v o l u m e 3 | issue 4 | APR IL 2008
A Monthly Magazine on Healthcare ICTs, Technologies & Applications
Cover Story: Investment and financing in healthcare sector Dilip Khanna, Associate Director, Healthsciences Practice, Ernst & Young
Page 8
Financing India’s healthcare infrastructure needs Dr. Rana Mehta VP - Healthcare Technopak Advisors Pvt. Ltd.
Page 14
Spotlight: Made In India Dr. G S K Velu Managing Director Trivitron Group of Companies
Page 20
Power Hospital: N. M. Virani Wockhardt Hospital, Rajkot Page 24
Prespective: National Health Policy - Need for Reforms Dr. Ajit K. Nagpal Chairman executive Council, Batra Hospital , New Delhi
Page 46
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ISSN 0973-8959
Rs. 75
w w w . e h e a l t h o n l i n e . o r g | volume 3 | issue 4 | April 2008
CONTENTS Cover story
8
Investment and Financing in Healthcare Sector
Dilip Khanna, Associate Director, Healthsciences Practice, Ernst & Young
14
Financing India’s Healthcare Infrastructure Needs
Dr. Rana Mehta, VP - Healthcare Technopak Advisors Pvt. Ltd.
Exclusive Interviews: Investing
in Healthcare
10 Chandraseker Kandasamy,
Managing Director, ePlanet Ventures
12 Vishwa Chandra, Tejus Sawjiani Partners, Singularity Ventures
SPOTLIGHT
power hospital
20
24
Made in India
Dr. G S K Velu Managing Director Trivitron Group of Companies
April 2008
N. M. Virani Wockhardt Hospital, Rajkot
eHEALTH
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w w w . e h e a l t h o n l i n e . o r g | volume 3 | issue 4 | April 2008
in conversation
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The Transformation Story
Deepak Venugopal, Director, N. M. Virani Wockhardt Hospital, Rajkot
perspective
35
National Health Policy - Need for Reforms
Dr. Ajit K. Nagpal (MBBS) Chairman Executive Council Batra Hospital & Medical Research Center, New Delhi
EVENT REPORT
48
Conference on Emerging Role of IT in Healthcare
29 February 2008, India Habitat Centre, New Delhi
Fujifilm Showcases Digital Mammography 8 March 2008, Le Meridien, Chennai
ZOOM IN
53
India’s Health Budget 2008
eHEALTH
RE G U LAR SE C T I ONS india news 32 BUSINESS NEWS
38
wORLD NEWS 44 NUMBERS events diary
56
58
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Editorial Guidelines eHealth is a print and online publication initiative of Elets Technomedia Pvt. Ltd. - an information research and media services organisation based in India, working on a range of international ICT publications, portals, project consultancy and highend event services at national and international levels. eHealth aims to be a rich, relevant and well-researched information and knowledge resource for healthcare service providers, medical professionals, researchers, policy makers and technology vendors involved in the business of healthcare IT and planning, service delivery, program management and application development. eHealth documents national and inter-national case studies, research outcomes, policy developments, industry trends, expert interviews, news, views and market intelligence on all aspects of IT applications in the healthcare sector.
Contributions to eHealth magazine could be in the form of articles, case studies, book reviews, event report and news related to e-Health projects and initiatives, which are of immense value for practitioners, professionals, corporate and academicians. We would like the contributors to follow the guidelines outlined below, while submitting their material for publication: Articles/ case studies should not exceed 2500 words. For book reviews and event reports, the word limit is 800. An abstract of the article/case study not exceeding 200 words should be submitted along with the article/case study. All articles/ case studies should provide proper references. Authors should give in writing stating that the work is new and has not been published in any form so far.
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Volume 3 | Issue 4 | April 2008
EDITORIAL
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Dr. M P Narayanan
Free Flowing Funds!
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Ravi Gupta
The healthcare sector in India is attracting investments like never before.
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Partly influenced by rising opportunities in medical tourism and partly enthused by the growing domestic demand for high-end medicare services, hopes are flying high, and the sector is set for an overhaul, which was due for a long while. In ‘07-’08 alone, nearly US$ 400 million was pumped into this sector by a bunch of private equity firms. On top of it, there are corporate and industrial investors bringing big value capital to revamp this hitherto laggard sector of the economy. Going by industry forecasts, the healthcare sector will receive private investments to the tune of US$ 5 billion over the next 4-5 years. Although a bulk of this investment is expected to flow into metro centres, some portion might find its way to non-metro towns and cities – at least after the recent grant of five year tax holiday for new facilities in tier II & III cities. The government is also trying to catch up with the trend. Union Budget ‘08-’09 has hiked healthcare allocations by 15% over last year, amounting to a total outlay of INR 16,534 crores. Following closely on this trend, medical technology and healthcare IT companies are also burning their boosters. With foreign and domestic firms coming into the foray and vying for the opportunity lying ahead - competition is getting stiffer. While the age-old legacy of price sensitiveness continues to prevail, the healthcare industry (like many others) has lately acquired good tastes of global competitiveness and high quality. Thus, manufacturers of medical equipments are left with no choice but to find ways of delivering world-class products, at ‘Indian prices’. This trend is strongly reflected in the setting up of local manufacturing base for many foreign and domestic companies alike. Sparks are flying in the insurance sector as well. With a host of private and public players entering the health insurance space, the ‘provider-payer-patient’ triangle is slowly reeling out of its long drawn overload on the last ‘p’. Some proactive measures from the government are also helping in this direction. For instance, recently announced tax benefit scheme for paying medical insurance premium of elderly parents and introduction of Rashtriya Swathya Bima Yojana having health insurance coverage up to INR 30,000 for workers and their families in the unorganised sectors is commendable. However, it’s a long way that lies ahead, as the average health insurance coverage in India stands at a mere 4% of the population. Get a deeper insight inside this issue.
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Ravi Gupta Ravi.Gupta@ehealthonline.org
April 2008
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COVER STORY
Investment and Financing in
Healthcare Sector Dilip Khanna, Associate Director, Healthsciences Practice, Ernst & Young
Background The Indian healthcare sector is on a high-growth trajectory propelled by unparalleled domestic growth, increasing public awareness and growing global interest in India’s delivery capabilities. The government’s focus on making healthcare a priority sector, increasing penetration of health insurance, rising per capita income and increased incidence of lifestyle related diseases is resulting in an increase in the patient base. The sector is currently estimated at about US$ 30 billion and is expected to grow at a CAGR of 12-15% out for the next 10-15 years.1 According to industry estimates, over next 6 years about US$ 78 billion worth of investment would be required in the Indian healthcare sector. However, the government spending in the healthcare sector still lags behind other developing nations. According to WHO, government spending on healthcare in 2004 amounted to 24.8% of the total health expenditure in India, as compared to 45.3% in Brazil and 49.4% in South Korea. As a result, private sector participation in this sector is crucial to meet the shortage of quality healthcare facilities – it is expected that of the US$ 78 billion investment, up to US$ 70 billion may come from the private sector.2 Historically, participation of private sector players has been extensive in the primary and secondary healthcare segment. Corporate hospitals were set up in the late 1980s, but the emergence of chains (other than Apollo to some extent) was not forthcoming. The focus at the time was on availability of medical care rather than providing comprehensive quality healthcare. However, the last 5-7 years have witnessed the emergence of organised healthcare with a number of players such as Fortis, Apollo, Wockhardt, Max Healthcare etc. setting up multiple hospitals and creating a comprehensive healthcare delivery platform. In addition, even players like Apollo Tyres and Reliance, who have traditionally concentrated on other industrial segments, are making a foray into
this sector. Due to such private sector participation, revenues from private sector hospitals are estimated to reach around US$ 35.9 billion by 2012.3 Investment Considerations The healthcare delivery industry (particularly the hospitals) is characterised by the following: Capital Intensive: The hospital business is extremely capital intensive and involves long gestation periods. The initial costs per bed are in the range of INR 5-10 million for tertiary care hospitals in large cities.3 Manpower Shortage: Doctors and nurses are critical to the success of any hospital. Due to shortage of these skilled professionals, attracting and retaining medical talent is a key concern area. By 2012, the country will be short by an estimated 4.5 lakh doctors and 12 lakh nurses.3 Brand Building: Long term success of a hospital is dependent on the brand image it enjoys in the market. Building a brand requires significant commitment of time and monetary resources which a lot of players are not able to afford. Success of hospitals such as Gangaram and Escorts to a large extent is attributable to the brand and the niche they have carved out for themselves. Obsolescence Costs: The healthcare industry is characterised by frequent product innovations and evolving technology. This leads to redundancy of expensive medical equipments every 5-7 years, thus requiring regular reinvestment in the facility, and thereby, serving as an impediment to the hospitals growth plans. Complex Business Model: This mainly results from two factors - the high risk environment involving human lives and managing the doctor & corporate management interface, with doctors still continuing to be prime agents for filling up hospital beds. The increased presence of corporate players has resulted in a transformation of the sector with various operating models
1 - Fortis Healthcare - ENAM Report Dec 2007, 2 - FICCI Ernst & Young Report, 3 Industry Research
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emerging to achieve twin objectives of geographical presence These Brownfield expansions are also vital to the ‘hub and as well as profitability. Some of the modes of entry/expansion spoke’ strategy being increasingly followed by leading healthdeployed by the corporate players are described below: care chains to expand their network. The ‘hub and spoke’ model enables patients to transit smoothly from primary to Greenfield Expansions: In a Greenfield set up, the owner tertiary care. The tertiary care hospital is the hub where as the is responsible for construction of the facility and all other primary and secondary healthcare facilities, diagnostic centers operating costs including equipment, staff, liability insur- and pathology labs act as spokes. This ‘hub and spoke’ modance, maintenance supplies and capital expenditures. Such el allows hospitals to further expand their reach, build their a set up can cost anywhere between INR 2.5 to 10 million brand and effectively utilise the available resources. per bed, depending on factors such as hospital specialty, location of the facility, target consumer segment etc. Some Acquisitions: The Indian healthcare delivery market is extremely fragmented. Consolidation through acquisitions is of the recent hospital projects announced and the associated cost per bed are as under. one of the key steps being taken by existing players to expand their networks and healthcare delivery capabilities. Sl. No. Facility Name Location Speciality
Capex # of Beds Cost/bed (In INR mn) (in INR mn)
1. Fortis Escorts Jaipur
Cardaic Sciences, Neuro Sciences 200 320 0.60 Renal Care and GI diseases
2. Fortis Medicity Gurgaon
Oncolgy Flagship, Pediatrics 3500 350 Trauma specialisation
10.00
3.
Fortis Hospitals-Shalimar Bagh
West Delhi
Multi-Speciality
2000
250
8.00
4.
Fortis Hospital - Noida
Delhi
Orthopaedics and Neurology
1200
350
3.40
5.
Apollo
Chennai
Orthopaedic
1100
200
5.50
6.
Apollo
Mumbai
Multi-Speciality
2500
400
6.30
Speciality cancer hospital and research centre
1000
100
10.00
7. Vedanta Group - Raipur Chattisgarh
It can take 2 to 3 years from the time of conceptualisation of a project and its completion. The construction of the facility alone takes 18 to 30 months.4 The capital commitments and associated gestation period for Greenfield hospitals impact the ability of players to create new facilities in a short period of time.
Fortis’ acquisition of Escorts Heart business was a marquee transaction to acquire capability in the cardiac care
Brownfield/Management Contracts: Due to problems associated with Greenfield projects, companies have started showing an inclination towards Brownfield facilities or ‘operate and manage’ arrangements. Brownfield facilities require the company to refurbish, equip and operate hospitals that are owned by another player/ company.(Graph:1) Typically, these arrangements do not require significant capital expenditure and have a much shorter gestation period of about 6 months. Some of the organised players are entering into these ‘operate and manage’ arrangements with smaller hospital owners as a market consolidation/low-cost market entry strategy. These arrangements are structured as a revenue & profit share or as fixed lease contracts with varying durations (dependent mostly on the level of investment being made by the new entrant).
(Graph: 1)
segment and to establish a strong market presence in the national capital. Private equity players such as ICICI Venture are also playing a proactive role in acquiring hospitals to create an integrated delivery system.
4 - Industry Research,
April 2008
COVER STORY
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Investing in Healthcare Q. How do you foresee the growth of the healthcare market in India? What role do you see ePlanet play in it? A: The healthcare sector in India is one of the most promising and fastest growing sectors in the country. Mainly due to the growing middle class of 300 to 400 million Indians who are demanding more sophisticated medical treatment in addition the changing patterns of disease; increase in health awareness; unmet clinical needs (though the number of private healthcare institutions has doubled in the last ten years, the number of doctors and beds, 0.5 and 0.9 per person respectively, is still well below the world average of 1.5 and 3.3); rising income levels; increase in health insurance & awareness (hospitalised Indians spend on an average 58% of their total annual expenditure.) Over 40% of hospitalised Indians borrow heavily or sell assets to cover expenses and over 25% of hospitalised Indians fall below the poverty line.
“
The expenditure on healthcare in
India is 5.5 % of the GDP, while most
established market economies of the world spend 7-10 % of their GDP on health.
