eHEALTH - September - 2014

asia’s first monthly magazine on The Enterprise of Healthcare

volume 9 / issue 09 / september 2014 / ` 75 / US $10 / ISSN 0973-8959

IT in Healthcare Trends & Challenges

Stem Cell Banking

Insuring your child’s future

AWDC - 2014

eHealth Magazine

Oral Healthcare for All

volume

09

issue

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Special feature

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Contents

ISSN 0973-8959

Digital DRX X-ray Detectors

Surat extends a warm Welcome to Transasia Scientific Seminar

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past

Long waiting time has become a thing of

>>> Kapil Mehrotra

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Kapil Mehrotra ‘Connected

Healthcare’ a Reality >>> Somenath Nag

Dentistry

14 Oral Health is a Fundamental Human Right oncology

16 Haploidentical Family Donor Transplantation - a Saga of Success it in healthcare

40 Building Face to Face Collab oration >>> Ron Emerson 42 Delivering next Generation of Healthcare >>> Bipin Thomas 44 The IT Fecilitators >>> Manisha Chowdhury 46 Expert Healthcare Backed by State-of-the-art Technology

cardiology

50 Lifestyle to Blame for Blocking of Arteries >>> Dr Anil Dhal

68 Latest Breakthrough in Cardiac Care >>> Dr Sandeep Attawar, Dr Nikhil Kumar, Dr Sharad Tandon

stem cell

22 We are coming up with Exciting Technology Solutions >>> Arvind Sivaramakrishnan

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Leveraging Mobility to Empower Customers >>> Varun Sood

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WHP Surges Ahead in Telemedicine

>>> Harsh Shetty

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BLK Introduces Online Helpdesk Manager Portal >>> Prashant Singh

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IT’s Healing Touch

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‘We keep pushing the envelope’

>>> Dr Amardeep Singh Kohli >>> Rajesh Batra

34 ‘Internet bandwidth key for Cloud Computing’ >>> Rajendra S Kshirsagar

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56 Insuring Your Child’s Health 57 Beginning to Make a Mark >>> Dr P Srinivasan

58 Superior Technology for a Better Yield >>> Dr CV Nerikar

60 Investing in a Healthy Life from Birth >>> Mayur Abhaya

64 Treating Technology as a Commodity to Give Service >>> Naveen Kulkarni

asia’s first monthly magazine on The Enterprise of Healthcare volume

09

issue

09

september 2014

President: Dr M P Narayanan Editor-in-Chief: Dr Ravi Gupta

Partner publications

I C E CO ECT Connecting Technologies,Trends & Business

Infrastructure Construction Engineering

Editorial Team Health Sr Assistant Editor: Shahid Akhter Sr Copy Editor: Rajesh Sharma governance Sr Correspondent: Kartik Sharma, Nayana Singh, Souvik Goswami Research Associate: Sunil Kumar education Correspondent: Seema Gupta Sales & Marketing Team West: Douglas Digo Menezes, Mobile: +91-9821580403 North: Vinay Shil Gautam, Mobile: +91-9910998066 South: Vishukumar Hichkad, Mobile: +91-9886404680 Subscription & Circulation Team Manager Subscriptions: Mobile: +91-8860635832; subscription@elets.in Design Team Sr Graphic Designers: Om Prakash Thakur, Pramod Gupta Sr Web Designer: Shyam Kishore Editorial & Marketing Correspondence eHEALTH - Elets Technomedia Pvt Ltd Stellar IT Park, Office No: 7A/7B, 5th Floor, Annexe Tower, C-25 , Sector 62, Noida, Uttar Pradesh 201309, email: info@ehealthonline.org Phone: +91-120-4812600 Fax: +91-120-4812660 WEB DEVELOPMENT & IT INFRASTRUCTURE Team Lead - Web Development: Ishvinder Singh Executive-IT Infrastructure: Zuber Ahmed Executive – Information Management: Khabirul Islam

ehealth does not neccesarily subscribe to the views expressed in this publication. All views expressed in the magazine are those of the contributors.

The magazine is not responsible or accountable for any loss incurred, directly or indirectly as a result of the information provided. ehealth is published by Elets Technomedia Pvt. Ltd in technical collaboration with Centre for Science, Development and Media Studies (CSDMS) Owner, Publisher, Printer - Dr Ravi Gupta, Printed at Vinayak Print Media A-29, Sector-8, Noida, UP, INDIA & published from 710 Vasto Mahagun Manor, F-30, Sector - 50, Noida, UP, Editor: Dr Ravi Gupta © All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic and mechanical, including photocopy, or any information storage or retrieval system, without publisher’s permission.

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editorial

High tech healthcare for all Latest breakthrough in mobile technologies, devices, dahboards, genomic data and other emerging applications in telemedicine is fast piling up on the CIOs daunting and demanding desk. Can we call them exciting new opportunities? Today the role of a tech CIO seems to have morphed into a more challenging role where he needs to think of business by leveraging the available technology. The end result is evident from the improvement in patient outcomes.

Robust IT platform in health care is the need of the hour. Today, pizzas can be tracked and delivered online but what about the patients and medicine? As of today, our investment in IT is very low, despite the fact that we are aware of its immense potential. According to WHO, just the use of mobile to support achievements of health ojectives has the potential to transform the face of health service delivery across the globe.

The health care data needs to flow in a more meaningful way where it can be accessed by all the players - the hospitals, providers and the patient.

Given the inequity in distribution of healthcare infrastructure (26 percent of hospitals are squeezed in 7 metros that cater to only 7 percent of the Indian population), the solution lies in telemedicine, remote diagnosis, remote ECGs. This issue takes a look at the IT segment in healthcare and we have interviewed some of the CIOs and IT heads in hospitals and the industry that delivers IT solutions.

Stem cell banking is fast catching the imagination of urban, middle class parents, who want to secure their child against future health conditions.

In the nine years since the first stem cell bank opened, its awareness has grown. With less than one percent of the annual births being covered by this sector, the future hold immense potential. We look at this exciting growth story in this issue.

The Annual World Dental Congress (AWDC) is being organised again in New Delhi. This is happening after ten years. We take a look at the highlights of the much awaited conference. India continues to be one of the world’s largest growth markets for dental products and services.

The Indian dental equipment industry is valued at over USD 116 million, the dental care services at USD 1.16 billion and oral care market at 1.8 billion. The Dental Congress will certainly add wings and vision to the government’s plan of ‘Oral health care for all by 2020’.

Dr Ravi Gupta ravi.gupta@elets.in

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news

Cabinet approves MoC in Healthcare between India and Japan

The central government has approved the signing of an agreement that will lay the groundwork for healthcare cooperation between India and Japan.

The approval for the Memorandum of Cooperation (MoC) was given at a meeting of the union cabinet chaired by Prime Minister Narendra Modi.

The MoC would be signed between India’s Health and Family Welfare Ministry and Japan’s Ministry of Health, Labour and Welfare.

The cooperation envisaged are in the fields of human resource development, such as training programmes for medical practitioners, nurses and public health professionals, financing of universal health coverage and healthcare service delivery, including technical exchange to improve quality of care.

The two countries will also seek to cooperate on healthcare system governance and management, including sharing of know-how on management of hospitals and community healthcare centres and health information systems.

A working group will be set up to further elaborate the details of cooperation and to oversee the implementation of this agreement, the release said.

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PM Modi seeks help on sickle cell anaemia Prime Minister Narendra Modi sought Japanese stem cell pioneer Shinya Yamanaka’s assistance in battling sickle cell anaemia in India.

Shinya Yamanaka is Japan’s stem cell pioneer and a 2012 Nobel Prize winner.

PM Modi met him at the Kyoto University’s stem cell centre lab on his visit to Japan.

The two discussed the possibilities of sickle cell anaemia cure and prospects of cooperation among Indian and Japanese institutes. PM Modi asked Yamanaka to help battle sickle cell anaemia in India, to which the Japanese scientist agreed. The meeting lasted for nearly 30 minutes.

Tokyo and Delhi are now looking at an agreement to help fight the hereditary disorder in which the body’s red blood cells take on a sickle shape, and contain defective haemoglobin. In India, the disease is found mostly commonly among tribals in some parts of Gujarat and Orissa, as well as in Maharashtra, Madhya Pradesh and Chhattigarh.

Harsh Vardhan says Government to set up 20 cancer treatment centers Union Health Minister Dr Harsh Vardhan said the government will set up 20 new advanced cancer treatment facilities across the country over the next few years in view of the rising number of cases.

He said that a new State Cancer Institute (SCI) and two Tertiary Care Cancer Centres (TCCC) would be set up in Madhya Pradesh, to begin with, a the state accounted for a lot of new cancer cases.

Dr Harsh Vardhan was speaking at the inauguration of an indigenously developed Linear Accelerator at the Indian Institute of Head and Neck Oncology, a project of the Indore Cancer Foundation Charitable Trust.

Dr Harsh Vardhan said the TCCCs will be part of an existing government hospital with well-equipped and functional departments of medicine, surgery, gynaecology, ENT, pathology and radiology.

He said the Health Ministry would provide a one-time support of up to Rs 450 million to each TCCC, including up to 30 percent for construction and renovation. About the State Cancer Institues, he said each would be built at a cost of `1,200 million, of which the Union government will contribute 75 per cent.

4th International Congress on Patient Safety held In its endeavour to build awareness and consciousness, Apollo Hospitals in association with ISQua, JCI, NABH and many other institutions hosted the 4th International Congress on Patient Safety in the Kolkata.

The International Congress on Patient Safety served as a unique platform where the global healthcare leaders shared their experiences and exchanged knowledge and expertise on patient safety which in turn could help in implementing best practices at all levels. This Congress, a collaborative effort by all stakeholders to share their experiences in patient safety was also aimed at improving communication between Caregivers and Enterprise Risk Management and Patient Safety.

The International Conference on Transforming Healthcare through IT witnessed an exciting confluence of minds from the field of Healthcare and Information Technology who discussed and disseminated the latest happenings in the field of Healthcare IT. This edition of India’s only not-for-

profit International Conference on the Impact of Information Technology in Healthcare brought together nearly 40 speakers from across the world addressing over 500 delegates about the latest happenings in the field of Healthcare IT in their respective countries.

Patient safety is the cornerstone of a patient-centric healthcare system. The First ever Asian Patients Safety Awards 2014 to recognise the best practices within Asia were also held on the first day of the conference. These awards recognized the major contribution of individuals and

5th International Conference On Transforming Healthcare through IT A two day conference titled ‘Transforming Healthcare through IT’ was held in Kolkata, that focussed on the latest happenings in Healthcare IT. It was attended by Suptendra Nath Sarbadhikari, Director, National Health portal on the Indian government’s initiatives, Kshitij Marwah, Head and Curator of MIT Media Labs, Khsitij Marwah, and Veera Raghavan, Executive Director and Global Healthcare Practive Head, Dell Services. spoke about the upcoming technologies and its use in Healthcare while DELL Services, Executive Director and Global Healthcare Practice head, Veera Ragahavan elaborated on cloud computing

and its immense potential to scale up infrastructure solutions and add layers of effectiveness.

Healthcare Information Technology must have specific applications in different clinical disciplines. In this session, the role of ICT in Ophthalmology, Geriatrics, Genetic Counseling, Surgery and Stroke were covered by experts from various countries.

organizations promoting patient safety and quality healthcare by consistently upholding principles of healthy patients, safe and affordable care.

Innovation in Safe Communication, Medication Safety, Anaesthesia & Surgical Safety, Infection Prevention and Practice, Innovation in Staff Education were some of the categories in which awards were presented.

Keeping patients free from harm in a healthcare setting is widely becoming one of the biggest healthcare issues today but the challenge is to further patient safety and patient satisfaction hand in hand.

India among top three medical tourism destinations A study on medical tourism destinations by KPMG-FICCI has ranked India among the top three in Asia. The study, titled Medical Value Travel in India, put India behind Thailand and Singapore.

These countries receive the maximum medical tourists, the study said. In all, the three countries accounted for nearly 60 percent of medical tourists travelling to Asia.

The reason for the high percentage of medical tourists in these countries, according to the report, is the low cost of treatment, quality health care infrastructure and availability of highlyskilled doctors.

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focus in focus

ASP Conducts Workshops to

Promote Sterilization In order to promote the importance of sterilization in hospitals, Advanced Sterilization Products (ASP) conducted a series of workshops, inviting the CSSD managers for providing a platform to them to share their experiences among each other, and a one-day dedicated course on instrument reprocessing. The workshop proved beneficial to both the parties involved, as ENN’s Rajesh K Sharma finds out

A

s healthcare in India improves, the number of surgeries being conducted is increasing as well. An estimated one million surgeries are conducted in India every year. These range from minor Laparoscopic surgeries, to major ones like a heart bypass. With such a high number of surgeries, the risk of Hospital Acquired Infections

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(HAI) or Nosocomical infections due to contaminated instruments poses a threat to the patients. As the science of surgeries advances with instruments that are more precise and delicate, sterilizing them poses a huge challenge. According to a report by the Global Antibiotic Resistance Partnership (GARP) - India Working Group and Centre for

Disease Dynamics, Economics and Policy (CDDEP), hospitals in India have a high burden of infections in their intensive care units (ICU) and general wards, many of which are resistant to antibiotic treatment.

Currently, Nocomical infections account for nearly 25 percent of all infections in hospitals. A big reason for these infections is the improper

ASP designed a dedicated program instrument sterilization called SOTS or Science of Terminal Sterilization

instrument decontamination process. Methods that were effective just ten days ago are proving to be inadequate in this age of specialized tools.

Advanced Sterilization Products (ASP) Division of Ethicon Inc, a subsidiary of Johnson & Johnson and an industry leader in infection prevention, conducted a market research to identify current challenges and unmet needs to determine market opportunities and gaps in Johnson & Johnson’s product portfolio. It found that with weak sterilization guidelines and no sterilization certification program, there is a big gap between hospital protocols and actual practice as far as HAI is concerned.

The research found that there is a need for ongoing education and scientific knowledge for Central Sterile Services Department (CSSD).

Taking a cue from the findings, ASP designed a dedicated program instrument sterilization called SOTS or Science of Terminal Sterilization, a one day unique educational conclave to spread the awareness of HAI among hospital professionals, as well as improve the compliance

to instrument sterilization by highlighting its STERRAD line of instruments built specially for this purpose. It also conducted a series of workshops to promote sterilization of medical instruments across various cities in India. The workshops, called the Science of Terminal Sterilization (SOTS) workshops were held in Coimbatore, Hyderabad, Cochin, Bangalore, Chennai, Kolkotta, Pune and New Delhi.

Spread across the months of June, July and August, SOTS featured participation from hospitals across India. This attracted many STERRAD end users from across the country to the SOTS seminars in whichever city they were held.

The workshops stressed on learning about the importance of sterilization through a game-based module that was designed, that saw the attendees collaborate and compete among each other as teams. In a section titled ‘Life in Device’, the attendees were asked to talk about their experiences in using STERRAD and how similar or different the experiences were.

A feature that dwelt upon was

how to build the confidence in the product by improving it technologically. The end users gave their suggestions on how to improve STERRAD and make it more relevant in the fight against HAIs. ASP took note of all the suggestions in its quest to improve its product.

Ways to engage the customer was also discussed at each of the SOTS workshops. Sterilization of surgical instruments has increased in importance as well as complexity, and training the CSSD professionals is essential to improve compliance sterilization.

The workshops proved to be an eye opener for all involved. While the attendees benefitted from gaining more knowledge about how to use their STERRAD machines more efficiently, ASP too gained knowledge about how the healthcare industry professionals approached sterilization, and how its STERRAD line of products could be improved upon to be the de facto machine to achieve sterilization of instruments.

In all, the workshops and conferences managed to train nearly 550 managers across India.

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????????feature special

Worldwide Shipments of Carestream’s

Digital DRX X-ray Detectors

Surpass 9,000 Units Features That Help Enhance X-ray Exams Carestream Health has shipped more than 9,000 DRX detectors since launching the CARESTREAM DRX-1, a revolutionary wireless X-ray detector that quickly and affordably retrofits existing X-ray rooms or portable diagnostic imaging systems from CR to DR technology, or powers new DR rooms and mobile systems. Carestream DRX systems and detectors are used in surgical suites, ER/ICU areas and radiology departments—as well as clinics, imaging centers, nursing homes and field military hospitals.

These detectors deliver high-quality, affordable digital X-ray images in about five seconds. “Our innovative family of wireless DRX detectors, imaging systems and specialized software delivers excellent image quality while enabling healthcare providers to improve productivity and control costs,” said Diana L. Nole, President, Digital Medical Solutions, Carestream.

The company’s DRX systems help streamline workflow and improve patient care in both room and mobile environments. Carestream’s DRX-based portfolio includes: CARE-

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STREAM DRX-Revolution Mobile Xray Systems, CARESTREAM DRX-1 Systems, CARESTREAM DRX-Mobile Retrofit Kits, CARESTREAM DRXEvolution Systems, CARESTREAM DRX-Transportable Systems, CARESTREAM DRX-Ascend Systems, and the Q-Rad-Digital DRX-Series from Quantum Medical Imaging that is sold through the company’s large dealer network in the United States and Canada. Quantum Medical Imaging is a division of Carestream.

In addition to the DRX-1 detector, the DRX portfolio also includes the CARESTREAM DRX-1C that utilizes cesium iodide technology and offers excellent image quality and improved DQE (detective quantum efficiency).

The DRX-1C detector can be used to treat patients in trauma, orthopaedic and other clinical environments.

Carestream’s newest cesium-iodidebased detector, the CARESTREAM DRX 2530C, fits into pediatric incubator trays and is also used for orthopaedic and extremity imaging. The small-format DRX 2530C detector is intended for use with DRX-Revolution systems or DRX-Mobile Retrofit Kits for mobile imaging of neonatal and

pediatric patients. It also can be used with DRX-Evolution and DRX-Ascend systems, as well as DRX-1 room retrofit systems, for orthopaedic applications and other tabletop exams that can benefit from a smaller detector.

Patient care in ED, ICU, pediatric ICU and other environments can be enhanced with advanced Carestream software that uses a single exposure to produce a companion image with algorithms designed to accentuate specific devices or conditions. For example, the companion image can produce a clear view of tubes and PICC lines, display free air in the chest cavity, or suppress the appearance of posterior ribs and clavicles to deliver a better view of soft tissue in the chest. Use of this software can help physicians deliver a higher level of patient care while simultaneously reducing the need for additional exposures.

