which is expected to escalate at a CAGR of 33.5 per cent in the time span of 2015-2020, reported by Allied market research. In the global mHealth market the blood pressure monitors hold a larger share followed by glucose and cardiac monitors. On geographical terms, North America and Europe
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mHealth Integral Part of Healthcare Use of Information and Communication Technology (ICT) in Healthcare ie eHealth is becoming an integral part of healthcare systems across the world. While mobile Health ie mHealth is one of the segments of eHealth that basically covers delivery of healthcare services and information etc via mobile, smartphones, mobile apps, and integrated devices. In India, given a very wide scale penetration of mobile subscribers- around 90 crores mobile connections- mHealth possess huge potential for efficient and effective delivery of services and information in different segments of health care in both rural and urban areas. The mHealth services vary from simple applications such as SMS based health information, online appointment scheduling, basic test at home, online consultation, video consultation over 3G, information to frontline health workers (FLWs), health programme monitoring etc. to a more sophisticated services such as remote patient monitoring through Internet -of-Things, wearable devices, machine-to-machine technologies etc. In line with the given potential, Ministry of Health & Family Welfare (MoHFW), Government of India has undertaken various initiatives to harness the potential of mHealth in various areas including information dissemination, preventive healthcare, disease monitoring as well as mentoring of healthcare workers. mHealth applications through National Health Portal National Health Portal (NHP) has been designed keeping in the view mobile friendly access and is fully compatible with WAP browsers for mobile devices. It has recently launched “NHP Health - Directory Services” mobile App to benefit the Indian citizens under the mHealth initiatives. This application has database of hospitals and blood banks across India. The user friendly application accesses the user location and enables a person to find nearby hospitals and blood banks. mHealth for Tobacco Cessation MoHFW in partnership with World Health Organization (WHO), has initiated implementing a mHealth application for Tobacco Cessation as part of the WHO ‘Be Healthy Be Mobile’ initiative to reach out to tobacco users of all categories who want to quit tobacco. This encompasses sending a series of standardised and tested messages to the registered users for supporting them to quit tobacco use. This initiative is rolled all over India, however during initial phase, the messages will be sent only in Hindi and English languages. mHealth under Reproductive & Child Health (RCH) Programme Mother and Child Tracking System (MCTS) is a web based name based tracking system implemented across the States and UTs to facilitate timely delivery of antenatal and postnatal care services to all the pregnant women and immunization to all the children. Objectives of MCTS include to reduce IMR, MMR, TFR; promote and facilitate timely delivery of full services to beneficiaries; promote institutional delivery; improve service delivery coverage; establish robust monitoring system at all levels. Total registration as on date in MCTS includes over 8 crores mothers, over 7 crores children & over 11 lakh FLWs (ANMs & ASHAs). Kilkari: Audio information (IVR) about maternal & child health delivered on mobile phones up to 16 months age of child. A phone service called Kilkari – or baby’s gurgle - that calls the registered women with automated IVR calls. Families register for the service and
mHealth
messages are then delivered over the course of pregnancy (from the sixth month) and the child’s first month of life, at the relevant time. It has been successfully implemented in Bihar and piloted in Uttar Pradesh. National level adoption and implementation is underway. Mobile Academy: It is an IVR-based training and certificate programme which provides voice-based lectures and quizzes in nine chapters over 190 minutes, to increase FLWs’ knowledge of healthy behaviours for mother and child health. It has been successfully implemented in Bihar and is being piloted in select districts in Odisha and Uttar Pradesh. National level adoption and implementation of Mobile Academy is underway. Other key mHealth Applications SMS based services are being used for communication with patients for monitoring as well registration in following eHealth initiatives: Online Tracking of TB Patients – NIKSHAY In order to monitor individual TB patient, NIKSHAY, case-based, web-based application software has been implemented. The application includes monitoring & management of users and masters at National, State and District level. SMS based services are being used effectively for communication with patients and monitoring authorities for effective monitoring of Revised National TB Control Programme (RNTCP).Central Government Health Schemes (CGHS) A web based application under CGHS has been implemented for all the wellness centres across the country. It includes registration, prescription and pharmacy. SMS based services are being used for disseminating pharmacy and drug dispensing details to the beneficiaries. Online Registration System (ORS) The Online Registration System (ORS) under the eHospital application has been recently launched under Digital India programme. ORS is a framework to link various hospitals across the country. The application provides important services such as online registration, payment of fees and appointment, online diagnostic reports, enquiring availability of blood online etc. ORS uses SMS based services for appointment update to citizens. To realise optimal level of benefits from use of mHealth in Indian healthcare system, especially public health system, still much more needs to be done in mHealth ecosystem encompassing different stakeholder groupsconsumers, hospitals, physicians, pharmacy, and insurance etc. Private health system having already significantly progressed in use of mHealth has an important role to play in terms of partnership, collaboration and knowledge or experience sharing with public Authours: Jitendra Arora, Director (eHealth) and Chandrasen Shrivastava, Consultant e-Governance Division, Ministry of Health and Family Welfare constitutes the two largest markets for mHealth, which collectively accounted 67 per cent market revenue in 2014. Both the countries are expected to hold the leading position in this domain. The AsiaPacific region is projected as the fast growing market in this sector registering a CAGR of 35.9 per cent during the 2015-2020 tenure. In these regions, an early adoption of
innovative technology, large patient population and high capacity to pay for services are the key drivers to the growth in specific mHealth market. In 2014, the United Kingdom, France, Germany collectively accounted 45 per cent share in the Europe mHealth equipment market. The cardiovascular and diabetes mHealth application market remains a lucrative segment for manufacturers.
“Till date e-consulting and online knowledge forums have captured the imagination of the doctors of the country. Also, recently many doctor discovery platforms have gained traction and are doing well. Of late, there has been a slew of companies who have come up to solve the healthcare conundrum in our country and the future really looks bright. In the next five years patient-centric interfaces like digitalised health records, booking appointments, telemedicine and wearable devices are expected to rise. For hospitals, better IT enabled apps with a scheduling system, improved MIS, EMRs and for doctors, apps providing news on the go, connections with other doctors, and collaborative learning, online CMEs is an expected trend. Pharma and medtech companies would start e-detailing features on mobile to reach out to doctors. Gradually, the Indian mHealth market might follow global majors like DXY, who had more than 50 apps at one stage clearly stating the need for one integrated platform. With the global market estimated to reach the 60 billion mark by 2020, it is a safe bet that India will account for about 2-3 per cent of the of the world’s market share by 2017,” says Mudit Vijayvergiya, Co-Founder, Curofy. However, the market outlook across the developing economies is favourable and strong, owing to the increasing awareness of chronic diseases, favourable government regulations and healthcare expenditure. Philips Healthcare, Bayer Healthcare and Sanfoni are among the major players with a strong foothold in the global mHealth market especially in the Asian countries. Some other aggersive players include Omron Healthcare Inc., Lifewatch, Cardionet Inc., Masimo Cooperation, Boston Scientific, AT&T Inc., and Johnson & Johnson.