”
At ePlanet, our major focus will be on the Medical Technology market which includes healthcare devices and equipment, diagnostic equipment and services, medical software and consumables and home care products, though we are also looking at other niche services like clini- setting up a large domestic network- while an early stage company can get into development and manufacture of a product, they will need to cal services and contract research services. spend heavily in setting up a large distribution and support network Q. What are the key challenges in the current healthcare scenario to sell its products; duty differential rates between imported products that hold back venture capitalists from investing more heavily in and raw materials/components are not very attractive for domestic manufacturing; the large capital expenditure required for setting up India? A: Challenges are many, the key ones include- need for increased do- hospitals; products to be sold in international markets require quality mestic manufacturing of high-end technology products; high cost of approvals like FDA, CE etc., which is time consuming and expensive;
Performance Evaluation terparts with respect to various key financial parameters. Key financial milestones for a tertiary hospital in India are Some of the critical financial parameters of a hospital’s profpresented in the below table:5 itability and financial efficiency are as under:6 Year end
Milestone achived
1
-ve EBITDA
2/3
Cash break even
4/5
Profits
6
Peak margins reached
8
Majority Debts paid off
EBITDA Margin - The Indian healthcare industry’s average EBITDA margin of 17.7% compares favorably to its US counterpart (15.7 %). The EBITDA margin depends on various factors including location, target market, price sensitivity and hospital specialty. Return on Capital Employed (ROCE) - Even in this performance measure, the Indian healthcare sector’s leading players have an average ROCE of about 13% which is significantly higher compared to their US counterpart’s average of 7.3%. (Graph: 2)
Leading healthcare players are leveraging their size, experiAs the Indian Industry matures and improves its operating ence and capabilities to shorten this time line and achieve higher profitability and financial viability. Even though the efficiency (in terms of ALOS, BOR etc1)7 these financial perIndian healthcare sector is still in its infancy, private health- formance measures are expected to improve further. care players in India are faring better than their overseas counEven though the above parameters are average perfor5, 6 - Ernst & Young Business of Healthcare Report, 7 - ALOS at Indian Tertiary care hospitals in approximately 5 days, which is higher than the international standard of 4 days,
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Q. How do you see the healthcare IT market emerge in the face of increased investments in healthcare in India? Do you think the healthcare market is ripe for increased automation and interoperability? A: Currently IT forms 2% of the medical technology market. However, the increasing demand for software in medical technology varies from place to place, hospital administration, medical equipment software, clinical applications software, networking between equipment & facilities, telemedicine and medical transcription. While the market is slowly getting into increased automation (given that hospitals are increasingly being run by the corporate.) For interoperability, the main challenges are that most stand-alone IT solutions are disparate and have major interoperability issues, since the customer expects the software to be provided free along with the hardware and hence most IT solutions are bundled along with the hardware; issues on software up-gradation and AMC also continue to be a challenge.
Chandrasekar Kandasamy, Managing Director, ePlanet Ventures
Q. Please elaborate on your future investment plans in healthcare in India. A: As indicated earlier, our major focus will be on the medical technology market which includes healthcare devices and equipment, diagnostic equipment and services, medical software and consumables and home care products, though we are also looking at other niche services like clinical and contract research services.Also, given our global footprint, we are able to identify replication products and services in other global markets, which look attractive in India.
Q. What has been your key focus and strategy for investments in healthcare? Have you looked at a more hands on approach, such government hospitals continue to be the largest consumer of health- as buy-outs? care products and services and this has got its own challenges like A: We continue to look at investment opportunities in medical techtendering and approval, collections etc.; delay in acceptance of IT by nology and related services. We are also open to looking to do small various healthcare organizations in improving their automation. buyouts, if the target fits into our investment strategy.
mance measure of the players in Indian healthcare industry, it is important to note that there exists significant variation in their individual performance depending on different factors including hospital specialty, size etc. An Ernst & Young Healthcare Survey conducted in October 2007 made some interesting observations: Multi-specialty hospitals tend to show the maximum average EBITDA margins (20.7%), followed by single-specialty (14%) and cardiology (13%) Cardiac speciality hospitals generate the maximum revenue per occupied bed per day (INR 13,413) followed by single-specialty hospitals (INR 11,141) and multi-specialty hospitals (INR 10,620) (Graph: 3) Also, the Multi-speciality showed maximum profitability per occupied bed per day (INR 2200 per occupied bed per day); (Graph: 4) (Graph: 2)
April 2008
An analysis of the EBITDA margins revealed that hospitals
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COVER STORY
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Vishwa Chandra, Tejus Sawjiani Partners, Singularity Ventures Q. How do you forsee the growth of the health care market in India? What role do you see Singularity Ventures play in it? I believe the health care market in India is going to continue to grow at a significant pace. There is a service gap that needs to be met and a number of companies such as Max, Fortis are looking at this. However, while each of these companies will look to grow significantly in the coming years I do believe that there will still be a significant portion of the population in rural / semi urban / tier III towns that will remain underserved. Given this we see opportunities in two areas. The first is in companies that would benefit from the growth in organized health care – this includes companies like medical supplies distributors, nursing training and other ancillary services. The second is in companies that can leverage technology to improve the scale of current facilities. As we mentioned before, no matter how many hospital rooms are put up by organized players there will still be a significant service gap. Technology companies involved in remote diagnostics, telemedicine, low cost device manufacturers and so on can help bridge this gap. Singularity ventures focuses on opportunities in these two areas. We are an early stage fund and look to invest between INR 1 – INR 6 Cr in each opportunity. We are indeed very excited by the deals we are seeing and by how the market is evolving. Q. What are the key challenges in the current health care scenario that hold back venture capitalists from investing more heavily in India? We believe there are different challenges being faced by investors, based on which part of the health care sector they are focused on. On the one hand you have the large investors that are looking at financing hospitals and healthcare infrastructure. They face two major challenges. The first is a reduction in margins / returns. This is primarily being driven by rising costs on one side (real estate, equipment etc.) and a constraint on how much can be charged by hospitals. We have seen returns in this sector fall from IRRs in the mid 30’s to mid 20’s. The second challenge is in gestation time. Most funds look at an average duration of 5 years for their investment – this would allow them time to exit and return the money to their investors. Most hospitals take about 3-4 years just to start running at capacity so funds are often faced with the prospect of exiting an investment before it has fully matured. The larger organized health care players are focused on driving down this time
of medium size (141-220 beds) have the maximum profitability; (Graph: 5) Financing Options As significant variations exist in the financial and operat-
(Graph: 4) (Graph: 3)
ing parameters among different players, even the lenders and investors pay significant attention to these parameters in their evaluation. Equity investors are attracted by proposals to invest in hospitals that are a part of a larger business model or several such stand-alone hospital projects are being financed
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through a holding company format. Such a strategy leads to value accretion at the holding company level and risk mitigation across the hospital projects. The promoter’s track record of establishing such projects is another key factor in the evaluation process. Hospital configuration i.e a general hospital v/s a tertiary/multi-specialty format is important in determining the commercial viability based on the hospital’s location,
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to profitability with some of them trying to be cash flow positive within 24 months. This is still a challenge that larger hospitals face. On the innovation / support side of the healthcare business where we primarily focus the challenge is on having a team that can understanding the technical aspects / needs of the industry. In India most of the venture capital players have emerged from technology backgrounds. There is a lack of understanding of the nuances of the healthcare market. In India we do not have specialist healthcare firms unlike the US / Europe where you had specialist healthcare VC firms which are often run by Doctors with MBAs. At Singularity Ventures we have addressed this by building a panel of doctors, professors, medical professionals who can advise and support us as we look at deals. This we have found, helps us significantly understand and evaluate healthcare opportunities that we otherwise would not have been able to focus on. Q. How do you see the health care IT market emerge in the face of increased investments in health care in India? Do you think the health care market is ripe for increased automation and interoperability? Yes, we are very excited about the role technology will play in healthcare. The world over you are seeing technology play a big role in healthcare delivery. That will continue within India as well. In addition, in India we believe technology will be key in providing scale to our limited resources that we have to deploy. We are currently looking at a number of very innovative healthcare companies especially in the remote diagnostics and telemedicine field. Q. Please elaborate on your future investment plans in health care in India. We have finalized our board of advisors in healthcare and are in the process of evaluating business opportunities which are in the early stages of their development. We are not looking at infrastructure / hospital investments but at companies that will benefit from the growth in the number of such hospitals. We are mainly looking at healthcare technology and healthcare services. Q. What has been your key focus and strategy for investments in health care? Have you looked at a more hands on approach, such as buyouts? We are not looking at buy outs – we believe the founders should be the ones to run the business. However, through our advisors and our extended network we would look to provide significant support to any company we invest in. We are very hands on and collaborative investors and look to work closely with each investment. We have found that many times what we can bring is additional capability support (e.g. management, finance, HR etc) that would allow our investments to scale significantly.
sector. Some of the marquee transactions in the healthcare delivery space include Apax Partners’ US$ 104 million fund infusion in Apollo Hospitals, Warburg Pincus’ investment of US$ 32 million in Max Healthcare and Trinity Capital’s funding of US$ 31.4 million to Fortis. ICICI Ventures has launched a US$ 250 million fund for acquiring hospitals and investing in the healthcare sector.9 On the debt side, hospital projects need access to long term funds. Multilateral institutions such as IFC, World Bank, Asian Development Bank etc have lent to this sector. Indian banks and financial Institutions are also increasing their exposure to this sector. The recent budget announcements would also improve the viability of new Greenfield hospitals being set up in Tier II & III cities, thereby encouraging debt and equity investments in this sector. other competitors, characteristics of the target market etc. Investors/Lenders evaluate the business case and the operating assumptions very closely. For Greenfield hospitals, the debt to equity ratio of 1:1 is considered optimum.8 Despite the above mentioned stringent criterions being used by investors for evaluating project financing, there is an increased appetite amongst the private equity players to invest in the healthcare
Conclusion Given the urgent need for developing quality healthcare infrastructure in India, the Government may also consider according Infrastructure status to this sector, thereby, enabling a better fund allocation and longer tenure to this important industry. The views expressed herein are the personal views of the author and do not necessarily represent the views of Ernst & Young Global or any of its member firms.
8, 9 - Industry Research April 2008
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COVER STORY
Financing India’s Healthcare Infrastructure Needs The growing demand for quality healthcare and the absence of appropriate infrastructure pose a challenge both to the government and private healthcare delivery providers. The article examines the quantum of the problem and how newer modes of financing including Private Equity infusion and Healthcare REITs could contribute to this colossal task of infrastructure building in this vital sector.
Dr. Rana Mehta, VP – Healthcare Technopak Advisors Pvt. Ltd.
T
he concept of an Inflection Point suggests that there are critical points in the history of an industry or an individual company that signal permanent and enduring change. Failure to recognize or respond appropriately to changes in consumer behavior, market conditions or opportunities has often spelled disaster for food retailers in markets around the world. Successful companies appear to consistently and accurately anticipate or create new market trends, while those less successful either fail to react to market conditions or make the wrong choices.
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The healthcare sector in India is today at the point of inflection in transforming the delivery setting in terms of the formats, quality of care, affordability and geographical access.
therefore, that almost all of the current organised healthcare service providers are struggling to show any profitability at all despite carrying the tag of being “premium”. In these circumstances, it is very difficult to imagine fresh capital formation of this magnitude anytime in the near future, since, generating adequate return on investment under current healthcare sector dynamics is a huge challenge. Till a decade ago, health (and the healthcare sector) was not considered a key driver of national economic performance. Today, there is incontrovertible evidence from the world over establishing that improved health leads to better economic performance. Poor healthcare on the other hand can severely impact economic growth (Estimated loss due to cardiac disease & diabetes alone in India will be US$ 236 billion in the coming decade).
A fast growing economy, rising incomes and increased urThe delivery capacity of India’s healthcare industry has not banisation have been instrumental in changing the perception been able to match up with the burgeoning population and of patients as consumers. The present day patients are more socio economic changes. demanding, expect better services for their money and exercises choice in choosing a facility for reasons other than cost. India needs an annual incremental addition of healthcare The Indian consumer spend on healthcare will increase from facilities equivalent to almost half of what UK or France or the current 7% to as much as 13% by 2028. Italy may need for their entire populations. Against a world average of 3.96 hospital beds per 1000 population, Russia has One of the prime concerns for any industry in India has 9.7, Brazil has 2.6, China has 2.2, and India languishes at just been the inability to acquire real estate properties on lease at over 0.7 indicating the big gap. Just to bring the availability a reasonable cost. This was aptly brought out in the forefront of the beds to 1.7 per thousand from the current levels, it is by the retail industry. The challenge is more in the healthcare required to create a million or more new beds, requiring sub- sector where gestation periods are long and accessibility is of stantial financial investment. prime importance. Real estate will continue to remain a challenge for some time now, however, we examine how the proposed healthcare Real Estate Investment Trusts (REITs) could help address this vital issue.
To reach developed country healthcare norms by 2028, it will require an astronomical US$ 1000 billion over the next 20 years. Even reaching halfway (i.e. the current norms of China and Brazil in terms of number of beds) will entail an investment of over US$ 500 billion (i.e. anywhere between US$ 25 billion to US$ 50 billion per year for next 20 consecutive years). Unfortunately, unlike other sectors, healthcare delivery cannot be priced on a cost plus basis since the payee’s ability in India is severely constrained with practically negligible penetration of health insurance. It is no surprise, April 2008
2008
2028
Ref.: National Account Statistics, Technopak Analysis
Real Estate Investment Trusts (REITs) are corporate, tax-advantaged entities designed specifically to own and sometimes operate real estate, including retail properties, apartments, office buildings, and healthcare facilities. REITs were originally formed to provide small investors with the opportunity to invest in diversified real estate without directly owning properties and having to bear any management and operating costs or responsibilities. 15
COVER STORY
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Private equity investments in India have witnessed significant growth during 2007. PE deals have increased from US$ 7.9 billion in 2006 to US$ 19.03 billion in 2007. There were around 53 deals of over US$ 100 million as against 11 deals in 2006.
“Healthcare sector attract-
ed over US$ 448 million in year 2007. Between 2008 and 2011, the sector is expected to see investments of around US$ 5 billion.”
Healthcare sector attracted over US$ 448 million in year 2007. Between 2008 and 2011, the sector is expected to see investments of around US$ 5 billion. According to industry experts, funds will flow from capital markets or PEs to set up greenfield and brownfield projects. India already has an active fund provider base supported by ICICI Ventures - one of the largest privateequities, which allocated US$ 250 million for a dedicated healthcare fund through I-Ven Medicare. Others include IDFC, HSBC, JP Morgan Private Equity Fund, American International Group Inc. (AIG), Evolvence India Life Sciences Fund, George Soros’s fund Quantum and BlueRidge. The healthcare sector in India is witnessing a surge of activity and the beginning of what is seen as a rapid phase of growth. Emerging healthcare segments like diagnostic chains, medical device manufactures as well as hospital chains are increasingly attracting investments from a variety of venture capitalists. At a broader level, this trend in healthcare is often seen as a manifestation of the overall surge in private equity and also growing interest among private equity funds for Indian companies. Private equity is smart money because these investors bring more to the table than just money. The capital and expertise of private equity act as a catalyst for creating enterprise value.