To maximize utilization and flexibility, Carestream’s DRX detectors can easily be moved to any DRX room or mobile DRX system—a feature referred to as the “X-Factor.”

For more information on Carestream’s medical imaging solutions please visit www.carestream.in

dentistry

How healthy are the Indian teeth?

The health of Indian teeth leaves much to be desired. Lack of awareness about oral health and hygiene, compounded by poverty, illiteracy and lack of accessibility are the major reasons. Also, lifestyle changes have brought about considerable damage to oral health. Oral health is a highly neglected area since it is not life threatening. People are unaware of the links between oral health and general health and the impact of oral diseases on general health. However, In-

dian Dental Association has launched several oral health initiatives to improve the scenario in the country. But its efforts have touched only the tip of the iceberg and more work remains to be done in this regard. Indian Dental Association’s goal is to bring about optimal oral health in the country.

How do you sum up the oral care scenario of India and the prevalence of oral diseases?

Quality of life can be affected by oral health and diseases. The most basic

Oral Health is

a Fundamental

Human Right India hosts the 2014 Annual World Dental Congress, AWDC (11-14, September, 2014). Dr Ashok Dhoble, Hon. General Secretary, Indian Dental Association, in conversation with Shahid Akhter, ENN discusses the highlights of the second AWDC taking place in India after 10 years

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human needs, including the ability to eat and drink, swallow, maintain proper nutrition, smile and communicate is dependent on oral health. We realise that not only the quality of life, but it also affects self- esteem and performance at school or work. In a nutshell, oral health is an essential component of health throughout life.

In India there is lack of awareness regarding oral care; a little over 2% of the population visits the dentist. People are not even aware of the basics like how to hold a brush properly or how to floss. The basic of brushing twice a day is not adhered to, which results in Dental Carries. Also people are not aware that good oral health contributes to good overall health.

Despite increased awareness in certain pockets/ regions in India, still over 50 percent of the population is unaware

of prevention techniques or of cures available for various dental problems.

How different is the dental care divide between rural and urban India?

An estimated of 40-50 percent of Indian population has never visited a dentist. Moreover, nearly 70 percent of the population is suffering from dental diseases. The dentist/population ratio in India clearly indicates that there is a major rural and urban divide in the availability of dentists in India; it is 1: 10,000 in urban areas and 1: 250,000 in rural areas. This of late has undergone slight improvement. The distribution of dental professional is skewed in favour of urban areas.

Also, the rural population still needs to be educated on the use of toothbrush and toothpaste maintainance of oral hygiene. Most of the time the patients visit the dentist when in pain and never bother to return for follow-up in most cases.

Oral Health for All by 2020 India is one of the world’s largest growth markets for dental skills and dental products. Every year, some 25,000 newly trained dentists graduate from the country’s nearly 300 institutes offering dental qualifications. AWDC will give a boost to the Indian government’s plan of ‘Oral Health for All by 2020’ Dr Tin Chun Wong, President, FDI

India is a favored destination today because of superior dental treatments at reasonable cost, by experienced dentists recting Cleft Palette to bring smiles on the faces of people.

What are the highlights of IDA 2014? What can we look forward to at IDA 2014?

How has technological advancement shaped dental care in India?

As stated earlier, Indian Dental Association has been designing program and projects to improve the oral health conditions in the country. One of the major oral diseases is Oral Cancer, caused primarily by tobacco. Indian Dental Association has set up an Oral Cancer Foundation and also an Oral Cancer Registry exclusively for registering oral cancer cases. Together with Tobacco Intervention Initiative which aims at tobacco secession, Indian Dental Association is making concerted efforts to reduce the incidence of oral cancer in the country by setting up Spot and Prevent Oral – Cancer Trauma (S – P – O – T) for the early detection of oral malignancy and potentially malignant lesions. Detecting and treating cancerous tissues as early as possible is critical in helping you beat a potentially deadly disease. Indian Dental Association will also be launching an initiative for cor-

There has been a remarkable change in Dental technology, products and materials, offering various treatment options. Consistent with the changing technology, the spectrum of diseases has also been expanding. This has also led to growing demand for quality treatment among the elite, on par with international standards. Consequently, demand for aesthetic dentistry and other innovative, restorative procedures aimed at sustaining natural dentition for life has increased. In a way we can say that this growing demand has resulted in employment generation in related sub-sectors.

Please share your thoughts on the emerging trends in oral care equipment market?

The dental market can be divided into (a) Market for Equipment (b) Materials and (c) Services. India presents a huge

market estimated at about $50 million annually. India has nearly 300 dental colleges with an annual turnover of 25 to 30 thousand graduates entering the dental market. Given the existing dental professionals of about 1,80,000 and the annual additions would make a huge demand for dental equipment in the country. India thus provides a huge potential market for dental equipment in the country.

What kinds of specialised dental services are patients opting for these days?

An increase in disposable income supported by growing awareness about healthcare amongst the masses has resulted in patients opting for dental cosmetic procedures for Crown restoration, Dental Veneers, Bridges, Implant dentures, Full Mouth rehabilitation, Cosmetic Dentistry, Teeth Whitening, etc.

Please tell us about the emergence of aesthetic treatments in India? The current trend and the way ahead?

The advent of new technology combined with rising patient needs has radically altered the field of dentistry while creating a number of sub branches offering exciting opportunities. An important sub-field that is witnessing a rising demand for trained professionals is cosmetic/ aesthetic dentistry. Cosmetic dentistry focuses on reconstruction and other aesthetic dental procedures.

Cosmetic dentistry offers the following services: Dental whitening, reshaping, resizing, Dental veneering, Root canals, dental bonding and Gum lift.

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oncology

Haploidentical Family Donor Transplantation

- a Saga of Success Dr Sandeep Chatrath, CEO, Dharamshila Hospital, discusses the success story of Haploidentical Transplantation with Shahid Akhter, ENN What is Haploidentical Transplantation?

Haploidentical Bone Marrow Transplantation (BMT) is a procedure in which, instead of fully HLA matched family donor, a half HLA matched parent or sibling is the donor for bone marrow or blood stem cells.

What is the scientific basis for Haploidentical Family Donor BMT? Is BMT possible from a half matched unrelated Donor?

The saying that ‘nature is the mother of all inventions’ is not without reason. HLA antigens are inherited as a set from each of the parents. A mother nurtures a baby in her womb for 9 months without rejecting it even though the paternal HLA antigens inherited by the baby should cause a rejection. This is nature’s example of development of tolerance and thus, a child and the mother are natural donors for each other in most cases even though they are only half matched in their HLA antigens.

Based on the pioneering work by doctors from Italy, BMT from a half matched (Haploidentical) donor from the family was developed. Due to the absence of this ‘natural law of tolerance’, BMT from a half matched unrelated donor is not possible.

How is Haploidentical BMT different from other forms of BMT? BMT from a Haploidentical family donor is associated with a higher risk of both GVHD and Graft Failure. Thus, the success of such BMT depends on the selection of the right Haploidentical Donor amongst the family

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members, delivery of the most suitable ‘Conditioning’ therapy to prevent Graft Failure and to prevent GVHD by processing the graft or using a combination of immunosuppressive drugs.

What are the indications for a Haploidentical BMT? The indications for Haploidentical BMT are the same as Matched Family Donor BMT.

Why do we need a centre for Haploidentical BMT? There are six private and two stateowned BMT centres in Delhi and NCR and one might query intuitively as to ‘why another one?’ To answer this, we need to look at the Indian scenario in the field of BMT. It is estimated that over 30,000 patients per year in our country need a BMT to save their lives and the statistics from Indian Stem Cell Transplant Registry reveals that with over 40 centres across the country, only about 1000 transplants are performed annually.

So, is our venture just to add a few numbers to the mammoth need of our population? If all the centres performed 4 transplants per month -which we are sure they are capable of-the need would be largely met.

Then, why is that not happening?

The answer lies in the fact that BMT is dependent on availability of HLA matched donors from the family. However, this is available to only 20 percent of the patients by simple law of

inheritance. Yet, Europe, USA and Japan meet their needs largely through Volunteer Unrelated Donor Registries which currently boast of 20 million donors. In India, such registries are in their infancy and the chance of finding a match from the foreign registries is less than 10%. More importantly, the cost of procuring the blood or marrow products from Europe or USA ranges from 10,000-30,000 USD. Similar transplants can be performed from unrelated cord blood units at a similar cost, but the procedure is more challenging.

What are the unique features and infrastructure of this life saving procedure ?

Dr Suversha Khanna, president of dcfrc conceptualised the development of this unique one of its kind of bmt centre. It was her dream to have this state of the art facility in Dharamshila Hospital.

In a country where alternate donor BMT is rarely available for patients lacking a matched family donor, Haploidentical BMT seems to be the logical option. However, lack of expertise and infrastructure halted its development.

Dharamshila BMT Centre has developed state-of-the art infrastructure and laboratory facilities to promote the use of Haploidentical Donor BMT in India.

The patients undergoing intensive conditioning and T cell depleted stem cells from Haploidentical donors are at the highest risk of infections. Infections mostly come in the form of bacterial infections from the gut or skin of the patient or as resistant bacteria from other infected patients, or as fungal infection through the air. The HVAC system of highest standards has been installed in Dharamshila BMT centre, which is first of its kind in the country. This ensures protection to the patient from all airborne infections, whilst inside the unit.

Twenty-Four Bedded Dharamshila BMT Centre have 4 dedicated rooms for Haploidentical Bone Marrow Transplants. Each Room is equipped with

dedicated Air Handling Unit, Anteroom for each BMT Room (for maintaining 12-15 hepafiltered fresh air changes per hour, with positive air pressure) as per class 1000 clean rooms; stainless steel doors, vinyl flooring and wall cladding for maintaining clean surfaces, which will definitely help in improving outcomes in Blood and Marrow stem cell transplantations. Each BMT Room has been furnished like an ICU with double outlets for oxygen, vaccum, six parameter monitors, infusion pumps, syrings pumps and crash cart. Sick patients with zero white blood counts cannot be taken out of the BMT unit, as this will entail risking their life. Therefore, there is a provision for stand-by ventilators, Dialysis machine, Ultrasound and XRay Machine in the BMT Unit.

To support the hapaloidentical BMT Programme, Dharamshila BMT Lab provides l 8-colour Flow-cytometry based

l

for Viral Pathogens Drug Levels for BMT.

Who are the team members associated with BMT programme?

Dr. Suparno Chakrabarti and Dr. Sarita Jaiswal pioneered the first Haploidentical BMT program in India. Their work and research has been widely presented and published in the last two years.

What makes Dharmashila so different?

Internationally and nationally acclaimed team of Haemato-oncologists’ and Haematologists trained in Europe with extensive experience in BMT at Europe and India. We are the only centre with expertise and infrastructure for Haploidentical BMT (from half matched family donors).

We have the highest standards of infection control and top notch technology brought together to achieve

Haploidentical or half matched donor bone marrow transplant (BMT) is the only treatment option available for patients of blood disorders, who have been advised BMT, but do not have a fully HLA matched family donor or a matched unrelated donor diagnostics for Leukemia, Lymphoma and Aplastic Anemia l Detection of Minimal Residual Disease (MRD) l Molecular diagnosis for Leukemia l HLA typing, NK Cell Genotyping and CD34 + Stem Cell Estimation l Comprehensive donor selection for Haplo-identical BMT based on NK-KIR Profile. l Magnetic Separation of Cells using MACS Technology. l Long Term Cryopreservation of Stem Cells at -1960 C liquid nitrogen freezer in vapour phase l Conventional and Real Time PCR

highest cure rates to transform dreams for being disease-free into reality. Add to this 21 beded BMT Centre on the top floor of India’s first NABH accredited Cancer Hospital which is operational since 1994 with 300 beds.

We have an excellent stem cell lab facilities for Collection, Processing, Enumeration and Cryopreservation of Stem Cells, HLA typing, Leukemia markers and other molecular tests. We have the support of laboratory facilities which are fully equipped to carry out routine and special tests like HLA testing, drug blood levels, bacterial and fungal cultures and viral analysis.

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Special feature special Focus

Surat extends a warm

Welcome to Transasia

Scientific Seminar

Dr Anil Handoo wth Jotwani

Transasia Scientific Seminar (TSS) is organised in tier II and III cities all round the year to encourage knowledge sharing and exchange of scientific updates

F

or the last thirty five years, Transasia Bio-Medicals Ltd. has become a name synonymous with quality and precision in the Indian in-vitro diagnostic industry. With its wide range of products and solutions, backed by excellent after sales service, Transasia has expanded its network in more than 94 countries.

India’s leading in-vitro diagnostic company leaves no stone unturned in delivering holistic healthcare solutions. At Transasia the efforts are channelized at providing its patrons with the technological advances backed by expertise and experience.

Transasia Scientific Seminar (TSS) is a unique platform that encourages knowledge sharing and exchange of scientific updates.

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Throughout the year, the team from Transasia organizes a series of TSS’s in tier II and tier III cities bringing together the Doctors and technicians from the nearby areas for exchange of technical knowhow and hands-on experience on the instruments.

The latest TSS was held in the ‘city of flyovers-Surat’ on 3rd August at Hotel Gateway. Dr. Anil Handoo, Sr. Consultant Hematology and DirectorLaboratory Services, BLK Super Speciality Hospital, New Delhi delivered a lecture on ‘From workhorse to a thoroughbred-Journey of the hematology analyzer.’ The session was chaired

by Dr. K.G. Naik and Dr. R.M. Khandwala, senior pathologists from Surat.

Senior Hematologist, Dr. Kiran Shah moderated the session.

Inspite of the heavy rains, the seminar received an overwhelming response with more than 80 top pathologists attending the session not only from Surat but other towns such as Bharuch, Ankleshwar, Navsari, Valsad, Vapi, Bardoli and Vyara. The event was well by supported South Gujarat Practicing Pathologists Association, Surat.

The attending Doctors also got a chance for a hands-on training on 6-Part Differential Hematology Analyzer XN-1000, 5-Part Differential Hematology Analyzer XS-800i and 3-Part Differential Hematology Analyzer XP-100.

The attending Doctors appreciated the session demanding more such seminars to be held in the future as well.

it in healthcare

IT@Indian Healthcare New Horizons, Newer Opportunities

I

nformation technology is a pivotal tool that has the potential to tilt the growth scenario in all verticals of life. Sectors like banking and telecom have leveraged IT and they are at an advanced stage of IT adoption. In healthcare, we have been talking about the dire need for transformation but so far the change has been slow. The viable and vibrant solution seems to have evaded healthcare IT so far. The IT segment in healthcare has yet to capture the full share of the limelight.

Healthcare IT is a cluster of alliances spread across organisations like healthcare providers, diagnostic industry, infrastructure companies, policy makers, health funders, software developers, healthcare insur-

ance and even academic institutions.

They need to work in tandem to emerge as winners.

In India, the medical technology sector was valued at USD 6.3 billion in 2013 at end consumer prices and is growing around 12 percent per year.

This sector remains highly unexplored, rather under-penetrated; accounting for 8 percent of spending in healthcare vs 18 percent in pharmaceuticals.

Challenging demands Besides lack of clarity (in terms of regulation) and market access, there are other impediments that impact the limited investment in the sector. This adversely tells on the basic healthcare ecosystem and the subsidiary technology skills to support the market.

Unlike banking and telecom sectors, which have leveraged Information Technology and are at an advanced stage of IT adoption, the healthcare sector is yet to repeat the feat

Technology adoption in healthcare in India Patients India has more than 900 million mobile users Country has 243 million Internet users, growing @ 28% CAGR Increasing awareness pushing demand for services Providers Healthcare providers are increasingly recognising IT as an important tool for meeting their business objective Both central and state governments are investing in Healthcare IT CIOs are increasingly becoming part of strategy development Willingness to try new technology has increased tremendously Partners (technology) Large corporates are venturing into Healthcare IT New age entrepreneurs, innovators, and start-ups are using cutting edge technology to take healthcare to masses (Source; Internet And Mobile Association of India)

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26 percent of the hospitals are positioned in the seven metros that cater to only 7 percent of the Indian population. A large percentage of Indians in the remote areas have been left behind. They lag behind in access to healthcare, and medical technologies in particular. These include - lack of screening, awareness, diagnosis, affordable technologies, etc.

The government has recognised these challenges and efforts (like Rashtriya Bima Yojna) have been made to consolidate the reachout. It is precisely here that the medical technology comes to the fore to extend their reach beyond the physical catchment

area. We take a look (page 26) at the model initiated by World Health Partners (WHP) who made over 1, 20,000 telemedicine consultations in rural India. Using the latest advances in medical technology, WHP, with support from Bill & Melinda Gates Foundation, has established a cost effective network of health services in rural India.

Given the inequity in distribution of healthcare infrastructure, telemedicine can play a pivotal role. This leads the industry to provide medical devices to remotely use the video and audio applications. Today, we can compress a high definition (HD) video (720 P 30 fps ) into as little as

512 kbps. The current issue features the industries that are working hard to overcome the challenges of time and distance.

CIOs At one point of time, the CIO was a transient position but today it’s a vibrant profile. On one hand the CIO needs to think of business by leveraging technology and on the other they need to deliver high end patient care using the interoperable technology. Today, patients are exposed to multiple health conditions and this warrants multiple treatment locations. In general, IT needs to address this multiple

sharing of health records amidst dizzying array of disparate systems. More precisely, the CIO needs to ponder over these given equations, besides the sweep of regulatory reforms, patient outreach, readmissions, image branding, etc.

Aspects of CIOs’ role in healthcare have been evolving and will continue to do so. Today, a good many hospitals have embraced IT and others are on the verge of integrating technology in various ways.

We talk to CIOs in healthcare across the nation, to assess their achievements, problems, solutions and the road ahead.

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IT in Healthcare

We are coming up

with Exciting Technology

Solutions Arvind Sivaramakrishnan, CIO, Apollo Hospitals Enterprises Ltd, in conversation with Shahid Akhter, ENN, talks about the IT initiatives and innovations at Apollo Hospitals In what way has IT affected global healthcare delivery and comparatively, how has India benefited from this ?