Procuring Feasible Services Irrespective of the advancement of
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the medical technologies and increase in income levels, healthcare continues to face challenges of affordability, complexity and access across the world. The adoption of mHealth is not unique, but is more complex than other mobile value-added services (MVAS) when incorporated in healthcare context, for instance, concerns regarding the poor network coverage. A patient cannot be left at the mercy of an underdeveloped mobile network. Also, the security and privacy of the healthcare information is a matter of concern. Low literacy rate and widely spoken regional languages come in the way of adoption of mHealth apps. The lower accuracy devices, technology infancy in middle and lower income economies, weak reimbursement coverage, uncertainty in government regulations in certain regions, and low adoption among ageing population is the major obstacle for the sector. Saurabh Arora, CEO, Lybrate says, “For the mHealth market in India, less Internet penetration, slow broadband services and language barrier acts as a stumbling block on the efficiency of mHealth services. However, all the challenges are opportunities in themselves.” Nonetheless, with healthcare sector going through a plethora of challenges, there is an ardent need to devise techniques to improve the healthcare systems in the country. And, there lies the opportunity: the emerging concept of mHealth, which could be a boon for the Indian healthcare as mobile devices can help in quick conceptualise smart healthcare systems, more so, because of the fact that India is the second largest country of mobile consumers. The mobile devices have good penetration even in the rural areas where existence of other infrastructure components existence is negligible. From offering high-quality network access to managing end-to-end service delivery, telcos can facilitate the
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In 2014, the global mHealth market is estimated at US$ 10.5 billion and it is expected to grow at a CAGR of 33.5 per cent by 2020 effective delivery of mHealth services in various ways. This could encourage mHealth adoption in the country. But for that, telcos will need to deliver an assured, affordable connectivity especially in rural areas, where there is limited connectivity.
Trending through mHealth mHealth is accelerating trends, to the revolution of making the healthcare delivery more accessible, faster, better and affordable. Due to the rising revelation to technologies such as 3G and 4G networks in the industry the mobile network coverage and active subscribers have expanded, enhancing the growth of the mobile healthcare sector. The public sector provides better healthcare access and quality while the private sector gives it innovation and efficiency. The foundations of industrialisation of healthcare – electronic medical records, remote monitoring and communications, has set a platform for mHealth. It offers personal toolkits for predictive, participatory and preventive care. “Medical apps have substantiated an advanced dynamics in healthcare
landscape. In one hand, fitness apps have induced better lifestyle in users, and on the other hand, medical apps have preffered intensity and agility in health care. The emergence of mobile applications in healthcare domain was inevitable as mobile gradually transformed into a lifestyle trait. The usage and advantages of mHealth have intensified its popularity with burgeoning users as well as number of health apps. However, still there is a chasm between demand and supply of healthcare throughout the globe as well as in India. Mobile devices, internet technology and applications can have substantial impact to reduce this gap and offer avenues to reach the unreached,” said Dr Anil Jindal, CMD, SRS Group. There are various arenas where mHealth acts beneficial in promoting better care delivery such as promoting healthcare campaigns where SMS can create a profound impact among people. SMS can be used to educate the masses about various aspects like disease symptoms, disease management and precautionary measures. Given the perceived value and that cost-effective, high quality healthcare services are not readily available in the market place, mHealth has the potential to be a substitute and a complement to traditional in-person healthcare services.
Exclusive Interview
mHealth for Inclusive Healthcare Delivery mHealth is the idea of using mobile phones and electronic devices to make healthcare delivery affordable and more effective, and the Department of Health, Chhattisgarh looks upon the mode to reach out to the difficult terrains of the State, says R Prasanna, Director - Health Services, Chhattisgarh, in an interview with Arpit Gupta of Elets News Network (ENN) Could you elaborate on mHealth projects undertaken by the State Health Department to improve healthcare. Digital health is all set to transform the delivery of health services in remote areas of Chhattisgarh, mainly the Naxal-affected region. The Health Department has undertaken many technology-driven steps to improve the healthcare in the State, with launch of eHealth portal in Hindi being the major one. This portal enables public to access all information related to the Department in both Hindi and English. Now, we are thinking beyond the traditional healthcare delivery system and planning to develop a mobile app using new technologies. We have already started monitoring and registering of pregnant women and children through mobile phones. The Department has also introduced an online application system called ‘eMahatari’ — a mother and child tracking system, to monitor the services given to pregnant women and children of the State. This system aims to curb the maternal and infant mortality rate through regular monitoring of pregnant women and infants’ health. Besides, GIS mapping of health facilities in Chhattisgarh has also
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been done to provide details of PHCs, CHCs and district hospitals. We have developed an online software for tracking various activities in the health domain on mobile and email. Also, district hospitals are likely to have online facilities soon wherein reports of all activities would be regularly updated.
How have the mobile devices been aiding remote healthcare monitoring?
“Before the e-Mahatari software was launched, record of the pregnant women and immunisation for children used to be maintained manually. Now, the record of registration of pregnant women and subsequent ANC, Delivery and PNC, Immunisation services is being captured through e-Mahatari software”
The usage of Information technology in Health started in 2008-09. The Department’s website was relaunched giving information related to all National and State specific health programmes. Basically, it’s not possible for an official to visit all health centres of each district and check the records, stock of medicines, etc., every now and then. Communication or paucity of staff may be the barrier many a time. In such a scenario, we have to look for new ways of delivering healthcare, and technology seems the way out. The Heath Department has developed an application namely ‘Sachet’ (alert), which is used for preparing weekly epidemic alert bulletin and disease outbreaks in the districts. If a medical officer posted in a block or village finds symptoms of an uncontrolled disease in his territory, he can use Sachet to
Exclusive Interview
shoot bulk SMSs and apprise senior officials of the Department of the latest situation. Also, GIS mapping of health centres can help locate the nearby hospitals and dispensaries.
Features of Chhattisgarh Government’s Sachet
What are the factors that you see as challenges in implementation of mHealth?
Through this system any practicing Doctor of (Allopathic, Ayurvedic, Unani, Homeo) under Government/Private sector can send SMS alerting the department of any epidemic situation.
As the name suggests, mHealth flies on telecommunication network; wherever there is mobile network, there’s no hurdle in its execution. But the challenges emerge when it comes to the interiors like Bastar and similar regions. Needless to say, efforts are being made to improve the situation in those difficult terrains. The Government has already signed MoUs with the BSNL in order to address the network-related problems. We are confident that we will be able to successfully implement our plans in every nook and corner of the State and soon people will be able to avail our services on their phones. We will also conduct training programmes to make people aware on how to operate mobile applications and avail services.
Please share your future plans with us. As technology and medical science develop at a fast pace, dissemination of knowledge by interlinking primary, secondary and tertiary level health centres through ICT applications is very much possible now. To implement a model of this kind, we are also in talks with the private players to support us. Although all 27 districts are high priorities, special attention is being paid to Bastar region, which remains mostly inaccessible due to Naxal problems. We have been facilitating people of that area through telemedicine, tele-referal services and health information dissemination through video conferencing. We are also planning to develop an Android app in the future, which
Sachet - is a mobile SMS based reporting of some of the disease prevalent in the state.
