vo l u m e 4 | i s s u e 2 | FEBR UARY 2009
Philips, GE enters home healthcare market
ISSN 0973-8959
Siemens launches eSie Touch for breast cancer deduction
A Monthly Magazine on Healthcare ICTs, Technologies & Applications vo l u m e 4 | is s u e 4 | A P R I L 2 0 0 9 | I N R 7 5 / U S D 10
Cover Story Emerging avenues in Healthcare Education Harsha Chawla Sr. Correspondent, eHEALTH Page 8
pERSPECTIVE ICRI emphasises on highest standards of teaching Shiv Raman Dugal Chairman, ICRI Page 16
ZOOM IN Impetus of project management in Healthcare Prof. Indrajit Bhattacharya IIHMR, New Delhi Page 26
TECH TRENDS Philips Neuro Perfusion Package (NPP) - Software for brain care S Bhaskaran, Sr. Director Philips Innovation Campus Bangalore Page 38
DEVELOPMENT DIMENSION A ‘Private’ Affair - analysing the need for private sector in Indian healthcare system Kadri SM, Regional Institute of H&FW, DHS, Srinagar Kashmir, India PAGE 40
www. e h e a l t h o n l i n e . o r g
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merging healthcare ducation
CONTENTS w w w . e h e a l t h o n l i n e . o r g | volume 4 | issue 4 | April 2009
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COVER STORY
Appraising Telemedicine Case Studies - Lessons and Challenges
Emerging Avenues in Healthcare Education
Lieutenant Colonel Salil Garg Cardiologist, Command Hospital, Pune
Harsha Chawla, eHEALTH
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TELEMEDICINE
Squadron Leader Mudit Mathur DD Space Ops, DSCC, Bhopal
PERSPECTIVE
“ICRI emphasises on highest standards of teaching” Shiv Raman Dugal, Chairman, ICRI
18
“Clinical Research is a recession proof industry” Vijay Moza, Chairman, CREMA
19
“Non-medicos can make better administrators” Major General (Retd.) Dr. S K Biswas, Founding Member and Patron, AHA
20
“Health and hospital managers will be in great
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demand”
Dental Implants - safer, faster, permanent solution for tooth loss
Surgeon Rear Admiral (Retd.) Dr. V. K. Singh Director, IIHMR, Delhi
21
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26
SPOT LIGHT
Sameer Bhat Country Manager, Nobel Biocare
“Mixing medicine and technology” Dr. S K Mishra, Nodal Officer, SGPGI Telemedicine Programme
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‘Click-through’ CMEs
TECH TRENDS
Philips Neuro Perfusion Package (NPP) software for brain care
Dr. P S Reddy, VP (Operations) & Chief Content Officer, Medvarsity Online Ltd.
S Bhaskaran Senior Director, Philips Innovation Campus, Bangalore
ZOOM IN
Impetus of Project Management in Healthcare Prof. Indrajit Bhattacharya, IIHMR, New Delhi
Approaches in Project Management eHealth
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DEVELOPMENT DIMENSION
A ‘Private’ Affair SKadri SM Regional Institute of Health and Family Welfare, DHS, Srinagar, Kashmir, India Danish Ahmed Research Scholar, University of Delhi Medical School, New Delhi
REGULAR SECTIONS India News 12 Business News 24 World News 36 Numbers 44 Events Diary 46
April 2009
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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 wellresearched 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 international 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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April 2009
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EDITORIAL Volume 4 | Issue 4 | April 2009
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Age old industry, new age education In recent years, the buzzing Indian healthcare industry has generated a huge demand for manpower across many new skill areas and specialisations. This has considerably broadened the scope for healthcare education. Traditionally, medicine and nursing were known to be the only two career avenues in healthcare domain. However, emergence of new job opportunities has given rise to a host of new training areas, such as - Clinical Research, Health and Hospital Management, Telemedicine and Health Informatics, Medical Tourism etc. Currently, education and training has become one of the fastest growing sub-sectors within the healthcare industry. Nowadays, opportunities are available for graduates and post graduates in pharmacy, life sciences, microbiology, biotechnology, physiotherapy, dentistry, homeopathy, ayurveda, veterinary, statistics and IT to opt for a specialisation in any of the emerging areas as above. The passing of Patents bill in 2005 and the entry of big pharmaceutical companies in Indian market have given a big boom to clinical research business in India. Today, a post graduate qualification in clinical research can command a handsome salary and provides ample choices to branch out. The other area where the demand for skilled manpower would be tremendous is Health IT. Healthcare is increasingly becoming technology driven to make it accessible, interactive, interoperable and intelligent. Telemedicine, Telehealth, Hospital Information Systems (HIS), Picture Archiving & Communication System (PACS) are few of the many ICT application areas in healthcare. In coming years, the implementation of newer and better technology in hospitals would change the healthcare scenario. The healthcare system would be less dependent on physical presence of doctors or their direct involvement in patient care – in turn, increasing the demand for paramedics, healthcare managers and allied professionals.
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Similarly, rush of international patients in Indian hospitals would give rise to new opportunities in healthcare and medical tourism. Recently, India has been ranked second in terms of preferred destinations for medical tourists. In 2007, Indian hospitals treated nearly half a million overseas patients as against the topper Thailand which treated 1.2 million. Realising, India’s potential in this domain, many educational institutes are contemplating to offer specialised courses in medical tourism. The thrust of this issue is to give current healthcare professionals (and also those aspiring for it) an insight into some of the emerging areas in healthcare education. We hope this will help them in making informed decision regarding their choice of career and specialisation. The Indian healthcare industry is growing like never before and opening up a whole range of exciting avenues. It is the right time to equip yourself with new age skills and knowledge, and get ready for a promising and rewarding career ahead.
does not neccesarily subscribe to the views expressed in this publication. All views expressed in the magazine are those of the contributors. The magazine is not responsible or accountable for any loss incurred, directly or indirectly as a result of the information provided. Owner, Publisher, Printer - Ravi Gupta. Printed at Print Explorer 553, Udyog Vihar, Phase-V, Gurgaon, Haryana, INDIA and published from 710 Vasto Mahagun Manor, F-30, Sector - 50, Noida, UP Editor: Dr. Ravi Gupta
Dr. Ravi Gupta Ravi.Gupta@ehealthonline.org April 2009
COVER STORY
emerging avenues in Healthcare Education The liberalisation of the foreign investment policy and the emergence of private healthcare providers have proved to be a shot in the arm for the Indian healthcare industry, giving rise to specialised fields in healthcare and opening new career opportunities for thousands of job seekers in India. In a short span of time many educational institutes have sprung up providing professional training in the allied fields of medicine. So, this is the time to specialise in these emerging fields for a promising future.
T
he entry of corporate players in the Indian health industry has not just improved the quality of medical services but has brought in new career opportunities for graduates in medicine and its allied fields. As new private players are entering the market and the existing ones expand their market in health care industry, the private educational institutes are also keeping pace with them by introducing specialised courses to fulfill the demand of trained manpower. India faces a huge need gap in terms of availability of number of hospital beds per 1000 population. With a world average of 3.96 hospital beds per 1000 population India stands just a little over 0.7 hospital beds per 1000 population. It is estimated that each additional bed has the potential to create 5 direct jobs and 25 indirect jobs. According to official statistics, the number of clinics and hospitals have increased almost four times from that in the 1950s. The Indian healthcare sector has seen progressive increase in investments in healthcare infrastructure and the booming Indian healthcare sector is in an expansion mode owing to the availablity of several financing opportunities. Currently, the Apollo hospitals’ network includes about 26 hospitals while Fortis Healthcare runs 13 hospitals and 16 satellite centres and Wockhardt has 12 hospitals.
April 2009
The corporatisation of hospitals has resulted in improved infrastructure and medical services and has also opened up new career opportunities in hospitals. There is a rising demand for not only doctors but also for hospital administrators to manage large hospitals. Areas of opportunities The Indian healthcare sector constitutes of medical care providers, diagnostic service centers and pathology laboratories, medical equipment manufacturers, Contract Research Organisations (CRO’s), pharmaceutical manufacturers, and third party support service providers (catering, laundry). Within the healthcare sector there are some key areas which are undergoing a lot of change and would experience a spurt of opportunities in the near future. These are medical infrastructure, telemedicine, medical equipment, medical textiles, health Insurance, clinical trials, health services outsourcing, medical value travel and training and education.
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Hospital Administration The rapid growth in the Indian economy has led to urbanisation of Indian cities which means better jobs and higher disposable incomes. The improved standard of living has increased awareness among urban dwellers about health and health insurance, which in turn has increased the demand for quality healthcare in India. In addition to that, changing demographics, disease profiles and the shift from chronic to lifestyle diseases has led to increased spending on healthcare.The total expenditure on health per capita has increased $19 in 2000 to $36 (at average exchange rates) in 2005. The corporatisation of hospitals has resulted in improved infrastructure and medical services and has also opened up new career opportunities in hospitals. There is a rising demand for not only doctors but also for hospital administrators to manage large hospitals. In hospitals, there are several administrators, one for each department. In smaller facilities, they oversee the day-to-day operations of all departments. Administrators make sure hospitals operate efficiently and provide adequate medical care to patients. “The hospital administrator’s job is not an easy one as the administration of a hospital is unlike the administration of any other business. It deals with human beings and not material prod-
COVER STORY
In 2007 Indian hospitals treated 4.5 lakh international patients against the topper Thailand, which treated 12 lakh patients. According to a study by McKinsey and the Confederation of Indian Industry (CII), medical tourism in India could become a $1 billion business by 2012.
ucts. A hospital administrator’s job is to effectively manage the management of health system and the effectiveness of health outcomes. “At IIHMR we train our students to manage various core as well as functional areas of a hospital like health delivery, health laws, health infrastructure, health problems and health needs. We train them in logistics, finance, health informatics, hospital waste management, equipment management and quality assurance in hospitals,” says Dr S D Gupta, Director, Institute of Health Management Research, Jaipur, which offers postgraduate programme with specialisation in Hospital Management, Health Management and Pharmaceutical Management. Most of the work which the hospital administrators do in administration does not require medical knowledge and most of the doctors are either not keen on taking charge of administrative matters or are not good at it as they are not trained in administrative sciences. This has raised the demand of non-medical hospital administrators as the large hospital chains require specialised staff with a degree in hospital and health management. “We prefer to call hospital administrators as hospital managers as
the nature of their job is dynamic whereas administration is a oneway process. Hospital mangers facilitate clinicians in better delivery of medical services. Generally doctors lack managerial skills as most of them are not trained in hospital management, so students from nonmedical background are more preferred,” adds Dr Gupta.
Medical Tourism Medical tourism refers to people travelling to different destinations for tourism as well as medical services. The idea behind this concept is to get a cost-effective quality medical care along with a tour to surrounding destinations. India is becoming a hub for medical tourism because the talent of Indian doctors is well-known globally. Other factors which have contributed to the rise in numbers of international patients are opening up of corporate hospitals which provide high quality care in half the price in foreign countries and long patient waiting list, especially in the UK and Europe. Recently India was ranked second in medical tourism. In 2007 Indian hospitals treated 4.5 lakh international patients against the topper Thailand’s which treated 12 lakh patients. And, according to a study by McKinsey and the Confederation of Indian Industry (CII), medical tourism in India could become a $1 billion business by 2012. As travel agencies act as a facilitator between patients and various hospitals, many hospitals with a medical tourism department employ people graduated in tourism and travel management. There are many tourism and travel institutes in India which train students in medical tourism. However students with a degree in hospital administration and trained in medical tourism can have better job openings. Recently, Indian Institute of Clinical Research (ICRI) moved from being a clinical research education provider to health care education provider by launching
courses in Healthcare management with a specialisation in medical tourism. “Though India treats about 5 lakhs patients in a year which is about to grow double in the near future, it is still an unorganised sector. As of now there is not a single institute in India offering a course in medical tourism despite the fact that medical tourism in India could become a $1 billion business by 2012. ICRI is the first institute in India to provide a specialisation in medical tourism. Students taking this course will be placed in hospitals or travel agencies or embassies as facilitators. A part of their job deals with discussing with foreign patients the estimated costs and expenses including the travelling, treatment, the selection of the hospital, where to stay and how long to stay, pre and post surgery care, tourist attractions, translators, nurses etc.,” explains Major General M Srivastava, Director, ICRI Health.