India is undoubtedly the leader in IT solutions. With abundant talent from the IT industry, Indian healthcare has greatly benefitted from solutions that aide effectiveness and efficiency to healthcare delivery for patients, providers and associated sectors. We have clearly seen a surge in the implementation of hospital information systems across the country. The medical imaging solutions such as PACs have matured and eHealth and mhealth is finding significant adoption. Both eHealth and mhealth solutions have opened up a lot of innovation in solutions for the delivery of healthcare and the awareness of health related matters and managing chronic diseases. This has created a very healthy cycle of growth for the healthcare and IT

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industries; its management, has increased health and wellness awareness in the society and has benefited public health programs and population health.

Could you give an idea of the scale of IT dependence in Apollo hospitals?

It is an inherent part of the strategy of Apollo Hospitals. We constantly assess the effective adoption and implementation of technology in all our initiatives. Our models of Clinical, Service and Operational excellence have a great IT dependency and we believe that by using a combination of traditional and disruptive technologies we can add higher levels of efficiency to our overall system. Our IT solutions have greatly assisted us in achieving high standards of clinical excellence, patient safety and medication safety. Our hospitals and clinics are interconnected by a

single hospital information system and we are clearly seeing the operational benefits and reduction in maintenance opex costs on IT.

Please elaborate on some of the obstacles faced in adopting IT in Indian healthcare domain.

Obstacles in adoption of IT in healthcare are typical to those faced world over. Change Management is crucial.

While everyone would agree on the need for standardisation, the change associated with such initiatives have to be well managed and communicated. Training and operational hand holding are essential elements to successful implementations.

It is essential that IT solutions effectively align to hospital workflows and aide clinical and operational activities. Solutions have to be easy to use and intuitive. This will reduce the inertia to adopt and adapt such solutions.

Cost, maintenance and reliability are essential factors. There is no standard recipe on this but organizations have to pay close attention to each of these in tandem with their business operations and ensure they maximize the reliability and keep the cost at a logical minimum.

In the absence of strict federal regulations around IT and Healthcare, organizations have to be proactive in working out organisational policies and protocols around IT solutions

How can IT tools help reduce raising healthcare costs?

IT tools help in reducing complex labor and overheads in operations. Telemedicine can greatly help reducing costs.

Tele radiology is clearly helping in increasing accessibility and reducing costs. Innovative IT solutions at point of care help the clinicians and aide in managing patient safety and completely reduce adverse events. This greatly helps in increasing clinical effectiveness, positive outcomes, reduced infection rates and overall reduction in costs of healthcare. ICT is also a great

tool for raising awareness and preventive medicine. Use of ICT in managing wellness reduces healthcare costs.

Use of ICT in managing patient adherence to disease management protocols such as diabetes and hypertension also significantly contribute to reduction of healthcare costs.

Has data integration improved the clinician’s user experience?

Absolutely. All data has to be delivered in a meaningful manner at the right place, at the right time and the translated to the right information. Silos of data are meaningless and will frustrate and confuse the clinicians. Furthermore, it is not safe. Integration is an absolute must and cannot be compromised.

Apollo prism is our PHR with close to 2.5 million subscribed patients What are some of the unique IT initiatives you have adopted at Apollo?

We have a single HIS that connects all our hospitals and clinics. Using this we are able to have a single unique patient health identifier. This means one patient and one electronic health record and a seamless continuum of care. Our EMR is connected to a PHR – Apollo Prism which has close to 2.5 million patients subscribed. We have an effective mHealth platform and our eHealth solutions are greatly effective.

Our social media facebook page has 2 million fans on it. Our tele medicine practice has been very successful. We now have a very effective tele radiology practice that is serving domestic and international clients. Our eICU solution is truly state-of-the-art.

How have you integrated mobile applications?

Yes. The power of the system is greatly realized when its integrated and seamless. It removes operational overhead and benefits inter-departmental communication. Our clinical systems, supply chain, financials, HR and service solutions are integrated.

What is your assessment and strategy towards cloud, private and public?

Cloud strategy clearly has merits. Concerns around service from providers and security continue to remain and need to be addressed. Our hospital information system and imaging solution are on the private cloud and we have embraced the cloud for our HCM and Office productivity solutions. The risks and the benefits have to be carefully balanced and we have to pick solutions that fit our business need.

In a country like India, telemedicine can play a huge role. How do you forsee the problem and the solution.

Telemedicine is clearly a great asset and a boon to the healthcare delivery. The problem is clearly the lack of awareness and the misconceptions on its effectiveness. Unfortunately there are no binding regulations around tele medicine.

This area has to be addressed. Technology is mature today and the mobile revolution of India can play a great partner to furthering tele health solutions. It will greatly help in bridging the demand-supply gap that challenges the healthcare industry. The cost of healthcare can be significantly reduced and all our healthcare resources can be effectively maximized.

Next big thing happening at Apollo by way of IT ?

We are constantly evolving and innovating. Please do keep watching as we are coming up with exciting technology solutions to help us in our effective and efficient healthcare delivery.

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it in healthcare

Leveraging Mobility to

Empower Customers Varun Sood, CIO, Fortis Healthcare, in conversation with Shahid Akhter, ENN, discusses the innovative ways to leverage IT technology in healthcare In what way has IT affected global healthcare delivery and comparatively, how has India benefited from this?

Advancements and developments in IT have affected healthcare delivery in innovative ways. For example, analytics of available clinical data have improved risk profiling and early diagnosis and interventions. Communication and video technologies have made it possible for patients in remote locations to have access to high quality healthcare services and professionals. Continuous gathering of data on patients has enabled near real-time monitoring of health and raising selfawareness. Cloud technologies are enabling ability to scale on demand while helping reduce costs and making services more affordable. Mobility and social technologies are empowering and enabling people to access services and information where they are and when they want.

One of the unique aspects of technology is that it is truly geography agnostic.

Advancements in one geography can be used in another location depending on regulations and laws. While India is leveraging most of the global IT driven healthcare advancements, it is also contributing to creation of the same.

How has the IT helped to channelize the flow of information between the hospital, doctors and patients?

Timely availability of data and information is a critical need for effective clinical care and patient care. In to-

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day’s environment, patients and their families are well informed and expect to have information available when they want and to be involved and updated on all aspects of their care. IT has enabled this flow and availability of information in an effective and efficient manner using various tools and platforms.

Please elaborate on some of the obstacles faced in adopting IT in Indian hospitals?

Adoptions of IT systems are normally driven by the following key aspects: ease of use, impact on individuals and cost effectiveness. The challenges in Indian healthcare are primarily of a huge demand and supply mismatch and af-

fordability. From a global standpoint, India has one of the lowest price points for most aspects of healthcare but from a domestic standpoint, affordability is an issue that needs to be addressed.

If the cost of the IT system adversely impacts affordability, it can be an impediment to adoption. Due to the supply and demand mismatch, the number of patients being treated by our medical fraternity is one of the highest globally.

The interaction or ease of use of an IT system needs to be such that it either maintains or improves efficiency and productivity otherwise it would be an obstacle to adoption.

Can IT tools help reduce raising healthcare costs?

IT is leading the charge in controlling if not reducing rising healthcare costs. From a reach and access standpoint, IT systems are enabling accesses to quality medical care from distant locations using technologies like telemedicine, e-icu’s. Electronic capture of clinical data and analytics is enabling better risk profiling and early detection of issues. Systems for supply chain are helping healthcare organizations better manage inventories and leverage scale leading to reduced costs.

What are some of the unique IT initiatives you have adopted at Fortis?

As an organization, we have identified IT as a source of competitive advantage going forward and have accordingly undertaken strategic IT initiatives focused on enhancing clinical excellence, providing distinctive patient care and driving efficiency and productivity. All initiatives undertaken are targeted at one or more of these three areas. As examples, we have made a move to a 100 percent public cloud company enabling significant efficiency and productivity and enabling us to rollout new services at speeds not possible earlier. We are working on empowering our patients with any-

While India is leveraging most of the global IT driven healthcare advancements, it is also contributing to creation of the same time, anywhere access to Fortis including all their information and data.

What is your assessment and strategy towards cloud - private and public?

clear regulations and the wide availability of low cost, high quality communication networks.

Where do see Fortis hospitals by way of IT, five years from now?

The cloud is a reality at Fortis. We have chosen to be a 100 percent public cloud company and completed our transition in the last calendar year and the benefits realized by adopting the public cloud have been numerous.

In 5 years, using technology Fortis would be proactively managing the health of its customers where they are and at their convenience and require them to visit our hospitals when an intervention is required.

In a country like India, telemedicine can play a huge role. How do you for see the problem and the solution.

Your advice to fellow CIOs ?

Technologies like Telemedicine have the potential to disruptively overcome the issues of access and affordability that we as a nation face. There are 2 key drivers for wide spread adoption of these technologies: enabling and

Think business outcomes and not technology. Technology is just one of the components needed to achieve business outcomes. Taking a business view will change the decisions we take on technology. Think partnerships and not vendor relationships.

Partners will go the extra mile, while vendors will do what is contracted.

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IT in Healthcare

WHP was recently in news for 1,20,402 tele-medicine consultations which cost a fraction of a trip to an urban doctor. Most of these patients were from lowest economic background. How did you achieve this feat?

WHP has worked relentlessly over the last 6 years to execute this goal. We have listened closely to our healthcare providers to understand what works and what doesn’t in a telemedicine consultation. We have also kept our focus on the lowest economic background. Our donors have strongly supported us in this.

Does this prove that telemedicine has really kicked off in India?

India is still in the early stages of the adoption of this technology but increasing, adoption in other countries – both developed and developing – indicates that this is a technology whose time has come. We are one of the few operators of telemedicine in India.

What were the obstacles you encountered in setting up your tele-medicine project?

As one of the innovators of this technology, we encountered all the teething problems that are experienced by the pioneers. The problems ranged from tuning sensors, increasing the range of sensors, the communication flow between patients-providers-doctors, the transmission and decoding of the prescription that is sent back. We now have a stable platform that we are taking to several countries. (a) Poor internet connectivity: it is also one of the main operational problems today in these rural areas.

What initiatives you took to overcome them?

WHP has taken several initiatives to overcome these problems like (a)Tuning sensors: We have a crisis helpline where a provider can re-

WHP Surges

Ahead in

Telemedicine

Using the latest advances in medical technology, World Health Partners (WHP) with support from Bill & Melinda Gates Foundation, have established a cost effective network of health services in rural areas in India. Harsh Shetty, Director Technology and Innovation, WHP, in conversation with Shahid Akhter, ENN, evaluates the technology and innovations that redefine WHP

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port a problem. We have service teams on the ground that visit the providers as soon as a problem is reported. We have repair and tuning centers in close proximity for any sensors that need a significant fix. (b) Increasing the range of sensors: To overcome this challenge, we strive to add more sensors as they become commercially viable. We are continuously watching developments in this industry. (c) Communication flow: To streamline communication between providers and doctors, our design and human interaction experts work at both ends to simplify the experience. (d) Transmission and de-coding of prescriptions: In the areas with low connectivity, we send the prescription back via coded SMS that is decoded at the provider end with a physical decoding manual. In areas with high connectivity, a prescription is sent back to the tablet device being used by the provider, he then takes printout of the documents via bluetooth-attached printers.

Besides tele-medicine, what other innovative technology initiatives were created in the rural areas?

1. Using Interactive Voice Response System(IVRS) – for instance, we have a general healthline number for a community wherein people from the rural community can give a missedcall to this number and get an automoted call back, which is menu-driven system to give brief information and advisory of selected disease. This system educates the community on the disease before they head out to seek diagnosis from private/Govt facilities.

We then pull children records from the call records based on disease selection and subsequently track for pneumonia and diarrhea.

2. Introducing tablet technology – we have introduced tablet based technology for providers as a lower-cost solution to using a telemedicine platform.

In this solution there is no video con-

WHP Rural Impact

20,000 rural villages 74 million people

524 telemedicine centres in Bihar 9,267 outlets TB Project in 13 districts of Bihar

sultation but sensor data is still sent to our central medical facility (CMF) of doctors and the consultation happens over the phone.

In what way has IT affected healthcare delivery in India?

We are in an era which is the democratization of healthcare.

IT is having and will continue to have a tremendous impact on healthcare delivery in India. We are in the midst of an era at the culmination of which healthcare delivery will be unrecognizable from where it started.

Especially in rural areas we are able to bring the latest technologies and knowledge to everyone.

IT touches every part of the ecosystem. As a result, access, experience and outcome is improved.

Access: Patients in both urban and rural settings have much more access to care providers and information. For instance, WHP has Skycare providers that reach out to rural patients and Skyhealth centers from which patients have telemedicine access to urban doctors.

Experience: Modern IT technologies seamlessly move patient medical record data between first line providers, specialists, hospitals and chemists. Coupled with technologies that support post-care, the healthcare experience has improved significantly.

Outcome: As a result of a tremendous amount of information now easily available and peer networks amongst doctors facilitated by IT, outcomes have improved.

How have you integrated mobile applications?

Different entities in our value chain use specific mobile apps with the data being written back to our central data warehouse in real time. For instance, a provider may use a diagnosis app, a field officer may use a data capture app regarding how many patients were treated by the provider, a supply officer may use an app that registers how much inventory is available in various chemist shops. Data from each app is entered into our central data warehouse in real time.

Does IT require investment and long term vision to conceptualize any strategy?

Without long term vision, the organization ends up with ad-hoc solutions and it becomes difficult to have a single view/ analysis of the data. Without a concrete analysis of the data, it isn’t easy to take management and operational decisions.

Investment comes next, the vision has to be clear first. With a clear vision, you can start working on specific parts of the vision even without much investment. You need more investment if you are looking at capital-intensive deployments of technology (such as remote/ robotic surgery) or if you are going to invest in medical-technology research.

The vision has to accommodate the rapid changes in technology we see today. Lightweight apps for various entities in the value chain are the norm now. Electronic sensors become cheaper and cheaper every day, and the best, cheapest sensor must be integrated into the vision.

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it in healthcare

BLK Introduces Online Helpdesk

Manager Portal Prashant Singh, DGM-IT, is all set to revamp IT at BLK Super Specialty Hospital. In conversation with Shahid Akhter, ENN, he shares his experience and the technological road map How has IT helped in channelizing the flow of information between hospital, doctors and patients at BLK SSH? There are various HIS modules installed at the hospital which takes care of the complete workflow between all stakeholders of the patient care delivery cycle. All modules are tightly integrated with each other in order to seamlessly transfer information from one touch point to another. The moment the patient is billed for consultation, doctors sitting inside their chambers manage the queue as the information is updated real time on their computer screens.

As soon as the patient gets admitted in the hospital, all related healthcare providers get intimation through SMS which helps in smooth interdependent operations between all the stakeholders.

Has data integration improved the clinician’s user experience?

There are various data integration touchpoints in the hospital like BiDirectional interfacing of 14 Lab equipments with HIS,

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which helps in reducing diagnostic reporting error; it also provides the clinician an extra confidence in diagnosis and the line of treatment. There is also seamless data integration between HIS and Microsoft Dynamic Navision which is responsible for auto posting of several financial entries being generated during the patient delivery cycle.

What are the challenges that come in the way of IT governance in the hospital?

One of the biggest challenges in the way of IT governance is the lack of adoption of the EMR/ EHR standards. Government of India, though, intends to introduce a uniform system for maintenance of Electronic Medical Records / Electronic Health Records (EMR / EHR ) by the hospitals and healthcare providers in the country. An expert committee was set up to develop EMR / EHR standards for adoption / implementation in the country. Draft EMR / EHR standards were hosted on the website of the Health Ministry soliciting comments from the stakeholders and general public. After due consideration of the recommendation of the Committee and the comments received thereon, the ‘Electronic Health Record Standards for India’ has been finalized and approved by the Ministry of Health and Family Welfare, Government of India.

But the implementation of these standards is still a distant goal.

What are some of the unique IT initiatives you have adopted at BLK SSH? l We have implemented an online “Help Desk Manager” portal which takes care of the complete workflow between the complainant and the service department. This received Gold Excellence award organized by HMA (Health management Asia award) in Sep 2013. l To increase the effectiveness of the whole process of patient feedback, we have implemented a software module called “Patient delight Management” which takes care of all capturing points starting from daily ward round when the patient is admitted to the feedback captured during ward round and finally, feedback captured from the post discharge SMS sent to every patient within 48 hours of discharge time.

Queue management software has been installed to enable seamless queue

any strategy. IT helps transform the business idea to actual implementable process on ground. IT is an enabler and should be able to transform the management business ideas into reality. I am proud to be part of BLK where the management consists of IT savvy people who always think from the end point perspective and are sure of transforming it into the final goal or results.

How does IT transformation help the patient during his stay in the hospital and thereafter ?

Through IT transformation during the patient’s stay, various data points are captured through various processes which help in maintaining the transparency between the hospital and patient. Important diagnostic information is always available during and after the hospital stay. Lot of automated communication happens at

Queue management software has been installed to enable seamless queue management in patient waiting area management in the patient waiting area which also has features like Automated monitoring of Service wise TAT, Centralized Monitoring of Patient Waiting which ultimately converts into increased patient satisfaction.

How have you integrated mobile applications?

We are in the process integrating mobile application which might be launched by the end of Aug 2014 or only Sep 2014 which will host various features like calling hospital for help, viewing lab reports, giving patients feedback, Doctor’s directory, etc.

Does IT require investment and long term vision to conceptualize any strategy ?

Yes of course, IT requires a good amount of investment and a collective management vision to conceptualize

various check points, for example the “Bill Ready” information sent to patient attendant’s mobile which really eradicates the botheration of asking the status of any process.

Seamless cross specialty referral communication help quick visit of a referral (not clear) consultation ensuring a speedy recovery. Implementation of Bar Coding technology in pharmacies helped patients getting the right medicine with reduced TAT (Turn Around time) BLK SSH is also planning to have a CRM which will take care of the post discharge communication and giving a wonderful experience even after the hospital stay.

How do you ensure the safety of your data in the age of constant hacking and similar threats that can severely compromise the life of patients?

The hospital is equipped with the state-of-the-art firewall with intrusion detection protection along with the end-point security installed all across the hospital network.

Various encryption techniques have also been followed to prevent data leakage. Beside this, there is a continuous monitoring process of incoming traffic and gives alerts through various mechanisms. We are also planning a have a Data Intrusion audit from an authorized third party firm.