A link in the departmental web-site name Sachet has been created. Codes have been given to diseases and format of reporting has been created. The SMS is send to a pre-defined number. Once the SMS is received the information is automatically passed to the concerned District IDSP Officer from where the message was received. The information is verified and the IDSP officer takes the necessary steps to control the epidemic. The sender of the SMS is registered in the system and feedback action is send. The login id and password is sent to the registered person. The reports of the hospitals are also clubbed with Sachet to know about the epidemic tracking situation. Various Epidemic Control teams are there in districts and state level, which use the data of Sachet as required. SMS sending No. 7389939899 SMS Format - OERSCG (Disease Code) (No. of patients) Website Link - http://cg.nic.in/health/oers/
SMS based monitoring system launched in November 2011 in Dhamtari district as a pilot project covering four blocks and 165 ANMs for implementing mobile based system for ANMs. BSNL provided complete solution to the Department on the lines of the Government’s ambitious ‘Digital India’ programme would enable patients to book ambulance and reach hospital. So far, ambulances have been available on toll-free phone calls, but mobile app would further ease the process. We are planning to provide patients’ prescription and lab reports on their
mobile phone. If a patient walks from Bastar, Surguja or any other distant area to, say, BR Ambedkar Hospital, Raipur, he does not need to come again for collecting blood reports or similar documents, as all this will be available on his phone itself.
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Industry Speak
Alleviating Health Through mHealth Ananda Sen Gupta, Founder & CEO, TrackMyBeat, shares his insights with Romiya Das of Elets News Network (ENN), on the scope of mhealth in India and how healthcare can be alleviated through new solutions What is your opinion on the emerging mHealth market in India vis-a-vis global market? mHealth market in India is still largely at a nascent stage. The opportunity is of course incredibly large. The need is well defined but the systems are not in place yet to take advantage of mHealth. There are two aspects: one is the use of technology, and second is embedding mHealth in the process of healthcare delivery. Regarding the inclusion of mHealth in the process of healthcare delivery, the world is not that far ahead of India. The healthcare systems are not yet fully geared to bring in technology in an efficient manner. It is still difficult for people to understand the separation between taking care of one’s health and doctors or hospitals. So, an in-person interaction is always considered to be of greater value than a remote conversation, and often mHealth gets clubbed with tele-health and thus gets sidelined as being too-difficult-to-implement into the process. Organisations are yet to fully appreciate how to use mHealth efficiently. As far as the technology use is concerned, barring various pilots that have and are indeed being tried out in many pockets of India. The Ministry of Health & Family Welfare (MoHFW) has a published standard for Electronic Medical Records (EMR), but it is hardly implemented on the ground. As a result, any design for mHealth, which needs the backend connectivity to an EMR, falls flat. Here the developed nations have already
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designed comprehensive EMR systems with international coding standards, which can take the data in from mHealth solutions, once implemented.
What are the trends in the mobile computing industry? And how has it changed in last few years? A key trend in the mobile industry is the continuous drop in price of mobile platforms. Smartphones, which allow various mHealth applications to run, continue to get cheaper, thus allowing more people to have access to them. Access has then led to people getting more comfortable with using mobile applications, including using video and interactive tools. Other than this, the availability of Internet access has grown manifold over the past few years, which allow people in remote locations to get connected more easily – whether directly through mobile data network, WiFi connecting through a land broadband connection. This makes the opportunity for adopting mHealth more.
What are your upcoming projects? TrackMyBeat is a three-year old startup focussed on innovative use of mHealth and eHealth technology in enhancing healthcare delivery process. TrackMyBeat has launched flexible corporate health plans to support corporates who have been struggling to provide structured health and wellness benefits to employees with clear results. The solution allows employees to correlate the health outcomes to various
actions they take to remain fit and healthy, and monitor their health easily anywhere anytime and have a contiguous electronic health record, which they can share with a doctor. TrackMyBeat is also planning to launch the solutions in the US, in the area of home healthcare.
Do you see the need for any policy changes to facilitate the growth of mHealth in India? The Government of India has taken some strong steps forward. The leadership of Telecomm Engineering Centre (TEC), under Department of Telecommunications, has created a machine-to-machine (m2m) communication workgroup for Health. The workgroup’s first report on Remote Health Management was released by Shri Ravi Shankar Prasad, Minister of Communications & IT in May, 2015. The workgroup is unique in the way that it has members from the government bureaucracy both from IT and health departments, pioneers of technology. Other than detailing health usage cases, the workgroup also made strong recommendations for supporting ‘Make in India’ efforts to help boost Indian manufacturers and solution providers. The government has also announced the plans to create a National e-Health Authority (NeHA), which will drive the adoption of e-Health and mHealth. Awareness about creating policies to regularise e-prescriptions, for easy healthcare delivery is also being deliberated upon.
Industry Speak
Developing Healthcare Ecosystem Dr Nishita Rai, Executive Director, HITLAB, New York talks to Romiya Das of EIets News Network (ENN) about the innovative ideas developed for mobile platforms What is your opinion on the emerging mHealth market in India vis-a-vis global market? The Indian healthcare system seems extremely open to innovation and change. The opportunity to positively impact access, affordability, and quality in the Indian ecosystem has never been greater. The future of healthcare in India is going to be through mobile phones wherein people will have ‘handheld clinics’. This will not only revolutionise the healthcare system, but also benefit people with better services. In India, to help mHealth become a frontrunner, the government has designed constructive policies and adopted mHealth programmes to improve healthcare services. These programmes focus on healthcare emergency response, prevention and control services, and awareness programs on HIV, TB, and maternal and parental care. In global markets or developed nations, eHealth services are driven by desktop or laptops. The widespread availability of internet landlines has slowed down the growth of mHealth in developed countries.
challenges. mHealth programmes are changing this paradigm day by day. Mobile phones enable doctors and government-supported health agencies to connect with the wider population and provide them with health care. Services like emergency care, maternal and parental care, and telemedicine are accessible to both rural and urban sectors in India. Innovators are developing creative ideas on mobile platforms to deliver quality and affordable healthcare. mHealth has tremendous potential to fill gaps in the system by providing services at a much more affordable cost and better quality.
How are the mobility devices aiding remote healthcare monitoring? Thousands of tracking devices are available today at lower costs that are easily implemented. The fact that lives can be saved and costs can be lowered is no longer debatable. It has come down to the ability of management teams to identify, negotiate price, and implement these technologies in order to save lives and improve the quality of healthcare.
How will mobile healthcare be a game changer in Indian healthcare industry?
Can you elaborate on the projects undertaken to improve healthcare across the globe?
Mobile healthcare has already started spreading its wings in India. Approximately, 14 million mobile phones are sold every year in India. With support networks from telecom companies in 3G and 4G, people are able to access information on mobile. Previously, affordability and access to healthcare were major
HITLAB’s research and teachings over the past 15 years have spanned from Washington Heights in New York City to Ghana to New Delhi and has included over 25 therapeutic areas, 500 studies, and 5000 students, resulting in more than 100 peer-review publications and presentations. Our work has
encompassed everything from developing algorithms that predict falls to testing devices that can detect heart attacks to evaluating whether national health voicemail services can reduce infant mortality.