Health Informatics Health informatics or medical informatics is the intersection of information science, computer science and health care. It deals with the resources, devices and methods required to optimise the acquisition, storage, retrieval and use of information in health and biomedicine. Health informatics tools include not only computers but also clinical guidelines, formal medical terminologies, and information and communication systems.
April 2009
COVER STORY
Health information technology (Health IT) allows comprehensive management of medical information and its secure exchange between health care consumers and providers. The healthcare industry is one of the biggest spenders on IT across the globe but despite the IT revolution in India the use of IT in healthcare is confined to peripheral functions. Currently the IT investment in Govt-run hospitals and private hospitals is negligible may be 3 to 7 per cent of the overall hospital infrastructure budgets. However, the experts predict that the growth rate of IT in healthcare is going to be 15 to 20 per cent CAGR. The Internet has made healthcare more accessible, interactive, and highly useful. Telemedicine, picture archiving and communication systems (PACS), and healthcare information systems (HIS) are a few of the many IT applications in healthcare. The health department of the Delhi government has been working on developing and testing an e-hospital software for a very long time. Very soon the Delhi government will computerise hospital functions of all the government-run hospitals in Delhi by installing Hospital Information Management System (HIMS). Telemedicine, a good combination of medicine and modern technology, is also raising new hopes in health care. Telemedicine means providing medical assistance at a distance with
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the help of Information and communication Technologies. Telemedicine is a method by which patients can be examined, monitored and treated, while the patient and doctor are located in different places. The patient’s reports can be sent via text, voice, images or even video, and medical advice offered from a remote location. The telehealth segment is growing at a rapid pace and requires professionally qualified people to support this segment. Currently, there are a few institutes in India providing courses in Telemedicine like Centre for Development of Advanced Computing(CDAC), Mohali, School of Telemedicine and Biomedicine Informatics, Lucknow, the Apollo Telemedicine Networking Foundation in a tie up with the Anna University and Tamil Nadu Dr. MGR Medical University. “Department of Telemedicine, CDAC, has been conducting workshops for healthcare professionals in telemedicine technology since 2007 and we have been receiving a very favourable response from hospitals across the country. This February we have introduced an advance course of eight-week duration in Telemedicine and Medical Informatics for doctors and paramedics. Currently, we are training 18 doctors from across the globe in the first batch and we have been receiving lots of calls from healthcare professionals all over the world especially developing countries to know about the course. Unlike in the West, telemedicine is at a very nascent stage in India and job opportunities are still not much. So in the present scenario it can be a very good valueaddition for doctors, paramedics and students of hospital management. In the near future CDAC is stating a masters’ program in Medical Information Technology,”informs J S Bhatia, Director, CDAC, Mohali. There are several institutes and universities running a course in
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Medical Informatics like Medvarsity; Amrita Institute of Medical sciences, Kochi; Bioinformatics Institute of India, Noida; eHCF School of Medical Informatics, Delhi; and Indian Academy of Health Informatics, Delhi.
Clinical Research In the span of about four years Clinical research has become one of the most preferred career option for graduates in medicine and its allied fields owing to many factors: the rise in demand for professionally trained clinical research professionals, India becoming a hub for clinical trials, tremendous scope for higher growth, and attractive pay packages. With all major pharmaceutical companies and Contract Research Organisations (CROs) setting their base in India the clinical research business is projected to grow $1.5 billion by 2010 and the demand of CR professionals would be about 50, 000 by 2010. Currently, there are many institutes in India offering part-time as well as full time post-graduate diploma in Clinical research. There is a huge demand for clinical research professionals in business development, investigation, reporting and trials in hospitals, CROs, clinical study investigating sites, clinical laboratories and clinical trials consulting companies and site management organisations. Clinical research industry is considered to be a recession-proof industry. Here is an industry expert’s views. “Pharma companies are unlikely to get hit, as healthcare is a booming industry even in a recession. The other factor which takes care that the job opportunities wouldn’t thin out is the medical infrastructure, thanks to the Drug Authority of India which has played a very positive role in putting together a good structure of regulations. It gives foreign companies enough confidence that the Indian market is secure. Apart from this low costs and easy availability of naive patients will maintain India’s status of a hub for clinical trials,” says Shiv Raman Dugal, Chairman, Institute of Clinical Research in India.
NEWS REVIEW >> INDIA
Trivitron and Brandon Medical (UK) announces JV for manufacturing advanced OT Lights in India Trivitron recently announced its alliance with Brandon Medical, U.K to manufacture advanced OT Lights. Through this tie-up, Brandon Medical will manufacture shadow less lights used for operation theatres by setting up its manufacturing facility at Trivitron’s Medical Technology Park in Chennai, India. Located in Leeds, England, Brandon Medical UK, is one of the leading manufacturers of lights for operation theatres. The company designs and manufacture its range of products which caters to the requirements of the international market. Brandon Medical product range include operating theatre lamps, mobile operating lamps, minor surgical / examination lamps, surgeons control panels and emergency power systems. Commenting on the JV, Dr. G.S.K. Velu, Managing Director, Trivitron, says “We are happy to be associated with Brandon Medical. Our focus in setting up a medical technology park in India is to manufacture medical equipments in the areas of critical care, cardiac care, imaging and routine laboratory diagnostics. The objective is to manufacture quality and cost-effective medical technology products suited to the needs of developing countries. Products manufactured in India would be 30 to 40 per cent cheaper than imported ones and even rural hospitals would be able to afford them.”
Welch Allyn Partners with BPL Healthcare to Support Emerging Indian Market Welch Allyn, a leading global manufacturer of frontline medical products and solutions, announced that it has partnered with BPL Healthcare to provide easy access of state-of-the-art products, world class services and localized training programs for medical practitioners, hospitals and the public health system at large in India. Through this partnership, BPL Healthcare will serve as a Welch Allyn Master Distributor, putting the company closer to its prospective customers and better positioning it to provide innovative products that meet the growing needs of healthcare professionals in this part of the world. The occassion also marked the launch of e-Clinic - a joint initiative of these two companies to provide state-of-art primary healthcare center or family health clinic set up, using world class diagnostic instruments. “The BPL Healthcare business unit has one of the most comprehensive service and delivery systems in India,” said Con Hickey, senior vice president, Asia Pacific at Welch Allyn. “The strategic alliance between Welch Allyn and BPL provides us with a tremendous opportunity to broaden our reach in this country.” On the occasion of signing the MOU, Mr. Ajit Nambiar, Chairman and Managing Director of BPL Ltd., said “BPL’s focus on diagnostic products for the point-of-care will only drive healthcare costs down and make modern healthcare facilities available to the masses.” Launching the e-Clinic, Mr. Nambiar said, “such a show and tell demonstration facility will showcase global trends of a greatly empowered and connected GP clinic. The e-Clinic will represent a new paradigm as an integrated point of care or primary healthcare center.”
Hosmac opens new office in Guwahati, Assam Mumbai based Hosmac has announced the opening up of a new branch office in Guwahati, which is a part of the broader plans of the company to expand it’s presence in the Eastern region (in addition to Kolkata and Patna). The new office reinforces the company’s belief in improving customer support and proximity, which effectively sets it apart from most of its competitors. It already has three key projects in the East - two specialty hospitals in Assam and one medical college project for the Government of Manipur. Also in the pipeline are NRHM and other government funded projects. “For consultancy to be effective and acceptable it is very important to understand the psyche of the region” says Dr. Vivek Desai, MD of Hosmac “It is our strong conviction that the NE region will see a lot of developmental initiatives in the healthcare sector in the days to come. Hopefully, with a branch office in the region, Hosmac would be able to catalyze and add value to such initiatives.”
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NEWS REVIEW >> INDIA
SoftLink International installs C-PACS in Nanavati Hospital, Mumbai Nanavati Hospital in Mumbai, one of the pioneering healthcare institutions in India, recently installed an advanced cardiology PACS from SoftLink International, replacing its old stand alone Workstation solution procured from SoftLink. In last couple of years, a number of significant changes have occurred in image capture, archiving, data retrieval. Integration with information systems and networked approach have dramatically changed the outlook of the management, which decided to implement C-PACS, Cardiology Imaging Network Solution by upgrading traditional stand alone workstation. Softlink deployed C-PACS solution connecting to Cathlab with approximately one year of on-line storage on a high-end RAID L5 server for total storage and security of patient images. The Medical director of the Hospital Dr. Mohanty said, “The Solution has enabled doctors to access patient studies from diagnostic review stations on the hospital’s LAN and they are no longer required to visit Cathlab for accessing patient studies”. He further added “Two networked enterprise review stations that are strategically placed to increase physicians’ access to recent as well as the older images during patient interaction and consultation, resulting in improved workflow as well as patient care in the cardiology department.”
‘CyberKnife’, introduced by Apollo Speciality Cancer Hospital, Chennai
Frontier Mediville medicity project near Chennai accorded SEZ status
The Apollo Hospitals Group recently introduced the advanced ‘CyberKnife’ Robotic Radio Surgery System in Asia Pacific region, by launching it at the Apollo Speciality Cancer Hospital in Chennai. ‘Cyberknife’ is the world’s first and only robotic radiosurgery system designed to treat tumors anywhere in the body. Unveiling the ‘CyberKnife’, Dr. Prathap C. Reddy, Executive Chairman, Apollo Hospitals Group said, “India is today a global hub for world-class healthcare and we will be adding another highlight with the launch of the CyberKnife® Robotic Radiosurgery System in the country”. Developed by Dr. John.R.Adler M.D, Professor of Neurosurgery and Radiation Oncology at Stanford University Medical Centre, the CyberKnife uses real time image guidance technology and computer-controlled robotics to deliver an extremely precise dose of radiation to targets, avoiding the surrounding healthy tissue and adjusting for patient and tumor movement during treatment. Elaborating on patient benefits, Dr. Sanjay Chandrasekar, Senior Consultant Radiation Oncology, Apollo Speciality Cancer Hospital said, “Many complications associated with other conventional cancer therapies are minimised by CyberKnife system. It can be used to treat multiple tumors and those previously considered inoperable. Many of the treatments can also be performed on outpatient basis”.
The first medicity project in the country - Frontier Mediville, promoted by Chennai-based Dr KM Cherian’s Frontier Lifeline Hospital, has been given the status of a Special Economic Zone (SEZ) by the Ministry of Commerce and Industry. Coming up with an investment of Rs 1,500 crore, the medicity will begin operations with the setting up of a national medical science park and a 1,000-bed multi-speciality bio-hospital.
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The bio-hospital would be the first of its kind in India and one among the 18 proposed around the world. The proposed medicinal science park would be a hub for R&D in regenerative medicine and in advanced scientific areas such as nano-technology and genetic engineering.
NEWS REVIEW >> INDIA
Fortis expanding Escorts as a separate unit Hospital chain Fortis Healthcare is expanding its flagship cardiac hospital brand Escorts Heart Institutes’ as a separate unit within its newly acquired hospitals. It has already opened Escorts Heart Institute in Chennai’s Malar Hospital and plans to position the brand as a cardiac speciality unit in its other recently acquired multispeciality hospitals. Fortis is expanding its presence both within India and abroad. In 2007, Fortis acquired Malar Hospital and last month forayed into the international market by acquiring Clinique Darne in Mauritius. In January it also bought over Bangalorebased Apollo RM Hospital. Fortis Healthcare CEO and MD Shivinder Singh said, “We have a good cardiac team in Malar Hospital who can go with the reputation of the Escorts brand. We may consider expanding Escorts brand in other new hospitals including Clinique Darne in Mauritius.”