Is Cloud gathering momentum in Indian healthcare scenario?

Yes, of course. Cloud is really gathering momentum in India but not with a rapid speed; rather the momentum is basically led by big players or corporate hospitals. Although smaller hospitals are going for smaller cloud offering in terms of using mobile application hosted on cloud. Many hospitals are also moving various hospital applications on cloud to get rid of maintaining the infrastructure required for running application. BLK has already started the Cloud journey with migration of 1000 user mailboxes to Microsoft Exchange Cloud. Going further, moving the data centre will be next step towards the cloud journey.

Next big thing happening at BLK SSH by way of IT? The implementation of PACS (Picture Archival and Communication System) is in process and will be completed by the end of September 2014, which will enable the hospital to archive and distribute diagnostic images within and outside the hospital for patient care enhancements, workflow improvements and operational efficiencies. This will significantly reduce the Image Processing and Transmission times and help in instant acquisition of data and analytical and clinical findings.

In order to improve the service excellence, we are evaluating CRM and BI tools which are available in the market as the next immediate step.

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it in healthcare

What are the challenges of Health Information technology?

It begins with high investment costs and concerns about revenue loss from lower productivity during the transition phase. Add to this consumer concerns about the privacy and security of their data and lack of uniform privacy laws and data disclosure requirements governing electronic information exchange across states and jurisdictions.

There are variations in agreed-upon technical standards for interoperability, which provide a pathway for how to transmit and receive data between different HIT systems, and inconsistent implementation of standards by vendors and health systems.

data. It is relatively straightforward to do this right. However most Sys Admins don’t, which jeopardizes the security of their system. In healthcare, and in business in general, it violates IT best practices.

Data backup plan. Here again, this sounds obvious to anyone. But many medical practices – and many businesses — do not do this properly. We have seen backup systems that have been failing for months, backup systems that are not set up to back up all

What are the prime concerns about Privacy and Security in Health Information?

Some of the major concerns are rolebased security. Users should have different levels of security, based on their job function. It sounds intuitively obvious, but most medical practices — and most businesses — do not carefully control who has access to what

IT’s Healing Touch Dr Amardeep Singh Kohli, Medical Superintendent, Medanta, in conversation with Shahid Akhter, ENN, discusses the IT solutions that finally culminate in improving patient care and clinical care

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critical data, and backup systems that overwrite the backup system every day. Data backup systems should be designed to periodically back up data to external media. The exact rotation (daily, weekly, monthly) depends on how frequently the data changes, and how much appetite the practice has for lost data since the last backup.

Strong user names and passwords: Most people — both inside and outside of healthcare — use simple passwords that can be easily guessed,

e.g. date of birth, etc. And because jobs are frequently shared by multiple part-time employees, and sometimes to avoid licensing costs, many healthcare entities will use generic or shared user names, like “Nurse Station” or “Billing.” This is a no-no, especially in conjunction with easy to guess passwords. Passwords should have a minimum of 6 characters, and should be a combination of letters, numbers and symbols.

Protection against malicious software & software patch management.

Most medical facilities fail to keep their systems updated and their operating and security software patched.

Facility access controls and physical security. Many times servers and data storage systems are not properly secured. They may be in a common area, in the kitchen or supply room, under the front desk or even in a hallway. Core IT systems should be located behind locked doors, with access only by those with a legitimate need.

Network security: One need multiple layers of security. If one fails, others still stand.

Network security is accomplished through hardware and software many network security threats today are spread over the Internet. The most common include viruses, worms, and Trojan horses; Spyware and adware; Hacker attacks; Denial of service attacks; Data interception and theft; Identity theft; Anti-virus and anti-spyware; Firewall, to block unauthorized access to your network; Intrusion prevention systems (IPS), to identify fast-spreading threats, such as zeroday or zero-hour attacks; Virtual Private Networks (VPNs), to provide secure remote access

How has the IT helped to channelize the flow of information between the hospital, doctors and patients?

It goes without saying that more and more people are using the Internet to research their medical issue. This

means not only looking for symptoms but exploring treatments and medicines on the web. While it is never a good idea to skip out on the doctor completely, the internet has made patients more empowered to make decisions about what to do next. Healthcare facilities are using social media to establish contact with patients, launch public awareness campaign & perform community outreach.

IT adds to better treatment and less suffering by providing new machines, medicines & non- invasive treatments that save lives & improve chances of recovery. It adds to improved patient care and work efficiency. Doctors and nurses use hand held computers to record a patient’s medical history and check that they are administered the correct treatment.

Results of laboratory tests, record of

mind the security of the data as confidentiality of patient’s related data is very important. Because of the stringent security and privacy needs, it is important for healthcare organizations to carefully select vendors that specialize in the Healthcare industry, and are compliant with the various regulations and guidelines relevant to this industry.

Cloud computing applications for the Healthcare industry are typically less expensive than the legacy applications that they replace, and offer organizations much more flexibility in where and when they can be used. Cloud computing also makes it less challenging to grow your health care organization, including setting up new offices, forming partnerships with other healthcare organizations, or setting up a brand new practice.

IT adds to better treatment and less suffering by providing new machines, medicines & non- invasive treatments that save lives & improve chances of recovery vital signs and medicine orders are all electronically put into a main database that can be refereed to later.

Doctors are easier to reach and are better at their jobs. Technology has also enabled doctors to use emails, tests, videos and conference facilities to consults colleagues from all over the world. The practice known as telemedicine is especially useful for doctors& patients in rural and under developed areas. Online database can accurately predict medical trends. This breakthrough will help medical experts respond to an outbreak quickly as well as take preventive measures.

The value of cloud in Health care?

In Healthcare cloud takes many forms, but the private cloud is among the most common for line of business application. One needs to keep in

What are the unique initiatives you have adopted at Medanta the Medicity?

A number of IT initiatives can be seen at Medanta. Hospital Information system which is integrated with Outpatient department, Inpatient department, Laboratory, Blood Bank, Radiology etc. Picture Archiving and communication system (PACS) where in a physician can see radiology images anywhere in the hospital and thereby increasing the efficiency.We use SMS Gateway to send SMS to patients while admission, discharges etc and to internal staff for different type of alerts like financial clearance etc.

There are digital Information Kiosks, telemedicine projects, E-prescription, Patient Portal, Mobile apps and Integrating Quality (JCI& NABH) standards.

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‘We keep pushing the envelope’

Rajesh Batra, Vice President, IT, Kokilaben Dhirubhai Ambani Hospital, believes that IT has all the ingredients to provide seamless experience not only to the patients but the hospital staff as well. He tells more to eHealth in a detailed conversation IT is still fraught with obstacles when it comes to Indian healthcare domain. How do you plan to overcome these challenges?

As anywhere in life, change is not easy to embrace but a necessary constant.

Hence, when we introduced a new HIS (Hospital Information System), the adaption was slow. IT had to partner with Clinical Administration to provide a path to the health practitioners to explain benefits of the change being introduced. The path clearly spoke about better outcomes and more time for patients. Partnering with clinical

administration and billing helped sail the new system to becoming a new way of life.

How can cloud help in healthcare sector?

Fast pacing cloud technology is the way forward to providing a lower cost and better care. We are always exploring new boundaries to improve the outcomes. We are also implementing a new PACS system that is Picture Archiving & Communication System, that would provide images to doctors to start patient care while being anywhere in case of emergencies.

We are exploring home devices to push data to the hospital systems through the cloud, as a start.

In the long term, when the telecom platform is ready to take on the load of heavy hospital data, we will explore to move more and more to the cloud.

How can it be of help in improving patient care?

The cloud has huge potential in improving the standards of care. The boundaries are being explored and people are starting to do more and more while reducing costs. This is one space which will push the boundaries every year and help the care givers focus more on patients and outcome of treatment.

How does IT channelize the flow of information among hospitals, doctors and patients?

Prime strategy of IT is to help seamless flow of data between all parts of the wheel in the hospital. By implementing HIS, SAP and PACS and improved reporting tools, data is flowing between all. Today, data is available to care givers at their desk without moving around and focus on the patient.

IT is a strategic partner in the wheel at a modern hospital integrating and providing a seamless experience.

Has data integration improved the clinician’s user experience?

The clinician gets all the data at a single source to decide treatment plan without following up or running around or chasing people. Today, the clinicians

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based on data can have discussions with their colleagues and decide care plans which have better outcomes.

How does IT help in the maintenance of quality in healthcare?

IT is becoming strategic component of health care delivery in modern hospitals. It is seamlessly and repeatedly providing details and information from all the sources. Hence, there is enough data going around in maintaining and focusing on patient care and outcome.

Spell out some of the challenges that come in the way of IT governance?

IT being a strategic part of the hospital has its own share of challenges. It takes strategy and vision along with good salesmanship to make the care giver grasp the IT tool being offered and use it effectively. Partnering with all quarters in the hospital is the key to improved health care delivery and better adoption. This helps in measuring health care standards and improves IT governance.

What are the IT initiatives that you have adopted at your hospital?

We have implemented a newer HIS and integrated our back office SAP and provided seamless integration providing a single window for all things for patient and employee. This allows the care givers spend more time with the patient.

The path lab reports have created a new standard in the industry in terms of visual appeal and information. It removes patient anxiety and shows trends, if the patient has been to KDAH earlier.

And a brand new PACS providing more information to the doctors to make better decisions and improve patient safety.

What about mobile applications?

The doctors in any hospital believe, like in patient examinations to ascertain

patient problems and provide better treatment. We have health care related mobile application already available for iOS and Android. We are in the process of implementing a new PACS which provides images through hand held.

We are looking at options to provide more option through mobile medium.

Does IT require investment and long term vision to conceptualize any strategy?

The key to an improved life needs vision, investment and planning. Like a person plans his investment, retirement and old age care needs careful vision and planning, IT is encompassing of a lifecycle.

In real life IT needs long term vision and strategic conceptualization to meet end results. Kokilaben Hospital is always open to newer technologies to improve patient safety. Hence, we keep exploring and pushing the envelope.

various OEM’s to start home care through devices and data flowing back to the hospital. This would be especially helpful to the elderly.

What is the next big IT initiative you are looking at?

KDAH is dedicated to patient safety and we keep exploring ways and means to provide more to the care givers to improve outcomes. We are in the process of implementing a new PACS. This will improve reporting time and will provide images to the doctors earlier through hand held devices. That allows doctors to start treatment earlier in case of emergency and improve care.

We are implementing an advanced visualization tool for doctors. This would allow the doctors to plan surgeries better and improve patient safety and reduced surgical times.

Also, we are exploring CRM to improve contact centre experience for patients and their relatives.

Like a person plans his investment, retirement and old age care needs careful vision and planning, IT is encompassing of a lifecycle How has IT transformation helped the patient during his stay in the hospital and thereafter?

KDAH is dedicated to patient care and safety. KDAH has implemented a new HIS which enables the care givers to focus on patients and less on sundry.

The system allows more transparency of outcome as the doctors and nurses focus on patients and making billing more transparent. The clinical reports are color coded reducing patient guess work or internet search.

We have follow up mechanism in place which allows clinical administration to schedule follow ups etc.

We are looking at possibility with

As IT gets more strategic, will IT be driven more by way of business rather than IT? IT has got more strategic than in the past. Hospital strategies have IT in the centre and no modern hospital can be without. These days IT gets more done in the hospital from Patient care through HIS to back office in terms of Materials Management to financial accounting to HR and providing diagnostic results from Pathology labs to Radiology to the practitioners desktop.

Remote centres of hospital are being connected to the main hospital providing the Patient a seamless experience and record availability. IT just keeps doing it silently and gets more done.

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it in healthcare

‘Internet bandwidth key for

Cloud Computing’ Rajendra S Kshirsagar, Head IT, Hinduja Healthcare, talks to eHealth about the revolution that IT has brought about in hospitals and at the same time, how traditional methods remain in vogue How has IT impacted healthcare delivery?

IT has played a vital role in healthcare delivery, especially in medium and large size hospitals and will continue to do so. In today’s age, it’s almost impossible to run a hospital without having a full-fledged IT setup. Almost all departments within the hospital are interlinked with each other using IT services and this enables the respective department in serving the patient efficiently. For example, when a patient walks into the hospital, he first gets registered at the reception and the data captured in the HIS (Hospital Information System) system is mostly his demographic details, i.e., name, age, sex, address, etc. Subsequently, there may be a service request for the patient which is based on his registration number or name.

The same is then internally linked with the investigation machine and post processing of the sample by the machine, the result is sent back to HIS. The report thus generated

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considers the normal range parameters as applicable depending on the sex and age of the patient. Similarly, same thing applies for an admitted patient. All investigations, service, radiology, pharmacy and other requests are made through the HIS and billed accordingly to the patient bill. MIS is available at various levels based on the user’s rights.

IT system helps in generation of varied records, including classification based on demography, gender, age, and so on which enhances continuity of care as well. Internet-based access improves the ability to remotely access such data.

Hinduja Healthcare Surgical uses Siemens Syngo Via/Plaza PACS (Picture archiving and Communication System), which, in addition to its advanced reporting tools, allows the doctor to view the digital report from any remote location using his laptop and internet connection. We are in process of enhancing the system so that the same can be accessed through smartphones and other handheld devices.

How does IT help in other allied activities?

IT system also helps efficient and accurate administration of finance, diet of patient, and distribution of medical aid. Improves monitoring of drug usage thus helps reduce adverse drug interac-

sis, equipment’s help in better diagnosis in some cases non-evasive methods and cure.

What about the safety aspect?

Hinduja Healthcare Surgical uses a robust Document Management System (DMS) for maintaining patient medical health records. All ‘Out Patient’ and ‘In-Patient’ files are scanned and stored in encrypted digital format. The system allows segregation of the record in to multiple cabinets, e.g. case papers, investigation reports, etc. Like manual system, the entire control for sharing the documents to

By using handled devices, video conferencing medical service providers can interact with other professionals outside the hospital tions while promoting more appropriate pharmaceutical utilization. It also enhances information integrity, reducing transcription errors and duplication of information entries. Hospital software are quite user-friendly and eliminate errors caused by handwriting.

In addition to the routine patient care task, today, many value added services are possible using IT tools. At HHS, whenever an OPD appointment is fixed/re-schedule/cancelled for the patient on the system, an automated SMS is sent to the registered patient and doctor’s mobile numbers indicating the same.

Some of the IT or IT related things which help in this are:l Internet:- Most of the information is now available online which helps people at various levels, especially service providers to know the latest development in their respective field. l Social Media:- Helps in educating patients on health awareness initiatives and various services provided at the hospital. l Better Technology:-Better diagno-

authorized users is with the Medical Records department. The added benefit here being that in addition to faster access to patient records on the care givers desk, the chances of tampering the patients physical file is eliminated. The system also has provision to restrict printing and copying of digital patient file records.

How is your hospital making use of cloud computing?

Cloud computing allows use of HIS and other applications as a service.

Thus this will mean reduction in individual hospital hardware and application software investment cost to a large extent. This is especially useful for chain of hospitals where the data center can be centrally located and branch hospital can access the HIS remotely. But ideally, this should be restricted to non-core applications since for accessing remote data centers internet bandwidth will be the key factor and any outage in same will result in affecting the hospital operations.

What are the bottlenecks that you face?

Lack of standards which result in hospital specific customized HIS modules. This creates a big problem when any future changes are to be incorporated in the system by the vendor or on account of statutory requirements. l Lack of in-house IT domain knowledge. Today, IT functions whether hardware or application software process are disintegrated in various specialized levels on account of which it is rather difficult to get personnel with all-round knowledge or hire individual experts with respective domain expertise. l Tendency to rely on paper based system. Many cases even after having electronic storage users prefer a printed copy. l Lack of proper vendor support for maintaining the IT infrastructure.

Most of the Hospital Information System(HIS) presently available in Indian markets have evolved over a period of time and in many cases a particular module is a forte for that particular vendor. For example, some vendors have a strong system for patient billing whereas others for modules like, Lab Investigation, Finance, Materails management, etc. Thus on account of same, most HIS available in the market serve at most 70 percent to 80 percent hospitals automation requirements. Many HIS vendors allow customization of their product to meet individual hospital needs. Even though this makes the hospital happy initially, but in case of any changes required in the program coding especially due to statutory policy changes etc., incorporating the changes becomes difficult for the HIS vendor as the same needs to be separately incorporated in every hospital HIS code. This results in hospital getting updates with bugs and results in IT personnel spending quite an amount of their time in getting the same resolved. l

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Long waiting time has become a thing of past Kapil Mehrotra, Head, Information Technology, Artemis Hospitals, in a conversation with eHealth, says IT has become a backbone in all industries and healthcare is no different

In what way has IT affected global healthcare delivery and comparatively, how has India benefited from this?

Modernization in Information Technology has changed healthcare reach. For example, big data analysis has improved patient management system and early diagnosis. Telemedicine and EICU have made it possible for patients in remote locations to have access to high quality healthcare services and professional doctors. Cloud based patient monitoring application with mobile apps are a great innovation.

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Has data integration improved the clinician’s user experience?

Yes it has. For example, various modalities integration with HIS, PACS and E-Reports have helped us reduce long waiting time in diagnostic area. It gives great experience and commitment to the each patient for high standard facilities. There is also seamless data integration between HIS and SAP which is used to run smother operation of Pharmacy and Finance.

How has the IT helped to channelize the flow of information between the hospital, doctors and patients?

IT has enabled this flow and availability by using various Technologies and platforms. Accessing EMR information on iPAD in OT is classic example of that and the attendant can track to the patient through dashboard outside the OT. Where exactly patient is? Is patient procedure is completed? Etc.

Please elaborate on some of the obstacles faced in adopting IT in Indian hospitals?

In today’s world, IT is the backbone of any services as it is driven by the few key aspects, i.e, ease of use and cost effectiveness. I don’t think there any challenges in terms of adoption.

Artemis always welcomes new technology and is always a step ahead to adopt it.

What is your assessment and strategy towards cloud - private and public?

We are already on cloud and have been using the same from more than two years. It is really required to save the cost, storage and infrastructure of the hospital. I have recently finalized a cloud project which will go live in a month’s time.

What are some of the unique IT initiatives you have adopted at Artemis?