What are your current operations in India and your expansion plans in the upcoming years? HITLAB is developing an ecosystem of doctors, physicians, medical device companies, government agencies, non-profit organisations, startups, and individual researchers and innovators. This ecosystem will encourage the development of highquality healthcare innovations in the near future. We connect institutions and professors across India to nurture students on healthcare innovations, as this upcoming generation’s ideas will bring a rapid change in the healthcare sector. As a grant-funded institution, much of HITLAB’s expansion plans hinge upon the vision and generosity of our donors.
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Exclusive Interview
Credible Data on Healthcare Professionals Needed Shashank ND, Founder & CEO, Practo discusses the need of dependable information about healthcare professionals in conversation with Romiya Das of Elets News Network (ENN) What is your opinion on the emerging mHealth market in India vis-a-vis global market? Mobile is the largest platform in the history of mankind. India is the second largest telecom market and this presents a huge opportunity to help people get better healthcare. This is our mission at Practo to help people live healthier, longer lives globally. Having our presence in multiple countries has given us considerable insights into the industry and we broadly find that the challenges across various countries are similar. With our overseas presence we’ve found the same issue catering acute shortage of dependable information about healthcare professionals.
What according to you are the challenges and opportunities in mHealth industry? Information asymmetry is the biggest
challenge of Indian healthcare. It is not really about how you communicate with the doctor but fundamentally, how do you find the right doctor for you? Providing detailed, credible information on doctors enables people to make better decisions on which healthcare practitioner they want to consult. Our Practo Feedback enables verified patients can provide feedback on their experience with the doctor which is helpful when people are finding the right healthcare professional – suddenly instead of 1-2 friends telling you the right doctor, you can read hundreds of verified patients are saying about a doctor and decide which one you want to consult. Secondly, the other challenge is that healthcare information is not digitised and hence is not available at all times. This also means that most consumers don’t really have a comprehensive healthcare history which can often lead to incorrect or suboptimal diagnosis and treatment. With Practo Ray’s cloud based SAAS practice management software for doctors, we enable them to manage their practice (scheduling, billing, and inventory) and most importantly - create and share digital records with their patients and patients can in-turn share them with others if they want. It is used by doctors to manage millions of patients a month. We receive over 25 per cent of our traffic from tier II and III cities. Hence, there is massive need for people to get detailed verified information about doctors.
Do you see the need for any policy changes to facilitate the growth of mHealth in India? We work closely with various stakeholders
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including the government and welcome the ‘Digital India’ and ‘Make in India’ initiatives which, we are sure, will propel digital health to a billion Indians.
What are the most pressing trends in the mhealth sector? The most important trend in the healthcare sector is digitisation as digitising information will help patients to get information about the right healthcare practitioner whenever and wherever they want. This is not just limited to doctors but to hospitals, clinics, wellness and fitness centers and professionals as well. Digitisation of the practice and establishments to ensure doctors can focus on patients, and consumers have a seamless experience across finding the doctor, interacting with him and getting their healthcare records digitally including prescriptions as well.
What are Practo’s current operations in India and expansion plans for upcoming years? Practo is the largest healthcare platform in Asia. Currently, we are present in 35 cities in India and countries including Singapore, Philippines and Indonesia. Presently, we are listed over 2,00,000 doctors, 10,000 hospitals and 5,000 diagnostic centres. Over the next few months, we will expand to cover 100 cities in India, be in 10 countries, grow our team from 1500 to over 2500, and continue to launch more products across curative, medication, preventive, wellness, fitness and more making Practo a single health app for all health and fitness needs.
Spotlight
Reaching the Unreached The health solutions through mobile can have immense impact and reach the conventionally far away population, says Rahul Mullick, Head – ICT & Supply Chain, India Programs, Bill & Melinda Gates Foundation in conversation with Romiya Das of Elets News Network (ENN) What is your opinion on the emerging mHealth market in India vis-a-vis global market? mHealth is a growing global market and the same trend is visible in India. A study by PwC projects the market to be around US$ 0.6 billion in India and US$ 23 billion globally by 2017. While India’s share seems relatively small, the growth trajectory is very promising.
How will mobile healthcare be a game changer in Indian healthcare industry? Mobile penetration in India has increased phenomenally over the last few years and this makes for a great opportunity to use mobile for healthcare. In India’s most populous states of Uttar Pradesh and Bihar mobile penetration is upwards of 65– 70 per cent. The right health solutions when delivered through mobile can have immense impact and reach people who are conventionally not easy to reach.
How are the mobility devices aiding remote healthcare monitoring? A large part of the global mHealth market will focus on monitoring services. Mobility devices (bands, health apps on phones etc.) are the ones capturing global attention in mhealth. Many of these are however, urban focussed. To address India’s health concerns, there are many projects in the rural areas that can be game changers. For instance, realtime capturing of weight and height of malnourished children and monitoring
growth remotely can help us take corrective measures in solving India’s nutrition concerns. Using mobility devices to capture key diagnostics (BP, Haemoglobin etc.) for rural women can help us proactively take remedial measures for high risk pregnancies and help reduce maternal mortality. Mobility devices can aid in monitoring treatment adherence, a critical need in managing Tuberculosis (TB) patients. All these projects are presently underway in India and present a great opportunity to leverage mobile technology.
What according to you are the challenges and opportunities in the mHealth domain? The biggest challenge I see is whether mHealth solutions are being designed for scale, especially for the public sector, a large part of India’s health challenge is in the rural areas. Experiments and pilots have to be designed keeping in mind that they can be scaled across the country. This also presents a great opportunity for those developing robust platforms and scalable systems. The other challenge I see is with maintainability of the mobile devices in the rural settings. Smartphones and tablets will get subjected to a lot of rigor and tough use and ensuring procurement of quality devices (and their maintenance) will be important.
How has mHealth evolved in India? India is now clearly distinguishing between conventional ICT systems which offer SMS or IVR based alerts or services and mHealth applications
used on-the-go. This means that hand-held devices (phones or tablets) are also being seen as tools for information capture at source, health diagnostic and workflow management that can enable quicker health response, measurement and analysis, rather than just using them as jobaids, messaging or educational tools. Of course, there is still a great value in the mobile as a behaviour change tool using inter-personal messaging.
Do you see the need for any policy changes to facilitate the growth of mHealth in India? The government’s intent on using mobile technology for health is clearly visible. The ministry of health is forming the National eHealth Authority (NeHA). This, I expect would become a key part of the Digital India programme and will help drive the focus on mHealth for healthcare delivery. As a policy, I would expect that the government would encourage (or even mandate) use of mHealth platforms in the public health system. The efficiency and effectiveness these can bring in (if implemented and supported well) are enormous. I am very hopeful that the paper registers would go in the near future.
september / 2015 ehealth.eletsonline.com
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Government Desk
NSAIDs Sale Ban by Delhi Government
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he Delhi Government has banned the over-the-counter sale of non-steroidal anti-inflammatory drugs (NSAIDs) such as Aspirin, Dispirin, Brufen, Voveran, without a doctor’s prescription. The step has been taken as the use of these drugs may pose a threat to dengue patients. Health Minister Satyender Singh said that NSAIDs drug will be banned for OTC sale by chemists. It will be sold only on the basis of prescription by a qualified doctor. The Health department will take action against any retail chemist found selling NSAIDs without prescription. According to media reports, the chemists have been advised to maintain the records of stocks of such pain-killer drugs such as Aspirin, Ibuprofen and Diclofenac group of medicines.