Cryo-Save plans AsiaPacific growth strategy through India
Philips, GE enters home healthcare market in India
Cryo-Save Group, Europe’s largest stem cell company announced its plans to scale up investments by US$ 2 million in its 100% subsidiary Cryo-Save India and a similar amount for the rest of Asia Pacific region to meet the emerging demands of these two high-growth markets. Rob Koremans, Group CEO, Cryo-Save said, “Our new business alignment is a reflection of the significant role India plays in the company’s growth strategy. Cryo-Save is valued for its strong leadership presence in over 38 countries, cutting edge technology and fully automated storage facility that helps us to meet our customer’s needs”. Speaking about the uniqueness of the Cryo-Save lab in India, Prof. Colin McGuckin, Scientific Director, Cryo-Save India and
Two of the leading healthcare technology providers, Philips and GE recently announced their almost simultaneous entry into the fast-growing Indian home healthcare market. Both these companies have launched their sleep therapy solutions and respiratory care solutions in India. Philips added the Respironics product categories in obstructive sleep apnea management and home respiratory care to its existing healthcare product portfolio in India. Philips’ ‘in-hospital’ position was also strengthened through the introduction of Respironics’ strong non-invasive ventilation and respiratory monitor-
creator of ‘mini liver’ said, “Our lab in Bangalore adheres to GMP & highest international standards. I was very impressed by it and we would be looking at Bangalore lab to do some of our projects”. Mr.V.R.Chandramouli, Managing Director, Cryo-Save India informed, “Women in India are slowly but steadily realizing the potential of banking their umbilical cord cells. Our endeavor like always has been to bring to the table a depth of expertise and experience in stem cell banking space and we plan to devise new marketing strategies to reach out effectively to our target audience”.
ing products for hospitals and clinics. With this launch, India becomes the first country where Philips Respironics portfolio has been formally launched post the company’s global acquisition of Respironics in 2008. On the other hand, GE’s home health solutions are added through its acquisition of Vital Signs Inc. and its subsidiary Breas Medical AB. While Vital Signs is a global provider of medical products applicable to a wide range of care areas such as anesthesia, respiratory, sleep therapy and emergency medicine, Breas Medical AB developed the ‘iSleep’ (sleep apnea management solution) and Vivo series of respiratory care solutions. Both Vital Signs and Breas Medical AB’s products will highly complement GE Healthcare’s leading anesthesia delivery, patient monitoring and acute respiratory offerings.
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PERSPECTIVE>>> CLINICAL RESEARCH
“ICRI emphasises on
highest standards of teaching” Set up in 2004, Institute of Clinical Research India (ICRI) is known to be the country’s first premier institute exclusively focused on specialised Clinical Research education. Currently, ICRI has its presence in five Indian cities and is planning to set up a center in London. ICRI has recently launched its healthcare division ‘ICRI Health’, for imparting structured management education for preparing future professionals for the emerging healthcare industry. It has recently launched post-graduate courses in Hospital Operations Management and Medical Tourism. eHEALTH met with Shiv Raman Dugal, Chairman, ICRI, to know in depth about clinical research education in India and recent developments at ICRI. With over 30 years of experience, Mr Dugal is the founder of the institute and has been a part of the core team since ICRI’s inception in 2003. He is an active member of many industry associations and societies and has served these bodies in various capacities in implementing their programmes.
Q. How did ICRI come up? A. In 2003, I was toying with the idea of starting a clinical trial business in India. In 2004, India signed the IPR treaty; and I foresaw a tremendous scope for clinical research as we had qualified health professionals, a large pool of patients, and the costs to conduct trials were relatively lower than in Europe or US. In 2004, one of our prospective customers visited us but refused to give us any trials. Instead, they advised us to train people in clinical research, as then clinical research was not taught in the country. So, we decided to go ahead with it to get specialists for our business. It was a residential set up and teachers would come from Mumbai.
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We took about 20 students out of 70 for our business and the rest got placed in clinical trials firms. In the next batch, we took about 750 students as the market had opened up with the passing of Patents bill. Pharma companies started seeing potential in the Indian market because it gave them security that their products wouldn’t be copied. By the end of 2005 about 150 CROs had sprung up in the country.
Q. Can you tell us about the recent devel-opments at ICRI? A. We have recently launched a healthcare services education division-ICRI HEALTH. It gives ICRI a wider perspective, as now along with education in
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clinical research it will have courses in medical tourism and hospital operations management. Though the hospital operations management is been taught in many institutes but the programmes are focused on the broad strategic areas. Most of them ignore how detailed operations in a hospital are managed. For instance, they don’t teach how to run an ICU to bring down the morality rate, or how to run a laundry. They don’t get into the small details of planning a hospital or how a bed or an equipment is to be placed. Whereas at ICRI we emphasise on highest standards of teaching detailed step by step processes in a hospital. In the field of medical tourism ICRI is
PERSPECTIVE>>> CLINICAL RESEARCH
What is Clinical Research? A clinical research is a scientific study of the effects, risks, efficacy and benefits of a medicinal product. These are carried out prior to the release of the medicine in the market. These trials are undertaken at various stages and studies are conducted after the launch of a new product to monitor safety and side effects during large-scale use. Clinical trials are conducted by pharmaceutical companies or Contract Research Organizations (CRO’s) on their behalf.
Eligibility A B. Sc. degree is a must to enter this field. Ideally the industry prefers science graduates in pharmacy, medicine, life sciences and bioscience but graduate or post graduate in microbiology, biotechnology, nursing, physiotherapy, dentistry, homoeopathy, ayurvedic, veterinary, science, statistics and IT are also eligible. In fact they form the majority in any clinical research institute.
Job Profile Clinical Research branches off into various categories at the entry level. The most common entry-level position is that of a Clinical Res earch Associate (CRA). They can rise up to the post of Clinical Research Manger (CRM). The role of a CRMs is to supervise design and writing of protocols, case report forms and informed consent forms for clinical trials. The other posts also like Clinical Research Coordinator, Business Development Manager, Investigator (at the site where subjects are actually given the study drug), Site coordinator, Clinician (responsible for the trial from the sponsor’s end), Project manager, Data Manager, Programmer, Statistician, Medical writer etc.
Remuneration Freshers can expect a pay package of 2.5 to 3 lacs or more per annum depending on the educational background. If you have a master’s degree then you can expect a higher package. However, in Clinical research experience counts so the longer you are in the field the higher the salary.
the first institute in India to introduce a course in medical tourism with a tie up with Singapore Health--a public sector healthcare institution. We are also the first to have a largest pool of faculty in Healthcare education--we have about 40 faculty members to teach medical tourism in various branches of ICRI. The other important development at ICRI is that for the first time we have two students enrolled in doctorate course in clinical research. Also, we are launching an Adverse Drug Reaction Center in Mumbai.
Q. Tell us about the current scenario of Clinical Research education in India? A. In recent years hundreds of private CR institutions have mushroomed in the country. However, despite that there hasn’t been any major development in the clinical research education in India. UGC is yet to acknowledge clinical research as an approved subject. Most of these institutions don’t have full-time programmes andfaculty. Their programs are plagiarized because there is no education material available in India. That’s
one of the reasons ICRI has tied up with Cranfield University, UK, and with Singapore Health.
Q. According to a report India would require 50, 000 clinical research professional by 2010. Do you think such predictions are modest looking at the ongoing financial crisis? A. Honestly, I was a little apprehensive about the placements this year but luckily all the students got placed
well. It’s not that we alone are doing a fantastic job but it reflects that the market is doing well. I don’t see clinical research market getting affected in the short run for the simple reason that before each medicine makes it to the market, it has to pass a lengthy approval process. So, by the time a drug reaches the stage of clinical trial a company has already invested half of the money, so the chances of backing out are very slim. Moreover, Pharma companies are unlikely to get hit, as healthcare is a booming industry even in a recession. The other factor which takes care that the job opportunities wouldn’t thin out is the medical infrastructure, thanks to the Drug Authority of India which has played a very positive role in putting together a good structure of regulations. It gives foreign companies enough confidence that the Indian market is secure. Apart from this, low costs and easy availability of naive patients will maintain India’s position of desired destination for clinical trials. April 2009
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PERSPECTIVE>>> CLINICAL RESEARCH
“Clinical Research
is a recession-proof industry” CREMA - Clinical Research Education and Management Academy, is a premier training and research institute in Clinical and Biomedical studies. Launched in 2007 in Mumbai, it runs three campuses at Bengaluru, New Delhi and Hyderabad and plans to set up three more centers by the end of 2009. Last year CREMA started a full-time Advanced Post Graduate Ddiploma in Clinical Research. eHEALTH caught up with Vijay Moza, Chairman, CREMA, a pioneer in introducing clinical research education and site management organisation in the country, and also an active advisory member of Indian Society of Clinical Research (ISCR) - a non-profit organisation promoting Clinical Research in India. Q. How did CREMA come up? A. I have been a part of ICRI, the institute which pioneered clinical research education in India, for about four years. In 2007, I decided to start my own institute. I have been regularly interacting with the CEOs of clinical research organisations (CROs) and pharmaceutical companies to get the pulse of the industry. I kept the duration of our program one year as there was an acute shortage of skilled clinical research professionals, while the industry was growing fast. As the clinical research professionals were lacking in project management and communication skills, we put emphasis on honing the soft skills of our students.
Q. What makes CREMA different from other clinical research institutes? A. I think the industry-driven curriculum sets us apart from other institutes. I strongly believe that industry should endorse upcoming educational fields like clinical research as ultimately they are the employers. They are the ones who can guide us on customising the curriculum according to the needs of the industry, as clinical research is relatively a new domain. CREMA’s core committee comprises of Who’s Who of industry, who help us in upgrading our curriculum on a regular basis to enable students and practitioners to stay upto-date with prevailing practices.
Q. It has become a trend in private institutions to tie up with foreign universities. How important are foreign affiliations for CREMA? 18
April 2009
A. Our tie-up with William Harvey Research Ltd (WHRL), UK, help students get global exposure through lectures by internationally-renowned faculty and the exchange programs. CREMA has also formed a joint venture with Canadabased Clinical Research International, well-known for its online education in clinical research, by which students can enroll for online certification courses. Students qualifying in these courses will get an added recognition in the industry.
Q. With India surpassing China to become Asia’s most popular destination for conducting clinical trials how do you see the career prospects of clinical research in India? A. There is a phenomenal scope for clinical research business in India. Currently we have about 370 CROs in India and the boom in yet to come. India is at an advantage due to its huge pool of patients and lower infrastructure costs. Clinical research is a recessionproof industry as it is less expensive for foreign companies to conduct trials here. As the Indian government have become more strict on regulations, it is a very win-win situation. So, the career prospects are very bright for clinical research professionals.
Q. Comment on the industry’s concern about the quality of clinical research professionals passing out from various institutes that have sprung up in recent years? A. It’s true that many sub-standard clinical research institutes have come up in
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India in recent times but I have also observed that such institutes don’t stay for long as the market is very competitive. You need state-of-the-art infrastructure and renowned faculty to run a clinical research institute which requires huge investments. So, in longer run only the ones who take it seriously will survive.
Q. Suggest some ways to make clinical research a mainstream career? A. Clinical research has opened a new career path for many medical graduates as well as graduates in Life Sciences, Microbiology, Biotechnology, Pharmacy, Nursing etc. Some years back many of such graduates would struggle for years. However, now passing out from an institute like ours enables the student to earn a starting salary of around Rs. 20,000 a month. The government should seriously consider making clinical research part of the university curriculum. There has to be diploma, graduate and PG programs in universities.
Q. Could you tell us about the placements at CREMA?How about the remuneration? A. CREMA students achieved successful placement in reputed companies namely CliniRx, Sun Pharma, TCS, Cognizant, Novartis, Piramal Life Sciences, Quintiles, Sanofi Aventis and many more. Depending on the qualification and aptitude, an average trained professional can earn about Rs 20,000 to Rs 50,000 per month. With work experience of about 3-4 years, one can earn about a lakh rupees per month.
PERSPECTIVE>>> HEALTH & HOSPITAL MANAGEMENT
“Non-medicos can make better administrators” In 1966, the Department of Hospital Administration was established at the All India Institute of Medical Sciences (AIIMS), New Delhi. As the specialty of Hospital Administration gained momentum in India a formal professional body of hospital administrators was conceptualised and Academy of Hospital Administration (AHA) came into existence in 1987. AHA became the first institution in India to impart education in Hospital administration through its distant learning programme. Currently AHA is expanding into new areas of healthcare education. eHEALTH spoke to Major General (Retd.) Dr. S K Biswas - one of the founding members and patron of AHA, to know about the academy and the profession of hospital administration.
Q. Can you take us through the journey of AHA? A. In the year 1966 the Department of Hospital Administration was established at the AIIMS. As with the years the specialty of hospital administration gained importance in hospitals, interactions of the hospital administrators at various forums felt the need to have a professional body of hospital administrators. And, in 1987 Academy of Hospital Administration or AHA got established. In 2005, AHA moved to Noida owing to the space crunch as the number of students enrolling for the programs had increased. Also, AHA collaborated with IGNOU to add credibility to its distant learning programmes.
Q. Can you briefly tell us about the new courses? A. In 2007 AHA launched a six-month post graduate certificate programme in Quality Management and Accreditation of Health Care Organisation through distant learning. In 2008, for the first time AHA launched a full-time course
in Hospital Administration. It is a twin degree programme with PGPHA combining with MBA in partnership with the Hierank Business School. And this year AHA is adding two new courses to its portfolio: PG diploma in Health and Law and PG diploma in Medical Architecture.