As a Healthcare provider, we use IT as an information enabler and accordingly build the strategic road map of the IT initiatives. All initiatives speeded in four quarters. As examples, in this quarter we are focusing on EICU, Tele medicines, PACS migration, Asset management and Cloud. Similarly follow up quarters will be managed.

What are the challenges that come in the way of IT governance in the hospital?

IT governance in the hospital is very much required. There are numbers of challenges, i.e. adoption of the EMR/ HER, frequent change request, security, lack of access matrix, etc. In my opinion we can address and overcome such challenges if we form a joint committee and give transparent opinion to them on monthly basis. That way we can have better control and management to address the issues right in time.

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Special it in healthcare Focus

mHealth – Making

‘Connected

Healthcare’ a

Somenath Nag, Director, ALTEN Calsoft Labs

Reality

W

e live in a connected world where the number of wireless subscribers is almost equal to the population of the planet.

Mobile health (mHealth) is an attractive solution that leverages the ubiquity of mobile devices to address one of the most pressing global challenges – making healthcare more accessible, efficient, and affordable. In fact, a PwC and GSMA study predicts that global mHealth revenues will increase by nearly six-fold to $23 billion by 2017. According to a PwC and GSMA report, remote health monitoring services and applications are expected to represent 65% of the market in 2017, driven primarily by the rapidly ageing population in developed countries and the high levels of chronic disease in emerging markets.

Traditionally,institutional providers, physicians, home health care providers, and patients have worked in silos and due to this, efficiency of the system and quality of care have suf-

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l

fered. Smartphones and mobility in general, have opened up an opportunity for the healthcare ecosystem providers to address these challenges by making the concept of ‘Connected Healthcare’ a reality. Mobile Health (mhealth) will have a bigger impact on how care is delivered because: l Mobile devices are personal & ubiquitous

Meteoric adoption mobile technology and a highly competitive marketplace has ensured low cost of ownership of devices and services l Mobility ensures that users are always connected which increases accessibility of patient information, collaboration & care If we analyze the mHealth adoption globally following three key trends can be identified: l With consumer adoption of smartphones on a meteoric rise, people are seeking to use mobile technology to better manage their healthcare.Emerging markets like India are ahead of development markets with regard to patient needs, expectations, and usage. l Payers are willing to pay for the mHealth services because they believe that mHealth will increase access to care, improve the qualityof that care and related outcomes, and at the same time decrease overall healthcare costs.

l

Healthcare providers are looking at mHealth as an option to increase efficiencies, reduce cost of care, and improved patient collaboration. Majority of providers believe that mHealth can have a profound impact in the areaof remote patient monitoring, remote care management, preventive care, and personal wellness.

mHealth with the perspective of ‘Connected Healthcare’ ‘Connected Healthcare’ is a model for healthcare delivery that uses technology to connect different ecosystem players and deliver care more comprehensively and holistically. ‘Connected Healthcare’ aims to increase the quality of care while reducing the cost of care by maximization of utilization of resources, increased collaboration, and modern technology. It uses technology – often leveraging readily available consumer technologies – to deliver patient care outside of the hospital or doctor’s office, and mobility is one of the key technologies that are being used for building ‘Connected Healthcare’ solutions. Connected health encompasses programs in telehealth, remote care (such as home care) and disease and lifestyle management, often leverages existing technologies such as connected devices using existing cellular networks and is associated with efforts to improve chronic care.

Following are few areas where mHealth, as a component of overall ‘Connected Healthcare’, can have bigger impact: l Home care: mHealthtechnologies & solutions are also helping to provide home care solutions for elderly and individuals living independently, and are providing vital support for patients recovering from acute conditions, including cancer, joint replacement surgery, and pregnancy. l Remote patient monitoring:mHealth solutionscan improve the access to care and to specialized medical ser-

vices, provide more effective preventive care and better monitoring of chronic conditions, and improved patient outcomes through remote patient monitoring solutions. Healthcareproviders can deliver personalized services to patients and families anytime, anywhere through interactive mobile applications for smartphones, tablets, and laptops. l Chronic disease management:A key component of successful care management is engaging patients in their health and wellness. Con-

“The Indian government has shown some positive indications to improve the overall status of Healthcare system in the country by allocating increased budgetary funds for building infrastructure for Medical education, and care delivery. This year’s Union Budget has a higher outlay of 1.7 percent of total GDP compared to 1.4% of last year. But with a projected 5.5 percent GDP growth, and headline inflation hovering around 6 percent & retail inflation around 9.7 percent, this increase does not looks like a significant one. To achieve its stated goal of “Health to All by 2020 “ Indian Government needs to spend at least 3 to 4 per cent of the GDP for next few years.” nected devices & health technologies—from wireless blood pressure monitor that automatically upload readings and text messaging programs that remind patients to take their medication, to virtual visits conducted via video that connect providers to remote patients—facilitate and personalize patient engagement. An mHealth solution based on ‘Connected Healthcare’ principlecan connect all stakeholders in delivering education, information, and support to individuals to improve awareness and encourages positive behavior change.

l

Clinical Applications: With electronic medical records, remotely monitored patient data, and digital information becoming prevalent, predictive analytics solutions can help healthcare providers to improve patient care, support population health management, and lower costs. Hence, the integration of data from various sources with electronic medical records (EMR) and provider health IT systems and delivering through mHealth solutions will be a key driver in achieving the objective of improved patient care & efficiency of the overall healthcare system l Consumer Engagement: Mobile technology and social media is enabling consumer engagement by meeting consumer need for more empowerment, convenience, and control. mHealth solutions will support provider clinical and financial goals by empowering people with the actionable decision support, convenience, and control they desire. With regard to managing healthcare, mobile technology will empower consumers to take a more proactive approach in assessing their symptoms and selecting providers, accessing healthcare systems, and connecting with care providers for ongoing care management.

One important aspect of mHealth to remember is that if mHealth provides more affordable healthcare with better access and quality, consumers are eager to pay for this value. For this reason, we have seen many examples of rapid adoption of solutions in emerging markets like India that have gone wanting in developed markets. The challenge is convincing the consumer and patient that the mHealth solution provides better outcomes, treatment and value than they would typically receive from traditional services. Consumers may consider paying a premium if they were to save time and effort in realizing their healthcare objectives.

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it in healthcare

‘We overcome the challenges of distance and time’, says Ron Emerson RN BSN, Global Director Solutions Market Development - Global Director of Healthcare, Polycom.

In conversation with Shahid Akhter, ENN, he discusses the evolving IT scenario

Building Face to Face

Collab oration Please specify some of the solutions offered by Polycom that has impacted the Indian healthcare industry.

Healthcare organisations are under pressure to reduce costs, increase revenues and deliver the best possible patient care with available resources.

Aging populations, shortages of practitioners, as well as the rising costs of delivering patient care and an increasing shortage of hospital beds, also impact both patients and medical professionals. All these factors essentially contribute to the growing demand of telemedicine applications. Polycom’s Telemedicine solution allows clini-

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cians to provide a high level interaction to provide patient care regardless of patient and clinician location. High definition video, along with our eco system of Telemedicine providers allows organizations to provide diagnostic quality care from a distance. Also, the requirement for continual medical education conflicts with demand for care especially as requirements on medical knowledge are increasing every year.

With these developments, medical professionals are expected to keep up.

However, there are not enough providers in practice to support the information overload. Polycom real time high definition video, along with our video

content management solutions, allows healthcare professionals to receive education over real time video on any device, live streaming sessions or watch archived sessions at their own convenience. This flexibility and high level interaction is crucial in the dynamic and ever changing field of medicine.

While benefiting from the telemedicine and medical education platform that Polycom provides, a healthcare organization can also use it for administrative purposes. Moving information in the form of high definition video rather than people provides an efficient way to conduct business on a day-to-day basis.

How video conferencing is becoming pervasive in healthcare business?

Healthcare organizations are under pressure globally… Aging populations, rising costs, large geographic distances and shortage and mal-distribution of healthcare providers is forcing healthcare organizations to look at different way of providing care. Video has been proved as a way to increase efficiencies in patient care through Telemedicine, medical education through live, streaming and archived video and for use in administrative applications that increase the efficiency of the organization. Polycom is in 8 out of the 10 hospitals (Hospitals In US News and World Report 2013).

How a physician can now use a tablet device to collaborate via video with medical experts to streamline telemedicine evaluations, speed diagnosis, and help save lives?

Mobility is key for the clinicians. Allowing physicians to connect from any device or location is crucial to integrate Telehealth into their everyday workflow. This practice is common… a physician on a tablet in their home seeing a patient in the hospital on a telemedicine cart. A great example is Orlando Health in Florida, USA. Telestroke doctors are in their office or home on a tablet and connect to patients in the ER who are having a stroke to decide if thrombolytics are needed. This shows the importance and flexibility needed for clinicians in this space. This will become even more prevalent in India as more Physicians can access Patient Health Information from their tablets as they connect to electronic health records through the cloud.

Please outline the reasons why video conferencing in general and telemedicine in particular has seen significant growth?

We’ve outlined the challenges faced by the healthcare system that are

driving adoption of Telehealth. High definition quality video is critical because it allows physicians the ability to provide clinical efficacy, or put another way to provide high quality care. The goal is to provide an experience where the patient and physician feel they were able to interact as if they were in the same room and for the physician to provide an assessment at the same quality of care as if they were in the same room.

The new innovative video and voice collaboration solutions available for healthcare businesses of all sizes in India?

India, like other countries can benefit from the advancement of video and voice solutions. For instance, Poly-

Our ecosystem of Telehealth partners allows for a turnkey solution to meet all of our customer’s healthcare needs com can compress video to the point where a high definition video call (720 P 30 fps) can be made at as little as 512 kbps. This is key because many voice and video calls are made over the open internet. Also, loss packet recovery allows packet loss of up to seven percent not noticed by the user.

This video compression and buffers to lower bandwidth environment still allow a great experience for the user.

Also, video and voice on any device is critical. Many healthcare professionals carry the phone or table of their choice and this technology allows them to have secure connectivity on those devices. One last key advancement is adhoc meetings. Polycom released

CloudAXIS which allows users to simply email a URL link to someone and when they click on it a video call will be made from any device. This provides flexibility and allows business (hospital/ clinics/ doctors’ offices) to connect to patients (Consumer) easily.

Why should one choose Polycom over other available products and services? Your USP? Polycom provides a world class enterprise solution that meets needs of the organization. Our video, audio and video content management provide a solution is reliable (redundancy available) and provides the best quality at the lowest bandwidth.

Using this platform, healthcare organizations can benefit from a multipurpose approach for Telemedicine, medical education and administration. Our ecosystem of Telehealth partners allows for a turnkey solution to meet all of our customer’s healthcare needs.

What product category is driving business in India for Polycom?

Utilization of Polycom solutions for Medical Education and Administrative use are prevalent in India, but Telehealth is gaining more and more traction and interest from healhcare organizations across the country.

What new should we expect from Polycom in the coming years?

In Healthcare, workflow and integration are key to successfully utilizing Telehealth. Polycom has and continues to build and integrate with key industry leaders to provide the best of solutions for our customers. Telemedicine is at a tipping point. Market drivers and demands followed by necessity are changing care delivery models. We’re positioned now and in the future for end to end solutions that provide scale, quality and integration into the daily workflow of physicians and healthcare organizations.

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it in healthcare

You provide end to end IT services and solutions across several industry segments.

Please tell us about your foray into healthcare IT services?

UST Global is a leading provider of end-to-end IT services and solutions for Global 1000 companies. Since 2001, the UST Global Health Group has built a solid reputation for being a strategic IT partner for over 40 healthcare and insurance leaders.

Our capabilities across healthcare ecosystem include consumer/patient experience, wellness, payer-provider convergence, and regulatory compliance. In the present scenario, many other stakeholders too must adapt to its new consumer-centric imperative in concert with one another. Medical device companies, home health enterprises, employers, pharmacies and pharmaceutical companies will need to be connected and exchange data seamlessly. We have an integrated set of technology solutions and services to drive continuous advances in this massive new ecosystem.

What are the new trends in Health IT in India and what are the emerging new technologies?

In the new system, IT is playing a far more active role in binding the players together. Providers and payers alike will have to use technology to evolve quickly from B2B to B2C businesses.

Through the kind of connectivity we provide customers, they will begin to monitor and track members’ progress on these counts. Pharmacies will become more important, for instance, in sharing data to keep consumers more compliant with their drug regimens.

Using real-time communications and data, they will more efficiently interact with providers to adjust dosage and prescriptions where needed to reduce the need for clinic appointments. In many respects, health IT is facilitating similar models around the world, models that make universal sense.

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Delivering next

Generation of Healthcare Bipin Thomas, President of UST GlobalHealth Group, in conversation with Shahid Akhter, ENN talks about the healthcare technology and how it is binding the players together

Please spell out your healthcare IT initiatives that have impacted the Indian healthcare industry?

To further equip healthcare in India, UST Global Health Group is replicating its healthcare technology assets and proven capabilities from the U.S. We plan to offer it as a service and touch the larger community in India.

Currently, our solutions in telemedicine are offered to a handful of large hospitals and telecommunication carriers, especially over wireless systems. However, the challenge remains to identify the high risk population early and create a disease management pathway that has a real impact.

This would be done by leveraging population healthcare management and care management systems. UST Global is already engaged with government organizations to turn this dream into reality.

Why should one choose UST Global over other products and service providers? Your USP? We are a substantial, experienced enterprise with healthcare business and clinical expertise. We are much more than just technology providers, we are healthcare strategists who understand the complex problems of healthcare delivery systems. We recognize and even create opportunities for customers using innovative IT programs. We cover the healthcare continuum with service offerings to address the specific requirements of managed health care, healthcare payers, providers, and life science sector-from claims systems to healthcare informatics and medical risk management systems.

What is your assessment and strategy towards cloud’s build-up?

A recent report from market research firm Markets and Markets reveal that cloud market is expected to grow to US$121 billion dollars by 2015: over three times the US$37 billion value in 2010. At UST Global, the cloud assessment and strategy for healthcare is built

on our unique client-centric global engagement model. We apply client-centric approach to determine and propose the best cloud solution for improving efficiency, containing costs, and driving innovation. The R&D team uses a cloud agnostic approach and tests different cloud platforms and technologies to determine the best fit to meet customer requirements. Our cloud strategy delivers value through multiple levels, including flexible resource planning, agility, low risk delivery and continuous innovation.

In a country like India, there is a significant reliance telemedicine. How do you foresee the problem and the solution that can help the cause?

India’s journey to such digitization is at an early stage where support from the Government is still ramping up.

We can learn from several countries that are already making use of vast amount of digital information to pro-

has full-fledged sandbox environment within their offices for the team to build hands-on experience.

Telehealth Enhancement Act of 2014 has been introduced. Will there be a significant impact on healthcare if the bill becomes a law?

Yes, there would be significant impact on healthcare. In the US, for instance, one of the conditions is that patients must be located in an eligible location such as a physician’s office, clinic, or hospital in a rural setting. That rules out the patient receiving care at home.

The Telehealth Enhancement Act would waive that restriction.

What new should we expect from UST Global in coming years in the field of healthcare?

UST Global will continue to work closely with clients to provide innovative solutions to information, patient

India is new to digitization. Either the data has not been collected, or it resides in silos vide improved healthcare outcomes, save resources and enhance customer satisfaction. India is new to digitization. Either the data has not been collected, or it resides in silos.

UST’s India Healthcare Industry Innovation Center is playing a crucial role in making this growth manageable. It started as a technology support center for global clients, but today the Innovation Center focuses on providing core technology solutions to clients globally. This Innovation Center hosts telepresence systems fully integrated with medical devices, and has built experience on major EMR technologies including the VistA electronic health record (VistA is an open source enterprise solution available from the Department of Veterans Affairs (VA) in the U.S.). The company

and business problems that are dependent on people, technology, and processes. Globally, we are solving complex consumer engagement, care management and ACO (Account Care Organizations) integration problems by combining technology expertise and subject matter experts.

UST Global leverages deep industry expertise from financial services, retail, and even online gaming to offer healthcare clients a competitive advantage and best possible care and outcomes for the consumers they serve. So we focus on customers and customer’s customer as our first priority. Our approach and commitment beyond contract to increase customers’ speed to market is the single most important factor in today’s competitive marketplace.

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it in healthcare

The IT Fecilitators Manisha Chowdhury, Co-founder and Managing Director, Aptsource Software, talks to eHealth about how her 7-year-old company has made a mark for itself in such a short span

When did Aptsource come into being and what was the original vision of the company?

Aptsource started operations in January 2007 with a clear focus in Healthcare IT. Aptsource always had a vision to develop, acquire, and integrate health Information Technology capabilities for quick turnaround of cost effective software solutions for the healthcare sector.

Why Healthcare, I mean what was the driver for your business to specialize in Healthcare domain ?

Timely delivery of information to healthcare professionals is critical for delivery of the most appropriate care for the patients. I have witnessed loved ones falling victims to situations that demanded such timely information and complete lack of the same led to wrong decisions and fatalities!

This has always troubled me inside and drove me to constantly explore how I could leverage technology for significant positive impact on improving the quality of care and increasing access to healthcare. Based on my professional experience in Healthcare IT markets with products and solutions across geographies, I still feel that in most of the developing countries health informatics is in its infancy and there are a myriad of opportunities available, especially with changing regulations of the healthcare industry and larger emphasis on prevention rather than cure.

What kind of work are you doing in the healthcare space?

Solution consulting services encompassing Enterprise IT Strategy, Healthcare Informatics Maturity Planning & Execution , assessment of EHR readiness, analytics, implementation of risk stratification tools and techniques ( for chronic and long term ailment) and algorithms related to disease prevention.

We work with partner companies in the UK on several such projects for NHS and its endorsed partners.

We also have our own product APTCARE which is a comprehensive and configurable EHR solution conforming to international standards.

We further have derivative web based solutions (from base version of Aptcare) for rehabilitation and community health settings .

It seems right now you do service business as well as product -would you like to transition to a pure play

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product company or continue to grow your service business as well?

We are a small team which also includes few senior experts with decades of experience in Health Informatics. These people are the core team that helps build the domain competencies as well as generate revenue from their specialized consulting skills. We plan to be seen more as a product company within the next two years, however, this service business which is earning us the desired insight and experience in the healthcare domain should continue to complement as well as support our product initiatives.