Healthcare is poised to be a new driver of growth for economy. Given the geographical access required for delivering care and the fact that infrastructure has to be spatially distributed, it has the potential to create pan India job opportunities across a number of towns and villages. It is estimated that each additional bed has the potential to create 5 direct jobs and 25 indirect jobs. This could translate into over 27.5 million jobs by 2017. The additional employment generated could lift 8-10% of households above the poverty line. Medical value travel could make India the ‘Healthcare Destination of the As estimated, India requires about a trillion dollar and a World’. It has the potential to contribute more than US$ 2 bulk of these investments would be made by the private sec- billion annually by 2012. tor. But due to high land cost many private players tend to And last but not the least, healthcare could greatly enavoid investing in healthcare. REITs would overcome this challenge by unlocking the healthcare delivery value. hance the ‘Brand Perception’ of the country. No wonder Healthcare REITs, if correctly implemented, will become that all prospective stakeholders are excited at the very a key financial instrument in helping existing and new thought of this market. Clearly, some of the most healthcare providers. The other trend we examine is the exciting laps of the healthcare race will be run in India in the coming years. infusion of private equity in the healthcare sector. Healthcare REITs specialize in healthcare facilities, including acute care, rehabilitation and psychiatric hospitals, medical office buildings, nursing homes and assisted living centers. REITs do not directly provide healthcare services at the properties they own. Rather, REITs rent facilities to licensed third-party healthcare providers. By supplying quality healthcare facilities and expertise in property management, REITs can help reduce the burden on providers and facilitate the delivery of medical care.
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INVESTMENT ce, to invest
dia presen eing pan-In
INR 2,000
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ay Fortis ey pany, on Sund er group com out ab st ve in 26 Aug, 2007 Ltd, a Ranbaxy promot to d is ready care a presence an -five years. Fortis Health ve a pan-Indi the next four ha in to e) s or an cr pl 0 00 the north, is 2, said it R in IN ily ion (nearly itals primar CEO m US$ 500 mill s a network of 12 hosp e co pany’s ha network”, th s conferw ne Fortis, which build a “strong national a ld to to an Singh e to now focusing ivinder Moh R 1,000 cror g Director Sh ch last year invested IN in ties ag ci an th M al d he hi an o w to set up tw e company, s an Th ent pl . nm re its er he ence revealed Punjab Gov twork, also hips” lks with the ta ns w in to is d expand its ne it te ra id like “integ ortly and sa s would be ent institute, in Punjab sh e health citie th managem al Th . he , rd ge ga lle re tity may in this a dental co id a new en ical college, spital. He sa alth city projects, ho r la gu having a med re spital and a g the two he rtis a teaching ho pharma giant for fundin ngh said Fo e 600 crore. Si le Lucknow th 0by 50 ed Rs n ee hi be float tw w , be ar may cost and Srinag stic centre in ls in Jaipur each of which s, its diagno ened hospita de op si Be ly nt e. ce lin re had e pipe l by 2009. ad were in th dged hospita and Ahmedab ed to a full-fle ad gr up be Kuwait may
vest re foray, to in ans healthca Bluewater pl INR 500 cr 2007 rna27 September Bluewater Inte ate equity firm iv 500 pr R ed IN as st -b ve UK to in ent Ltd plans are sechc alt he tional Investm e iv at cr a to tap the lu crore in India ity hospital with a multi-special up ng tti se by tor g centre. medical trainin
14 st US$ to inve e r a c h Healt Omega India in n re o li mil healthca 2007 r e b vider of d growth to ro p , 26 Oc re e a nounc Healthc e next es, has an Omega PO servic perations over th vest K d n a in o BPO n to ia s d n la ny p r its In plans fo ths. The Compa d its Bangalore n n a o p 18-24 m 4 million to ex will more than $1 s and ie it over US il c . fa ennai to 3,000 and Ch yee base lo p m e s double it
RIL plans INR 25,000 cr healthca re initiative over 7-8 yrs 17 September 2007 According to sources, Reliance Industries (RIL) plans a INR 25,000 crore healthcare initiative over 7-8 years . The healthcare initiative will integrate with Reliance Retail foray. This is one of the biggest plans that RIL has formulated on the lines of its retail foray, as it plans to set up 1,500 healthcare units in B, C towns. A pilot project, is already under implementation at Jalandhar and will be replicated at all the existing primary healthcare centres of the government, which probably don’t give the right kind of service that is needed to service the healthcare needs of the rural population. Over the next 7-8 years, the plan is to invest up to INR 25,000 crore in rural healthcare population . McKinsey had earlier predicted that by 2015 the Indian healthcare market itself will become US$ 20 billion, probably Reliance will play a massive role in getting to that figure.
(US$ 125m) s INR 500 cr an pl s nk ba yo Cr investment 12 October 2007 JV between Cryoonal India (CII), a Cryobanks Internati Corp of India, is RJ d an , al Inc of US banks Internation health care inthe in INR 500 crore planning to invest e years. The stem try over the next fiv dustry in the coun esting INR 150 inv at g any is lookin cell banking comp blood stem-cell rdphase to set up co t firs the in re cro will come up, of to 15 such banks banks. Around 10 to start stem cell ed aim It be overseas. which some would country as well. therapy units in the
India eyes U S$ 6.5 billion funding for medical tour ism November 14 2007 India is trying to simplify proc edures for foreign investors to invest in In dian hospitals and hotels. An d it is forecast ed that US$ 6. billion flowing 5 into the sector in the coming years.
on vest in Trivitr ion, by a wholly and ePlanet in nd Fu a) si (A of US$ 11 mill t ty en ui stm Eq e ve in at ited and t iv HSBC Pr 07 uity (Asia) Lim ced a significan ember 24, 20 mpany announ SBC Private Eq on. The H Co itr gy by iv lo d Tr se no in vi ch Saturday, Nov ke ad te ding medical a minority sta nd 2 Limited ld lea Fu ho a’s es es and di er ur ur In th , nt nt ge ve on Ve to t Trivitr Asian firms will tions and join y of The HSBC uity firm. Both through acquisi Coprorate s da an pl Ve s . es owned subsidiar nture Capital and Private Eq rk sin pa l technology anufacturing bu al Ve coming medica ’s ambitious m ePlanet, a Glob Trivitron’s forth ilitate Trivitron r fac fo ll t wi en d pm ise lo ra funds tural deve r the infrastruc will be used fo is transaction. th r fo r so vi ad as Advisors acted
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NOTICE BOARD Foundation commit Rotary Intl. and Gates io pol ate dic US$ 200 m to era 7 200 ber vem No 29 es the Bill and Melinda Gat Rotary International and 2007 an, ber vem No 26 on ) Foundation (BMGF to provide US$ 200 mil nounced a partnership The io. pol ate h to eradic lion for the intensified pus ary Foundation with one BMGF has awarded the Rot ge grants of US$ 100 mil of its largest-ever challen for-dollar over lardol tch ma l wil ary lion, which Rot the coming three years.
NASSCOM: IN R including med 100 cr fund for small cos ical devices 14 January 20 08 Software indu stry body NAS SCOM announ mation of a fu ced fornd with an in itial corpus of crore to help in INR 100 dividuals and ve ry small compa setting up their nies businesses. Th e anchor investo in the Nasscom-IC rs in ICI Knowledge Park Innovatio (NIIF) - are Ta n Fund ta Consultancy Se Ltd and ICICI rvices, Bharti Ai Knowledge Pa rtel rk, Nasscom sa com President id. NassKiran Karnik sa id the fund wo a corpus of INR uld have 100 crore to sta rt with, but this be increased to could INR 200 crore in future. Ther be more than te e will not n institutional investors in the fund.
ICICI Ventur e plans to flo at healthcare firm holding 03 December 2007 ICICI Venture is planning to float buy medium-si zed hospitals an a company that will d pharmacy ch act as a holdin ains and g company for the fund’s inve the booming he stments in althcare sector . India’s largest PE fund has alr domestic eady decided to allocate $250 m the holding com illion to pany, which wi ll be set up over one month. Th the next e fund, tempo rarily called I-V care, the compa en Mediny will be the lead vehicle fo Venture’s investm r all ICICI ents, buyouts in the healthcare space.
record USD 9.1 bn erest in Biotech raises Venture capitalists’ int technol21 January 2008 into privately-held US bio a record US$ 9.1 billion they can ries ove disc g kin ma Venture capitalists pumped of es companies last year, in hop US$ 29.4 billion in ogy and medical device italists invested a total of cap ture Ven rs. ake gm ing to the report. ord acc 1, sell to larger dru 200 e sinc all industries, the most oss acr ies a record share of , pan ices com dev 13 al 3,8 biotechnology and medic to t wen h to US$ 5.3 cas the of e About 31% re investment ros 2.7% ing to the report. Softwa according to e, reas inc 12% a venture investment, accord , ion panies raised US$ 4.6 bill billion, while internet com the report.
major healthcare investment IVEN keen to become 21 January 2008 ity fund, is all set to est domestic private equ ICICI Venture, the larg endeavor to become its in strategic investor sign a deal with a foreign strategic partner major in the country. The y-owned suba health care investment full the are dic Me lion in IVEN lion in IVEN would invest US$ 80 mil mil 80 US$ . “Currently, we have sidiary of ICICI Venture uld raise another wo we and II, ies Ser d age Fun from ICICI India Advant e a capital base of t. So, the entity would hav $90 million through deb , director (investRao with,” said Alluri Srinivas US$ 250 million to start d in three maeste inv ady alre has y compan 200 crore in ments), ICICI Venture. The INR est inv to country, and plans u. ICICI Nad jor healthcare units in the il Tam hospitals in Karnataka and in Kolkataa couple of South- based re cro 65 INR of ent an investm Venture today announced de through I-VEN PL). The investments, ma based Medica Synergie (MS PL. MS of ion ans exp for the Medicare, would be used
Mayar to open 14 Medispa, invest INR 400 cr in 3 yrs 09 February 2008 Diversified business conglomerate Mayar Group said recently it will set up a chain of medical spa centres in the country with an investment of INR 400 crore in the next three years and is also looking to have an inorganic growth in West Europe through acquisitions. The company is planning to open 14 such centres through its wholly-owned subsidiary Maya Health resorts limited (MRHL) and has opened its first such centre in the national capital with an investment of around INR 30 crore.
billion INR 165.34 to n o ti ca lo in health al in h allocation sees increase et g d u b al sed the healtINR 165.34 bilu ea cr Ann in am ar 007 . Chidamb fiscal year to e rural andn 01 March 2 ce Minister%Pcompared to the lasto and healthcare for thsu rance pla li 5 in India’s Finban o 1 IDS, p entions such as an dget by /A u IV H st n te o . la ss e re rv th ca ticular stre ed new inte for geriatric lion with pr.arHe has also promisan ecial facility sp a d o e o p rc fo urban anised work for the unorg
April 2008
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spotlight
Trivitron Technologies is poised to become India’s leading medical technology company. Dr. G S K Velu, Managing Director, Trivitron group of companies shares his vision for the company with eHEALTH.
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Q. Trivitron Medical Systems already enjoys a place of pride among the top five medical technology companies of India. What is your vision regarding Trivitron’s brandbuilding in the long term? We want Trivitron to be a globally recognised medical technology brand standing for quality and innovation with strong customer relationships in the areas we are present. For this we will do sustained campaigns and ensure we live up to the promises we communicate through our branding campaign. The market for medical devices and equipment in India is estimated to reach nearly US$ 5 billion by 2012. What share of the market do you hope to capture by next 3-5 years and which segments do you target in particular?
Q.
Our market share of various products ranges from 5% to 40% but as a total share we will be happy to achieve 10% of medical technology industry in the next 5 years’ time. As the leading and the largest medical technology company of Indian origin we hope we can achieve our ambition of reaching 10% of market share of the industry by offering a comprehensive range of medical technology products and solutions. Q. What are your plans for tapping the overseas market – particularly places like Singapore, Malaysia, Thailand, Philippines and the US and Europe? Trivitron already operates in the Middle East territories through a joint venture company Star Trivitron, which is based in Dubai Healthcare City. Apart from UAE the JV is focusing on establishing its presence in Oman, Qatar, Saudi Arabia, Kuwait and Middle Eastern/North African countries. Trivitron is also looking at establishing its presence in Africa by creating a hub in South Africa and creating a presence in South East Asia by creating a hub in Thailand and Vietnam. We also hope to become a contract-manufacturing partner for the US, European and Japanese companies once Trivitron Medical Technology Park becomes operational in the year 2009. Q. China already has a strong base in medical equipment manufacturing, along with a few good brand names originating from the country. Do you think there is any competitive threat for Indian manufacturers?
“Our market share of various products ranges from 5% to 40% but as a total share we will be happy to achieve 10% of medical technology industry in the next 5 years’ time.”
China is already way ahead of India in medical technology manufacturing and India has a lot of catching up to do before it becomes a potential threat to China. Chinas’ Medical Technology industry is estimated to be over US$ 12 billion, with US$ 6 billion of exports; but with the abundance of manpower, research and development base and the growing IT/biotech industry, India can definitely become a viable alternative to China for medical technology. April 2008
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Q. What do you think are the existing bottlenecks and hur-
dles for the medical devices industry in the context of the current policy environment? What is your wish list from the government to facilitate the growth of this industry? Present import policies of the Government of India for medical technology industry is quite lopsided and it favours trading rather than manufacturing. The inverted duty impact of this industry is also very significant making trading much more attractive than manufacturing. Simplified tariff structure in which there is a clear distinction between raw materials/component imports to finished good imports will help indigenous manufacturing initiatives. Also, the government should look at specific schemes to promote medical technology manufacturing by creating medical technology parks on the lines of software technology parks.
Q.
Trivitron’s proposed medical technology park near Chennai is going to be the first of its kind in the country. What is the total budget outlay for this initiative? What will be some of the most salient features of this park and what is the planned manufacturing capacity to be achieved on completion?
“Trivitron’s proposed Medical Technology Park in Chennai is going to be the first of its kind in the country and will attract investments to the tune of INR 250 crores in Phase -1.”