Q. How has the role of hospital administrators changed with the entry of corporate hospitals in the Indian healthcare industry? A. Government-run hospitals are yet to recognize the importance of hospital administrators. Most of them still feel that their role in running a hospital is not indispensable. It’s generally seen that their contribution in running a hospital is undermined by doctors. However, private hospitals value them and that’s the reason we have seen a rise in the demand of health administrators in recent years. Another change which has come is that nowadays we see health administrators from non-medical background.
I believe non-medicos can make better administrators because unlike doctors their minds are less occupied. Therefore, they are better performers. On the other hand, the skills of a doctor should not be wasted especially in developing countries where the doctor to patient ratio is already low. Moreover, most of the work health administrators do in administration doesn’t require medical knowledge.
Q. Comment on the current scenario of health care administration education in India? A. Definitely, in many ways education has improved in recent years but at the same time many institutes have come up which attractively package their programmes to charge exorbitant fee from the students. Such institutions lack well-qualified faculty, training material and work experience to standardise the training programmes, as their concern is not to produce competent students for the industry. April 2009
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PERSPECTIVE>>> HEALTH & HOSPITAL MANAGEMENT
“Health and Hospital managers
will be in great demand” Established in 1984 in Jaipur, Institute of Health Management Research (IHMR) is the first of its kind in India, with attention solely focused on health systems management. It is a premier institute in health management education, training, research, programme management and consulting in the health sector including Hospitals and Healthcare IT. IHMR has two centers at Bangalore and Delhi. eHealth spoke to Surgeon Rear Admiral (Retd.) Dr. V.K. Singh, Director, International Institute of Health Management Research, Delhi, to know about the recent developments at IIHMR and the changing role of health and hospital managers in health care industry. Dr Singh
Q. Tell us about the changing role of health and hospital managers in Indian health care industry? A. According to WHO there is a lack of awareness in healthcare industry of developing nations about the management techniques to optimise the available resources. However, the health industry is slowly recognising the benefits of health management and in the coming years we will witness a huge demand of hospital and health managers in hospitals, public health and rural India. Seeing the lack of interest among doctors to work in public health, the government of India has established four Indian Institute of Public Health across the country under the Public Health Foundation of India (PHFI). These institutes offer Masters in Public Health (MPH) and doctoral programmes in various public health disciplines for medicos as well as non-medicos. The other sector from where the huge demand would come is rural India. The future focus would be on rural India which we can make out from this year’s health budget: the lion’s share of health budget is allocated to the National Rural Health Mission i.e. Rs. 12,070 crore. Here again health and
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hospital managers from non-clinical background would be in great demand for the simple reason that doctors often hesitate to get into the non-clinical side of healthcare services.
only institute in India solely focused on health system management and dedicated to the improvement in standards of health through better management of health care.
Q. Does the job profile of a medico and a non-medico differ after taking an MBA in hospital and health management? A. Health and hospital management
Q. Could you tell us about the new courses at IIHMR? A. Currently, IIHMR offers a two-year
system has continued with the modification from time to time. Initially, only doctors were eligible for the specialisation in Hospital and Health Management. Gradually, non-medicos also started entering this domain. Today at the top level for the job of clinical director or chief medical officer only an MBBS is hired, as the job requires him/her to discuss issues related to clinical protocol and patient’s safety. For the support services managers from non-clinical background are preferred as they are more competent to manage administrative services than clinicians.
Q. How is IIHMR different from other institutes? A. Most of the institutes offer a number of management courses, and health and hospital management forms a part of them. However, IIHMR is the
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full-time postgraduate programme in Health Management and Hospital Management. Seeing the growth of Health IT in India we have introduced specialisation in Health IT Management this year. We have already launched an online certificate course in Project Management with specialisation in healthcare. We are also launching in April 2009 an advance diploma course in Pharmacovigilance and Clinical Research in collaboration with the University College London, U.K, and Uppsala Monitoring Centre of Sweden. We are planning a weekend certificate course in Healthcare Finance and Insurance for working professionals and would also launch a diploma in Healthcare Facility Management and Hospital Designing.
PERSPECTIVE>>> TELEMEDICINE
“Mixing medicine and technology� Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, is known for teaching and training medical professionals in various medical super-specialties. The latest achievement of SGPGIMS is the setting up of the School of Telemedicine and Biomedical Informatics. Currently, the infrastructure at the school consists of several laboratories in all areas of healthcare IT, Telemedicine, HIMS, Health Knowledge Management, Medical Imaging Informatics, Biomedical Informatics, Artificial Intelligence, CDSS, Medical Mutimedia & Animation, Surgical Informatics etc. Although functional since 2006, it will open admissions to its masters and diploma programmes in Telemedicine and eHealth later this year. To know more about the courses and the school, eHealth spoke to Dr S K Mishra, Nodal Officer, SGPGI Telemedicine Programme, who has been instrumental in starting the telemedicine programme at SGPGIMS. Dr Mishra is also the Professor and Head, Dept. of Endocrine Surgery, SGPGIMS. Q. Despite the presence of IITs for over half a century the School of Telemedicine is the first institution in the country to teach Telemedicine and eHealth. How does it feel to be a part of such a project? A. Application of Information Technology in healthcare is relatively a recent phenomenon in this country. Telemedicine is one of the technologies that has a great potential in facilitating healthcare delivery, knowledge and health information exchange across geographically dispersed groups of people/ organisation. In India engineering and technology educational institutions have always focused on the traditional disciplines. SGPGI is formed on the philosophy of creating human resources in emerging superspecialty fields of medical science and is a forerunner in such experiments in the country. Starting an academic programme in Healthcare IT is one such example. Though the discipline is a mix of medicine and technology but the current scenario has blurred the margins of scientific disciplines.
Q. Can you detail upon the evolution of School of Telemedicine and Biomedical Informatics? A. SGPGIMS has been actively involved in telemedicine since 1999. We realised very early that automation is the only solution that can help hospitals to meet the challenges of modern health care delivery. SGPGIMS was the first fully computerised public hospital in the country with all patient activities taking place online and continues to be only
one with an exceeding experience in the Government sector. The objectives of setting up of the School of Telemedicine are creation of various resource facilities, structured training programme, research and development, providing consultancy to government and private healthcare organisations and collaboration with technological and medical universities in the country and abroad. And, the most important is to meet the demand of skilled manpower in the emerging highly skilled health technologies. Presently, the healthcare industry recruits IT people from non-healthcare backgrounds and then train them.
after assessing the job market for these courses. In 2006, we started customised training programs for doctors and technicians sponsored by various agencies. We have trained batches of doctors and IT professionals from states of Uttar Pradesh, Andhra Pradesh, Madhya Pradesh, Jammu and Kashmir and Maharashtra sponsored by their respective governments. We also conducted a training programme for a delegation from Maldives sponsored by WHO.
Q. Can you tell us about the courses and the training programmes conducted by the School of Telemedicine? A. Keeping in view the slow acceptance
practice in urban, 23 per cent in semiurban and only 2 per cent in rural areas where the vast majority of population live. So, tele-consultation and telemedicine can help us in reaching out to the people in rural areas. Whereas in the US tele-consultation is more home-based for patients suffering from chronic or terminal diseases. In India, telemedicine is still not a part of healthcare system. Hospitals in cities especially metro cities which get patients from far off places should have telemedicine facilities. There are many benefits of telemedicine technology in follow up of patients after initial surgical treatment. Dropouts during follow up have been due to the fact that patients had to travel long distances after surgery. At SGPGIMS the Department of Endocrine Surgery started its tele-follow up programme as it gets patients from far off places due to non-availability of this speciality elsewhere.
of ICT in Indian hospitals we decided to make a modest starting. This year we will open admissions to a masters programme in Telemedicine and eHealth with specialisations in Telemedicine, eHealth, Biomedical Informatics, Hospital Information Management System, Public Health System and Health IT Management. Keeping in mind the needs of low-end working professionals we have also planned to start one year advanced diploma programme in the same. Both programmes will have 20 to 30 seats each. We will keep upgrading the curriculum as per the needs of the industry. There are many courses in the line like digital medical library, medical education content development, computer-based surgical training etc., but we are going to launch them only
Q. What is the scope of telemedicine in a developing country like ours? A. Currently, 75 per cent of the doctors
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PERSPECTIVE>>> ONLINE MEDICAL EDUCATION
‘Click-through’ CMEs harnessing Web-power in up skilling medical professionals
Launched nine years ago by Apollo Hospitals Group, ‘Medvarsity’ is the first and only medical training organisation in India offering an array of advanced online courses for doctors, paramedics, nurses and allied medical professionals. Dr. P S Reddy, VP (Operations) & Chief Content Officer, Medvarsity Online Ltd. talks with eHEALTH about the contribution made by this institute in introducing technology-enabled continuing medical education in the country and plans ahead to make it even better. Q. Medvarsity is known to be the only organization delivering online skill development courses in healthcare domain. Kindly let us know when and how did it start. A. Medvarsity was launched in October 2000 by Apollo Hospitals Group in association with NIIT Ltd as its technology partner, to provide the platform (interface) for online delivery of Medvarsity run courses. Medvarsity was an initiative to provide continuing medical education for doctors, nurses and other paramedical personnel with the sole aim was to impart learning without dislocating from his/her place of work. The online learning management system (LMS) adopted by Medvarsity is specially suited for this purpose.
Q. What courses are you currently offering under Medvarsity? A. Medvarsity offers variety of courses for doctors, nurses, paramedics and allied medical professionals. For doctors and medical graduates we offer - Diploma in Emergency Medicine, Diploma in Family Medicine; PG Diploma in Hospital Administration, Medical Informatics; PG Certificate course in Accident and Emergency Care, Pain Management; Fellowship in Intensive Care Medicine, Clinical Research, Cardiac Rehabilitation, Orthopaedic Rehabilitation, Neurological Rehabilitation, Applied Nutrition;
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Certificate course in Health Insurance, ECG, Diabetes Management, Cardiac Emergencies, Hospital and Medical Laws and Quality Management in Healthcare. For nursing graduates we offer - PG Certificate course in Nursing Administration, Critical Care Nursing, Cardiac Nursing, Surgical Nursing, Cancer and Palliative Nursing and Ward Sister course.
Q. What is the delivery mechanism of your online courses? How do you incorporate practical and/or hands-on experience for your students? A. Medvarsity follows a hybrid model - combination of both online and offline education. First part of the course requires self-study with assistance from online faculty and second part provides hands on practical exposure at Apollo Hospitals in different locations. Students are provided with learning modules in various formats such as web-based, on CDs, in print and instructor led. It is ensured that each module maintains the flow of the entire course and that appropriate format is used to enhance the overall learning in an effective manner. Progress of students is evaluated on a regular basis throughout the course.
Q. What is the level of industry acceptance for students graduating from Medvarsity? Which are some of the
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well-known organizations where your students are currently working? A. Medvarsity over the years has built a brand name for itself in the healthcare education field. With support of the Apollo Group Hospitals and Medvarsity branch offices spread across various cities, Medvarsity has grown leaps and bounds with thousands of students joining in every year. Successful candidates have been placed in reputed hospitals and other health care organizations. Many hospitals sponsor their employees to undergo our training as it suits them in not dislocating the employee.
Q. What are the future plans in terms of introducing new programs and more value added services through Medvarsity? A. Future plan of Medvarsity is to grow and expand in imparting online education in association with world leaders in online medical training. We have signed MoU with a British University to collaborate in imparting their courses through our e-learning platform and we are actively discussing with an Australian medical e-learning organization for mutual collaboration. Medvarsity aims to establish itself as a global educational body offering varied training options to the entire healthcare fraternity, including medical, paramedical and allied medical professionals.