Tell us about your product Aptcare? How is it different from other similar products?

As you know, the healthcare land-

bling rapid implementation through customization techniques using scripts rather than having to change code. It has the capability to embed treatment protocol adapted from local, national and international guidelines which can be configured using a simple toolkit.

How big is the global market for EHR like that of Aptcare ?

Where do you see market for Aptcare?

Driven by regulations and the Federal Meaningful Use guidelines in particular, the United States is expected to remain the largest EHR market and globally, with a projected annual growth rate of 7.1 percent , it will be total $9.3 billion by the end of 2015.

As per reports in EMEA, where a slow economic recovery has prevented EHR growth in recent years, the market is

We plan to come up with our next release of the community health version for mother and child health in India & UK scape is really complex with evolving regulations, new research findings, emerging technologies and diverse speciality practices . Hence, healthcare practitioners no longer require static products but adaptable solutions that can evolve and support new trends and practices. Aptcare was built to keep pace with such changing trends in the most efficient way.

Aptcare rests on a domain model leaving the practice of healthcare in the hands of care providers and not software designers. Rather than guiding the clinicians to use the system adhering to its processes, the system can flexibly accommodate requirements of diverse range of clinicians and their institutions by customization of data structure, screens, process etc. That makes it different ena-

expected to grow from $6.5 billion in 2014 to $7.1 billion by the end of 2015.

Government-funded initiatives are expected to generate most significant EHR growth in the Nordic countries (5.1 percent), United Kingdom (4.1 percent) and Germany (3.6 percent).

Within EMEA, the United Kingdom is expected to remain the largest EHR market, growing to $2.1 billion by the end of 2015. Although the Asia Pacific region represents a smaller market, it is expected to grow 7.7 percent to $4 billion overall by the end of 2015, with country governments expected to invest in EHR initiatives through 2018.

Also from studies it is revealed that IT is being more widely available in resource-poor areas, is allowing health advocates tackling complex challenges such as managing HIV/AIDS and

tuberculosis. Successful EMR projects are now operating in such diverse locations as Zambia, Peru, Haiti, Rwanda, Kenya and Malawi.

Although US is the largest market, we are currently not planning to market Aptcare in the US unless we chance to strike strategic partnerships in complementary areas. We have started selling the base version of Aptcare for both out-patient and in-patient care delivery in India and Africa. We are selling the rehabilitation version (which is a derivative of the base version) in the UK market which is more of a scheduling and billing system for smoking, drugs and alcohol management.

What is your business plan and product roadmap for the next 3 years?

We are still very small but have aggressive plans to grow our business in ‘Mid-market’ in the developed economies with special focus on UK and rest of Europe as well as all segments in the emerging Economies in Africa and Asia . While we are working through our partner company in the UK right now, we have plans to set up Aptsource, UK within March ‘2015. Allen Carr is our recently acquired customer in the UK who should soon be going live with Aptcare (rehabilitation version) from 11 locations. As a next step we plan to closely work with their franchise clinics to see how they can also possibly adopt Aptcare within a reasonable time frame.

We have implemented Aptcare already in Lusaka and currently working on a decent pipeline. Considering the business opportunities we also would like to expand in Africa through our own branch office in Lusaka very soon.

Needless to mention that we have a desire to add customers in India and we are already working on several possibilities to tie up with consultants working on Healthcare projects across India.

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it in healthcare

Expert Healthcare

Backed by State-of-

the-art Technology

Sahyadri Speciality Hospitals at Nagar Road

S

ahydari Hospitals, Maharashtra’s largest and most trusted chains of hospitals offer an array of specialities and super specialities. It is also one of the youngest hospitals to get the revered NABH accreditation.

Sahyadri Speciality Hospitals Nagar Road has marked its presence in the eastern section of Pune city.

The hospital has a capacity of 130 beds with fully operational tertiary

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care wings in place. Inaugurated in May 2013, the Hospital is dedicated to provide services in all specialties, super specialties and diagnostic facilities backed by the best technology and medical care under one roof. The Hospital follows protocols and care pathways as per national and international accreditation standards to ensure best outcomes for patients. Our patients are at the centre of what we do, we offer thoughtful convenience,

comfort and quality care that make the hospital experiences stress free and calming. Our team of doctors is committed to exceptional care amidst a sense of professional approach.

Medical Advancement and support services: Nagar Road Unit has set a bench marks in multi speciality services, with a healing touch. The hospital stands as a ‘centre of excellence’,

it in healthcare

for providing advance care in Neuro Sciences, Cardiology, Gastroenterology, Ortho and Joint Replacement, Neonatal intensive care, critical care, minimal invasive surgery, Urology and Nephrology. Our world class diagnostic services like Cathlab, 1.5 tesla MRI and multi scanner CT gives timely support to our speciality wings.

Department of Obstetrics and Gynaecology is another state-of the art hub that provides comprehensive care under one roof. We have the most advanced equipments and approach to run Infertility centre with significant success rates. The hospital provides expert Consultation of gynecologist and andrologists, detailed investigations and counseling sessions for the couple. In addition a free counseling with the IVF experts has been conducted every Thursday to address fertility issues. In a very short span of time, we already had our first pregnancy by IVF. Our facilities also include Antenatal care, Post natal care, high risk pregnancy and complicated gynecological issues besides conventional procedures.

Emergency and critical care: The hospital has three major and two minor OT. The spacious OT complex is designed with expertise and precise approach to meet the standard guidelines. The Operation Theaters are equipped with LED surgical lights, double dome system and HEPA filters.

The critical care department provides Comprehensive Care and Life Support Services to patients who are critically ill and require intensive monitoring. The infrastructure of 11bedded ICU department meets international standards to assist patient recovery.

Also,8 Bedded cardiac care unit is equipped with all life-saving equipment like multi-monitors, ventilators and life support equipment.

Neonatal Intensive care is another advanced care unit which is capable of managing in- utero and ex-utero high-risk cases. It provides level III care and has capacity of 24 beds and

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imparts specialized care to critically ill new born. Apart from routine neonatal services, the unit is competent of caring for extremely premature and low birth weight babies with an aim to provide good survival as well as quality outcome. The department is backed by 24X7 fully equipped neonatal ambulance services.

Recently Sahyadri Hospitals Group in association with Rotary Pune Pride has launched a noble project:

Highlights of Sahyadri Hospitals Group Maharashtra’s largest Chain of Hospitals Youngest Hospital to get NABH accreditation in Maharashtra 4th in the country to get AAHRPP accreditation Pioneer in performing CT Coronary Angiographies for preventive & diagnostic in Asia Performs highest number of Bone Marrow Transplants in Western Maharashtra Performs highest number of Neurosurgeries in Pune In-house NABL accredited pathology Labs

‘Yashoda’-A Human Milk Bank to take care of the ill or fragile babies. The milk bank is located in NICU itself for quick provision of donor milk to these babies. The department follows strict guidelines, established by the Human Milk Banking Association of North America (HMBANA), to ensure the safety of donor human milk. There are many situations wherein a mother may not be able to provide sufficient breast milk to her own baby. In the absence of the baby’s own mother’s milk, the milk is donated by mothers who have a tendency to make more milk than required by their own babies. This collected breast milk then undergoes a series of rigid testing and processing before it is deemed safe for use for another baby. The department also has well equipped milk collector Van. Nagar Road Unit also extends a caring hand to the expected mom by introducing ‘Club Motherhood’. It is a dedicated cell to address all the queries related to pregnancy and childbirth wherein we conduct free sessions for expecting mothers twice a month. The session is taken by OBGY experts, Dietician, Physiotherapist, Neonatologist and Lactation expert.

With Sahyadri, you can always be assured that your health is our top priority.

cardiology

People prefer angioplasties as compared to surgeries. Why this shift and surge in angioplasty?

Angioplasty is a medical procedure that opens up blocked or narrowed blood vessels without surgery. During angioplasty, the interventional cardiologist inserts a very small balloon attached to a thin tube (a catheter) into a blood vessel through a very small incision in the skin, about the size of a pencil tip. The catheter is threaded under X-ray guidance to the site of the blocked artery. When the balloon is in the area of the blockage, it is inflated to open the artery, improving blood flow through the area.

What are the risks attached to angioplasty?

Angioplasty is safer than surgery, thanks to modern technology and techniques which makes complications infrequent. However, because the procedure involves stretching one of your arteries, and includes the use of catheters and contrast injection, there is some risk.

Placing a catheter in your artery can damage the artery and may result in bleeding. Even when the artery has not been damaged, you may have a bruise or a small lump where the catheter was inserted. The bruise or lump may be sore, but will go away in a few days to a week. Because everyone is different, there may be risks associated with angioplasty.

What is Rotational Athrectomy Rotablation?

A rotational atherectomy is a type of percutaneous coronary intervention (PCI) that uses a revolving instrument to break up calcified plaque clogging a coronary artery in order to restore blood flow to the heart.Rotational atherectomy uses a tiny rotating cutting blade to open a narrowed artery and improve blood flow to or from the heart. Often a stent—a small tube made of metal mesh—is put in the artery to prevent it from re-narrowing.

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Lifestyle to Blame

for Blocking of Arteries

Dr Anil Dhal, Director and Head, Cardiology, Sarvodaya Hospital, in conversation with Shahid Akhter, ENN, talks about angioplasty is a much easier medical procedure compared to surgery

What are the risks involved with this procedure?

The risks of rotational atherectomy are extremely low. They include the same risks as balloon angioplasty, as well as heat-produced damage to the arterial walls, temporary slow blood flow, and most rarely, temporary impaired blood flow down the artery. This can generally be corrected with medicines in the catheterization laboratory before the procedure is completed.

What does sudden cardiac death mean? What are the causes and can it be reversed?

Sudden cardiac death refers to the sudden loss of function of the heart.

This is often labeled as cardiac arrest.

The problem emerges due to an abrupt disturbance in the heart’s rhythm which results in the heart not beating or beating too little to keep the person alive. The rhythm disturbances are of different types. “Asystole “ is where there is no electrical activity and thus no heart beat. Complete heart block is where the heart rate is too slow to keep the patient alive for long. In each case, it occurs suddenly or shortly after the onset of symptoms.

Disease of the coronary arteries is the most common cause of sudden cardiac death. This may occur after a heart attack or after an episode where there is reduced blood flow to the heart. Heart muscle conditions such as cardiomyopathies may also cause cardiac arrest. In some individuals with normal hearts, cardiac arrest can occur with certain drugs, both legal and illicit, with lack of oxygen, with chemical disturbances in the blood stream or following a chest injury.

Although coronary arteries adapt initially to plaques, they eventually narrow the artery and reduce its ability to provide blood to the heart If one can get to the patient within the first few minutes after a cardiac arrest, it is possible to restore the patient’s circulation by cardiopulmonary resuscitation (CPR) . In addition, CPR alone may restore a normal heart rhythm but often this requires the administration of medicine or the use of direct cardioversion using a defibrillator.

What is Coronary artery chronic total occlusion and how is it treated?

Coronary artery chronic total occlusion (CTO) is total or almost complete blockage of the coronary artery for 30 or more days. This is caused by heavy build-up of atherosclerotic plaque within the artery.

Traditionally, patients with CTO who have symptoms as noted above required coronary artery bypass graft (CABG) surgery to clear the blockage.

However, with the advent of advanced technology and innovative percutaneous (performed through a needle stick through the skin) techniques, interventional cardiologists are improving the outcomes of percutaneous coronary intervention, making it a viable option for some patients who are experiencing symptoms related to their CTO. Interventional cardiologists now are able to gently steer special guide wires and catheters across the blockages. In the last few years, the success rate of the combined percutaneous approach has increased from about 60

percent to 80 to 85 percent. Although the percutaneous approach has potential complications, the complication rate is comparable to that of standard angioplasty (about 1 percent).

What is an aortic aneurysm and how is it managed?

The aorta is the main blood vessel leading away from the heart which is the vessel that distributes blood to all body parts. Its walls can become weakened due to atherosclerosis or to an inherited condition such as Marfan syndrome. The aneurysm usually occurs in the abdominal area below the diaphragm and mostly below the arteries supplying blood to the kidneys (abdominal aortic aneurysm or triple A (AAA) as it may be referred).

In most instances, simply monitoring aneurysm growth is the best management. If an aneurysm is sufficiently large or there is evidence that it is weak or already partially ruptured, your doctor will have it treated urgently. Treatment of a brain aneurysm is by securing a metal clip around the base of the aneurysm.

Treatment of an aortic aneurysm is either surgical during which a patch or artificial piece of blood vessel is sewn in place where the aneurysm was or by an endovascular procedure where a pre-made patch is passed through the artery in your groin and positioned inside the aneurysm which protects it from rupture.

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it in healthcare

Not Compromising on Reliability and Quality J As Mitsubishi Electric enters the Indian healthcare sector, it is prepared to go for the long haul, as it pitches its advanced devices. Rajeev Sharma, Director, Strategic Planning and Business Development at Mitsubishi Electric India, explain to ENN’s Rachita Jha the roadmap that Mitsubishi has adopted for its Indian foray

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apanese electronics major Mitsubishi Electric is eyeing the Indian market with interest.

Though it has had a presence in India in sectors such as auto and infrastructure sectors, it is now poised to enter the burgeoning Indian healthcare market with devices that are manufactured in Japan. Mitsubishi has introduced its Particle Beam Therapy (PBT) system to be used in treating cancer in India.

It is also launching its colored medical printers for MRI and CT scans.

India has a dubious distinction of having among the highest cases of cancer in the world, and the number is feared to rise. But bleak as this outlook maybe, it has presented an opportunity to Mitsubishi Electric to venture out of Japan - where it has a 65-70 percent market share in this sector – for the first time.

Rajeev Sharma, Director, Strategic Planning and Business Development at Mitsubishi Electric India explains that Mitsubishi Electric has been present in the medical business indirectly by supplying the medical printers to MRI OEMs. In India, along with medical printers, it brings it superconductor magnets that are used in making the MRI machines, as well as its PBT systems. Sharma says that PBT is the most advanced system for treating cancer.

On their Indian experience so far, Mr Sharma says they started off by selling fast moving products like medical printers. But for superconductor magnets and PBT systems, the company is still doing a feasibility study on how to have a sustained business

for those products, as the size of transactions in each deal is big. He says that many cancer hospitals in India are keen on buying PBTs, but have not allocated the budget for it. In absence of a steady supply, Mitsubishi Electric plans to get the materials directly from Japan, with the India office doing the marketing and technical research. “Right now, the business model for these products for any player is not sustainable, because the demand varies every year,” he says.

Sharma explains the rationale for importing PBT instead of manufacturing as one of perceptions of quality. He says Mitsubishi’s strengths are reliability and quality, which they have been able to achieve in their Japanese plants. In shifting to Indian manufacturing, they may lose out on these USPs, hence the decision to import the machines rather than build them locally. “We don’t foresee that happening in India if we manufacture here, because many people still rely on ‘Made in Japan’ products,” he says.

The reason for the long time to make a purchase is because PBT systems deal with radiations. This brings in the Department of Atomic Energy and the Indian Government in the picture, as the hospitals need to get licenses. Sharma says getting approval from DAE has proven to be a big bottleneck for most hospitals, and so the decision to purchase can take as long as two years.

For its Indian foray, Mitsubishi Electric has chosen to bring its products carte blanche here. It has foregone any plans of customizing them to sit Indian conditions. Sharma explains this is because the PBT systems are customized to the end user’s needs every time they are sold.

He says the PBT systems are sold as a basic model, with a list of features that can be added to them. This fluidity in setting up the systems works in client’s favor, as they don’t end up with features that they don’t need, and also, they can control the costs.

For its Indian foray, Mitsubishi Electric has chosen to bring its products carte blanche here. It has foregone any plans of customizing them to suit Indian conditions Mr Sharma is clear to point out that the PBT does not do diagnosis of cancer, only the treatment. He says that most of the cancer hospitals that Mitsubishi India talked to wanted to know if the machines could also help in diagnosis, as in India, diagnosis of cancer happens at a very later stage.

Another product that Mitsubishi Electric India is promoting has run into an unexpected problem. Mitsubishi sells its superconductor magnets for MRI machines. It counts major healthcare devices manufacturers in Japan and Europe as its clients. But it was in or a surprise to learn that India does not have a single MRI manufacture for a market of its size. Most MRI machines sold in India are retrofitted, refurbished or imported. Even the big hospitals in metro cities use machines that have been retrofitted. Mitsubishi, as a policy, only sells its superconductor magnets to MRI OEMs. So while the particular business has not taken off, Mitsubishi hopes that in the future, some middle range MRI OEMs may come up in India, as the healthcare sector expands. In fact, so confident is Mitsubishi of MRI

OEMs, that it is part of their overall growth strategy in India.

As Mitsubishi looks to get a foothold in the Indian healthcare space, it is not looking to invest in Indian R&D. Sharma explains, “Right now, we can’t think of R&D, because we can’t even sell the product in India.

Also, diseases don’t have any geographical boundaries, so whether the R&D is done in India or in Japan does not make any difference on the product specifications. There is no point in setting up an R&D center for these products in India.” But Mitsubishi does plan to tie up with research firms in India. They will be procuring data like the requirement in India, how their product is performing etc to improve their products. But he is clear that investing in Indian R&D is not a part of the group’s overall plan.

As Mitsubishi Electric starts its innings in the Indian healthcare space, it is bringing in products that will revolutionize the industry. That it is willing to take long term risks is a testament to the confidence it has in the Indian market.

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it in healthcare

CIOs in

Transition Trends

and Challenges Usha Subramaniam, Head Pre-Sales, Blue Star Infotech

implementing patient centric processes to make a real difference to the entire healthcare paradigm. Right strategy for cloud technology adoption can help providers move from the costly infrastructure of their legacy systems to cloud based services with low cost operational expenses.

Patient information mostly resides in silos today in various unstructured forms, hand written notes, and paper medical records. When all this information is structured in EHR systems and analyzed using Big Data/Analytics for real-time insights, it can help present a comprehensive view to the physicians for the right line of treatment saving “time” – thus enhancing multifold the chance for successful outcomes.

Rapidly changing role

T

oday, the business of saving and caring for patient’s quality of life is being constantly challenged by time and a need to improvise, more than ever. Things need to get done in as less time as possible while maintaining a high degree of quality and efficiency. The role of IT to help realize this is now paramount.