Trivitron’s proposed Medical Technology Park in Chennai is going to be the first of its kind in the country and will attract investments to the tune of INR 250 crores in phase -1. This park will bring a cluster of manufacturers who are Trivitron’s present partners, under one roof; sharing common infrastructure and shared resources wherever possible. This manufacturing park should be able to produce medical technology products to the tune of INR 500 cr in the next 3 years.
Q. Trivitron had earlier announced its ambition to achieve INR 1000 crore turnover in the next 3 years. What are your strategies for achieving such phenomenal growth? Trivitron should have a turnover of over INR 200 cr. this financial year and with contributions from manufacturing through acquisitions, technology park initiatives and international expansion of trading activities. Trivitron hope to achieve INR 1000 cr turnover the next 3 years.
Q. What are your plans in terms of adding new product/ service lines to Trivitron in the near future? Do you wish to venture into healthcare services and/or the pharma sector? Trivitron has opened a Healthcare IT division offering comprehensive solution of IT hardware and software to healthcare institutions. The service offering will include Hospital Information System (HIS), Laboratory Information System (LIS), Radiology Information System (RIS), Telemedicine and PACS Solutions apart from a range of hardware accessories. Trivitron is also looking at venturing into a few healthcare services and consultancy services to leverage its present strength, customer relationships and networks.
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POWER HOSPITAL
N. M. VIRANI WOCKHARDT HOSPITAL, Rajkot Wockhardt Hospitals is exclusively associated with Harvard Medical International (HMI), giving it access to the latest clinical protocols, innovations and patient care practices from 17 prestigious Harvard-affiliated hospitals in the United States.
A
s part of its foray into Saurashtra, Wockhardt took over the N.M. Virani charitable hospital situated in Rajkot in 2006, converting it into a super-speciality facility. The hospital was formerly run by the Ashok Gondhia Memorial Trust. The Brownfield project combined the infrastructure and some manpower of the existing hospital with the technical expertise and over 18 years’ experience of Wockhardt. The Rajkot facility is a boon for patients who previously travelled to Ahmedabad and Mumbai for advanced procedures in cardiology, cardiac surgery, neurosurgery and orthopaedics.
Women’s Hospital and the Beth Israel Hospital. The administration leadership and senior employees were trained both at Rajkot and at Mumbai and Bangalore and best practices from the Bangalore and Mumbai facilities were incorporated into the training modules. The super-specialists at the N.M Virani Wockhardt Hospital have been brought in from across the country. Their families had to be relocated to the city. Though a major challenge, this was made easier by the huge clinical potential which Rajkot presented. A peaceful, non-violent society, yet in proximity to Ahmedabad helped to sell the idea.
There are several remarkable aspects of the transformation story. One is that, the hospital continued to operate during the makeover which took approximately 8 months. Also, the high-end facilities are still available at a price which is less than that at Mumbai or Ahmedabad. This has been a policy decision on the part of the administration. Patients arrive here from Gandhigram, Bhuj and Jamnagar.
Wockhardt’s expansion in the region began with the Nagpur facility. The IT team took 6-8 months to get the hospital’s IT systems ready and rolling. Thereafter, through learningby-doing, the subsequent facilities were completed much faster. The Mulund (Mumbai) hospital was completed in 34 months and today, the Wockhardt team is capable of setting up a hi-tech hospital within 1 month. There are plans to Wockhardt Hospitals is exclusively associated with Har- spread out in the region – a hospital has already been set up vard Medical International (HMI), giving it access to the latest in Bhavnagar. Another has been commissioned in Surat and clinical protocols, innovations and patient care practices from one is in the pipeline for later this year in Bhuj. 17 prestigious Harvard - affiliated hospitals in the US, including the Massachusetts General Hospital, the Brigham and There were a number of challenges that the team faced when 24
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setting up the hospital and making the sweeping changes. An important one was moving from a ‘Charitable Trust culture’ to a corporate, professional environment. The professional, international flavour that Wockhardt has introduced will no doubt raise the expectation levels of the sleepy town and surrounding areas. Changes Although Rajkot does have secondary level health care facilities, N.M. Virani Wockhardt brings world-class tertiary level facilities for the first time to a population of about 1.5 crores. INR 30 crores was spent on upgrading the equipment and technology. The previous EMR system was MS-DOS based and minimal. After the takeover, a Wipro Hospital Information System (HIS) was introduced. This was applied extensively to almost all areas of the hospital’s functioning.
“We have the advantage having run this software for five years, that when we go a new hospital, we can roll it out in 15-20 days flat. Every module is interconnected, every department is computerised.” “Our staff is trained at the nearest hospital, so they work on the same software. From day one, they are familiar with the screen.”
Pradeep Vaidya N. M. Virani Wockhardt Hospital is equipped with 166 Head, IT beds and 6 operation theaters. It offers a wide range of specialised services including Endocrinology, Oncology, Gynaecology, Cardiac surgery, Cardiology, Paediatrics, Critical care, Nephrology, Urology and preventive health care. Previously only catering to secondary care, it now offers bypass surgeries, replacement surgeries and minimal access surgeries. The perform quality invasive procedures. hospital layout plan was changed significantly to improve The Operation Theatres have Class 100 Laminar air flow work flow. The pharmacy, which was earlier placed at the systems, meeting international standards.
back, was brought forward and the laboratory placed at the back of the hospital. There are now separate entrances/exits for doctors, outpatients and equipment. An ‘ICU on wheels’ cardiac ambulance was introduced – the need of the hour today. There is a fingerprint ID system for all staff.
IT Infrastructure The IT software was initially developed by GE who in turn had acquired it from Citadel. Later Wipro took over the package. Wockhardt was the first customer of this software. At the time, it was a ground-breaking, highly integrated model. However, Wockhardt is now looking to further upgrade and integrate its existing IT systems. There are plans to build a super-architecture on the existing, underlying model and create a model which will integrate Wockhardt hospitals across the country.
The hospital is equiped with the Philips Cath Lab Allura Xper FD 10, one of the latest, state-of-the-art digital imaging systems for Cardiovascular Diagnostic and Interventional procedures, also one of the very few in the country. It can be ceiling rotated and allows a 3-sided patient approach at maximum free floor space with full body coverage, based on high With the experience of nearly 5 years that Wockhardt has frequency converter technique. It accepts minimal dosage and with its software, Mr. Pradeep Vaidya, IT Head and his team delivers high image quality, thus helping the cardiologist to can now roll out the model in a new facility within 20-odd April 2008
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“I have been working here for approximately 1 year. I handle the health check-ups from beginning to end, right from registration to the reports. Registration and billing is centralised, so it can be done at any counter.” Charmy Bharvada, Customer Care Trainee
Keeping up with the latest technology through constant software upgradation is difficult and costly. Wockhardt Hospital’s is on the lookout for an IT vendor to cater to their need for technologically advanced and highly integrated IT solutions. Getting the small towns ready for a corporate hospital. Small town populations are usually heavily dependent on alternate forms of medicine. Different methods of compiling discharge summary in different departments need to be streamlined to save more time. System failures and loopholes necessitate paper records and backups.
days! This he attributes to “duplication and a lot of learning along the way”. There are however a few issues which are tackled on-site, like faulty wiring, different LAN, different number of departments. Conclusion The N.M.Virani Wockhardt facility comes to the right place at Many of the staff at the new facility are trained at the nearest the right time. Rajkot is one of the fastest growing cities in the Wockhardt hospital, making it very easy for them to hit the world with a population of over 1 million. Before the N.M. ground running. There is a patient feedback system in English Virani Wockhardt facility was set up, patients in the region and Gujarati and also an internal monthly review mechanism. had to visit Ahmedabad for high-end treatment – situated 216 An HR portal is being developed, which will be an intranet km away. With a literacy rate of over 80%, the scope for IT solution. A central purchasing portal is also in the pipeline. interfacing between hospitals and the public is high. Through this, key items will be procured through the headquarters in order to enable cost-effective bulk purchases. The Ashok Gondhia Memorial Trust continues to provide financial assistance to Below Poverty Line (BPL) patients. One Challenges surgery and one plasty is sponsored every month. A char Doctors’ reluctance to adapt to advancements in technol- ity OPD operates between 1500 and 1700 everyday. In an ogy. The introduction of voice recognition systems and attempt to welcome the patients from the lower economic handwriting recognition systems should change this. strata, the general wards have maintained their old look and feel. Rajkot is a small town where most offices and businesses are shut between 2 and 4 in the afternoon in keeping with The state-run 108 ambulance service effectively augments the work culture of the place. This had to be overcome for the 3 ambulances which the hospital owns. One of them is the effective functioning of the modern-facility. well-equipped with emergency care facilities. As far as expansion goes, there is potential to build another floor on the same Switch from MS DOS to a new Wipro HIS and EMR sys- premises to serve the increasing needs of the region and city. tem. At the pharmacy, the product codes changed, necesResearch Team, eHEALTH sitating that the staff learn the new system. 26
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in conversation
The Transformation Story
Deepak Venugopal, Director, N.M. Virani Wockhardt Hospital, Rajkot, tells us about the challenges in setting up the superspeciality facility and what lies ahead for the region.
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Q
What are the challenges you faced whilst setting up this facility jointly with the Ashok Gondhia Memorial Trust?
The primary challenges were two. The first was to renovate a 20 year old building to Wockhardt standards and the second, to migrate from a Secondary Level care setting to Tertiary Level care setting. Another challenge we faced was that the project was rolled out whilst the old hospital continued to operate. This was possible because of skilled management and efficiency of the entire team. So effectively, we never refused patients.
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Q
Please tell us the nature of the relationship between Wockhardt and the charitable trust?
Q
Wockhardt Hospitals and the Ashok Gondhia Memorial Trust have a long term management agreement, where Wockhardt has invested in technology and manpower. The Trust will continue supporting the charity out of the revenue shared with them by Wockhardt. This will help bring in world class tertiary level care to the reach of people who cannot afford it.
Do you think India’s 2 and 3 tier cities are ready with the supporting infrastructure for projects such as this one?
Definitely yes, there are only four – five metros in the country. In the coming years, India will grow through these 2 and 3 tier cities. The populations here have high purchasing power. This, combined with the very poor existing health care infrastructure, makes them an ideal destination to set up projects such as this one. The need for branded health care is well recognised and accepted in 2 and 3 tier cities. That our experience at Bhavnagar and Rajkot has been no different bears testimony to this fact.
There are only 4-5 metros in the country. In the coming years, India will grow through II & III tier cities. The population in these places has high purchasing power.
Q
As a user of HIS solutions, what are your expectations from the vendors of these products?
Our primary needs as users of advanced Hospital Information Systems (HIS) are a high degree of integration and the ability to adapt to the latest developments in technology quickly. Thus, speed and flexibility are our primary expectations from HIS vendors.
April 2008
Q
With reference to the Rajkot facility, what (if any) are the plans for expansion in terms of infrastructure and also projects?
We are looking at creating a pan Gujarat presence. In keeping with this, we have already created capacities in the cities of Surat and Bhavnagar. Now, we are looking at establishing a presence in Bhuj by July 2008. We have also planned to set up hospitals in Baroda and Ahmedabad in a very short period.
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INDIA
2008
Supporting Partner
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news review
INDIA
Chandigarh to connect local health centres with telemedicine project
Delhi’s government hospitals to go online
In order to provide more quality health care to its people, the Chandigarh administration has decided to connect various important Community Health Centres - Manimajra and Community Health Centre Sector-22 with Government Multi Specialty Hospital (GMSH) Sector-16, through a telemedicine project.
To facilitate information on availability of beds in various hospitals across the Capital, the Delhi Government is bringing all its hospitals online, Chief Minister Sheila Dikshit announced at the Golden Jubilee celebrations of Maulana Azad Medical College recently. Addressing the gathering that comprised Union Minister of State for Communication, Shakeel Ahmad and Delhi Health Minister, Yoganand Shastri, the CM said that her government had taken several initiatives such as opening of new peripheral hospitals, upgradation of existing hospitals and augmentation of services, by making use of latest technological advancements in the medical system. “This institution has emerged as a mega-unit encompassing one of the largest and most prestigious medical colleges of the country. It houses Delhi’s biggest hospital, first dental college, an eye centre, a trauma centre and a specialised paediatric hospital. ” she said. Dr. Shastri announced that the government would be setting up new hospitals at Kokiwala Bagh, Ashok Vihar, Burari, Hastsaal, Sarita Vihar, Baprola, Keshav Puram and Molarband. He said it would also be adding 140 ambulances to the fleet of the Centralised Accident and Trauma Services during the year.
Two vans will cover the villages, slums and areas where there is no dispensary and will further connect to GMSH directly. People will greatly benefit by the project, which includes timely access to diagnostic Speciality Health Care at the grass root level. This will be through the low cost telemedicine network centering around the district hospital as service provider, augmenting rural health care delivery system by integration of low cost sustainable, scalable, fixed, mobile technology platform into existing rural health care services infrastructure, improvement on knowledge base of rural population to empower rural folk on self health care-disease prevention and health promotion remote education training/retraining and skill development of grass root health care workers and professionals under NRHM. It will also ensure public health related data harvest compilation, storage at district hub, archival and distribution across networks to facilitate electronic governance of NRHM. The implementation of the project will also help in reducing the burden on the key hospitals. All aforesaid benefits will be achieved by reaching people at their door step with medical advice backed by investigation so as to avoid people visiting hospital without sufficient cause.
SBI donates medical equipment to Sankara Eye Hospital The State Bank of India recently donated medical equipment worth INR 4.9 lakh to Sankara Eye Hospital, Pammal. Chief General Manager of the bank’s Chennai head office, J. Chandrasekaran handed over the equipment to the hospital. The bank undertakes such initiatives as part of community service banking. The equipment will be useful during the conduct of surgeries and detection of eye defects. According to a press release, Sankara Eye Hospital conducts free eye camps under its ‘Kannoli’ project in villages in Tiruvallur and Kancheepuram districts. The hospital also performs free eye surgeries for the benefit of the poor. 32
Artemis Health Institute (AHI) inaugurated by Haryana CM Haryana Chief Minister Bhupinder Singh Hooda recently inaugurated health care firm, Artemis Health Sciences’ multi-speciality hospital Artemis Health Institute (AHI) in Gurgaon. “We have to make quality health care accessible and affordable to every citizen in this country. The public and private insurance companies must interact with hospitals like this, to come out with an economic and sustainable model.”,Hooda said. AHI, Gurgaon is Artemis Health Sciences’ first super speciality hospital where it intends to have 260 beds during the first phase. The company plans to increase the number of beds to 550 over the next few months. PTL Enterprises Ltd., holding company of health care firm Artemis Health Sciences, said recently, that its shareholders have approved the proposed stock-split in the company in the ratio of 1:5. The company has proposed a stock-split in the ratio of 1:5 under which an equity share with face value of INR 10 each would be split into five stocks of face value INR 2 each, PTL said in a statement.