NEWS REVIEW >> BUSINESS
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GE Healthcare and HCL form healthcare IT partnership
Philips announces Magnetic Particle Imaging technology
HCL and GE Healthcare, a leading provider of healthcare technology, announced recently a structured partnership to bring together HCL’s renowned business and technology services with GE Healthcare’s portfolio of healthcare IT software. The combination of the two industry leaders will enable current and future customers to utilise HCL for all aspects of their healthcare IT lifecycle – planning, deployment, customization, and ongoing maintenance. Through the partnership, GE Healthcare will certify HCL on its core healthcare IT offering ‘Centricity Enterprise’ and integrate HCL into its ‘Digital Day One’ effort which helps new hospitals in emerging markets open their doors as fully digital hospitals. “Making Digital Day One a reality will require a massive ecosystem, with systems integrators playing a critical role. To have an industry leader like HCL join forces with us is a significant step forward and a great endorsement of our approach,” said Laurent Rotival, Vice President and General Manager, GE Healthcare IT. “We’re aligned with GE’s vision and approach in every way and are proud to be their strategic systems integration partner,” said Shami Khorana, president for HCL Technologies for North and South America.
Royal Philips Electronics recently announced the first 3D imaging results obtained with a new imaging technology called Magnetic Particle Imaging (MPI). The technology, which uses the magnetic properties of iron-oxide nanoparticles injected into the bloodstream, has been used in a pre-clinical study to generate unprecedented real-time images of arterial blood flow and volumetric heart motion. This represents a major step forward in taking Magnetic Particle Imaging from a theoretical concept to an imaging tool to help improve diagnosis and therapy planning for many of the world’s major diseases, such as heart disease, stroke and cancer. The results of the pre-clinical study were published in issue 54 of Physics in Medicine and Biology (2009). The results obtained from Philips’ experimental MPI scanner mark an important step towards the development of a whole-body system for use on humans. Philips MPI scanners can perform a wide range of functional cardiovascular measurements in a single scan. These could include measurements of coronary blood supply, myocardial perfusion and the heart’s ejection fraction, wall motion and flow speeds.
Relisys and 2 Spring BV Netherland sign exclusive European representation agreement
iSOFT reports First Half Year Revenue Up by 168%
Relisys Medical Devices Limited, an India based integrated medical device manufacturer headquartered at Hyderabad, has successfully closed an Exclusive European Representation agreement with the Netherland based 2 Spring BV. RMDL has given exclusive representative rights for its wide range of OEM products covering coronary stents, peripheral stents, PTCA catheters, SDS, Guide catheters, Dx catheters, Intracranial micro catheters, neurology catheters, nephrology catheters, semi finished components and complex medical tubing’s including multiple lumen tubing’s, braided tubing’s and catheter tubing’s, balloon tubing’s to 2 spring, one of the leading service provider to the medical device companies in Europe. Dr. Krishna Reddy, Chairman of Relisys Medical Devices Limited announcing the agreement said, “The agreement is the first step in a strategic international marketing collaboration with Europe’s leading OEM partner. Relisys will enforce the collaboration with 2 Springs that enables us not only to exploit our finished devices but also take up contract manufacture as per the customer’s designs. Mr. Paul MD of 2Spring said, Relisys would be one of the unique companies which can offer a basket full of solutions for the device industry. We are very happy to see that Relisys had built one of the best facilities on par with international standards and are excited to work with them in the European OEM market.
iSOFT, an IBA Health Group Company, Australia’s largest listed health information technology company announced a revenue growth of 168% in its first-half yearly results ending 31 December, 2008. For the half year ended 31 December 2008, the total revenue of iSOFT on a standalone basis, stood at A$275.4 (US$176.7) million, up by 168% from the first half yearly revenue of A$102.8 (US$66) million. The company’s net profit for the first six months increased to A$10.3 (US$6.6) million, compared to a loss of A$1.1 (US$0.7) million in the previous corresponding period. Underlying EBITDA was A$67.5 (US$43.3) million, up 161% from A$25.8 (US$16.6) million. Executive Chairman and CEO of iSOFT, Gary Cohen said: “We have achieved profitable revenue growth in the first half, driven by solid recurring revenues across all our geographies. We are continuing to benefit from global investment in health IT by governments worldwide, and the computerisation of healthcare records”.
April 2009
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NEWS REVIEW >> BUSINESS
Siemens introduces eSie Touch - ‘breast elasticity’ technology for early detection of breast cancer Siemens Healthcare – known for bringing innovative medical technologies recently launched their latest ultrasound software feature ‘eSie Touch’ for early breast cancer detection in Mumbai.
The technology of elasticity imaging is the first in India for healthcare diagnostics, designed to add useful information for clinical management of breast cancer. The software introduced in India after its proven success in the US, will supplement the regular ultrasound breast examination for cancerous tissues and address early diagnosis of breast cancer amongst women in India. The unique technology is called breast elasticity, and by software called eSie Touch, the breast elasticity technique enhances the image quality to differentiate relative stiffness of tissues. It is a diagnostic tool available with ACUSON Antares - Siemens premium ultrasound system. Elasticity imaging within breast ultrasound imaging is poised to assist doctors to early detection and improve diagnostic efficiency. The technology eliminates the usual method of applying pressure on the breast to get better image quality. It also reduces the need for multiple biopsies.
Transasia Biomedical launches new Autoclavable Mechanical Pipette Range - Proline Plus Transasia Bio-Medicals Ltd. has launched a new autoclavable mechanical pipette range, the Proline Plus family (Erba Biohit Range manufactured by Biohit, Finland). The new Proline Plus pipettor has combined the basic functionalities of the traditional Proline mechanical with new, state-ofthe-art pipettor design and technology. Particular emphasis has
been put on safety, ergonomics, and efficiency in pipetting, as well as on the high quality of the device. The new Proline Plus is fully autoclavable, resistant to UV light and a wide range of chemicals and easy to maintain and calibrate. Additionally, the pipettors are equipped with replaceable tip cone filters that give additional protection against contamination. Proline Plus is available in both adjustable single and multichannel models and fixed volume single-channel models, in volume ranges from 0.1 µl to 10 ml. Like all other mechanical pipettors from Transasia, Proline Plus is CE/IVD marked and comes with a 3-year warranty.
GE Healthcare brings web-based imaging solutions to Asia GE recently unveiled a suite of Centricity solutions targeted for hospitals and outpatient imaging centers. Building on Centricity’s business process and advanced clinical capabilities, the suite provides the robust Webbased accessibility of IntegradWeb® solutions through the acquisition from Dynamic Imaging. With this, Centricity PACS-IW Solutions for hospitals will be able to offer Web-based portability, instantaneous image reporting and scalable business processes. This single-desktop solution will drive practice efficiency, productivity for the radiologist and immediate results access for the referring physician by fostering a more collaborative approach to patient care and provider partnerships. “Centricity PACS-IW is a one-stop destination that will take medical imaging to new heights of clinical productivity and collaboration without boundaries, said Clarence Wu, VP and Asia Pacific GM, said, GE Healthcare IT Solutions. April 2009
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ZOOM IN
Impetus of
Project Management in Healthcare
Everything we do now is based on the concept of ‘Managing By Projects’ or MBP, especially in health sector. In this scenario, it is absolutely essential to equip ourselves with knowledge of project management and its linkages with healthcare. Project Management (PM) is one of the fastest growing disciplines across the world. Very recently, Fortune magazine rated project management as the most preferred career choice among professionals. In order to enhance ‘knowledge value’ irrespective of the discipline one is associated with (such as - medicine, law, engineering, software, construction, consulting etc.) it is important to have a clear understanding of principles and practices of project management.
Prof. Indrajit Bhattacharya IIHMR, New Delhi
Winds of rapid globalisation and phenomenal transformation of the entire world to emerge as a single global village have made organisations and societies to become ‘projectised’...
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A project is a vision, a need, a dream or a strategy which need to be converted to reality through planned delivery of work. Project management helps us in effective and efficient accomplishment of this mission, by enabling better planning, implementation and control of events in pre-defined ways. Project management is the art and science of converting abstract into concrete, vision into reality and strategy into delivery. At every stage, we need to create value and deliver value. This realisation can be most effective through formal understanding of project management processes. To emerge as an independent discipline, PM need to have its own code of ethics and governance; standards and best practices; a Body-of-Knowledge; continuous research activities; and certification
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programs for people to display their understanding of fundamentals associated with the discipline – thankfully, PM is having all of these five ingredients. Though project management has been in practice since the beginning of the civilisation, its modern day interpretation is new. While general management encompasses aspects of planning, organising, staffing, executing and controlling, it is essentially applicable to operations of an ongoing enterprise. In contrast, project management principles are more specific to implementation of a specific project, which is unique and temporary, having a finite start and finish time and has all the associated problems and risks associated with it. Winds of rapid globalisation and phenomenal transformation of the entire world to emerge as a single global village have made organisations and societies to become ‘projectised’ in their functioning and operations. This happens due to the fact that in a globalised scenario, organisations need to be faster, better and more cost effective in order to survive and remain in business. In this new scenario, it is imperative to bring efficiency by reducing the total
ZOOM IN
‘CIPM’ program of IIHMR, New Delhi, with specialisation in Healthcare content
time taken from initiating a concept till its actual realisation. In 2001, Fujitsu, Japan had declared that “Project Management is the New Economic Infrastructure”. That is why, PM as a formal discipline is fast emerging as the key area of growth. Rosabeth Moss Kanter of Harvard University once said in the late 90’s, “There are two disciplines which would dominate the substantial part of 21st century… and one of them is project management.”
International Institute of Health Management Research, New Delhi (part of Society of Indian Institute of Health Management Research, established in 1984) has come up with its ‘Certificate in Project Management (CIPM)’ program. The course has been designed by some of the best PM professionals from the industry with years of rich experience. Based on a scientific approach, 8 Project Life Cycle phases are broken into 29 knowledge domains and further subdivided into 84 concepts, which are necessary to make the knowledge of project management both robust and strong. Each knowledge area is then further divided into various concepts that require mastery. CIPM is a special certificate in project management meant for all professionals across all sectors ranging from experienced persons to entry level persons. CIPM will provide extensive knowledge and skill of PM tools and techniques to all candidates to improve their management of both hard side of time, cost and quality, as well as soft skills required to manage changes effectively, address people issues like communication, team working, motivation, information management etc. CIPM training involves a fixed 45 hour internet based study program available round the clock from anywhere so that candidates can study at their own convenience. The 45 hours must be completed in 75 days from the day of course commencement. After completing the 45 hours of study, participants are offered a 1.5 hour objective, multiple choice computer based exam conducted by PMA-India, a not-for-profit registered society leading to CIPM certification.
ZOOM IN
Approaches in Project Management Traditional Approach The traditional approach of project management identifies a sequence of steps to be completed. These can be distinguished as 5 components (4 stages and a control phase) in the development of a project. These are - (i) Project initiation stage; (ii) Project planning or design stage;(iii) Project execution or production stage; (iv) Project monitoring and controlling systems; (v) Project completion stage. It is not necessary that all projects will go through every stage as projects can be terminated before they reach completion. Some projects probably won’t have the planning and/or the monitoring. Some projects may go through certain steps multiple times. Many industries utilise variations in stages to suit their specific need. For instance, in software development, this approach is often known as the ‘Waterfall Model (i.e. doing one series of tasks after another in linear sequence). In software development, many organizations have adapted the ‘Rational Unified Process’ (RUP) to fit this methodology, although RUP does not require or explicitly recommend this practice. Waterfall development can work for small tightly defined projects, but it is not very suitable for larger projects of undefined or unknowable scope.
projects spanning only a few weeks has been proven to cause unnecessary costs and low maneuverability in several cases. Extreme project management provides that much needed ‘lightweight’ model required in current circumstances.
Event Chain Methodology
Critical Chain Project Management is a method of planning and managing projects that puts more emphasis on the resources required to execute project tasks. It is an application of ‘Theory of Constraints’ to project management. The goal is to increase the rate of throughput of projects. Under this approach, system constraints for projects are identified as resources. To exploit the constraints, tasks on the critical chain are given priority over all other activities. Finally, projects are planned and managed to ensure that critical chain tasks are ready to start as soon as the needed resources are available, by subordinating all other resources to the critical chain.
Event chain methodology is primarily an uncertainty modeling and employs network analysis techniques to identify and manage events and event chains, which affect project schedules. Event chain methodology helps to mitigate the negative impact of psychological heuristics and biases, and also allows for easy modeling of uncertainties in the project. Event chain methodology is based on the following principles Probabilistic Moment of Risk: Estimation of the probability for a task getting affected by external events that can occur at any point in time. Event Chains: Measurement of the effect of chain of events on project schedule, determined through quantitative analysis for determining cumulative effect.
Extreme project management refers to April 2009
Critical Events/Critical Event Chains: Analysis of the effect of isolated events or event chains that bear maximum potential of affecting a project schedule and outcome. Event-based Project Tracking: Refinement of information about future potential events and future project performance, based on available data about project duration, cost and adverse event occurrence of partially completed projects. Event Chain Visualisation: visualisation of events and event chains using event chain diagrams (Gantt Charts).