A study by Accenture Inc identifies following key trends: Devices are generating new levels of data: Medical devices are starting to generate large volumes of data about the treatment of individual patients, allowing for personalized and more effective treatment of symptoms as well as an opportunity for healthcare organizations to differentiate themselves. Worldwide sales of smart clothes (wearable textiles that have integrated electronic devices) is slated to jump.

Cloud based platforms are enhancing patient transparency: Integration of insurance payments and healthcare providers into one digital cloud platform can enable better transparency and choice for patients.

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The IT function is now a key partner in strategizing the business of the healthcare service enterprise, from being only the owners of the information infrastructure Remote diagnostics are spreading: Innovation such as remote consultancy, wearable technology and virtual aided surgery will provide patient flexibility, improved outlooks, reduced overhead for healthcare providers and patient transparency.

Digital Transformation with New Age technologies like Big Data, Analytics, Cloud and Mobility offer great opportunities for improving operational efficiencies, reducing costs and

As healthcare is witnessing a revolution in IT, the role of CIOs is undergoing rapid changes. The IT function is now a key partner in strategizing the business of the healthcare service enterprise, from being only the owners of the information infrastructure backbone not so long ago. They now need to understand the service delivery processes and business priorities of the enterprise and help strategize where and how technology can be integrated / upgraded to deliver target patient-outcomes, reduce cost and increase efficiencies. They also need to get buy-in from senior management for budgets by sharply forecasting the potential ROI for the proposed spend. Challenges of user adoption of new processes / technologies across differently skilled and goaled user communities (doctors, nurses, technicians, administration) would be heightened.

All of this calls for the CIO and his team to drive appropriate selection and usage of formal processes and tools for IT Services Management (ITSM), education and training on Digital (SMAC) Technologies that can aid the transformation of the healthcare enterprise and social collaboration tools with the healthcare community in IT for real time learning from each other’s experiences.

+91-44-66540922 1800-419-9868 Vitalsplus@amiindia.co.in

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tech trend stem cell

Insuring Your Child’s Health S

tarting a little over a decade ago, stem cell banking as a sector has seen an era of totally ignorance and abysmal sales followed by one of raised awareness and rapid rise. Today, it is counted as a sunshine industry in India, with a very positive outlook for the future. ENNs Rajesh K Sharma talks to some industry pioneers about how this sector is poised to expand, and what holds it back right now.

Expectant parenthood, at the best of times, is a trying period. As parents wait for their bundle of joy to be placed into their hands, their soaring hopes are matched by terrifying dreads about the baby’s health.

This dread is not without its reason, as science has thrown a light

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upon many diseases that previously went undetected. Diseases like Thalassemia and diabetes, that make their presence felt later in life, can now be detected as early as during the fetal stage. But while warning the parents of future disabilities that the child may face, science has also provided a solution.

Stem cells hold a world of cures for diseases that are considered incurable now. The magical stem cells can help us unlock the mysteries of the diseases that blight us today. But before a cure can be found, it is necessary to collect and store them.

Stem cell banking works on a premise similar to a blood bank wherein the umbilical cord, which was discarded earlier, is collected and stored since it contains cord blood containing the stem cells.

A sample of cord blood has a shelf life of twenty years, during which it can be used to cure the donor of a number of debilitating illness.

Stem cell banks have been operational in India for nearly a decade. During this time, they have helped spread awareness

about the benefits of stem cells to would-be parents. An expecting parent visiting a hospital or a gynaecologist will surely be made aware about the benefits of cell banking. Even the big hospitals now actively promote stem cell banking to would-be parents.

But in spite of such awareness, the number of people opting for stem cell banking remains abysmally low.

Estimates say that all the companies combined have not touched even one percent of market size. The outlook for stem cell banks remains very positive, as even foreign brands try to enter this exciting sector. eHealth profiles a few of the pioneering stem cell banks in this sector.

These banks have been in this business since the beginning, and have seen its rise. Together, they provide a bird’s eye view of this sunshine sector.

stem cell

Beginning to Make a Mark

Jeevan Stem Cell Bank is India’s first public stem cell bank. Dr P Srinivasan, its co-founder and Director, tells ENN’s Rajesh K Sharma about the thought behind operating a public cord blood bank, and how the journey has been How aware are people about stem cell banking? what is the picture in Tier I, II and III cities?

of matching is over 50 percent. On the other hand, the chances of finding a match in any international inventory is less than 10 and even if a match is found it will cost over $45,000 (`25 Lakhs).

Jeevan is involved only in cord blood donation or otherwise known as Public Cord Blood Banking. The stem cell units in the public bank are meant for anyone who needs them and is a HLA match. Awareness is limited to such hospitals, which choose to work with Jeevan in this programme.

Please tell us about how the transition from blood bank to a stem cell bank came about?

What was the idea behind opening public stem cell bank?

The concept and processes involved in blood banking and cord blood banking remain the same with minor variations in the processing and testing. With over 10 years experience (in 2005) in blood bank domain, we at Jeevan felt that we were well equipped to manage a public cord blood bank. World over, public cord

Stem cell banking requires a substantial investment in technology. Please tell us about the technology implemented in the storing of stem cells.

have blood banks started in well established blood banks.

Most knowledge about stem cell banking in India is through the private players, so how does Jeevan acquire the stem cells?

Jeevan creates awareness on cord blood donation among obstetricians and through them reach out to their clients. Once the contact is established, Jeevan’s staff counsels the couple about the uses of cord blood stem cells and encourages them to donate instead of discarding.

What are the chances of a donor’s stem cell matching the needs of a non donor’s?

With an inventory size of over 30,000, the chances

Harvesting stem cells from cord blood is a critical step. Since 2008, Jeevan uses the same technology used by over 90 percent of cord blood banks world over – the automated Sepax system from Biosafe, Switzerland.

Jeevan is the first cord blood bank in India to use the automated system for this process. Jeevan has also established a high resolution HLA typing laboratory to help patients with blood cancers and Thalassemia.

How has the response been?

Have the stem cells stored by Jeevan helped the needy?

After initial struggle with funding for the project, Jeevan managed to raise over `24 Crores in grants (Government of Tamil Nadu) and loan (World Bank aided fund) to process 7500 cord blood donations. Currently Jeevan has 2000 units of stem cells fully typed and ready for transplant at short notice. Jeevan has facilitated two successful transplants and few more are expected to happen in the next few months.

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stem cell

We process the stem cells from the cord blood and store the cord linings.

We operate in Singapore and Thailand as well, but see a huge potential in India, because all the service providers combined are not even touching one percent of the market. With 26 million births happening every year, the market is not enough for even 100 more stem cell banks. Soon, treatment by stem cells will be a part of healthcare.

We have more than 60,000 people who have banked with us. That means 60,000 people can be cured of diseases curable by stem cells as of now.

What are the states you have presence in?

CryoBanks International is a part of the RJ Group.

With a pan-India presence, it banks on providing superior technology for stem cell banking to its customers. Its CEO Dr CV Nerikar explains to Rajesh K Sharma, ENN about the growth of the sector

Superior Technology for

a Better Yield

Please tell us about Cryobanks International

CryoBanks International is a pure cord blood bank that stores the cord blood cells of new born babies. Our positioning is very clear - we want to be the best in technology and services. These are our core areas. We bring the best technology in the world from countries like US and Switzerland.

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We have a pan-India presence. We are present in 98 cities across the length and breadth of the country, from Kerala to Jammu and Kashmir and from Guwahati to Kutch. Location is not a criterion for us. But we don’t go to remote villages, because it incurs a cost.

Our service providers are present in any city with a population of 5-10 lakhs.

How do you reach out to prospective clients?

We spread awareness through brochures and websites. We offer reading material to expectant mothers who visit their gynaecologists in hospitals. It is not a tie up with hospitals; we talk to hospitals about what we want to do and distribute reading materials through them. Interested parents call us and our representative visits them and briefs them about our service. If convinced, they sign an agreement with us.

We then track their delivery dates. On the due date, a paramedic collects the cord and brings to our facility for processing and storing.

How do you convince expectant parent of your services?

Till a few years ago, stem cells were going in the dustbin. We tell the parents to not throw it; it is too precious and should be stored because it can cure a lot of diseases.

Tell us about the technology used at Cryobanks Firstly, we use a technology known as Sepax for cord blood banking. Sepax is a FDA approved technology by a Swiss company Biosafe. It is a zero manual intervention technology where everything is controlled and the program protocols are as per international norms. It does not involve any human intervention so human error is eliminated. It harvests the maximum number of stem cells.

While we collect the entire cord blood, only a small portion of it contains the stem cells. So we have to ensure maximum harvest rate. Most companies in India do it manually, which depends a lot on the technical prowess of an individual. It also depends on what you can visualize, because only the section of blood containing the stem cells, called the buffy coat, is to be harvested. But buffy coat itself forms about one percent of the total amount of blood. It all depends on how much your eyes will see and how much you will harvest. But Sepax uses optical sensors which can identify stem cell based population and harvest it. As a result, what I will harvest is the maximum possibility of stem cells. We are the only company in India that has moved in toto with Sepax.

While other players use it in bits and pieces, we do it in totality. It comes at a cost, but when you consider that stem cells are going to be the future and believe that this will make a difference to somebody’s life tomorrow, it think it is too small a decision to make.

Another technology is an experimental technology for Mesenchymal stem cells, which are harvested either by using enzymes or by a technology that we use, called Explant technology. This technology, through a technology transfer arrangement with DaVinci Biosciences, involves practically zero manipulation of the cell while harvesting. We take the cells and put them in a growth medium which allows the growth of only Mesenchymal cells. There is no manual intervention and no enzymes or chemicals are add-

ed into it. Cells that are thus harvest are naturally less damaged. So, from a technology perspective, we have been offering two of the best technology in this line for our customers.

How receptive are parent to the idea of stem cell banking?

In the last six years, there has been a significant change. Six years ago, we used to start from scratch while explaining stem cell banking to our prospective clients. But now, at least in the metros, awareness has improved.

Customers do know about stem cells, and look at what is better suited for them. But I wouldn’t say it is up to the levels that we expect. In the smaller towns too it is picking up. Belief that

How much more time is needed for the smaller towns to pick up.

At least another decade. This is not a product with an immediate impact.

This is a futuristic product; you store your stem cells for future use. The number of diseases that stem cells can cure is increasing. Nobody wants ill health in the family, but if cure comes out for diseases which are well known, like diabetes, then its awareness will increase. I am giving a figure of about a decade, because a lot of research is happening. Something or the other is bound to come out.

How has the government helped?

The government has created certain committees that govern the usage of

We have a pan-India presence. We are present in 98 cities across the length and breadth of the country stemcells will be the future is also slowly picking up. As successes happen, people will believe. People like us, the media and the doctors have a role to play in telling the customers about the benefits that stem cells can bring.

Is lack of more awareness holding back the growth of this sector?

Yes, it is holding it back significantly.

The price of this product has dropped.

It started at Rs 75,000 and through volumes and innovations, reducing our overall operation costs, we have been able to bring it down to Rs 45,000 over 21 years. It is not that big an amount for the common man today.

For a parent, 4000 a month is not too much. Question is how beneficial it is.

That awareness has to fully seep in.

If somebody understands the benefit of stem cells and is properly briefed, I am sure there is a huge chance. I am sure if increased awareness had been there, this industry would have been much larger.

stem cells. They have created rules and laws governing who can open and operate stem cell banks. There are certain guidelines about what is needed in a stem cell bank. The government has done its bit to regularize this sector. Otherwise you would have had a lot of people doing this business without any recognition.

But there is always scope for more.

Government can fund stem cell banking organizations or support them. At this juncture, all of these are nascent organizations. We need some sort of financial supporting, governmental support, make it more aware to people or acceptable to people. In other parts of the world, the government gives tax holidays to such organizations of does PPPs to support such organizations.

The intent of creating stem cell banks is the finally these stem cell banks need to be used for people and cure people who have diseases. If we can sure these disease, that’s where the government and private sector can gel together.

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stem cell

Investing in a

Healthy Life from Birth As MD and CEO of Life Cell International, Mayur Abhaya oversees a state-of-theart facility to store stem cells of newborns as a guard against future diseases. In a conversation with ENN’s Pradeesh Chandran, he talks about the growth of the company and the road ahead What do you do at Life Cell?

At Life Cell, we preserve the umbilical cords of new born babies. We preserve them for various treatments and drug conditions. It is also being used in research for many other organ and tissue regeneration like heart diseases, diabetes and many other body regeneration. We preserve them at our Chennai unit, which is the largest in the country. More than one lakh parents have stored their stem cells with us. We started our operation in 2004 in collaboration with Cryo Cell, which is the world’s largest and first stem cell bank created in the US.

Stem cell banking is still in its infancy in India, having tapped just 1 per cent of the market.

What are its growth drivers?

We believe that awareness, affordability, all those has to be addressed for the penetration to increase. In the last one year we have done an awareness creation and making people aware that this is far more affordable. If you see our volumes, they have gone up by 3 times in the last twelve months. The Indian market is of high opportunity.

When it comes for stem cell banking, why are parents opting for it?

The fact that the umbilical cord can be easily collected at birth without any harm to the mother and baby, and can be preserved for a lifetime is a very

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attractive proposition for the parents. It is the purest form of stem cell as it doesn’t have any damage since it is collected after ten minutes after the child is born and you can have a good match within the family also. In the medical science going forward, the benefits of stem cell will increase and it is only once a life time opportunity.

Lot of parents say that they have the ability to do it.

Do you think the parents who approach for stem cell banking are really aware of its merits?

The minimum cost of this kind of technique is `20,000 and nobody will spend this sort of money without understanding. They talk to their friends, families, doctors and gynaecologists and then they take the view on this. They talk to our company also and then we educate them about the benefit and the practice itself.

What are the regulations in stem cell banking and how are you planning to clear people’s concerns?

We don’t think regulatory pain points are there. Regulation is a necessary aspect of every service. For a very high quality service like this, you know the banks should have good quality standard. If we don’t have a good quality standard it will do a lot more harm.

We are working with certain standard that at least those kind of issues does not happen. When we started at 2004 there were no guidelines and in 2009 we established guidelines and we complied with them. In the early years, we

were adhering to the blood banking guidelines; now they have separate guidelines for stem cell banking.

Do you work with hospitals to create awareness?

Yes, we do work with various hospitals for creating awareness among people. The hospitals run workshops where the parents are given awareness on various topics. For example in the countries like the US, it is mandatory that every mother should be informed before child birth the value of stem cell banking. The stem cell can

Is there a body or association which work for creating speedy awareness of the stem cell banking?

Under the ambit of the association of stem cell banks of India, we are working on joint initiatives to speed up the awareness of the stem cell benefit to the country.

Pricing is still an important factor when parents consider stem cell banking. Do you see it coming down in the near future?

Have there been technological

The umbilical cord has no controversy as this is collected without any pain to the mother or the baby. So, therefore, there is no ethical controversy be stored for a lifetime as there is no time limit or expiry date.

Stem cell therapy has faced opposition from the religious as well as the traditionalists. Does stem cell banking also face such oppositions?

There was no opposition for stem cell therapy, the issue was that lot of people were taking stem cell from the embryo. That made a controversy where, you take the embryonic stem cell. The umbilical cord has no controversy as this is collected without any pain to the mother or the baby. So therefore there is no ethical controversy.

advancements that may bring down the cost of stem cell banking?

Price is not a critical factor in stem cell banking. If you track the previous growth of the sector in the country the prices are coming down constantly over a period of time. Anything which is a volume service can be scaled up.

The prices will become more affordable going forward. In the last twelve months we have seen the three times volume growth and now we are growing at around 4000 new signups every month. The umbilical cords are stored in our Chennai facility but we have presence in over top 150 cities across the country.

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Special Focus Advertorial hospital acquired infections

Curing Cancer,

Avoiding Infection D

r Jagdishwar Goud Gajagowni is Head Of Surgical Oncology and Clinical Director, Robotic Onco-surgery at Krishna Institute of Medical Sciences (KIMS), a 1800 bed super-specialty hospital situated in Hyderabad. KIMS is the largest corporate healthcare group in Telengana and Andhra Pradesh states, operating six successful, fullyindependent hospitals and treating more than three lakh people annually.

The KIMS Institute of Oncological Sciences treats patients suffering from more than 200 types of cancers. The department collaborates with other departments and divisions at KIMS to provide patients with comprehensive cancer care.

As the Clinical Director of the Oncology Robotic centre at KIMS, Dr Gajagowni over sees a high-tech

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set up involving the latest robotic equipment for treating cancer cases.

Treatment of cancer is now a multidisciplinary science, and the radiation oncologists, medical oncologists and surgeons at the Oncology Robot-

Dr Jagdishwar Gajagowni

As the Head of Surgical Oncology and Clinical Director of Oncosurgery at KIMS hospital, Dr Jagdishwar Gajagowni leads a hi-tech set up to fight cancer. But while attending to cancer cases, the risk of Hospital Acquired Infections (HAIs) presents a clear and present danger, he tells ENN’s Rajesh K Sharma.

Thankfully, STERRAD is an able deterrent for HAIs… ic Center at KIMS work closely with nurses, pathologists, radiologists and pain management specialists to maximize the effectiveness of the treatment.

Explaining the advantages of robotic surgery over Laparoscopic surgery, Dr Gajagowmi says the stable 3-D imaging makes the appreciation of the patient’s anatomy better. The stability offered by robotic surgery also makes the reaching and grasping of the various blood vessels easier and simpler. It is easier to hold the nerves with the help of robotic arms, he says. The resultant stability is a big advantage when dealing with soft tissues and small nerves, he says.

Robotic surgery also makes the movement of instrument more intuitive, thereby reducing the learning curve for dissection and suturing. Ne-

gotiation over and under structures like ligating vessels, dissection on opposite side like in Esophagus is better, he says. The 180 degree rotation of the robotic arm’s needle holder also makes the suturing of narrow spaces like prostatic neck, mid Esophagus etc easier and better, he points out. Since the surgeon controls the camera and the cautery, it saves his time as he doesn’t have to depend on a third person for all data. As a result, the surgeon can synchronize his dissections better, Dr Gajagowni points out.