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Foreign medical degrees to be recognised
India running short of 2 million nurses
Union Health Minister Anbumani Ramadoss has said that postgraduate degrees in medicine obtained from foreign institutes are legal and recognized in India. Indian doctors having their post graduate degrees in medicine from the UK, US, Canada, England and New Zealand are allowed to practice in India, he said.
The WHO accepted global average standard is 2.56 nurses per thousand population as against India’s average of point eight nurses available for per thousand population. India is short of two million nurses as per the global average on the number of nurses required in comparison to the population ratio. And the health care sector is expanding phenomenally with the demand for nurses growing by the day. 80% of the nurses came from the southern region with Kerala leading the supply sector followed by Tamil Nadu, Andhra Pradesh, Karnataka, he said. Nearly 20% of experienced nurses leave for greener pastures abroad with many opting for the US, UK and European countries as against the earlier trend of the Gulf countries employing them in large numbers.
The Union Government took a unilateral decision to recognize foreign degrees in medicine. It doesn’t come under the purview of Indian Medical Council and the decision will be informed to the IMA. This unilateral decision of the union government is expected to help thousands of Indian doctors in the UK who are out of jobs because of legislation.
Social franchising to address UP maternal and child health Dr Kriti Kumar, who has a degree in Ayurveda, has wanted to set up the hospital for a few years in UP’s Bijnoor district for some time now, given that there was no doctor within a 15 km radius. He was able to, thanks to a so-called social franchising initiative that will soon give UP the biggest private health care chain in India. The chain will focus on maternal and child health - of utmost significance in a state with the highest maternal mortality rates and the third highest infant mortality rates in India. Developed by donation agency US Agency for International Development (USAID), the state government and a trust promoted by condom maker Hindustan Latex Ltd, the unique franchising model has generated so much interest that new licences are no longer being issued. The public-private partnership Merrygold Health Network, envisages a network of 770 hospitals and clinics-branded Merrygold-over the next 4 years. All Merrygold hospitals and clinics offer services at half the rates of private hospitals and clinics. The initiative covers both primary and secondary levels of care.
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On the supply side, there are 1597 nursing schools, 833 nursing graduate colleges, 97 post-graduate nursing institutions. The institutes churn out nearly 80,000 nursing diploma holders, 41,650 graduate nurses and close to 2000 post-graduate nurses. Nearly 55% of the workforce in each hospital comprised the nursing staff, and the health sector is one of the largest employers. The health care delivery sector is currently US$ 35 billion and expected to rise to US$ 75 billion plus by 2012.
Columbia Asia benchmarks quality and cost Two hospitals in Bangalore, the Columbia Asia and the 18-yearold Manipal, recently joined the elite group (there are now 12 in all) which have been accredited by the National Accreditation Board for Hospitals. This badge of quality at an early age (2 years) is one of the attributes that makes Columbia Asia a little different and possibly a symbol of the change taking place in Indian private healthcare. The hospital group, promoted by a group of NRI investors based in the US, is headquartered in Malaysia and has footprints there and in Vietnam. The sole India operation, an 80-bed hospital in Bangalore, broke even on its 16th month of operation and 3 new group hospitals are coming up in Bangalore, Kolkata and Gurgaon (Palam Vihar) which will take the total number of beds to 500 by the end of the year. India will then account for half of the group’s total number of beds. Further down the line, the group is examining expansion plans in Indonesia and Sri Lanka. The third leg of Columbia Asia’s business model is cost, with its rates being “just above that of the cheapest corporate hospital in Bangalore.”
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National Health Policy - Need for Reforms “Healthy people make a healthy nation and therefore health of the community is fundamental to social and economic development of a nation.� Dr. Ajit K. Nagpal, MBBS (AIIMS), MHA (AIIMS), MPH (Harvard) Chairman Executive Council Batra Hospital & Medical Research Center, New Delhi
Organisation of Health Services Organisation and financing of healthcare services in a country depends largely on its economy & socio-political environment. Public policy determines the extent to which the health sector is funded and the manner in which the financial resources are collected, prioritized and distributed. Public policy also determines the level to which healthcare services are developed and the manner in which these services are distributed, delivered and accessed. Planned Development Universal access to basic healthcare is not a fundamental right within our constitution. However, there have been many initiatives taken by the Government to achieve this laudable objective since the commencement of our planned development in 1952. Primary care has been the basis of action and reaching out to the entire population with a comprehensive package of preventive, promotive and curative healthcare services has been the focus of public policy. Family welfare and assistance in attaining a small family norm has also been the thrust area of public endeavours. Unfortunately the accomplishments of the health sector have remained short of the set objectives primarily due to the phenomenal growth in our population which has almost tripled from 39 million to 1.1 billion during the past 60 years of our independence. Development Process During the first three decades of our independence, development of healthcare services remained in the domain of public sector, primarily by reaching out to communities in their home environment with a package of primary and secondary care through establishment of a nationwide network of district and taluka hospitals, community health centers, primary health centers and sub-centres. Although the Central and the State governments played a pivotal role in developing and managing academic medical centres and referral hospitals in major townships and metropolitan cities, voluntary sector also April 2008
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played a complementary role in the establishment of such institutions for referral care, medical education and research by creating large endowments under tax shelter provided by the government on industrial income. The growth of for-profit private sector during this period was in the form of solo and group practices and small to medium sized nursing homes offering personalised care largely to urban population with the ability and willingness to pay for such services.
cal skills within an environment which is both capital and labour intensive. Therefore, it tends to become monopolistic with leverage to price discriminate. Since healthcare is credence good, the providers of care also tend to over provide especially when there are incentives for over provision and a third party to pay for the services rendered. Third party payers on the other hand tend to become monosonic on the strength of their risk pool and therefore leverage price competitiveness and manage financing and provision of care. These are two Economic compulsions and competing priorities from conflicting and competing environments where the payer or other sectors, both at the Centre and at the State levels, and the beneficiary is not necessarily the gainer. virtual withdrawal of tax benefits for investment in healthcare in 1983, were a setback in this development process. Last Decade Introduction of Mediclaim hospitalisation insurance policy The last decade has witnessed maturation of the above anaby the Government during the same year to be offered by the lytical process and a virtual transition from a static sector to four public sector insurance giants of the GIC, with the pro- an increasingly dynamic and significant industry. Although, vision for tax exemption on the insurance premium rapidly this change is a welcome sign for the industry, it is not necincreased the demand for healthcare, and thus started a new essarily the best available option within the overall national era of for-profit corporate hospitals setting the stage for a new context, where public health and the physical and economic initiative to fill the gap between the need and availability of access to healthcare is a collective mission. A mission that contemporary healthcare. ensures access to continuum of care from domiciliary through primary and secondary to tertiary care; provided within rural, This initiative was led by Apollo Hospitals and followed semi-urban and urban environments; and accessible to the by many big players in the industry. Some of the major play- poor, the middle economic segments and the rich alike. A ers engaged in the delivery of healthcare also migrated their tall order! healthcare endeavors from non-profit endowments to forprofit corporations just for the reasons of techno-economic Health Sector Reforms viability and not necessarily with profit motive. Since rationale of corporate investment is determined on the basis of RoI, which includes cost of prime land, contemNational Health Policy porary infrastructure, state-of-the-art medical technology, In the midst of the above changing health scenario, the promoters, public equity and institutional borrowings, and Central Government published the National Health Policy in where capacity utilisation determines the potential to break1983. Since this policy was focused on public initiatives to even within a reasonable period from commencement of opreach the entire population with a package of primary health- erations, public policy plays a significant role in mobilising care, it did not make any impact on the free market influence such investments, be it developing or developed economies; that had already set in to fill the gap between supply and socialist or capitalist societies. India is at a threshold of bedemand of contemporary healthcare services in the country. coming a global economy by the year 2020. Thanks to the The National Health Policy was revisited and rephrased in initiatives of our policy makers for their foresight in imple2002 without any major change in its approach or policy menting industrial and economic reforms and bring them to structure. fruition. Since health is an integral part of the socio-economic development of the society, and since health of the populaThe stalemate continued and the industry as well as finan- tion is a formidable economic resource, there is no justifiable cial institutions willing to invest in healthcare grappled with reason to withhold health sector reforms in the country. the changing dynamics and waited for a clearer picture to emerge, which would substantiate the predicaments with In the midst of this rapidly changing socio-medical environground realities and establish the techno-economic viability ment in the country, and to facilitate universal and equitable of the healthcare industry in a free market. In the absence of access to basic health services, it is imperative that the policy any major policy initiative to encourage investment in health- maker address this issue of public significance and initiate care and to facilitate speedy development of healthcare infra- health sector reforms to stimulate investment in healthcare, structure in the country, the progress was very slow. enhance the pace of development of healthcare infrastructure, and most significantly, foster public-private partnership to atFree Market Dynamics tain the above formidable national objective within a reasonHealthcare is increasingly seen as a commodity and there- able time frame. fore health services has emerged as an industry. In a free market economy, the gap between demand and supply plays a significant role in the growth of the health sector. Healthcare, The author was formerly Advisor, Health Policy & Hospital Affairs, Ministry of Health, especially at the level of tertiary and quaternary care entails United Arab Emirates; Founder Director & CEO, Sher-i-Kashmir Institute of Medical high capital and operating cost to create and maintain the in- Sciences, Srinagar, J & K; Secretary to Government, Department of Health & Medical frastructure and to bring together high technology and clini- Education, Government of J & K 36
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Microsoft, SAP provide solutions for healthcare IT Microsoft Corp. and SAP America Inc., a subsidiary of SAP AG, have agreed to work together to deliver solutions that meet the unique needs of the healthcare industry. The companies’ collaboration will seek to help healthcare organisations increase operational efficiency and reduce costs using software to automate and streamline processes that are today often manual or based on cumbersome legacy technology. The companies will focus their healthcare collaboration activities in the United States. The combination of solutions from Microsoft and SAP is proven to reduce costs and create operational efficiency, with one of the lowest total costs of ownership on the market today. As an example, with more than 70,000 admissions per year, Montefiore Medical Center is one of the largest healthcare organizations in the United States and the dominant medical system in the Bronx borough of New York City. Working with SAP software enabling technology and utilizing the Microsoft suite of products for communication, Montefiore has been able to overhaul and streamline processes related to procurement including all purchasing activity. Concurrently, Montefiore was able to transform the institution to an online, real-time financial management system, including the budget process, significantly reducing the amount of time it takes clinical and administrative staff to complete non-value activities so that they can spend more time to support patient care. Maintaining accurate, complete, up-to-date information on inventory levels and materials needs is critical to hospital operations. By providing this information in an easy-to-use format, the staff can enjoy a flexible work culture and at the same time stay focused on patient care.
CompuGroup buys German HIS vendor CompuGroup recently announced its takeover of hospital information systems supplier, Dahm Aktiengesellschaft, better known as Fliegel. The deal gives CompuGroup a long looked for presence in the German hospital information systems (HIS) market. The deal marks the latest phase in the consolidation of the European and German health IT market. Dahm/Fliegel, is a medium-sized HIS vendor in the German market. The price paid for the acquisition was not disclosed. With its flagship product, the HIS “fd klinika”, Dahm/Fliegel has around 200 German hospitals and nursing homes as customers. In addition, approximately 30 laboratories also use Dahm/Fliegel software. Fliegel and its employees will be integrated into the CompuGroup subsidiary Systema, the HIS-market leader in Austria
with strong ties to SAP. The Fliegel-HIS “fd klinika” will continue to be developed further and not be replaced by existing Systema-HIS-solutions. “To create synergies, we will harmonise individual software modules, but not the complete HIS.” Such synergies are possible in the field of medical databases, where the CompuGroup subsidiary ifap is already active. Web-based referral solutions will also be standardised for the different CompuGroup-HIS, not only in Germany but also in Poland, Turkey, Austria and the Czech Republic. Finally, solutions for materials and logistics will be fused, with the CompuGroup subsidiary Aescudata as the company in charge.
GE Healthcare’s MRI technology at the Olympics GE Healthcare will be the sole supplier of Magnetic Resonance Imaging (MRI) technology of the Beijing 2008 Olympic Games. Installed at the Olympic Village General Hospital, two of GE Healthcare’s advanced MRI technologies, the Signa HDe 1.5T will be accessible to all international competing athletes during the Games. These technologies within close proximity of all the sporting competitions will enable clinicians to diagnose potential injuries earlier or simply monitor treatment with a view to maximize the time of play for an athlete - in other words, ensure a quick return to play. Every day an athlete spends in rehab is a day lost in training, which is why diagnosing injuries earlier or monitoring the recovery in real time is crucial for elite performance. Sports medicine is an advanced discipline focused on assisting athletes in achieving their optimum performances while ensuring their physical and psychological integrity. This requires sports physicians to equip themselves with the best available technologies in the field of medical imaging allowing them to have an earlier and more accurate diagnosis platform. MR imaging as a non-invasive technique proves to be an optimal means of acquiring high-contrast images of both the bone structures 38
and the soft tissue structures, which together create a complex joint such as the knee or shoulder. These body parts are of high risk for athletes as musculoskeletal injuries can occur any time. In addition, GE Healthcare’s Signa HDe 1.5T will help clinicians at the Olympic Village General Hospital not only benefit from high-definition images, but also decreased operation costs (water, electricity, liquid helium,) by up to 40 percent.