PRINCE2
Critical Chain Project Management:
Extreme Project Management
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prescribing a set of day-to-day stakeholder practices (rather than very long drawn and elaborate plan) that embody and encourage value-creation through development of high capacity for change adaptation and gain in overall efficiency in the project work. Practice of extreme project management stems out of some critical research, which indicated that several fundamental models are not well suited for multiproject organisation environment of the present day, as most of them are aimed at very large-scale, one-time, non-routine projects. Use of complex models for
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PRINCE2 is a structured approach to generic project management. It provides a method for managing projects within a clearly defined framework. PRINCE2 describes procedures to coordinate people and activities in a project, ways to design and supervise the project and ways to adjust a project if it doesn’t develop as planned. In this method each process is specified with its key inputs and outputs and with specific goals and activities to be carried out. This gives an automatic control of any deviations from the plan. Divided into manageable stages, the method enables an efficient control of resources to carry out the project in an organised way.
Process-based Management: Process-based management furthers the concept of project control. This practice has been driven by the use of Maturity models such as the CMMI (Capability Maturity Model Integration) and ISO/IEC15504. This is based on principles of human interaction management in terms of a process view of human collaboration. This contrasts sharply with traditional approach. The project is seen as a series of relatively small tasks conceived and executed as the situation demands in an adaptive manner, rather than as a completely pre-planned process.
TELEMEDICINE ARTICLE SERIES: III
Appraising
Telemedicine Case studies Lessons and Challenges
This is the third in a series of six articles on telemedicine to be contributed by the authors.
Lieutenant Colonel Salil Garg Cardiologist, Command Hospital, Pune
higher. Some horizontal adjustments were required, but when the last piece was put into place and the braces released, it fitted perfectly, according to plan, and no one was surprised (Liggett, 1998). Although, the last and most visible span that connected the two halves received the maximum attention of onlookers, but success was actually related to how the original supports were positioned. , Just like the arch, telemedicine requires a careful process that includes systematic design and implementation. There will be success if all pieces of the plan receive the same attention as the most obvious.
Squadron Leader Mudit Mathur DD Space Ops, DSCC, Bhopal
Time goes, you say? Ah, no! Alas, time stays, we go – Henry Austin Dobson
On October 25th, 1965, downtown St. Louis stopped in its tracks and thousands watched as the last piece of the mammoth gateway arch was being put into place. Weight of the two sides required braces to prevent them from falling against each other. Fire hoses poured water down the sides to keep the stainless steel cool, which kept the metal from expanding as the sun rose
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Developing countries face various problems in the provision of medical service and health-care, including funds, expertise, resources, shortage of doctors and healthcare professionals. Widespread use of telemedicine services could allow universal health access. Telemedicine offers a range of solutions covering emergency medical assistance, long-distance consultation, administration, logistics, supervision, quality assurance, and continuous medical education and training... In developed countries, there has also been a growing interest in telehealth as a means to ease the pressure of healthcare on national budgets. Telecom and healthcare ‘’ providers can achieve synergies in order to deliver such services.
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The future has a way of arriving unannounced - George Will
Indian Case A number of initiatives are underway in the area of telemedicine in India. The primary objective is to provide quality consultation and caring for patients in areas where specialised patient care is not available. Although, telemedicine implementation remains in its infancy, interest and activity appears to be growing to provide consultation of a super-specialty doctor from a distance through videoconferencing along with exchange of medical records online. In addition to major support and thrust provided by Department of IT (under Ministry of Communications & IT, Govt. of India) through projects and systems, organisations like ISRO, reputed academic medical institutions like SGPGI, AIIMS, PGIMER, AIMS, SRMC and corporate hospitals like Asia Heart Foundation, Apollo Hospitals, SGRH, Fortis, Max etc. have taken and are continuing to take significant initiatives for installation of telemedicine systems at different parts of the country. The Department of IT (DIT) has taken a pivotal role in defining and shaping the future of telemedicine application in India. DIT has been involved at multiple levels – from initiation of pilot schemes to standardisation of telemedicine in the country. It has funded development of telemedicine software systems - the prominent ones
TELEMEDICINE ARTICLE SERIES: III
being Mercury and Sanjeevani software by C-DAC. DIT has also sponsored the telemedicine project connecting three premier medical institutions - viz. SGPGI-Lucknow, AIIMS-New Delhi and PGIMER-Chandigarh - using ISDN connectivity. These hospitals are in turn connected to other state level hospitals. In West Bengal, DIT has implemented telemedicine for diagnosis & monitoring of tropical diseases using low speed WAN, developed by Webel, IIT-Kharagpur and School of Tropical Medicine, Kolkata. The system has been installed in School of Tropical Medicine, Kolkata and two district hospitals. DIT has also funded establishment of an Oncology Network for providing Telemedicine services in cancer detection, treatment, pain relief, patient follow-up and continuity of care in peripheral hospitals (nodal centers) of Regional Cancer Centers (RCC). The project was implemented by C-DAC and RCC-Trivandrum. The Kerala OncoNET model has been replicated by DIT at RCC-Adiyar in Chennai with C-DAC’s Mercury Telemedicine Solution. Success of the cancer network in Kerala has encouraged the Ministry of Health & Family Welfare, Government of India to take major step towards launching National Cancer Care Network. Several state level telemedicine networks like Kerala state Telemedicine Network, Tamilnadu state Telemedicine Network, Haryana & Punjab state Telemedicine Network, etc. are coming up as pilot projects and have shown promising results. In addition, three state capitals in north eastern states of India are getting connected with super- specialty hospitals - one at Kohima, Nagaland is already operational. Another initiative linking one state level hospital each in Sikkim and Mizoram, with Indraprastha Apollo Hospital in New Delhi is an example of Public-Private Telemedicine Network that is in place and under effective use. In a short span of time, some progress has already been achieved in the field of telemedicine in India. However, there is still a long way to go. While there are over 20,000 PHC’s providing primary care services in rural areas, and about 500 district hospitals, telemedicine has
In a short span of time, some progress has already been achieved in the field of telemedicine in India. However, there is still a long way to go.
and connectivity issues has been felt. This paves the way for introduction of integrated telemedicine network in India. Fiber optic network of government and private telecommunication service providers are resulting in availability of high bandwidth terrestrial connectivity to build ubiquitous telemedicine network across the country wide at competitive price. Any change, even a change for the better, is always accompanied by drawbacks and discomforts - Arnold Bennett
CASE STUDIES
reached only about 100 centers with 50% of them in urban centers. If we were to look at a five-year horizon for telemedicine in India, efforts would be considered successful only if we have telemedicine reaching out to at least all district and taluka level hospitals throughout the country. But for this to be a reality, we need a major thrust from the government and private sector and help from International agencies. One of the key factors for success of telemedicine in India is going to be the reliability of telecommunication link. In this context, the ISRO Chairman has committed to provide free bandwidth for the purpose of telemedicine and tele-education. ISRO has been deploying satellite based telemedicine nodes in collaboration with state governments and has so far deployed around 250 nodes across the country. Ministry of Health and Family Welfare has set up a National Task Force to address various issues to promote telemedicine in the country and has launched a major country wide network of district hospitals and medical colleges under the Integrated Disease Surveillance Project. In addition, National Cancer Care Network and Medical College network are going to be implemented in the near future. Need for an over arching architecture/framework for the country covering 3 levels, namely, PHCs, district hospitals and referral/super-specialty hospitals and also covering hardware/ software requirements, bandwidth
Case1: A young physician posted at a zonal hospital in a remote location. was called one night to attend an ailing family who has come from a remote village in the mountains after traveling close to 24 hours. Three members of the family are already dead after consuming a wild variety of mushroom. and rest of the four are extremely sick. Being an exotic form of poisoning not much information is available in standard textbooks. No expert on mushroom poisoning or mushrooms is available. The last time anyone has seen mushroom poisoning was in 1966, and the experienced and benign doctor does not remember much of the treatment. Internet connectivity is still poor, the speed is slow and marred by frequent electricity cuts and unavailability inside the hospital campus. The nearest internet café is 4 to 5 kms away. The doctor loses another patient by morning. He rings up his brother in Bangalore who does an internet search for him and gives him the basics of the treatment. He is not a doctor but a software engineer and dictates the basics and management and of mushroom poisoning on the telephone. After this, he gathers all the information and and sends an entire set of printed documents by speed post. It reaches the doctor by next morning. By that time, the other three are critically ill but still on the road to recovery as most of the treatment has already been initiated. Fortunately, they survived. However, there is an epidemic of mushroom poisoning in the region and few people do die, due to lack of dissemination of information. Case2: The year is 2009 and there are April 2009
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TELEMEDICINE ARTICLE SERIES: III
two sets of patients in two different settings. One is a businessman in one of the satellite towns of Delhi, who complains of severe retrosternal chest pain. He is suspected of having a heart attack and calls for an ambulance from one of the large corporate hospitals. The ambulance is equipped with a telemedicine portal and an urgent ECG is taken which confirms the diagnosis. The ECG is transmitted to a cardiologist in real time on his mobile and he plans further management. The nearest catheterization laboratory is located and the estimated door to balloon time calculated. It is estimated to be more than 90 min and the patient is offered chemical fibrinolysis and taken up for an angioplasty later on. Two days later, he walks out of the Hospital, ready to work, with his myocardium saved, two intracoronary stents in place and few chances of being a chronic heart failure patient, in view of the myocardium saved. The other is a middle-aged labourer in the backwaters of Maharashtra, who presents with chest pain during the night. There is no transport, and for two to three hours he is treated locally as a case of acute gastritis in the hope that the pain would subside. As the patient continues to be symptomatic, he is shifted to a PHC, where the paramedical staff suspects him of having a heart attack. He is immediately transferred to a district level hospital, but he dies enroute. With him dies hopes and aspirations of a seven member family that he left behind. Case 3: Circa 2025. Rahul is manning a space station orbiting around the Mars. He is already a hundred and one years old. He has already undergone lens replacement in both eyes, restructuring of all teeth by orthodontists, a pacemaker implantation, multiple bioabsorbable stents in his coronaries and replacement of the lower spines, hip joints and knees with prosthesis and multiple skin management programs. The joints were titanium and had been covered with biomaterial that was very much akin to skin but more resilient and replaceable, all carried out by robotic surgeons and controlled by
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surgeons posted millions of kilometers away. He looks 35 years old. Previously, he had hypertension, which was now adequately controlled with a drug given once every five years and has had a pancreatic transplant that had cured his diabetes. He is still considered to be a high risk for stroke and a myocardial infarction which could not be modified completely even with gene therapy. When he suddenly had blurring of eyesight and weakness of the left side of the body the monitors in the spacecraft detected the change in parameters and ordered a full radiology scan in situ. The results were transmitted to the nearest doctor who was at that time orbiting Jupiter and a clot bursting drug immediately injected. Rahul survives and he does not have any residual impairment. Drugs were stocked in the spaceship on the basis of a pre
Problems • •
•
•
Telemedicine applications
High maternal and perinatal mortality rate. Need to improve maternal and child care. I Inadequacy of trained staff and very late identification of pathological pregnancies.
•
The maternity units in any region could be connected by a telemedicine link to the maternity service in a large regional hospital or to a referral hospital.
Very few doctors (particularly in rural and remote areas) have access to medical journals after graduation. Need for continued medical education accessible to as many health professionals as possible. Poor internal telephone system in most hospitals.
•
E-mail and Internet access for regional and rural healthcare centres and small hospitals. Connecting as many hospitals and healthcare centres as possible to a medical information system to derive benefits such as: improved standard of medical practice improved epidemiological and other reporting· continuous education for doctors and medical staff outside urban areas access to several worldwide medical databases through Internet. Modernisation of internal communication systems of hospitals for improving efficiency in healthcare delivery and providing a basis for introduction of telemedicine services.
•
•
I used to think that cyberspace was fifty years away. What I thought was fifty years away, was only ten years away. And what I thought was ten years away... it was already here. I just wasn’t aware of it yet. - Bruce Sterling
•
•
•
All the three case studies given above have been taken from real life. The first incident actually happened; the second case study is an everyday occurrence all over the world many times over. The third case scenario is just an imaginary glimpse of the future and maybe here before we actually expect it.