The Government of Delhi through Drugs Control Department has issued an advisory in the public interest to make people aware about seasonal diseases and not to take certain medicines.
Institute of Ayurveda with 200-bedded Hospital in Delhi Soon
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he Government has approved the establishment of All India Institute of Ayurveda along with a 200-bedded referral hospital at Sarita Vihar. The Institute has been conceived as an Apex Institute of Ayurveda for imparting education in the field of Ayurveda at MD and Ph.D level. Research and Development in AYUSH are undertaken in accordance with the objectives and strategies outlined in the ‘National Policy for Indian Systems, of Medicine and Homoeopathy-2002.’ Central Government has set up Research Councils and implemented a Central Scheme of Extramural Research to undertake and support research & development activities including the development of drugs in Ayurveda, Siddha, Unani and Homoeopathy. At present, 80 units of the four Research Councils are functioning in the country. Adequate resources are provided to these initiatives inter-alia to facilitate development and discovery of such drugs, which are different from the classical formulations mentioned in the authoritative books. Drugs & Cosmetics Act, 1940 has a provision for patent or proprietary
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NDMC Plans to make Hospital Info Available Online
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medicines in relation to Ayurvedic, Siddha and Unani systems of medicine. Many such medicines are licensed and available in the market. Rule 158B of the Drugs & Cosmetics Rules, 1945 provides inter-alia the regulatory guidelines for the evidence of safety and effectiveness requirements for licensing of new formulations and Ayurvedic, Siddha and Unani drugs with new indications. The government has also published Good Clinical Practice guidelines for imparting technical assistance in the area of research and development of AYUSH drugs for the conduct of clinical trials. The construction activities and procurement of medical equipment and furniture are at an advanced stage of completion.
he civic agency NDMC has decided to take its hospital services online. NDMC has approached the National Informatics Centre for the implementation of Hospital Information System. This decision has been taken as a part of central government’s Digital India initiative. NDMC plans to implement it at Charak Palika Hospital in Moti Bagh, Poly Clinic in Baird Lane and Dental clinic at Dharam Marg in the first phase. According to media reports the e-hospital portal help NDMC in better delivery of services. All information on hospitals and dispensaries will be available on one portal and NDMC plans to complete it by October 2, 2015.
Government Desk
Death and Disability Cover for Age Group 18 - 59 years Old
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entral government’s Social Security Scheme – Aam Admi Bima Yojana (AABY) administered through Life Insurance Corporation of India (LIC) will provides death and disability cover to persons between the age group of 18-59 yrs, under 48 identified vocational, occupational groups or rural landless households. It is a group insurance scheme that will be implemented through Central Ministry, Department, State Government, Union Territory or other institutionalised arrangements, registered NGO. The AABY provides insurance cover for a sum of `30,000 on natural death, `75,000 on death due to an accident, `37,500 for partial permanent disability (loss of one eye or one limb) due to accident and `75,000 for total permanent disability (loss of two eyes or two limbs or loss of one eye and one limb) due to the accident. The scheme also provides an add-on benefit, wherein Scholarship of `100 per month per child is paid on a half-yearly basis to a maximum of two children per member, studying in IXth to XIIth Standard. The total annual premium under the scheme is `200 per beneficiary of which 50 per cent is contributed from the Social Security Fund created by the Central Government and maintained by LIC. The balance 50 per cent of the
premium is contributed by the State Government, Nodal Agency, Individual, as the case may be. The Government has set up a Centralised Social Security Fund and Aam Admi Bima Yojana Scholarship Fund. The same is being administered by LIC. There is no State, UT-wise allocation of these funds. The due amounts required for settling premium and scholarships are debited from these funds.
Government Hospitals Soon to Provide Free Ultrasound Tests
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he patients and attendants at the government hospitals in Uttar Pradesh will now be able to avail ultrasounds test free of cost. The government has decided to waive off user charge for the service. At present `100 is charged per test. According to media reports, the proposal has been cleared and an official announcement will be made soon. The state has 130 government hospitals, the financial burden on the state exchequer is expected to be `11.86 crore per annum. The amount is in addition to losses
incurred after making X-ray to the list of free services which cost `30 per sheet. The decision cost `16 lakh per hospital per year and translated
into a burden of `21.51 crore per annum for 131 hospitals in UP. The cost excludes money incurred in buying x-ray sheets and maintenance of machines.
SEPTEMBER / 2015 ehealth.eletsonline.com
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Company News
Unique Software for Organ Transplantation Launched
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Bengaluru based Genomic Data Sciences company called InterpretOmics has launched a Human Leukocyte Antigen (HLA) typing software solution called as ‘HLAScape’ for organ transplantation and autoimmune disease diagnosis. To commemorate ‘Organ Donation day’, the company will be offering the present version of HLAScape free to academic institutes, public research institutes and public hospitals to make their decision fast and precise for organ transplantation and clinical diagnosis. “Many organ transplants fail due to incorrect HLA typing. HLAScape is a comprehensive software solution for high precision HLA Typing from NGS (Genomics) data for - clinical and transplantation diagnostics. High-resolution HLA typing is essential in transplantation diagnostics to minimise risk of complexities and improvement of post transplantation graft acceptance”, said Dr Asoke Talukder, Co-Founder & Chief Scientific Officer (CSO), InterpretOmics. “Also, the algorithm accurately identifies the possibility of disease association with the HLA profile of a patient through InterpretOmics curated database called HLABase, which is a first in the world.” HLAScape can be successfully leveraged to probe HLA associated disease. It is aimed at identifying all known HLA alleles and also the common HLA alleles across samples.
Match profile for donors and patients is constructed based on the expressed alleles at HLA markers. “This powerful software developed by InterpretOmics is efficient in identifying all the alleles at high digit resolution, a feature that makes it far superior than any other available software in the market today. Available in On-Premise and Cloud modes, HLAScape ensures accuracy, repeatability and speed of analysis,” said Prahalad Achutharao, Co-Founder & CEO, InterpretOmics.
Prahalad Achutharao, Co-Founder & CEO (L) with Dr Asoke Talukder, Co-Founder & CSO of InterpretOmics
1mg Kicks off “Jaankari Hai To Jaan Hai” Campaign
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harma health app, 1mg has announced the commencement of “Jaankari Hai To Jaan Hai”, an awareness campaign aimed at informing consumers of cheaper alternatives when it comes to cancer medication. The campaign was kicked off on Youth Awareness Day organised in the capital by Yoddhas, an NGO that works for cancer patients. Dr Niharika, a representative from 1mg.com, talked about the challenges faced by cancer patients and launched the campaign dubbed, “Jaankari Hai To Jaan Hai”, enlightening the audience about Differential Drug Pricing in Cancer Medicines. Currently, it has been observed that the prices of some medicines are exorbitantly higher than equally potent yet affordable generic medicines, keeping most of the patients deprived of continuous treatment. She emphasised that patients should know their rights and always enquire if they can get a cheaper substitute of an expensive prescribed medicine. The empowered patients can have more meaningful discussion with
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their healthcare provider. Prashant Tandon, Founder & MD, 1mg said “Healthcare is a costly affair at this point of time. However, in various instances, a “well- informed” customer can massively cut down (Upto 80%) the treatment cost by choosing cheaper generic substitutes. With the awareness campaign, our objective is to encourage positive changes by bringing power of information to our users.” He also added, “ This initiative is a vital element of our core idea and along with other such campaigns, we will continue to reach out to people at a large scale through our online platforms.” The campaign stresses the importance of “Jaankari (Information)” about all aspects of cancer to minimise the suffering for the patients and their caregivers. The event concluded with a brilliant act put together by the NCC Cadets. It was dance and play galore with the cadets showcasing their creative talents, leaving the audience totally moved.