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Quest Diagnostics provides services to Birla Sun Life Quest Diagnostics recently announced that its wholly owned subsidiary Quest Diagnostics India has signed a long-term agreement to provide health assessment services, including diagnostic laboratory testing for Birla Sun Life Insurance Company. Quest Diagnostics will provide a range of health management services to Birla Sun Life, including laboratory testing through its new 65,000 square foot diagnostic testing facility in Gurgaon, as well as case management and appointment scheduling of medical exams by trained and credentialed physicians. Quest Diagnostics will serve Birla Sun Life using the company’s proprietary ExamView medical services and CaseView laboratory-test ordering and reporting software. Vikram Mehmi, President and CEO of Birla Sun Life Insurance, said: “Birla Sun Life Insurance has, once again, opened a new chapter in the history of life insurance in India, whereby we envision setting new levels of service, new standards in underwriting and improving quality of underwriting and risks involved.”
UNM Health Sciences plans US$ 15.5 mn telehealth grid
Carestream’s upgraded product launched
Carestream Health has debuted its newest version of Kodak Carestream Information Management Solutions (IMS) which offers health care providers more convenient viewing of medical imaging exams and other types of patient documents, while facilitating the integration of images with electronic medical record (EMR) systems. The firm said that these capabilities would be available worldwide in the second quarter of 2008. The newest IMS upgrade equips clinicians to view laboratory and pathology reports, imaging exams, video files, DICOM images and other types of patient data through one virtual desktop anywhere, anytime. Standards such as XDS (cross enterprise document sharing) protocol may be used to store and retrieve the fixed-content file types. Simplified access to patient information enhances the diagnostic process and simultaneously delivers improved staff and clinician productivity by negating the need to go to several locations to obtain information. Access is tightly controlled by system administrators: physicians and staff may be granted either readonly or read/write privileges, and access can be further limited to individual patient files or specific exam modalities. Basic archiving services include remote data storage for longterm storage and disaster recovery. The platform also offers multi-site networking capabilities that allow information communication and sharing among affiliated groups.
System C launches new health care consultancy
The University of New Mexico Health Sciences Center’s Center for Telehealth and Cybermedicine Research has been awarded US$ 15.5 million from the Federal government for the design, construction, operation and evaluation of a Southwest Telehealth Access Grid. Telehealth and telemedicine services can provide patients in rural areas access to medical specialties in areas like oncology, cardiology, pediatrics and radiology -- in some instances without leaving their homes or communities. The system also could be transitioned for emergency use in the event of a natural or other disaster. The program will use broadband capabilities for sharing telemedicine clinical services across sites and will provide education and training programs to rural health care professionals. More than 500 health-related facilities in New Mexico, Arizona, Nevada, California, Texas and Utah, including Indian Health Services, ultimately will be served by the Southwest Telehealth Access Grid.
April 2008
System C Healthcare has launched a new consultancy service aimed at helping health care organisations meet the challenges posed by the government’s reform agenda. Called Perigon Consulting, its focus is on improving services to patients through innovative clinical practice and associated business efficiencies. Areas of specialisation include the design and delivery of clinical assessment services, the redesign of clinical and business processes and public and employee engagement. This new service has been formed by merging Perigon Healthcare, an existing independent health care consulting partnership specialising in ‘future state’ health care development, with System C’s health care consulting service. This latter service is focused on deployment and change management issues associated with IT programmes. Perigon will operate as a division of System C Healthcare, and will have access to all of System C’s people and resources. Northern Ireland’s Department of Health, Social Services and Public Safety is an existing Perigon client. Previous Perigon clients have included Bolton PCT; Carlisle PCT, Walsall Manor Hospitals; Selly Oak Hospital; Grantham and District Hospital; Whipps Cross Hospital NHS Trust; North Cumbria Acute Services NHS Trust; Cumbria and Lancashire Strategic Health Authority and Nuffield Hospitals. 39
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Nortel, Polycom offer new telemedicine solutions
Microsoft’s US$ 3 million fund for HealthVault
Nortel and Polycom jointly demonstrated their endto-end solutions for healthcare needs as well as telemedicine recently. The two companies claim that the telepresence solution offered by them for the healthcare industry, provides hyperconnectivity by creating multilocation virtual meetings so real that geographically dispersed physicians, surgeons, researchers and other professionals will almost believe they are in the same room. “No one else offers such a complete and open telepresence solution - including technology and services - to address the realworld challenges of today’’s healthcare environments,” said Charles Salameh, vice president, Network Business Solutions, Nortel. “This includes real-time access to information and expertise regardless of location that can help improve patient care, reduce costs through greater efficiency, and improve overall productivity and effectiveness.” “The outstanding quality of experience of our telepresence and HD video collaboration offerings is ideal for healthcare applications, where seeing and hearing people and content in fine detail is critical,” said Ron Emerson, global director, healthcare markets, Polycom. “Polycom and Nortel are delivering these solutions in combination with managed services to provide a complete, end-toend solution for healthcare organizations.”
Microsoft has created a US$ 3 million fund to invest in applications built for its HealthVault electronic medical records platform, the company announced recently. Launched in October, HealthVault is intended to allow people to access their medical records through any device, regardless of the health care provider or insurer. Recently Google too announced a trial with Cleveland Clinic in which potentially thousands of patients will be able to access their health records through their Google accounts. Microsoft’s aim with the US$ 3 million fund is to create an ecosystem around its HealthVault initiative, much like its Windows platform attracts developers to create programs that run on that operating system. In particular, Microsoft is interested in applications related to preventive care, acute care diagnosis and treatment, management of juvenile diseases, women’s health, and community and social health applications. Microsoft, which last week decided to share details of its technology with open-source programmers, also is hosting a HealthVault open-source project to make development for the platform easier.
IBM unveils next gen enterprise health analytics IBM launched a new ground-breaking, comprehensive portfolio of health analytics solutions for health systems. IBM’s Enterprise Health Analytics harnesses the power of massive information generated by today’s healthcare industry by converting it into new, data-driven intelligence. This rich source of clinical and business insight can bring strategic differentiation to health systems by giving them unprecedented knowledge about their operations, patients, and effectively all aspects of their businesses. IBM’s Enterprise Health Analytics are a complete suite of services, infrastructure, and tools that can be tailored to the needs of any client-from entry level, off-the-shelf analytics capabilities to custom-built data warehouses for academic and research settings. The solutions fill a significant void in data integration and intelligent analyses that currently poses a major barrier to transformation in the healthcare industry. At present, most major health-system organizations have adopted a variety of proprietary, disparate processes designed and optimized for transactional performance. These departmental and transactional systems inhibit health systems from having an enterprise view and the ability to quickly respond to changes in the market, such as pay-for-performance and quality reporting. What they require is an integrated system that enables data aggregation and analysis, the results of which are applied in clinical and business settings to dramatically improve quality outcomes. 40
Max New York Life Insurance enters health sector Max New York Life Insurance has entered health insurance sector by launching ‘lifeline’ consisting of three distinct groups of solutions. The lifeline brings long term insurance coverage for hospitalisation surgeries and critical illness, Max New York Director Marketing Product Management and Corporate affairs Debashis Sarkar told the media. The medicash plans were hospital cash plans that provided the customer a fixed per day benefit for hospitalisation, ICU admission, recuperation benefit and a lump sum benefit against an unlimited number of surgeries, he said. The wellness plans were critical illness covered against 38 critical conditions from Alzheimers to liver disease, deafness to permanent disability, cancer to heart ailments, a range offered by no other insurer in India under one plan, Sarkar claimed. The third one, safety net was a comprehensive term plus health protection plan offering the policy holder protection from any losses arising from critical illness, accident disability and death. The company, which has 21 lakh life insurance policies with INR 62,000 crore sum assured, was targeting a business of at least five per cent of last year’s business of INR 1,700 crore in the initial year, he said. The company would expand its activities and branch offices in Tamil Nadu in the coming months, he said.
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ACS bags US$ 41 million IT services contract Mumbai set up most hospitals, says study with Parkland Hospital Affiliated Computer Services, Inc., a leading provider of diversified business process outsourcing (BPO) and information technology outsourcing (ITO) solutions for commercial and government clients worldwide, has been engaged into a sevenyear, $41 million deal, to offer ITO services to Parkland Health & Hospital System, a public hospital system based in Dallas, Texas. According to the contract, ACS will provide comprehensive infrastructure services, including data center operations, network monitoring and management, asset tracking, disaster recovery platform and support services.
Misys to merge healthcare arm with U.S. rival British software company Misys has announced the merging of its healthcare arm with Nasdaq-listed US rival Allscripts, a deal it said would help raise group revenue growth to 7-9 percent next year. The firm said it would raise around 75 million pounds (US$ 150 million) in a share placing to help fund the deal, which will see it pay US$ 330 million for controlling 54.5 percent stake in the combined entity. The healthcare arm reported flat sales in the first half of this year, rising to 3 percent growth in the third quarter. The combined group would be called Allscripts-Misys and listed on the Nasdaq. Allscripts-Misys will target the U.S. ambulatory market -- patients being treated outside hospitals. It will immediately have one in three U.S. physicians as clients. “The healthcare market in the U.S is growing at more than twice Gross National Product (GDP), and is more immune to the ups and downs in the economic cycle,” Lawrie said.
Perot Systems, ChinaSoft pursue Chinese healthcare opps Perot Systems Corporation and ChinaSoft International, one of the largest Chinabased information technology outsourcing (ITO) service and software companies, have announced that they have agreed to cooperatively develop mutually beneficial opportunities in the Chinese Healthcare market. “Perot Systems is excited about the opportunity to take our broad Healthcare IT expertise into the international marketplace, and our intent is to deepen our relationship with ChinaSoft in order to evaluate and pursue opportunities that are available in China,” said Chuck Lyles, president of Perot Systems’ Healthcare industry group. “ChinaSoft International is perceived as the window into China for global corporations. We are trying to build the platform for interacting between Chinese and global markets. I believe the agreement between Perot Systems and ChinaSoft International will improve our mutual development,” said Dr. Chen Yuhong, CEO of ChinaSoft International.
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Mumbai provides the best potential to set up hospitals for corporate healthcare providers, says a study by research firm Technopak. The study was carried out to measure healthcare market potential value (HMVP) in the top 14 cities. It was based on three parameters—total value of healthcare services consumed, per capita expenditure on healthcare and consumer perception of healthcare facilities in the particular city or town. “Given the high cost of real estate, few big hospitals have been commissioned in Mumbai in the last decade. With the burgeoning population of the city and its suburbs, this has greatly stretched the healthcare facilities availability,” said the study, India Healthcare Trends 2008. Lack of quality health facilities makes Kolkota second in the list. “Kolkota has a high percentage of population going to other cities for tertiary care treatment. This is reflected in the need gap for quality medical services that is highest in the city,” the report added. Industry officials say that the city can also cater to the north-eastern states making it an important city to set up hospitals. However, it is not the metros alone that would attract investment. Smaller cities such as Pune, Coimbatore, Ludhiana and Patna score higher than cities like Bangalore and Hyderabad. “It is estimated that around US$ 20 billion will be invested in tier II and tier III cities over the next five years. Most of the funds would be used to set up hospitals delivering secondary level care. We expect over 2,000 such hospitals to be operational with 100-200 beds per hospital,” Technopak VP Healthcare Rana Mehta said. About two-third of the new hospital beds in the next few years would be set up in these cities, he added.
Hindustan Latex, Acumen fund to build hospitals in India Hindustan Latex Ltd (HLL), a public sector undertaking under the union health and family welfare ministry, and Acumen Fund, a non-profit venture philanthropy fund, announced the formation of a joint venture (JV) to build a chain of small hospitals across India. The JV, Life Spring Hospitals Pvt. Ltd., plans to construct 30 hospitals each with 20 to 25 bed capacity by 2010 to provide low-income clients access to maternal and child health care services. ‘The (JV) company would be a 50:50 equity partnership between Acumen and HLL. It was recently incorporated here with an authorised capital of INR 200 million (US$ 5 million). Acumen’s initial equity investment would be INR 78.3 million,’ HLL chief managing director M. Ayyapan told reporters. Life Spring will open five hospitals in 2008 and thirty across India by the end of 2010. More than 100,000 women lose their lives in India every year due to pregnancy-related complications and an equal number suffer moderate to severe infections, according to studies on medicare facilities in the country. Life Spring charges would be 30-50 percent of the prevailing market rates. For instance, a Life Spring hospital will charge INR 1,499 for a normal delivery compared to average prevailing market price of over INR 5,000.
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Global Healthcare Transformation Congress 7th & 8th April 2008 I Kuala Lumpur, Malaysia Global Healthcare Transformation Congress brings you the best in professional development offerings, opportunities to network with and learn from peers in the field, and the latest healthcare information to enhance your career and your organization.
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ATTAIN a firm grasp of your organization’s financial management controls in order to effectively bring organizational vision to reality DISCOVER the missing link between organizational objectives and the IT plan IMPROVE the performance of your hospital on all levels EVALUATE, diagnose, and build a high-performance team PRACTICAL CASE STUDIES on hospital’s preparation to gain JCI Accreditation or Magnet Status from hospitals all over Asia
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Tennessee with AT&T creates health info exchange AT&T Inc. is partnering with Tennessee to provide the country’s first statewide system to electronically exchange patient medical information. The system is designed to securely transmit detailed patient information between medical professionals. It will allow doctors to access medical histories, prescribe medicines over the Internet and transfer images like X-rays, MRIs and CT scans. Tennessee’s program is seen as a model for other states and may be a springboard for interstate information sharing networks in the future. Doctors can use the system to remotely evaluate patients in rural areas who have less access to medical facilities. It will also link to the state Department of Health for access to the immunisation and disease registry, death certificate processing and medical license renewals. Tennessee Gov. Phil Bredesen has championed electronic records because of the inefficiency of the current paper-based system. Antoine Agassi, director and chairman of the governor’s eHealth Council, said Tennessee’s deal with AT&T should keep costs down for individual subscribers. Doctors can apply for state grants to defray the costs of getting set up on the system. “Having the ability to get this from a pre-negotiated service level at a very, very competitive rate is a huge step forward,” he said.