There is a severe shortage of healthcare professionals. Lack of competent medical specialists using state-of-the-art medical technology and other sophisticated diagnostic equipments. Lack of medical specialists and difficulties to obtain consultations between doctors in regional and remote hospitals with those in referral hospitals. The population living in rural and remote areas suffers from lack of healthcare.
•
•
operational mathematical probability. There has been a major debate for the last few years regarding the necessity for taking the concurrence of human doctors at all prior to medical management with a set of activists actually legislating to do away with doctors absolutely.
• •
•
• • • • •
Table 1
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Telemedicine links between hospitals and other medical institutions for improving healthcare services by centralisation and coordination of resources (specialists, hardware and software packages). Deployment of fixed or mobile telecentres, to bring telemedicine services to rural areas. Mobile telemetry service in remote areas using a small bus equipped with appropriate medical diagnostic equipments, a mobile satellite phone and a doctor.
TELEMEDICINE ARTICLE SERIES: III
Medical Approach Let us summarize the results and findings of telemedicine missions. What are the common and most urgent problems in developing countries which could be alleviated by using telemedicine? (Table:1)
Legal and Safety Issues Medico legal aspects of telemedicine are beginning to take a centre stage. Confidentiality in the transfer of electronic medical record is of prime concern. There is a debate on adequacy and accuracy of electronically transmitted data for establishing a correct diagnosis. Suppose, if due to technical malfunction, a patient’s data is not transferred correctly (e.g. image degradation in an echocardiogram or in a histopathology slide) it will alter the diagnosis. In this case, who will be held responsible - the attending physician? the hospital? the manufacturer/ distributor of the equipment? or the telecom provider? ATEL uses software that captures post consultancy details and authenticity of data is maintained through e-signature of doctors. Should there also be an acceptance from the patient’s side regarding limitations of technology. After all, caregivers are trying to do their best, with no wrong intentions.
STOPPING POINT “…Ever since my eye swelled up, I’ve gone to church three times a week to pray for a cure. As soon as I’m better I’m going back to thank God. I always knew He would send a way to make me better - I just didn’t know that it was going to be from London…” says Anna Mobutsu, a 23-year-old farm labourer, who cannot imagine taking a journey farther than a few hours’ bus ride from her home in the small African town of Nelspruit. As an illiterate single parent with a seven-year-old son and an elderly mother to support, Anna does not even have a television to introduce her to a world beyond her own. “…But this afternoon I went to London.” (The statement above is just one of many success stories on the adoption
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of Telemedicine in Africa). Telemedicine will continue to be a growing influence on the profession of medicine. The benefits of this innovation will be in two primary areas – medical benefits and cost benefits. First, telemedicine is a logical extension of the growth of the technical and technological aspects of health care. The medical benefits of an active telemedicine program are related to how professionals use the technology. Second, cost effectiveness is likely to be the most significant outcome of telemedicine. There will be substantial cost advantages for organisations that understand and utilise technologies effectively. Certainly, telemedicine is only one category of technology, but it may soon be the ‘ears and eyes’ of healthcare organisations. Dr Devi Shetty recently wrote in the Indian Heart Journal, “We have been running a chain of coronary care units and telemedicine centers in remote parts of the world and have treated over 22,000 heart patients in last 5 years. We use very basic technologies, and have realised that what makes the difference is people behind the services and not the technology they can use.”5 Every great advance in science has issued from a new audacity of imagination - John Dewey
This work provides the overview of the field of Telemedicine practices
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done by various experts and institutes. Author(s) take no claim in either designing the models or its concepts, however, direct integration of isolated work in the field of Telemedicine practices has been done in this article. Suitable cross references are marked.
References: 1.a) Clark, R. (1983). Reconsidering research on learning from media. Review of Educational Research, 53(4), 445-459. b) Grigsby, J. & Sanders, J. (1998). Telemedicine: Where it is and where it is going. Annals of Internal Medicine, 129 (2), 123-127. c) Kvedar, J., Menn, E., & Loughlin, K. (1998). Telemedicine: Present applications and future prospects. Urologic Clinics of North America, 25(1), 137-149. d) Liggett, R. (1998). A prescription for telemedicine. Telemedicine Today, October, 2. e) Simonson, M., Schlosser, C. & Hanson, D. (1999). Theory and distance Education: A new discussion. The American Journal of Distance Education, 13 (1), 60-75. 2. Michael Simonson, Program Professor, Instructional Technology and Distance Education 3. ‘National Rural Telemedicine Network Suggested Architecture and Guidelines’ ;Draft Proposal Version 1.0 ; Ministry of Health & Family Welfare, Government of India 4. Fenster,P. (2000). TeleMedicine. The Times, South Africa, Tuesday 14th March 2000 5. Telemedicine Indian Heart J. 2006 Nov-Dec;58(6)383.
SPOTLIGHT
Dental Implants
Safer, Faster, Permanent Solution for Tooth Loss Sameer Bhat, Country Manager, Nobel Biocare
A
s we age, some of us will lose teeth due to disease, injury, or simple daily wear. Traditionally, when a tooth was lost, the only fixed (non-removable) option for its replacement was a dental bridge. Bridges are constructed of metal subframes with tooth-colored porcelain applied to approximate the natural color of your existing teeth. These types of bridges are usually cemented to adjacent, healthy tooth structures, which serve as an abutment. Typically, conventional bridges require shaving a part of the healthy teeth adjacent to a missing tooth. A 3 unit bridge is then placed on these shaped teeth to support the artificial tooth. The goal of the bridge is to restore chewing function and achieve an acceptable aesthetic outcome. Apart from grounding down functional teeth, it provides potential for increased risk to the prepared teeth. There are some other disadvantages that dental bridgework can have like bone under the replacement tooth is no longer stimulated by chewing and is often resorbed into the body, creating a slowly growing gap between the replacement tooth and the gums. In addition, bridgework is connected Zto the adjacent teeth making flossing more challenging and long term success rates of bridgework tend to be low. Now, dental implants provide a more advanced replacement technology for a missing tooth than a traditional bridge. Dental implants eliminate the need for grinding down healthy teeth. Dental implants are small metal screws designed specifically to replace your natural tooth root. Manufactured from titanium, dental implants provide
a highly biocompatible surface like TiUnite, encouraging bone to attach to the implant during the healing process to ensure long-term results. Dental implants create stimulation to the underlying bone, enhancing longterm esthetics. Restoring your tooth with all-ceramic Procera components (crown and abutment) can result in a beautiful, natural-looking, translucent tooth, just like the rest of your teeth.
3 Unit Bridge- Traditional Option
Single Tooth Dental Implant There are many advantages of dental implants over fixed bridges. Dental implants preserve your healthy teeth as this process does not require to grid your adjacent teeth. They can be fixed with no change to the overall structure of the face or jawbone, as is often
the case when a tooth is removed. Dental implant hardly ever needs to be replaced since they are not prone to tooth decay or any other disease. These implants cost slightly higher than bridges but serves as a long-term solution for missing teeth, often for life. More and more people are benefiting from this life changing treatment of dental implants, which is a latest advancement in dental replacement technology. Lost or damaged teeth can now be quickly and easily replaced with a more permanent, natural looking and functional alternative than bridges or dentures. A Procera crown or bridge on Nobel Implants is a very common and effective solution for missing multiple teeth due to accidents or periodontal diseases. It prevents the teeth adjacent to the missing teeth from changing position and checks the jawbone from shrinking. So, the combination of Nobel Implants and Procera crowns looks and functions very much like natural teeth. They are useful in restoring a person’s natural appearance and assists in eating and speaking properly. Only Nobel Implants come with a global guarantee, necessary approvals and the right clinical backing. Also with the introduction of revolutionary dental technologies like NobelGuide software, it gives patient and dentist a chance to fix teeth with precision and is minimally invasive. Nobel guide procedure is also very well accepted by Diabetic patients since the patient doesn’t have to undergo any major surgery, no stitches and no painful procedures. The surgery is relatively painless and accurate. Dental implants can be called a safest route to a beautiful smile and self-confidence. April 2009
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NEWS REVIEW >> WORLD
Healthcare IT market in Asia-Pacific region sees strong SAP adoption
Careon & dbMotion join hands to tap eHealth market in Germany
SAP Asia Pacific recently announced strong adoption of its healthcare solution portfolio. Despite the current economic downturn, the company continues to see strong momentum in the healthcare sector. In a recent development, the much talked about ‘MediCity’coming up near New Delhi, in India, selected the SAP ERP ECC 6.0 application as its standard technology platform. “The new global centre will help integrate and explore pioneering frontiers in the field of medicine and healthcare. We believe technology will play a critical role in helping us achieve our clinical and business objectives”, says Dr Naresh Trehan, Chairman and Managing Director of Global Health, the company behind the MediCity project. In addition to MediCity, the rapidly growing SAP for healthcare customer base also includes leading healthcare institutions such as National Healthcare Group in Singapore, Ramsay Health in Australia among others. “We are witnessing a growing demand from the healthcare industry to better automate, streamline, and simplify businesses so that they can focus on their core mission of delivering quality patient care. Healthcare will be a priority focus for SAP in the years to come”, said Andy David, Industry Principal, Healthcare, SAP Asia Pacific Japan. To date, the SAP for Healthcare solution portfolio has attracted more than 2,300 healthcare institutions around the world.
Careon, Germany’s premier provider for personal health records and dbMotion, a prominent supplier of health interoperability and intelligence solutions, are partnering in the Germanlanguage eHealth market to meet the increasing needs for the exchange of medical information. This partnership brings together Careon’s expertise in the German market for personal health records (PHRs) with the proven technology of dbMotion, enabling Careon’s offering to be extended by dbMotion’s functionalities for cross-linking by physicians and hospitals. “The German market needs and regulations call for unique solutions for data and liability protection. Careon and dbMotion will, through this agreement, work together on common projects to deliver solutions to these needs, leveraging each of their individual product’s strengths,” said Dr Harald Sondhof. The SOA-based dbMotion Solution for health interoperability and intelligence enables healthcare organisations to meaningfully integrate and leverage their information assets, driving improvements in the quality, safety and efficiency of patient care. “Our team is experienced in health information exchange and has dealt with many of the data-sharing challenges that German healthcare organisations are currently facing. We see this important partnership as providing a truly innovative and beneficial approach to the needs of German healthcare.”” said Yuval Ofek, CEO of dbMotion.
InterSystems adds enterprise SOA to Ensemble InterSystems Corporation added innovative technology features to its InterSystems Ensemble rapid integration and development platform. Available immediately, the new capabilities, which include an HL7 Sequence Manager, target critical requirements of large-scale enterprises that are building highperformance, complex applications in an SOA environment. “Customers in multiple industries, including healthcare, financial services and telecommunications, are using Ensemble to build increasingly complex applications as they implement service-oriented architectures (SOAs) across the enterprise,” said Paul Grabscheid, InterSystems Vice President of Strategic Planning. “They need the most advanced security, monitoring and Web services performance to execute their SOA strategies and that’s what this rich, new feature set delivers.” The enhancements in this release ensure that organisations can use Ensemble to develop highly reliable and secure applications for SOA infrastructures.
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Siemens obtains full rights to the hospital information system i.s.h med Siemens Medical Solutions GSD GmbH, a wholly owned subsidiary of Siemens Healthcare Sector, will take over all use and exploitation rights of the software i.s.h.med, which are today held by T-Systems in Austria. The transfer is subject to customary closing conditions. i.s.h.med is a clinical information system that is fully integrated with the leading standard healthcare SAP software. The solution was jointly developed by the partner and forerunner companies of Siemens Medical Solutions GSD GmbH and the Austrian T-Systems. In the meantime, the software has become an important tool for planning, control, and communication for more than 300 hospitals in 16 countries worldwide. The complete transfer of product responsibility to Siemens allows us to directly introduce our future-oriented functionality like Smart User Interface, workflow, embedded analytics, and service oriented architecture into i.s.h.med, and implement our long-term development strategy for the product,” explains Stefan Herm, Head, Siemens Medical Solutions GSD GmbH and Senior VP, Health Services Europe Business.
NEWS REVIEW >> WORLD
Bumrungrad International wins Thailand Quality Class (TQC) award for organisational excellence Bumrungrad International, Bangkok, has been recognised for its world class organisational excellence by being awarded the Thailand Quality Class (TQC) award for 2008. Hosted by the Office of the Thailand Quality Award (TQA), the Deputy Prime Minister of Thailand, Korbsak Sabhavasu, presented this prestigious award to Mack Banner, CEO, Bumrungrad International in a highly decorative event. TQA, based on the famous Malcolm Baldrige Award in America, audits an organization’s strategic, management, and operational processes. Since TQA began in 2002, Bumrungrad International is the first private hospital to qualify for TQC.