International News
Google, Sanofi to Collaborate for New Diabetes Management Tools Development
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anofi has collaborated with the life sciences team of Google to develop new tools for diabetes management for people with type I and type II diabetes. In this collaboration Sanofi will pair its leadership in diabetes treatment and devices with Google’s expertise in analytics, miniaturised electronics and lower power chip design. According to Dr Oliver Brandicourt, CEO of Sanofi, as a global leader in diabetes care the company has both an obligation and a commitment to
provide integrated solutions for people living with diabetes. Both the companies will develop new tools to bring together many of
Europe: Philips Launches IntelliSpace Cardiovascular System
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oyal Philips has launched IntelliSpace cardiovascular, a web-enabled image and information management system in Europe. This new system is said to serve as a link of interoperability, helping all care team members to access data and introduce enhanced clinical applications such as IntelliSpace Portal or IntelliSpace ECG within a single workspace. Accordimg to reports, Yair Birman, Philips Senior Vice President and Healthcare IT General Manager, said that IntelliSpace cardiovascular enables clinicians to take a holistic view of the patient’s cardiovascular journey with one workspace and the ability to dive deeper into more clinical depths. This includes accessing other third party applications, providing a c o m p re h e n s i v e view of the patient, which helps enable care givers to deliver better patient care, he added. The product has been developed to centralise patient data from different areas of the hospital. The new information system enables all care team members to view the patient’s history spanning diagnostics, treatment and therapy, thereby allowing minimising unnecessary and repetitive tests. It also features built-in echocardiography reporting, which allows cardiologists to identify and eradicate inaccuracies within reports.
the previously used pieces of diabetes management, including health indicators such as blood glucose and hemoglobin A1c levels, patientreported information, medication regimens and sensor devices. Andy Conrad, CEO, Google Life Sciences team said that with new technologies emerging to provide a more continuous and real-time view of a patient’s health, promising more proactive and effective ways to control diabetes.
Medtronic Acquires Medina Medical for US$ 150 Million
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edtronic has acquired Medina, a USbased medical device company for around US$ 150 million. The deal includes additional payments based on achievement of key milestones. Medtronic had earlier invested in Medina medical and owned interest in the company allowing it to have a pre-tax gain in the second quarter of fiscal year. Medina Medical commercialises modern treatments for vascular abnormalities of the brain, including cerebral aneurysms. President Brett Wall, Medtronic’s Restorative Therapies Group neurovascular division said that Medina Medicals technology makes it a natural fit with the company’s Neurovascular portfolio, further strengthening our hemorrhagic stroke portfolio. The Medina embolisation device is an intravascular 3D mesh implant that has been developed to fill the inside of a brain aneurysm. The company has designed new technology to have an implant with 3D self-expandable mesh, which provides a scaffold across the aneurysm and neck adjusts to the shape of the aneurysm and reduces blood flow. According to Erik Engleson, CEO, Medina Medical, the acquisition offers an opportunity to bring together our breakthrough technologies with Medtronic’s leading legal clinical, regulatory, market development, and commercial expertise.
September / 2015 ehealth.eletsonline.com
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Hospital News
Air Ambulance Service for Doon Eye Patients
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ehradun soon get the first modern eye hospital, on the lines of PGI Chandigarh. The hospital is expected to become operational by October 02 this year. The eye centre will also be offering air ambulance services to the patients suffering not just eye ailments but also other diseases. According to media reports,
the four-floored hospital will have a helipad. The Gandhi Shatabadi Eye and Research Institute will be a 200-bedded hospital project was started in October 2007 and an initial fund of `12 crore was allotted for it. Due to the fund crunch the hospital couldn’t be completed in 2010. Later, the Union government in July 2014 extended support to the hospital by providing additional `9 crore.
Apollo to Open Hospital in Navi Mumbai
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n line with its philosophy of providing affordable healthcare to all sections of society with compassion and care, the Apollo Hospitals Group, the largest hospital chain across India, is setting up its 65th hospital in Navi Mumbai. Explaining the rationale behind this move, Dr Narendra Trivedi, CEO, Apollo Hospitals, Navi Mumbai said, “Navi Mumbai is fast developing, and patients sometimes have to go to Mumbai and Pune for their healthcare needs. Looking at the need to minimise travel, as time is critical to save life, the upcoming hospital will also cater to Panvel, Taloja, Raigad and surrounding areas.” Apollo Hospitals, Navi Mumbai will be a 500-bedded multi-specialty, tertiary care hospital with state-of-theart equipment and cutting edge technology. Its strategic location close to the Mumbai-Pune expressway will enable it to provide emergency medical services of the highest quality in case of road accidents, thanks to its 17-bedded emergency ward, 120-bedded ICU, and round the clock emergency physicians in the premises. Spread over a 5,00,000 square feet area, Apollo Hospital in Navi Mumbai will house 57 specialties with more than 200
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specialists, more than 450 operational beds and 14 operation theatres. The hospital will have ample parking space that can house about 350 vehicles. It will provide a complete range of latest diagnostic, medical and surgical facilities for the care of its patients. In July 2005, Indraprastha Apollo Hospital, Delhi, became the first hospital in India and the 6th in Asia to be accredited by JCI, USA. Today, the Apollo Hospitals Group boasts of 6 JCI, USA accreditations for its hospitals in Delhi, Chennai, Hyderabad, Dhaka, Bengaluru and Kolkata, the largest number of such accreditations to be awarded to any Indian chain of hospitals. Paula Wilson, CEO, JCI, USA said, “JCI accreditation is the international gold standard for hospitals. Accreditation is awarded after the hospital has met all of our standards. Our standards require a comprehensive quality plan, strong infection control practices, patient centered care, strong leadership as well as many other activities to improve the quality and safety of care.” Dr Preetha Reddy, Executive Vice Chairperson, Apollo Hospitals Group, shared her commitment to clinical excellence, “We have transformed the Indian healthcare landscape. From humble beginnings we are now a force to reckon with. Inspired and guided by my father Dr Prathap C Reddy, the pioneer of corporatised healthcare in India, we will be expanding to countries neighbouring India and the African sub-continent. I am particularly excited about our focus in areas of global clinical trials, hospitals in semi urban India, etc.” Dr Anupam Sibal, Group Medical Director, Apollo Hospitals Group said, “Apollo Hospitals has always believed in delivering the best care to its patients. We have continually worked to improve quality through accreditation, development of the Apollo Quality programme and our outcomes dashboard. Our value proposition defines our brand. We have touched 42 million lives in 121 countries.”