Handwriting recognition integrated with smartpen
Cardiac telemedicine reduces hospital admissions: study
Vision Objects has integrated its MyScript handwriting recognition into Livescribe’s Pulse smartpen and desktop application. The Pulse smartpen captures handwriting and simultaneously records spoken information (lectures or conversations) while writing, ensuring the user doesn’t miss a word. Users can tap directly on their paper notes and hear the corresponding sequence of the audio recording. The system can search for words in handwritten text, and increases productivity by converting handwritten text into digital information. Under a partnership agreement, Livescribe will distribute MyScript Notes for Pulse as an add-on application. Other applications include a translation tool that converts English into a wide range of languages and a calculator that carries out simple mathematical operations just by writing them down on paper.
The results of a 12-month trial of a cardiac telemedicine service supervised by the Greater Manchester and Cheshire (GMC) Cardiac Network, proves that the service avoids the need for immediate referral of patients with non-acute chest-pain symptoms to hospital care, in the majority of cases. In an analysis of the results of the first 12 months’ use of the telemedical ECG service from Broomwell HealthWatch across four PCTs (48 surgeries), GPs said that 58% of patients would have been referred to hospital if the ECG service had not been available to them. Over the 12-month period, this equates to nearly 2000 referrals to secondary care prevented by using the telemedical cardiac ECG interpretation service. Translated nationally across some 10,500 surgeries, the use of its ECG service could prevent up to 432,000 referrals per annum and could result in savings of around £250 million a year. The telemedicine service effectively imports ECG expertise into every surgery (via the telephone) and thus enables GPs to make betterinformed diagnoses. A key benefit of the service to patients is that it is carried out locally by their GP, removing the need to travel to hospital for diagnosis. Practice clinicians carry out ECG readings and transmit the results over the phone, with expert interpretation reported back within seconds.
Telecom firms have strong e-health presence A report by IT and telecommunications researcher, InfoCom, has highlighted the strong presence of telecom carriers in the e-health industry. Research of e-health applications across Europe has shown that carriers such as British Telecom (BT) and T-Systems have a large presence in national e-health strategies - BT is responsible for NHS London’s IT, the Spine and the N3 internet connection in England and T-Systems is deploying the backbone for the German national electronic health cards project. A T-Systems spokesperson said, “To deliver quality and efficiency, health care requires sophisticated ICT and telematics infrastructures geared to the specific needs of this unique sector. The goal is integrated care based on the seamless flow of information. The report says: “While e-health solutions targeting end-customers are still few, more choices are available for healthcare services targeting professionals… France and Spain seem to be the most dynamic European markets for e-health solutions targeting end-customers whereas as of new such services launched in other countries, for instance in Germany, in the UK, in Italy or in Portugal, most of such applications target professional users, for instance hospitals and health insurances rather than end-customers.”
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GPRS-enabled laptops keep nurses connected to patients GPRS-enabled laptops keep nurses connected to patients North East Lincolnshire Care Trust Plus has signed a five-year contract with British Telecommunications (BT) to equip community nurses with GPRS-enabled laptops that will allow them to access critical patient information at the point of care. BT will provide its ‘Mobile Health Worker Solution’, a managed service that includes a help desk, business management for a single point of contact and lightweight Panasonic semi-rugged ToughBook laptops for the community nurses. These have GPRS mobile phone communications and BT’s Field Force Automation technology. The shock-resistant laptops will allow secure access to clinical records, email and support systems and databases when visiting patients in the community, either at home or in a remote clinic. An early pilot completed in the community has revealed that the Mobile Health Worker technology improves patient care and delivers proven productivity and cost savings, estimated at more than £400 per week per clinician. Real-time access to patient records, planned care and current health service provision can reduce the need for unnecessary referrals and hospital admissions. Stuart Hill, Chief Executive of BT Health Sales said: “Improved patient care, a reduction in time and costs, improved data quality, lower operating costs and cutting unnecessary hospital admissions are some of the benefits the Northern Lincolnshire Health Community stand to realise having signed up to BT’s Mobile Health Worker.”
NHS Direct text details of local health services NHS Direct has launched a service that allows users to obtain details of local health services by text messages. Anyone wishing to find their nearest GP, dentist, pharmacy, optician, walk-in centre, A&E or hospital in England can text the name of the service required, followed by a postcode, to 61121. A text message is sent back in reply, with details of the closest services to that postcode, and further results can be obtained if needed.
Results contain the service name, address and telephone number (where available) plus the distance from the postcode. Commenting on the new service, Ronnette Lucraft, Commercial Director, said: “To start with, we’re launching the service as a pilot through our Freeview digital TV service, available on channel 108, to test the technology and gauge usage before promoting it to a wider audience. “There are now more active mobile phone connections than UK residents and 84% of UK adults use a mobile phone regularly, so the service has a huge potential audience. Significantly, mobile phones are now used by all sections of society, and there is evidence that mobile phone usage is higher amongst hard-to-reach social groups.
April 2008
Cerner Corp. and Hill-Rom Partner to unify hospital care delivery
Cerner Corporation and Hill-Rom, an operating company of Hillenbrand Industries, announced recently that they have formed a strategic relationship to integrate their technologies to improve and coordinate health care delivery, featuring Hill-Rom intelligent hospital beds that communicate directly with the Cerner Millennium(R) healthcare computing platform. Efforts in the first stage of the partnership are focusing on the integration of Hill-Rom’s intelligent bed systems, such as VersaCare(R) and TotalCare(R), with the Cerner Millennium system. Utilising the Cerner CareAware(TM) global device connectivity architecture, the intelligent bed is able to feed data, including patient weight, bed rail position and head elevation, to the Cerner Millennium system. Access to real-time information and automation of laborintensive tasks furthers safety initiatives and allows clinicians to spend more time with patients. In addition, the relationship is expected to expand to integrate the Cerner CareAware architecture with other Hill-Rom IT solutions such as nurse call, asset management and NaviCare(R) Patient Flow. As automation continues to increase in health care, so does the need to effectively manage the information generated by disparate medical devices. This partnership with Hill-Rom is one example of how the CareAware architecture creates a single source of truth for patient information in the electronic medical record incorporating data generated by medical devices. 45
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Google unveils personal medical record service Google Inc. has unveiled a plan to help U.S. patients gain control of their medical records and is working with doctors’ groups, pharmacies and labs to help them securely share sensitive health data. The company entry into the highly sensitive field came when Chief Executive Eric Schmidt introduced Google Health at a health-care conference in Florida recently. Google said it has signed deals with hospitals and companies including medical tester Quest Diagnostics Inc, health insurer Aetna Inc, Walgreens and Walmart Stores Inc. pharmacies. The password-protected Web service stores health records on Google computers, with a medical services directory that lets users import doctors’ records, drug history and test results. A week ago, Google said it was teaming up with leading academic medical researcher Cleveland Clinic to test a data exchange that puts patients in charge of records. Schmidt said it would likely be a few months before Google Health is offered more widely. IBM, Oracle Corp and Siemens AG, among many others, have worked on such digitization. Electronic record-keeping has been held back by a lack of focus on consumer needs, not privacy fears, he said. While medical providers are covered by U.S. privacy laws, there is little in the way of established privacy, security and data usage standards for electronic personal health records. Google earns almost all its revenue in Web advertising, but has no plan to sell ads on Google Health. It aims to make money indirectly when users search for other medical information.
Spanish hospital deploys wireless tracking Spain’s AT4 wireless has completed a project in Southern Spain to allow wireless tracking of nursing staff, improving staff safety and tracking of equipment at the Hospital Alta Resolucion (Benalmadena). Ekahau, a Finnish specialist in Wi-Fi-based Real Time Location Systems (RTLS), partnered with wireless firm AT4 to deliver the combined asset and staff tracking system which operates across an advanced Wi-Fi network. The system includes a staff alarm facility. Hospital Alta Resolucion features some of the latest technological solutions. The staff are now required to carry wireless tags with a panic button, which, when pressed, sends an alarm SMS direct to the hospital’s security centre prompting immediate response direct to the scene of the emergency.Gonzalez continued that the regional health authority was now evaluating the progress of the Ekahau implementation at Benalmadena with possible expansion later to its larger hospital site in Marbella. “This hospital deployment is a very good example of the Ekahau advantage, to be able to deploy a multi-purpose RTLS system over an existing enterprise Wi-Fi network, with a short deployment time and without any additional infrastructure installations,” said Jarmo Ikonen, Ekahau’s director of Sales.
Deloitte sees technology gap in healthcare A new study from the Deloitte Center for Health Solutions suggests that healthcare providers have fallen behind the needs of their patients. Nearly 80 percent of health care consumers are interested in having their physicians provide online access to medical records and test results; as many as one-fourth (26 percent) are willing to pay extra for these additional services. Consumers are interested in using online tools to shop around to compare prices and the quality of care provided by their health care providers. About two in three respondents are interested in visiting physician and hospital Web sites to research both the price and quality of services offered. The survey also found that 3 out of 4 of consumers want their physicians to provide online access to an integrated medical record as well as the ability to schedule visits. More than 70 percent of consumers want their hospitals to provide online access to their medical record and test result. The “2008 Survey of Health Care Consumers,” a representative poll of more than 3,000 Americans between the ages of 18 and 75, was conducted by the Deloitte Center for Health Solutions. “Patients clearly want and increasingly expect to be able to access their medical records and connect with their health care providers online,” said Russ Rudish, Vice Chairman and U.S. Health Care Providers Sector Leader, Deloitte LLP.
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Quest Diagnostics, Google bring lab results to patients electronically A partnership between Google and Quest Diagnostics Inc., will allow patients to view their diagnostic laboratory testing information electronically. Under the terms of the collaboration, Quest Diagnostics is developing solutions that will allow physicians to provide their patients with easy and secure electronic access to their diagnostic test results. Quest Diagnostics’ proprietary Care360 patient-centric physician portal will serve as the platform for securely transferring patient diagnostic laboratory data into a Google Health account, at the user’s request. Google Health will allow patients to manage their health information online.In addition to providing current diagnostic laboratory data, the collaboration will also allow physicians to securely send historical laboratory data to the patient’s Google Health account. Physicians will be able to comment on their patients’ test results to better inform them about their health status. “Laboratory data is the foundation of many patients’ medical histories and an important driver of treatment decisions made by physicians and their patients,” said Joyce G. Schwartz, MD, vice president and chief laboratory officer, Quest Diagnostics. “Working with Google Health, Quest Diagnostics will help patients collaborate with their physicians to make informed health care choices based on relevant diagnostic information.”
Medical groups launch e-prescribing web site Five doctors organizations have launched a Web site and campaign designed to persuade physicians to switch from paper-based prescriptions of medications to electronic prescribing. The Get Connected campaign, along with the GetRxConnected. com web site, are focused on helping doctors move from prescriptions written on paper pads or entered into a computer and faxed to pharmacies. The Web site includes a technology guide to help doctors move to e-prescribing. It also provides perspectives of other doctors on the benefits of e-prescribing, and points to connected pharmacies. The effort is aimed at the 94 percent of doctors in the U.S. who still do not write prescriptions electronically, said Dr. William Jessee, president and CEO of the Medical Group Management Association. About 150,000 doctors across the U.S. now fax prescriptions, but as of Jan. 1, 2009, the U.S. government Medicare program will require that prescriptions it covers be sent electronically, Jessee said. About 8,000 people in the U.S. die every year because of prescription errors, said Newt Gingrich, founder of the Center for Health Transformation and former Republican speaker of the U.S. House of Representatives. Some doctors are still fighting the move to e-prescribing and suggesting the U.S. government shouldn’t mandate the change, he said.
Vietnam Govt plans to standardise medical testing A national project to standardize medical tests among hospitals and health clinics in Vietnam will be launched this year, the Ministry of Health has said. Uniform standards will set out certain norms that will ensure the quality of sub-clinical medical tests, such as sample-taking and test results. Under the two-stage project, laboratories in health care facilities will be required to meet certain standards for internal and external tests, staff qualifications and equipment maintenance. Health workers will be able to conduct medical tests only if the equipment meets technical standards for such tests. Three standard analysis centres, to be built in Ha Noi, Hue and HCM City during the project’s second phase, will monitor test results at grassroots clinic and train hospital staff in examination
April 2008
techniques. The centres would not be allowed to administer medical tests, but would instead act only as an arbitrator of test results from health care facilities and later report to the ministry. A survey of 94 hospitals nationwide by Viet Nam Biochemical and Medical Association shows a strong increase in the number of examination clinics in recent years, with a total of 380 at the provincial level and up. 47
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EVENT REPORT
Conference on
Emerging Role of IT in Healthcare 29 February, 2008, India Habitat Centre, New Delhi
As healthcare sector is building up in India, so are the standards of service delivery and quality. In particular, IT has the capacity to play a crucial role and be a differentiator in this process. With software solutions and data management tools such as - electronic medical records, online health records, clinical information system, hospital information system, and applications such as - telemedicine, tele-radiology, GIS based health mapping and disease surveillance, management of healthcare is all set to be redefined.
in healthcare and shared his objective and long term vision in promoting the cause.
The key speaker of the event Professor M. S. Swaminathan, Chairman, M. S. Swaminathan Research Foundation (MSSRF ) emphasised the power of information in the current knowledge economy, and encouraged stakeholders in healthcare sector to make best use of IT tools. In this context, he shared MSSRF’s flagship initiatives - Mission 2007 (renamed as ‘Every Village a Knowledge Centre’) and the ‘National VirWith the purpose of promoting technology adoption in tual Academy’ which are playing key role in promoting grass healthcare and take stock of initiatives in public and private root development through ICTs. sector, HOSMAC Foundation – the non-profit wing of HosThe opening session focusing on ‘Telemedicine’ (Chaired mac India Pvt. Ltd. recently organised a one day seminar in by Rajeev Pradhan, Director-Technology, HOSMAC India Pvt New Delhi. Ltd) had two of the most eminent persons of this domain - Dr. In the Welcome Address, Dr Vivek Desai, Managing Trust- L S Satyamurthy from ISRO and Prof. Ashok Jhunjhunwala ee, HOSMAC Foundation highlighted the potential role of IT from IIT Chennai. Dr. Satyamurthy highlighted the efforts of
Rajiv Pradhan, Director - Technology HOSMAC India Pvt. Ltd.
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Prof. M. S. Swaminathan
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Prof. Swaminathan being felicilated by Dr. J. N. Srivastava, Director - Public Health , HOSMAC India Pvt. Ltd.