A surgery in any discipline carries with it a risk of Hospital Acquired Infections (HAI). Though hospitals and doctors take precautions against spreading an unwanted infection, the risk remains high. According to estimates, the rate of HAI is as high as five percent in India.

In Oncology, the risk of infection is high, as it involves contact with sensitive tissues and very small veins and vessels. The surgeons and

its equipments used in Laparoscopic and robotic surgeries.

KIMS also carries out regular fumigation on its premises to guard against the spread of vector diseases.

STERRAD, Dr Gajagowni says, has been beneficial to KIMS. He points out that the instruments are sterilized faster using STERRAD, thus saving on time. Robotic instruments are expensive, he says, and ensuring their cleanliness is of paramount importance. Sterilization time in STERRAD is less than an hour versus 12 hours in EO. This helps us do more cases with limited set of instruments. This technology helped us to upgrade from disinfection to terminal sterilization and avoid use of liquid chemicals.

This helps to reduce post-operative infections, he says.

Further expounding on the advantages of STERRAD, Dr Gajag-

Sterilization time in STERRAD is less than hours versus 12 hours in EO. This helps us do more cases with the limited set of instruments the nursing staff are by the patient’s side all the time, Dr Gajagowni clarifies. Also, the instruments, by virtue of being small, are difficult to sterilize by normal procedures, often requiring specialized instruments, like STERRAD. KIMS takes infection control very seriously at its premises. It has an infection control board that take note of any reports of infection that it comes across and analyzes them.

It then suggests measures to control the infections effectively. In addition, KIMS uses STERRAD to sterilize

owni says it is safe for the environment and the healthcare workers as it does not leave any toxic residues like other low temperature sterilizers. Its fast cycle time of less than an hour means that it is ready for use immediately without any aeration. This allows the instruments to be used for more surgeries.

The STERRAD is also very useful for sterilizing the minimal invasive and robotic instruments that are otherwise delicate to handle by human hands.

STERRAD is compatible with most of the delicate devices used for Robotics procedures.

As the Robotics Center at KIMS continues to treat cancer cases under Dr Gajagowni’s guidance, he is positive about the advances happening in Indian healthcare scenario.

He says advances are happening in both, Laparoscopy and Robotics. The future is even more optimistic, with advances happening in the malleability of instruments. The optics will further improve when better 3-D becomes available, he says. Advances in Staplers and Cautery mean that in time, they will have less lateral spread and their sealing effect will also improve.

For more information about STERRAD, contact Mr Kamakannan Thiru at tkamala@its.jnj.com

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stem cell

Please tell us about Cryo Stemcell.

Cryo Stemcell is India’s first fully autologus stem cell bank. We started in 2003 and offer preservation of stem cells, umbilical cords and cord blood that is collected at the birth of a child.

How has stem cell banking changed since you started in 2003?

In 2003 right till 2008, people were hardly aware about stem cells and the banking concept. But after 2008, many companies, especially foreign companies entered the Indian market space.

As a result, a lot of awareness about stem cell banking has come. People now are very aware about stem cell banking and today, in practically every major city, when a birth happens, the patient is aware that there is an option for stem cell banking. Awareness has grown a lot, but so has competition, as a lot of companies have come in. But the market is big enough for many more, actually.

support hospitals that have a need for stem cell therapy. We are the back end supporters for many such hospitals, and from the technology point of view, in stem cell banking, there is lot of process development that has happened.

Percentage wise, the number of people using the stem cells is less, but in terms of absolute, we are the highest. More than 85 patients have used the stem cells that they banked with us.

What are the cities that you are active in?

We are active in South India in Chennai and Hyderabad, Trivandrum and other places. Apart from that, we are active in Mumbai and Pune, and expanding to Delhi and parts of Rajasthan as well.

How do you go about convincing people to invest in stem cell banking, and later collecting the stem cells?

We have interactions with doctors and conduct workshops with doctors about

Treating Technology as a

Commodity to Give Service Naveen Kulkarni heads India’s first stem cell banking operation. He has seen the industry from its infancy, and feels that pricing does not play an important part in the sector’s growth, he tell ENN’s Rajesh K Sharma How has the technology in stem cell banking advanced since you started?

Stem cell has two components- stem cell banking and stem cell therapy.

We don’t do any stem cell therapy, but

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the benefits of stem cells and what their possibilities are, but the final decisions are made by parents. We do talk to parents, and many times when the parents

enquire from the doctors, they refer them to us. As the due date nears, parents are made aware of the stem cell banking option. Mostly they are aware of the concept. The challenge is convincing them why they should bank with us, and what are the chances of using the stems cells. But since the application of stem cells is plausible in India also, it is not that big a hurdle.

Has stem cell banking become affordable in India?

I don’t think so. So far, only one company has reduced its prices. But when you do an actual math and calculate every-

thing, it has not come down. People go by what is shown, without looking at the small print. The overall cost is the same. What they have done is restructure the whole financial model. Once restructured, it becomes appealing to the common man. But these are just the processing charges. There are other charges, like transportation, logistics and other charges all within one year.

Is there any chance of it becoming more affordable?

The word affordability is relative in India. What is affordability? I have argued about this a lot. BMW is also affordable.

Everything in India is affordable.

But reducing prices may help bring in more customers…

It is about financial modeling. Most families now have two cars. But the price of cars as well as fuel is rising.

But financial models like zero down payments make cars interesting. So, affordability has definitely gone up because of the options that are available.

I would say that the Indian market has nothing to do with the costing.

Please tell us about the technology implemented at Cryo Stemcell.

There are many technologies that companies are working on, but at the end of the day, the value of the technology is only what it can deliver and what it can add to the patient’s value. Does the patient end up paying more? From a technology point of view, I would use technology as a commodity. I would to bring the best out of technology from my client. For example we have improvised our processes and brought in a technology called PRP (Platelet Rich Plasma). It is not a new technology, and is known to doctors for more than 25 years. But no company was interested in plasma and threw it away. In fact, 99.9 percent of all components in a surgery including the placenta, amniotic membrane, amniotic fluid and cord blood, can be used. Nothing should be thrown away,

but everything is. We thought that the best way we can give better value to our clients would be through new features and new facilities for them when the need arose. The PRP of the cord blood is almost 15 times more potent than the regular peripheral blood plasma. It can be used not only for the child, but also for the siblings and the parents in accidents, injuries, burns etc. It can also be used for the expansion of the stem cell at the time of growth. PRP is nothing but a lot of growth factors that are useful for the body. This is technology that we are bringing in that is applied to bring greater benefit to the client at the time of need. Rather than saying that I have a particular technology, if the technology cannot deliver something valuable, it is of no use.

medical service, another says we are not and wants to take taxes from us.

Another thing is academia. Medical academic research is very low end in India. We have tied up with many hospitals and universities, where the intention of doing research is the last thing. Everyone is busy treating patients. But if you don’t do research and publish it in a structured manner, you will not be at par with other companies. You will keep borrowing technologies from everywhere else.

What is the current market scenario like?

The fact that there are many players in the market says that there is a market for stem cell banking. All the companies combined haven’t tapped 0.5 percent of the market. A huge un-

I don’t believe in pricing as key criteria in India at all. The whole thing is about the smartness of how you package it How has been the government’s support to stem cell banking?

The word stem cell is a taboo. It has received bad publicity because of which, the government is wary. At the same time, many committees that are formed that comprise people from various disciplines, who give advantages to their disciplines. Like an earlier committee had an Opthalmologist who was very keen on using stem cells in corneal operations. As a result, ICMR is a recognized therapy for corneal injuries.

Later, many people pushed for stem cell treatment in other fields, which is ok.

But the government is also bringing in lots of restrictions. For example, till recently, we had to pay service tax because we were not considered a medical field, but the DGCA still made licenses mandatory for all stem cell banking operators and considered stem cell banks at par with blood banks. While one government wing puts us under

tapped market needs to be addressed.

There is still scope for building awareness, and hospitals are building those gaps. Most companies have similar models, except a few that are working on pricing. But I don’t believe in pricing as key criteria in India at all. The whole thing is about the smartness of how you package it. Smart packaging about stem cell banking helps. We too are innovative in our own ways.

A lot of stem cell banking companies entered in India a few years ago, but are now folding up and going back.

They thought their experience outside would help them here, but the Indian market is different. The approach can’t be same as in developed markets.

Some companies have handed over their reins to Indian operators, who are primarily doctors with hospital experience. But while they can bring in the numbers initially, eventually it is a pure marketing operation.

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zoom in surgery

Converging Disciplines

For Tomorrow’s Operating Rooms As surgeries become less invasive and medical science progresses, the Operating Rooms too are changing to reflect this. Today, surgeries involve collaboration among various specialists working on a single patient, creating a demand for Hybrid Operating Rooms (OR). MAQUET, with its expertise in building ORs, provides an attractive option for the same

T

he world of surgery is currently undergoing a change to reflect the advances in medical science. The explosion of knowledge that the advances bring has led to minimally invasive surgeries, with specialists in multiple branches of medicine providing their own expertise to the surgery, respectively. In fact, surgeons nowadays increasingly prefer to perform minimally invasive or open procedures in Hybrid Operating Rooms (ORs), which transcend medical disci-

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plines and boundaries while enabling specialists like cardiologists, cardiac surgeons, interventional radiologists and vascular surgeons to collaborate in performing a surgery.

Clinics nowadays are constructing Hybrid ORs equipped with angiographic x-ray systems. This is of benefit to the patients undergoing cardiac and vascular surgery. It cannot be underestimated with regard to risk minimization that it offers.

Surgical equipment manufacturer

MAQUET offers support to planning and implementation as well as to the protection of a clinics investment that install Hybrid ORs. With more than ten years of experience, MAQUET is a global leader in the planning and designing of interdisciplinary Hybrid ORs. MAQUET has carried out over 150 projects around the world, working in close collaboration with imaging equipment providers like Philips , Siemens and Toshiba in Healthcare Sector.

MAQUET`s Hybird OR solution features modular, radio-translucent surgical tables synchronized with state-of-the-art angiographic systems, all designed for use in sterile environments. Interventionalists and surgeons can conduct a wide range of treatments and examine their results using angiography in a single room without delay.

The high-performance Hybrid OR is attributed to its phased and intensive planning and construction. It takes anywhere from 6 to 18 months to build a Hybrid OR. The challenge is to combine the many individual medical systems to form a single, holistically functioning system.

In both, planning as well as implementation phases, clinics greatly benefit from MAQUET’s many years of experience ­– from room classification, the room concept and configuration, to the viewing concept.

MAQUET supports clinics, architects and planners with its extensive knowledge and useful tools throughout all planning stages. MAQUET provides a 3D simulation of the desired Hybrid OR during the very early planning stages using its OR3D visualization software.

This contributes greatly to the transparency of the project. Using the 3D presentation of the OR, the customer can check the positioning of various devices and check and modify the workflow. The 3D presentation can also serve as the basis for a cost estimate.

Explaining the approach, Bhavesh Y Bhatt, General Manager, MAQUET says, “Our most important concern is to ensure optimal work processes in the new Hybrid OR for all user groups. This is why we place such importance on workflow consulting during the planning phase”.

Getting everyone involved at an early stage makes all the difference.

The operating room can only be equipped to optimally cater to everyone’s needs if it is clear from the on-

With more than ten years of experience, MAQUET is a global leader in the planning and designing of interdisciplinary Hybrid ORs set which departments will ultimately make use of the Hybrid OR. MAQUET offers custom-tailored Hybrid OR products for a perfectly configured operating room - from a single source: from Modular OR VARIOP , OR lights and ceiling elements with integrated x-ray protection to operating tables, systems for OR integration (for image and equipment control), Anesthesia workstations and heart-lung machines to name just a few. In this way, MAQUET sets up its fully integrated Hybrid OR in collaboration with manufacturers of imaging equipment.

The heart of the Hybrid OR is the operating table and the angiographic x-ray system. The 360 degree radiolucent and extremely flexible operating table by MAQUET turns the Hybrid OR into an interdisciplinary OR: the MAGNUS operating table system can be adapted to meet the requirements of cardiology, heart surgery, vascular surgery, neurosurgery and orthopedics.

Besides optimal workflows and the technical interaction of all devices, MAQUET also focuses on creating an attractive workplace and an appealing atmosphere. This involves the use of products that support ergonomic working methods for surgeons and surgical staff. In addition, colors, lights and wall images are used to create a pleasant and positive working atmosphere.

In the design of its Hybrid OR, MAQUET pays particular attention to the integration of sustainable products and future-proof solutions. This is why the company has opted for the use of flexible wall and ceiling elements to enable quick retrofitting at all times.

In addition to the provision of VARIOP wall elements for the occasional “overnight conversion”, all products ­– including the OR table and the OR integration system ­– are modular so that they can also be retrofitted whenever necessary.

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cardiology

Latest Breakthrough

in Cardiac Care

Dr Sandeep Attawar, Director, Cardiac Surgery and Thoracic Organ Transplantation, Fortis Memorial Research Institute Dr Nikhil Kumar, Director, Cardiology, Fortis Memorial Research Institute Dr Sharad Tandon, Director – Non Invasive Cardiology, Fortis Healthcare

Dr Sandeep Attawar

O

f late, of advances have taken place in the field of invasive cardiology in order to keep pace with management of complex cardiac disorders. The major advances are catheter based exclusion of LAA to prevent stroke and the role of Renal denervation therapy in uncontrolled hypertension, wearable cardioverter defibrillator, optical coherence tomography, Strain Imaging and hand held echo machine.

Catheter based exclusion of LAA Patient with lone or non-valvular AF are prone to have embolic strokes despite anticoagulant therapy. Ongoing search of many years has led to development of catheter based treatment in

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Dr Nikhil Kumar

Dr Sharad Tandon

order to prevent stroke. WATCHMAN LAA occluder has shown reduction in stroke incidence and also in cardiovascular mortality as compared to warfarin in PROTECT AF trial and awaiting FDA approval. Device is deployed through trans-septal technique. Other emerging devices like occlutech, coherex, etc, are under trial.

With increased incidence of uncontrolled primary hypertension, as a result of noncompliance, there was a desperate need of alternative therapy.

Renal denervation therapy has shown benefit in controlling blood pressure and also increasing compliance among patients because of decrease in number of antihypertensive medicines. It requires radiofrequency ablation of bilateral renal sympathetic afferent and

efferent nerves which travel across the renal arteries.

Wearable Cardioverter defibrillator The wearable cardioverter defibrillator (WCD) is an effective option for external monitoring and defibrillation in patients at risk for sudden cardiac arrest caused by ventricular tachycardia or ventricular fibrillation and who are not candidates for or who refuse an implantable cardioverter defibrillator (ICD).

The device has been used when a patient’s condition delays or prohibits ICD implantation, or as a bridge during periods when an indicated ICD must be explanted, such as for treatment of infection.

cardiology

The WCD has been increasingly used for primary prevention of sudden cardiac death during the high risk gap periods early after myocardial infarction, coronary revascularization with coronary artery bypass graft or percutaneous coronary intervention, or new diagnosis of heart failure, when its use is as a protective bridge to ICD or left ventricular improvement.

The WCD can also provide monitoring with backup defibrillation protection during diagnosis and risk stratification periods.

Although compliance and absence of pacing capability are limitations, shock efficacy and overall survival seem similar with a WCD compared with ICDs, and studies have reported satisfactory overall compliance.

Optical Coherence Tomography Optical coherence tomography (OCT) is a diagnostic procedure that is used in combination with a procedure called cardiac catheterization. The technique uses near-infrared light to create images of the inside of your blood vessels. Unlike ultrasound, which uses sound waves to produce an image of the blood vessels, OCT uses light. With OCT, doctors can obtain images of the blood vessels that are about the same as if they were looking under a microscope.

How does it work?

OCT uses near-infrared light to create images of the inside of the coronary arteries. The technique delivers such high-resolution images because it uses light instead of sound waves. In fact, OCT allows cardiologists to see in 10 times more detail the inside an artery than if they were using intravascular ultrasound.

OCT is used along with heart catheterization procedures, including angioplasty, in which cardiologists use a tiny balloon on the tip of a catheter to unblock a coronary artery. Most patients who undergo balloon angioplasty

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The major advances are catheter based exclusion of LAA to prevent stroke and the role of Renal denervation therapy in uncontrolled hypertension also receive a stent—a small mesh-like device placed inside the artery to keep it open. OCT images can help cardiologists see if a stent is holding an artery open and whether the stent is positioned correctly against the artery wall.

OCT also lets cardiologists clearly see the plaque inside an artery, find out how much fat or clot is inside an artery, and take precise measurements before and after placing stents.

The main applications of the OCT system are atherosclerotic plaque assessment, Stent struts coverage and apposition assessment, and in stent restenosis evaluation, PCI guide and optimisation, in case of bio absorbable stents, information regarding the time course of stent dissolution.

Hand Held/ Pocketsize ECHO machine An echocardiography system that conveniently slips into a coat pocket might seem a natural for cardiologists: a readily available window into the heart and how it’s functioning, far more informative and flashy than the venerable stethoscope

The pocket-sized echo system provides additive clinical value over the physical examination, contributing to an increased number of diagnoses, reducing the performance of unnecessary conventional echocardiographic studies and allows many patients to be released from the outpatient clinic / Emergency rooms without the need for further testing after the initial consultation.

Pocket-size hand-held echocardiographic (PHHE) devices are extremely mobile, providing the fundamentals for increased use of cardiac imaging in the diagnostics of patients. l They are suitable for a quick assessment of cardiac structures and function. l They are capable of high-quality recordings, with best accuracy for the assessment of left and right ventricular function, as well as the detection of pericardial or pleural effusions. l They are suitable for semi quantitative evaluation of valvular morphology and valvular function if equipped with color Doppler. l PHHE devices are also suitable for non-cardiac imaging in Emergency room settings. l A proper level of competence and skills are mandatory before using the technology.

Strain Imaging Echocardiographic strain imaging, also known as deformation imaging, has been developed as a means to objectively quantify regional functions of heart. First introduced as post-processing of tissue velocity Doppler imaging converted to strain and strain rate, strain imaging has more recently also been derived from digital speckle tracking analysis. Strain imaging has been used to gain greater understanding into the pathophysiology of cardiac ischemia and infarction, primary diseases of the heart muscle, and the effects of valvular disease on heart function, and to advance our understanding of diastolic function.

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