Hospital News
Advanced 3D Laparoscopy Machine MMHRC
Patients to get MRI Facilities in Panchkula General Hospital
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adurai based Meenakshi Mission Hospital and Research Centre (MMHRC) has introduced an advanced 3D, HD laproscopy imaging system with their department of surgical gastroenterology. According to Dr Ramesh Ardhanari, the use of the latest technology, the system will deliver bright, clear real life vision in 3D. The 3D HD imaging machine provides improved speed, accuracy, and precision for surgical tasks while helping the laparoscopic surgeon to shorten the learning curve. In terms of patient’s benefit, the technology is highly useful as their time under anesthesia is reduced and blood loss is minimised, he added. The 3D advanced imaging is used for a wide range of procedures such as bariatric surgery, thoracic surgery, and gastrointestinal surgery.
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etting an MRI done for patients seeking treatment at Panchkula General Hospital will become easier with the facility now set to be available at affordable rates. Scores of patients thronging to the Panchkula General Hospital will not have to go elsewhere now to get the MRI done. The important diagnostic test is set to be made available to the patients after the hospital has entered into a PublicPrivate-Partnership (PPP) project. The facility will be made operational by September and the contractors have begun work at the hospital premises. Dr V K Bansal, Civil Surgeon said that the equipment and machinery has been brought and is in the process of being set up. The hospital, which sees huge patient load from across the district, offers only X-ray, CT Scan and ultrasound facilities. Patients requiring MRI were till now being sent to other hospitals or being asked to get the test done from private laboratories flourishing in its vicinity. The new and much needed facility will be a boon to patients, especially since the rates of the essential diagnostic test will be far less than those being charged in the private hospitals.
OXXY to Launch Transparent and Affordable Hospital Chain
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XXY healthcare is all set to launch its hospital chain in metros and a few other cities in the next few months. These hospitals will be having 50 to 500 bed capacity. Pankaj Gupta, Founder, OXXY said, “The main objective of these hospitals is to bring affordability into healthcare without any extra undisclosed cost. We are aiming to bring a transparent, never before world class chain of hospitals, which shall soon mark its impressions on the world map”. “No other model at present exists in India and its success will purely depend on the affordability of quality treatment and services directly in comparison with the global standards,“ he added. The company aims to bring 50 hospitals under its belt by the end of 2015. These hospitals are in different areas of the country and shall be soon available for everyone at first affordable quality hospital chain in the country.
OXXY healthcare has already screened more than 12 million people so far under Swastha Bharat (Healthy India) through its various earlier initiatives of free checkups in 100 cities of India. Its initiative is for free screenings of eyes catering more than 200 cities of India. The company has partnered with various other companies such as Uber, Zo Rooms etc. It has also opened more than 60,000 Information Centers in about 500 Cities of India educating people about need of healthcare.
September / 2015 ehealth.eletsonline.com
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Start-up
Mobilising Healthcare Solutions SmartRx provides a mobile engagement platform offering healthcare solutions to hospitals, doctors and corporates. It provides solutions for chronic care management, post-discharge care and online consultation (e-consult)
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ncorporated in 2012 by Anil Kumar and Vijayakumar Kannan have innovated a platform in the area of Tele-Health and Care Management enabling smarter healthcare for everyone. SmartRx’s mobile platform enables engagement of patient, doctor and hospitals to improve quality of care. The company solutions improves access to healthcare for patients while improving care delivery for
techniques to reach out to population, especially the rural-population is a huge challenge. Technology and telehealth are emerging as the preferred means to further healthcare goals and connectivity. The company provides health solutions to hospitals, doctors and corporates. The platform enables hospitals and doctors to deliver services such as post-discharge care, chronic care management and remote
Mobile App Platform
Deep engagement with Care Plans (Chronic / PD) Push messages with regular tasks and fun activities
1-click E-Consult for doctor, counselor (paid) Convenience tools like PHR, reminders, lab report scans
doctors and patient outcomes. The company operates from Bangalore and Hyderabad. While there is lot of focus on finding doctor and appointment-scheduling, engaging patients at all times and improving quality of healthcare remains largely untouched. The doctor to patient ratio in India is well below recommended levels. Hence, effective means to save doctor time,
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monitoring programs through mobile apps. Presently, around one million patients are using the SmartRx application platform including top healthcare groups such as Care Hospitals, Rangadore, KIMS, Telerad Sol and others. The platform offers real time audio video interaction with health specialists. The platforms offer online consultation to worldwide patients through partnerships with doctors and hospitals. For corporations, SmartRx offers new generation wellness program to engage employees improving health, behaviour and thereby productivity. The student programme by the company is built by experienced doctors, psychologists, technologists with deep understanding of student’s requirements of physical and mental growth. The company foresees to expand its operations to more cities across India. The venture wants to disrupt the healthcare scenario of the country through telehealth and tech enabled care delivery platforms.
Start-up
Creating IT Infrastructure Health Corniche provides technology based solutions in the field of information technology, delivering adoptable solutions serving the healthcare providers and other sectors
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ith the idea of providing solutions in Healthcare IT Consultancy Service domain, Health Corniche was founded on February 02, 2015 by Dr Archana BM and co-founder Kiran Kumar. The company aims to provide the customer solutions to make the best use of IT, generating efficient and quality output.
“As we notice the paradigm shift in healthcare from practitioner centric to consumer centric we help healthcare organisation adopt to bring in the nextgeneration transformational web-based IT solutions. Removing barriers across the fragmented healthcare supply chain and bringing eHealth as a catalyst to improving healthcare.� - Dr Archana BM
Health Corniche is a local Bangalore based company that focuses on providing knowledge and support to the healthcare information technology solution by providing IT solutions consultancy services targeting primarily at healthcare sector. The company operates with business associates in the healthcare domain in India with diverse partnership from international software and local service companies. Health Corniche visions in providing a best-of-breed state-ofart technology based solutions in the field of information technology by delivering adaptive solutions serving the healthcare providers and other sectors. This company has invested around `10 lakh towards creating basic infrastructure, brand building exercise, travel expenses within the state and inter-state. The company currently does not look forward for any funding.
Health Corniche’s Business Stream Healthcare: Assisting providers to deliver administrative, clinical and diagnostic care Business Solution: Providing integrated Healthcare IT solution Consumer: Providing solutions to manage the flow of Information to patients in the community mHealth: Innovative Health and Well being solution for all Health Corniche seeks to operate with business associates in the healthcare domain with partnership from international software companies and local service providers to extend the penetration of Healthcare IT across India. The company wishes to be part of the largest and most sophisticated mHealth trial and deployment in the world. The company aims to provide innovative health and well-being solution for all across the country.
september / 2015 ehealth.eletsonline.com
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Product Launch
Carestream’s New Radiography / Fluoroscopy Systems
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arestream Health has entered the radiography/ fluoroscopy (R/F) market with two systems that deliver high-quality, cost-effective imaging the Carestream DRX-Excel and Carestream DRX-Excel Plus. These systems can enhance workflow and perform contrast exams using fluoroscopy that can be associated with a radiography image, in addition to specialised contrast procedures that record both fluoroscopy and radiography sequences and interventional procedures. Carestream’s DRX-Excel systems are configured with a table and a tube in one system. An optional integrated flat panel detector produces high-resolution images for general radiography as well as fluoroscopic sequences. The DRXExcel platform also is available as a conventional R/F system that uses either CR cassettes or DRX-1 detectors with an image intensifier. Jianqing Y Bennett, President, Digital Medical Solutions, Carestream says, “We are expanding our radiography leadership to include fluoroscopy, which is performed by many of the hospitals and imaging centers we serve. This is a natural extension for both our company and our customers, and enables healthcare providers to benefit from purchasing these systems from a single supplier with a strong reputation for outstanding service and support.”