ISRO in providing satellite based telemedicine network across the country and Prof. Jhunjhunwala delivered a sharp insight into the current public health scenario, while demonstrating, how low-cost technologies such as CorDECT (developed by TeNeT group of IIT-Chennai) can help in delivering healthcare in rural areas. The second session on ‘Health Management Information Systems’ (Chaired by Dr. S.K. Das, Additional DG, MoHFW, GOI) had Dr. Sundeep Sahay, Advisor-HMIS, National Health Systems Resource Centre, presenting on heterogeneity of health information systems and Mr. K.K. Panchal, Joint Director, D&E Cell, Commissionerate of Health, Medical Services and Medical Education, Government of Gujarat, deliberating on the concept of GIS based health information systems. Third session of the event, focused on application of geographical information systems (GIS) in healthcare. Chaired by Dr. T. Sundararaman, Executive Director, National Health Systems Resource Centre (NHSRC), the speakers included Dr. S. Sabesan, Deputy Director (Sr.Gr.), Chief Environmental Sciences & HRD, Vector Control Research Centre (ICMR)
& Mr. Vishawajeet Ringe, Sr. Technical Director, Health Informatics Division, National Informatics Centre (NIC), MoHFW, GOI. While Dr. Sabesan presented on GIS mapping and its application in integrated disease vector surveillance, Mr. Ringe shared his experience in applying GIS techniques for mapping public health facilities and its use in effective program management. The fourth and final session of the day presented a panel discussion of eminent speakers of the seminar, being moderated by Dr. J.P. Steinmann, Principal Advisor, Health Sector Support, GTZ. While stakeholders from both public and private sector agreed upon the need to harness the power of IT in improving healthcare management and service delivery, challenges in the form of - human capacity, data standardisation, technological interoperability and cost issues came up from members of the panel, as well as from audience. With greater acceptability and understanding among end users and policy makers, IT is poised to emerge as one of the most important tool in improving our healthcare system.
Watch out for 29-31 July, 2008, Pragati Maidan, New Delhi
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FUJIFILM SHOWCASES DIGITAL MAMMOGRAPHY 8 March 2008, Le Meridien, Chennai
To celebrate the spirit of International Women’s Day, FUJIFILM Corporation organised a seminar to spread awareness about breast cancer in India. Dr. S.K Ramani, MD, Additional Professor and Assistant Radiologist, Department of Radio Diagnosis, Tata Memorial Hospital chaired the Seminar. Mr.Kenichi Tanaka, Managing Director, FUJIFILM India and Ms.Miyuki Iizuka, Mammography Specialist from FUJIFILM Tokyo, also participated in the seminar. Dr. Ramani highlighted the significance of mammography in his presentation and focused on the merits of Digital Mammography for detecting breast cancer at an early stage. Mammography is a special type of X -ray Imaging used to create a detailed image of the breast. Mammography plays a vital role in the early diagnosis of breast cancer, on which chances of detecting breast cancer and cure depend. It is reported that, each year 80,000 women in India are diagnosed as having breast cancer, and that 35,000 die of it. 1 in 60 rural women and 1 in 30 urban women are likely to develop breast cancer in her lifetime. It is the second most common cancer after cervical cancer. According to Dr. S.S. Doda, former president of the Indian Radiological and Imaging Association (IRIA), “With the change in our lifestyles and the increase in urbanisation, there may soon be a need for widespread mammography screening programme in our country so as to save our women from breast cancer by early detection and cure.” There is unequivocal evidence from randomly controlled trials that screening of women between the ages of 50 and 65 years by mammography alone can, by early detection, reduce mortality from breast cancer by about 20 - 30%. It is the most practical, cost effective breast cancer detection method available. Mammography is the only scientifically validated screening test for early detection of breast cancer. According to Dr. Ramani, “Digital mammography has taken its place in radiology. It has operational advantages of diagnostic ability. Digital storage and transmission, eliminates the risk of lost films and eventually does away with the need for a film library. It reduces the variability in contrast, dose, and exposure time associated with film emulsion and processing. From the patient’s perspective, the biggest advantage of Digital Mammography is speed. They do not have to wait long for films to develop to make results available faster. Wire localizations are affected more dramatically – a patient does not have to stay in compression for a longer period. The time is cut down - between exposure and image display – from 10-20 secs (3 mins for Screen Film Mammography) - both total procedure time and patient discomfort are markedly decreased. Digital Mammography betters Screen Film Mammography (SFM), which has a limited dynamic range. Across the world it is seen that digital mammography is more effective in detecting cancers than film in women under
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Kenichi-Tanaka, Managing Director, FUJIFILM India
50 or pre-menopausal. Digital mammography allows radiologists to heighten the contrast between dense tissue and cancerous cells, which both appear to be white on a film mammogram. Speaking at the seminar, Ms. Iizuka, Mammography specialist from FUJIFILM Tokyo, said, “If detected at an early stage, breast cancer can be completely cured. Digital Mammography helps in detecting breast cancer at an early stage as the technology that is used absorbs X-rays at high efficiency and the image-processing technology obtains high-quality images.” FUJIFILM’s FCR Mammography Suite has FDA approval. It has also been approved by the National Health Service of U.K., as the only CR Mammography system to meet the European Reference Organisation for Quality Assured Breast Screening and Diagnostic Services, (EUREF) guidelines. To spread awareness about breast cancer, FUJIFILM supports the Pink Ribbon campaign in Japan, which appeals the importance of early detection, early diagnosis and early treatment for breast cancer. Mr. Tanaka, Managing Director, Fujifilm India said, “It has been our constant endeavour to spread awareness about breast cancer and how it can be stemmed at an early stage. FUJIFILM is a strong supporter of the Pink Ribbon campaign, which aims to raise awareness of breast cancer among women, and promote early examination and treatment to reduce the mortality rate from this disease. We are hopeful that we will be able to replicate the same model in India to spread awareness.”
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ZOOM IN
India’s Health Budget 2008
5 year tax holiday for building hospitals in tier II & III cities || Hospital sector scheduled to get relief on interest is likely to expand in 2007-08 || Health insurance for 17 lakh families of weavers || National Rural Health Mission allocation raised by 15% || Health covers of INR 30000 for workers in unorganised sectors
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ndia’s Finance Minister P. Chidambaram increased the health allocation in the latest budget by 15% compared to the last fiscal year to INR 165.34 billion with particular stress on HIV/AIDS, polio and health care for the rural and urban poor. He has also promised new interventions such as an insurance plan of up to INR 30,000 for the unorganised workforce and a special facility for geriatric care.
The finance minister has made an outlay of INR 10.42 billion (INR 1,042 crore) for a revised strategy on polio across the country and especially Bihar and Uttar Pradesh. For the aged poor, the center has promised geriatric medical care in a tertiary hospital in each state apart from setting up two institutes of geriatrics for which a total of INR 400 crore has been allocated.
On the delivery side, the government is upgrading 323 district hospitals and is planning to set up community-owned, 24X7 decentralised health centres under the National Rural Health Mission. Nearly 4.62 lakh social health activists have been trained to activate this plan. Praising the health ministry’s flagship programme - the National Rural Health Mission Chidambaram also proposed to exempt the expensive anti- (NRHM) that aims at improving the health care of the rural AIDS drug Atazanavir and its bulk drug from excise duty and population, Chidambaram allocated INR 120.5 billion for the cut customs duty from 10 to 5 percent, on lifesaving drugs. project. Reduction in customs duty on project imports and life-saving drugs and excise duty concessions for the pharma sector are By providing tax holiday for hospitals in semi-urban and also welcome relief. rural areas and with the active promotion of health insurance, Expressing satisfaction that the prevalence of HIV/AIDS in the country had come down to 0.36% from 0.9%, Chidambaram allotted INR 9.93 billion (INR 993 crore) for the National AIDS Control Organisation (NACO), the apex body set up to prevent, curb and educate people about the disease.
April 2008
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the budget seeks to ensure increased availability and financial access to quality health care for the common man. The FM announced income tax exemption for the premium paid for health insurance of parents and the introduction of Rashtriya Swasthya Bima Yojana (National Health Insurance Scheme,) which, it is hoped will pave way for universal health insurance in the country. The health insurance plan is expected to offer cover of INR 30,000 for every worker in the unorganised sector under the BPL category. The plan, for which the Centre’s share of premia will be INR 205 crore, is being rolled out in Delhi, Haryana and Rajasthan to begin with. Corporate health care is now expected to witness heightened activity with a new sub-section (11C) in Section 80-IB that will grant a 5 year tax holiday to hospitals set up anywhere in the country, except specified urban agglomerations. This window will be open between April 2008 and March 2013 during which the hospital has to begin operations. Corporate hospitals may now take a re-look at their growth strategies and deploy investments in these regions. High-tech health care facilities in rural India will reduce the need for patients to travel to urban centres for primary referrals. Given the need for 1 lakh beds in the next two decades, these incentives will help bridge the gap. The move may also trigger expansions by neighbourhood clinics and nursing homes. Health care trackers see growth in the number of 50-100 bed hospitals, which will offer speciality treatment in a few areas like cardiac or trauma care. The proposed weighted reduction of 125% on outsourced R&D expenditure will encourage higher spending by R&D focused companies towards new chemical entity (NCE) and novel drug delivery systems (NDDS) related R&D activities. Reservations There have of course been reservations about the the budget’s outlay on health being only 15% higher than last year. A steady annual increase of 35% is needed over several years to raise public health-spending from the present paltry 0.9% of GDP to the National Common Minimum Plans target of 2 to 3%. Another requirement is greater decentralisation of the public health delivery system. Health infrastructure is marked by great disparity between rural and urban areas. Most secondary and tertiary health facilities are available in urban and tier-II cities. There is a need to incentivise building up health previous year to the effect of 24%. Currently, the government infrastructure in rural areas. spends less than 1 percent of the Gross Domestic Product An important component of the National Rural Health Mis- (GDP) on health and this increased allocation, is being consion has seen its allocation decline by over 30%. Although sidered insignificant by many. the government promises to accelerate the Tobacco Control Still,the controls on drug prices, which has been a source of Programme, its outlay has been cut by 7%. And just as polio is spreading, support for polio eradication has been slashed. major concern within the industry, is a step in the right direcMonitoring and evaluation mechanisms need to be strength- tion. The Contract Research Organisations (CROs) would be particularly benefited. As Mr. Chidambaram said,”I think we ened significantly. do not pay enough attention to outcomes as we do to outlays; Many are complaining that this years budget increase of or to physical targets as we do to financial targets; or to qual15% is significantly less than the increase implemented in the ity as we do to quantity.” 54
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EVENTS DIARY
16 - 18 April, 2008 Med-e-Tel
9 – 11 June, 2008 ICMCC Event 08 London, UK
Luxembourg, Germany http://www.medetel.lu/index.php
http://2008.icmcc.org
18 - 20 April, 2008
Syrian Medicare 2008 Damascus, Syria http://www.syrianmedicare.com/
EVE SANTE 2008 Gurgaon (NCR Delhi) India http://www.evesante.com
16 - 19 April, 2008 2 - 4 April, 2008 1st India Health Conclave
Health Care Dental Damascus, Syria http://www.arabiangroup.com/healthcare/n_homepage.htm
Mumbai, India http://indiahealthsummit.com/
4 – 6 May, 2008
4 - 6 April, 2008 IDEM 2008 Singapore http://www.idem-singapore.com/
7 - 8 April, 2008 Global Healthcare Transformation Congress
EGYMEDICA 08 Cairo, Egypt http://www.egymedica.com/index.htm
10 - 11 May, 2008 1st International Online Medical Conference (IOMC 2008) Online, India http://ala.ir/iomc2008
Singapore www.availcorp.com/english/events_ list.php?eventsid=130&backurl=upco mingevents_list.php
13 – 15 May, 2008 HOSPIMedica Australia 2008
9 - 11 April, 2008 RFID World Asia 2008
14 - 17 May, 2008 Kazakhstan International Healthcare Exhibition (KIHE)
Singapore, Singapore http://www.terrapinn.com/2008/rfid/ index.stm
11 - 13 April, 2008 Pharma Future Expo ‘08 Singapore, Singapore http://www.pharmafutureexpo.com/
12 - 13 April, 2008 Unite For Sight 5th Annual International Health Conference Connecticut United States of America http://uniteforsight.org/conference/2008/registration.php 58
Sydney, Australia http://www.hospimedica-australia.com
Almaty, Kazakhstan http://www.healthcare-events.com/ kihe/
18 - 20 May, 2008 Symposium on Health Informatics and Bioinformatics, HIBIT ‘08 Ýstanbul, Turkey http://fens.sabanciuniv.edu/hibit08/
25 - 28 May, 2008 Geneva Health Forum Geneva, Switzerland http://www.genevahealthforum.org
18 - 22 June, 2008
20 - 22 August, 2008 Conference on Biomedical Electronics & Informatics (BEBI ‘08) Rhodes (Rodos) Island, Greece http://www.wseas.org/conferences/2008/rodos/bebi/
24 - 27 September 2008 Azerbaijan International Healthcare Exhibition (BIHE) Baku, Azerbaijan http://www.healthcare-events.com/ bihe/index.html
30 September - 2 October, 2008 Hospital / Pharmatsiya St. Petersburg, Russia http://www.primexpo.ru/hospital/eng
13 - 14 October 2008 3rd Annual GlobaL Healthcare Expansion Congress Dubai, UAE http://www.healthcareexpansion.com/ index.html?pagecode=home
10 - 14 November 2008 3rd Annual International Medical Travel Conference (IMTC) Seoul, Korea http://www.medicaltravelconference. com/index.php
14 – 17 November, 2008 TELEMEDCON ‘08 Chandigarh, India e-Mail: meenusingh4@rediffmail.com
5 – 7 December, 2008 Medifest 2008 New Delhi, India http://www.vantagemedifest.com/
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NUMBERS
400
Last year, private equity firms invested nearly US$ million in Indian healthcare sector.
Public healthcare system in France is incurring financial loss at a rate of Euros per minute.
80%
23,000
healthcare delivery in India happens through private sector.
Healthcare industry in India is expected to contribute of GDP by 2012.
500 56
8.5%
new mid-sized hospitals are expected to be added every year in India, over next five years.
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