DRX Excel The DRX-Excel System provides capabilities for both general radiography and Fluoroscopy exams in a single system. The system is also available in a choice of two models to match the needs and workflow: A conventional configuration, utilising film or CR cassettes or our wireless DRX-Detector for radiology and an image intensifier for the fluoroscopy exam, or A dRF configuration, with a single flat-panel digital detector for both RAD and fluoroscopy. Features Extensive SID capability exceeds competitors, acquiring images at any distance between110 cm to 180 cm Table features a 200 kg weight capacity to accommodate heavier patients
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Both DRX-Excel systems offer a source-to-image detector distance of 180 cm, an ergonomic design and the ability to select an image intensifier for fluoroscopy or use the optional flat panel detector. The DRX-Excel Plus has an elevating table that tilts for fluoroscopy exams and can be lowered or raised to provide flexible, comfortable imaging for patients. Table weight capacity is 265 Kg (584 pounds). The DRX-Excel has a fixed table with a weight limit of up to 200 Kg (440 pounds) and has the tilt capability for fluoroscopy exams. Both systems feature productivity-enhancing capabilities including a positioning pedal that allows the operator to have their hands free—which is helpful for interventional exams—and a remote control that can move the table from anywhere in the room. Other options include integration of a Carestream DRX detector four-way float top table movement and the ability to stitch multiple images together for long-length exams. These systems support Carestream’s X-Factor approach, which enables a DRX detector to be shared among an R/F room and other DRX mobile or room-based radiography or R/F systems. In the United States, only the DRX-Excel Plus model will be available. Both systems will be available in Europe, Asia, Latin America and other countries.
Product Launch
+90/- 30 degree tilting to enable all exam types Table offers the lowest fixed-table minimal height of 79 cm (31inches) in the industry making it accessible, even for wheelchair patients Control system operation remotely or at patient’s side Motorised movement of tube and column maximizes speed and convenience Offered with either an Image Intensifier with high resolution CCD camera that maximises image quality during fluoroscopy or a Flat Panel Detector that offers high image quality fluoroscopy and general radiology images Auto positioning, as a function of extensive anatomical
programmes, facilitates faster exam set-up times Patient overage of 196 cm allows full exploration of even very tall individuals without repositioning Relaxing ambient lighting and selectable music maximise patient comfort DAP measurements allow tracking of the exact radiation dose received by each patient Optional DRX-1 detector offers the power of the X-Factor and allows easy positioning for cross-table and weight-bearing exams Four-way table movement for easier patient positioning Image stitching station combines multiple images into one for easier reading of spine and lower-limb exams
DRX-Excel Plus Fluoroscopy technology has been optimised specifically for large and mid-size hospitals and medical centers with the CARESTREAM DRX-Excel Plus System. It combines both fluoroscopy and general radiology capabilities in one compact unit. It also delivers accelerated workflow, highresolution images and a wide range of exams. A conventional configuration, utilising film or CR cassettes or our wireless DRX-Detector for radiology and an image intensifier for the fluoroscopy exam A dRF configuration, with a single flat-panel digital detector for both RAD and fluoroscopy Features Extensive SID capability exceeds competitors, acquiring images at any distance between 110 cm to 180 cm Table features a 265 kg weight capacity with NO limitations on movements +/- 90 degree tilting to enable all exam types Table lowers to 48 cm (19 inches) making it easily accessible for wheelchair patients Full system access from every side for easier patient transfer and exam versatility Fully motorised, easy-to-use compression for abdominal and other exams Control system operation remotely, or right at patient’s side Motorised movement of tube and column maximises speed and convenience Offered with either an Image Intensifier* with high resolution CCD camera that maximises image quality during fluoroscopy or a Flat Panel Detector that offers high image quality for either fluoroscopy or general radiology images
Auto positioning, as a function of extensive anatomical programmes, facilitates faster exam set-up times Patient overage of 201 cm allows full exploration of even very tall individuals without repositioning Relaxing ambient lighting and selectable music maximise patient comfort DAP measurements allow tracking of the exact radiation dose received by each patient Optional DRX-1 detector offers the power of the X-Factor and allows easy positioning for cross-table and weight-bearing exams Four-way table movement facilitates easier patient positioning Image stitching station combines multiple images into one for easier reading of spine and lower-limb exams
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Pharma Buzz
Eli Lilly to Introduce New Diabetes Medication in India
E
li Lilly, a US-based pharma company is all set to launch a new medication to enhance its diabetes treatment portfolio by the end of the year in India. The company has received regulatory approval for the upcoming product. It is also gearing up to introduce another medication in oncology that could be launched by the end of 2016 or by early 2017. In an interview to a news agency, Managing Director Edgard A Olaizola said that they are planning to i n t ro d u c e a new medication later this year in diabetes and also received t h e a p p ro v a l s for the same. He also added that the diabetes is their primary segment with around 60 to 70 per cent of revenues in India from diabetes followed by oncology and osteoporosis. The company considers the US, Europe as a region and Japan as the biggest market globally and India an important market in Asia.
Aurbindo Pharma Receives USFDA Approval for Ulcer Drug
A
urbindo Pharma has received approval from the USFDA to market generic version of Prilosec delayed-release capsules, used to treat ulcer in the American market. According to reports the company can now manufacture and market Omeprazole delayed-release capsules in the strengths of 10mg, 20mg and 40mg. A u r b i n d o Pharma’s approved abbreviated new drug application (ANDA) is a generic version of AstraZeneca Pharmaceuticals Prilosec capules. The Omeprazole delayed-release capsules are indicated for short-term treatment of active duodenal ulcer in adults. The company has received approval from the USFDA to market generic version of Hoffmann-La Roche’s Boniva injection in the American Market, said in a separate issued by the company. Ibandronate Sodium injection by Aurbindo pharma is indicated for the treatment of osteoporosis in postmenopausal women.
Think-tank for Pharma Sector to Resolve Export Issues
T
o address the export situation and other issues in the pharmaceutical domain, the Commerce Ministry is planning to set up a think-thank consisting of government officials, private sector players and scientists. This came up after the discussion during a meeting convened by Commerce and Industry Minister Nirmala Sitharaman. As per statement released by the ministry, during the meeting with senior officers from Ministry of Health, DGCI, Department of Pharmaceuticles, Department of
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Biotechnology, Department of Commerce and Pharmexcil, the minister took stock of various issues and challengs confronted by the Indian Pharma Industry. A sector like pharma which
is deeply rooted in science and is truly global in nature, a think tank consisting of senior pharma professionals, CEOs, government officials, scientists, researchers and pharmacists can provide an ideal forum to identify bottlenecks and resolve various issues for overcoming challenges and promoting hassle free exports, the ministry added. By putting its act together, the Indian pharma sector can help the global community in its fight against various life threatning diseases, it said.
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