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Singapore 14th & 15th May 2009
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Incorporating Lean in your laboratory, designing the perfect it and managing changes to determine success
Your eminent panel of speakers: Liz Jazwinska Executive Director - New Business & Strategic Alliances Johnson & Johnson Research, Australia CEO of SpeeDx, Australia Scott Hawks General Manager – Food Science & Quality Assurance Nestle, Singapore Prof. Philip Choo Chairman of Medical Board Tan Tock Seng Hospital, Singapore LEAN Champion of National Healthcare Group
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TECH TRENDS
Philips Neuro Perfusion Package (NPP)
software for brain care The brain is the most sensitive organ in human body and consumes the maximum amount of oxygen and other nutrients to keep it alive and healthy. Thus, the brain needs to be continuously fed with fresh oxygenated blood, whilst deoxygenated blood is flushed out. Any disturbance to the supply of oxygen or nutrients can irreversibly damage the brain, resulting in serious to fatal implications. There are many cases where this can fail… for instance, due to a heart attack, due to brain tumors, due to blood clots caused by hemorrhage etc. The ability to study the rate of flushing of brain with blood (called Neuro Perfusion) can be of great help for clinicians to correctly diagnose, detect and devise treatment plans for patients. Researchers at the Philips Innovation Campus in Bangalore have recently come up with an innovative software package called ‘Neuro Perfusion Package’ (NPP) to help doctors correctly detect brain abnormalities by analysing metabolic characteristics of brain tissue. S Bhaskaran, Senior Director, Philips Innovation Campus, Bangalore talks with eHEALTH about this innovative solution and its potential clinical applications.
S Bhaskaran, Senior Director Philips Innovation Campus, Bangalore
Q. What is Neuro Perfusion? The brain – like any other part of the human body - requires a constant supply of blood. This is achieved through a complex system of arteries and veins that spread throughout the cranial encasing to ensure that every part of the brain receives the blood supply it needs. The blood in turn supplies all the nutrients required by the brain to keep it alive and healthy. Not surprisingly the brain uses the maximum amount of nutrients per gram vis-à-vis any other part of the body. This is called Brain Perfusion or Neuro Perfusion.
Q. What are the techniques for measuring Neuro Perfusion? There are of course various quantitative techniques for determining the exact quantum of neuro perfusion. Neuro perfusion can be studied using Magnetic Resonance, Computed Tomography or Nuclear Medicine modalities. Let us take the
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TECH TRENDS
example of the MR modality. A contrast agent (eg. Gadolinium) is injected into the human body. The initial uptake of the contrast agent by blood vessels in the brain, till it is completely flushed out of the brain is of interest in this study. This gives us a number called the ‘Cerebral Blood Volume’ (CBV). A specific slice of the brain is examined using the MR scanner - starting from the moment the contrast agent starts entering this slice of interest, till it is completely flushed out again. All of this is done automatically by the clinical software package – NPP or Neuro Perfusion Package. The CBV in various regions of the brain are compared. The clinician can then determine if any specific region of the brain has more CBV or less CBV than the normal condition. If such an abnormality exists, the clinician can determine the cause and recommend corrective steps.
The second is the case of a tumor inside the skull. The tumor needs additional blood to continue to live and grow. This is achieved by a process called angiogenesis which promotes the growth of additional blood vessels that supply the tumor with the required nutrients. Obviously the part of the brain which houses the tumor will have an above normal CBV. The clinician can then quickly do a more detailed examination of this part of the brain to decide on the best course of action.
Q. What clinical inferences can be drawn on the basis of neuro perfusion study and under what conditions it needs to be monitored and/or controlled? There are of course many possible infections and injuries that a brain can be subjected to. And of course not all cases can be detected by a Neuro Perfusion Package (NPP). What can however be detected are those events that impact the quantum of blood being supplied to a specific part of the brain. Let us discuss two such examples. The first example is that of a blood clot. A blood clot can develop within the brain or a clot can travel from other parts of the body and embed itself in the arteries supplying blood to the brain. This can lead to one of two situations. Either the part of the brain supplied by the blood vessel is starved of blood and dies. Or the blood vessel bursts because it is incapable of withstanding the pressure of the blood building up behind the clot. This causes a flooding of that part of the brain with blood. This typically leads to all the symptoms of a stroke. In both situations, the CBV value changes and can be detected by a Neuro Perfusion Package. The clinician again can determine the exact course of action based on the quantitative data provided by the package.
Q. How does the Neuro Perfusion Package (NPP) developed at Philips Innovation Campus promise to improve clinical outcomes? The ultimate goal of any clinical application package is to: • Provide accurate information to the clinician – reduce false positives and negatives. The pathology, if it exists, must be recognised by the application and no extraneous artifacts must be recognised as pathology. • The protocol must be reproducible - there are two aspects to any clinical application package, the actual protocol of the image acquisition itself (that is the imaging of the patient) and the translation of the raw data to clinically meaningful information. If neither of these steps is reproducible, the protocol will have little impact on clinical outcomes. • It must be simple for the clinician to use – independent of how complex the application/protocol
itself, the clinician must never lose focus of the patient. The NPP satisfies all these conditions. It is accurate, repeatable and extremely simple to use. The radiologist needs very little additional training to be able to use the package.
Q. For how long did your research in this application go on before you came up with the application? Besides PICBangalore, did any part of the R&D happen elsewhere as well? It is difficult to determine the exact amount of time required to come out with any new clinical package. Typically the concepts come from our research labs or from luminary clinical research sites. These are then converted to preclinical packages before clinical trials can start. It is only after this phase can an engineered package be delivered to the open market. Thus many companies, research institutes, clinical labs, doctors and engineers are involved before it hits the market. Only the most simplistic of clinical packages can be the outcome of any one company’s endeavor. PIC Bangalore was involved in engineering the current version of the product as is sold in the market.
Q. Is NPP already available in the market? What are the target clinical specialties where it can have potential use? Yes, it is available in the market. The target is typically the study of Oncology related events in the brain. Conditions such as angiogenesis around a tumor can be easily determined through this technique. The other situation would be in cases of blood clots leading to a starvation of a part of the brain.
Q. What other cutting-edge research are undergoing at your campus? We have quite a few research programs underway at any point in time. And across all modalities. Some of the other packages that we have already released for commercial purpose from out of our lab include: • MR Packages: Functional MRI. • CT Packages: Bone Mineral Density Analysis Package. • NM Packages : Multigated Acquisition for Cardiac Applications. April 2009
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DEVELOPMENT DIMENSION
A ‘Private’ Affair
analysing the need for private sector in Indian healthcare system Increased privatisation of Indian healthcare system would not only be beneficial for up gradation of medical facilities of the country but will also be beneficial for the poor and common people. It will also attract foreign investment and will able to keep the physicians staying in the country motivated.
P
Kadri SM Regional Institute of Health and Family Welfare, DHS, Srinagar, Kashmir, India
rivatisation is the process of transferring ownership of business from the public sector to the private sector. In a broader sense, privatisation refers to transfer of any government function to the private sector1. In terms of healthcare, it refers to providers who exist outside the public sector, either commercial or charitable. The private sector thus includes both ‘for profit’ hospitals, nursing homes, physicians, private commercial contractors/agencies, and ‘not-for-profit’ charitable institutions, industrial establishments, community associations or citizen groups. Types of health services include clinical or non-clinical services, either in hospitals or mobile services, in rural and urban areas. They also include preventive health care (e.g. antenatal care, institutional deliveries, immunisation, post-natal care etc.) and health promotion programs (e.g. IEC and health education activities). Stakeholders in both sectors include patients, doctors, medical associations, administrators, contractors, private entrepreneurs, NGOs, charitable institution and community leaders.
Danish Ahmed Research Scholar, University of Delhi Medical School, New Delhi, India
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April 2009
Over the years, private health sector in India has grown phenomenally. As financial constraints erode capability of the public health system, the poor are forced to spend out of pocket to seek healthcare from private sector. India has one of the largest numbers of public health institutions in the world. In 1999 there were 137,000 sub centres, 28,000 allopathic dispensaries, 23,000
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primary health centres, 3,500 urban family welfare facilities, 3,000 community health centres and 12,000 secondary and tertiary hospitals.2,3 However, public institutions have not been able to deliver healthcare services at the desired quality and efficiency4. A large proportion of population continues to suffer and die from communicable diseases, pregnancy related complications and malnutrition. It is estimated that 80% of spending on health in India is out of pocket and that the private health sector in India is worth 500-600 billion Indian rupees, which is around 5% of the GDP - one of the highest in the world. It is also estimated that 93% of hospitals, 64% of beds, 80% of doctors, 80% of outpatients and 57% of inpatients in India are accounted for in the private sector.5 The private health care provides 79% of outpatient care for those below poverty line, much of which is of low quality and the payment is primarily out of pocket 6. The nature of private sector itself has changed a lot in the last few decades. Until mid-70s, hospital services were predominantly in the public domain and even within private health sector, large hospitals were mostly in the notfor-profit or charitable sector. For profit private hospitals were primarily small nursing homes. However, huge growth in number of specialists in mid-seventies changed the scenario completely and by the mid-eighties the for-profit private hospitals came in limelight. With rapid changes in medical technology, the corporate sector recognised new emerging opportunities, and thus,
DEVELOPMENT DIMENSION
starting early ‘90s, private healthcare sector started expanding with in-flow of huge investments. India is emerging as a favourite destination for medical tourism. Medical education was almost entirely public until late ‘80s, after which, private medical schools started getting established, especially in southern Indian states like Tamil Nadu and Karnataka. Public medical schools contributed significantly to the growth of private sector. An average of 80% of medical graduates entered private practice or migrated out of country.5 With a billion plus people, India is the second largest country in terms of population. Providing basic services and amenities to its citizens is a constant challenge. This leads to the creation of two groups – ‘haves’ and ‘have nots’ in terms of access to primary healthcare. Most of the basic government healthcare schemes are unable to reach the people who are in need. The functioning of most clinics that are situated in rural areas is inadequate to serve their immediate vicinity. The penetration of quality primary health care to rural areas is also plagued by lack of skilled and professional workforce.
The choice of convenient timings, treatments and costs - though these factors can be limited in both private and public sector settings. Thus, privatisation has helped improve health services – their type, scope, quality and consequences.
Disadvantages of Privatisation •
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Advantages of Privatisation •
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Convenience: The private sector is perceived to be easily accessible, better managed, and more efficient than its public counterpart. Individualised care is obviously easier in private than in public sector. Freedom of choice: In private sector one can choose both the doctor and the time and place of his/her treatment. In certain conditions the patient may even choose the treatment method. This is especially true for surgery where more than one option is available, such as choice of laparoscopic or open surgery available these days. Service quality: A privatised health care system can provide better nursing and allied services. It can provide better facilities for attendants. Patients and their relatives are not neglected and ignored and treated with dignity and respect. April 2009
•
•
•
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High cost: Privatisation will increase the cost of healthcare in the country thus depriving poor people from access to healthcare. This will increase the divide between rich and the poor and denial of the right to health, and undermine the state’s responsibility in providing basic healthcare to citizens. Profit motive: National preventive programmes get neglected in private health sector as they are more focussed on curative aspect of health because of higher profits in curative treatment than preventive side. Quack practitioners: There would be increased dependency of poor people on quacks and superstitious methods of treating medical problems. Quack practitioners can undermine healthcare, by spreading communicable diseases like AIDS and Hepatitis-B, and will often provide inadequate guidance on the use of drugs, thus increasing drug resistance.7 Drug Resistance: Irrational use of anti malarial drugs by private practitioners and easy availability of these drugs in pharmacy (without prescription) has created lot of difficulty in national control program for Malaria. India is facing a big challenge due to resistance to different forms of anti malarial drugs and same is true for Tuberculosis (resulting in multi drug resistant tuberculosis - MDR TB and extremely drug resistant tuberculosis - XDR TB)9 Unnecessary/Over Medication: Private sector stress on procedure-oriented medicine. Wellconsidered, comprehensive advice is bypassed for a computerised laboratory test, resulting in the loss of the human touch. Lack of Staff Development: Small
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•
•
•
and medium segment private providers give little emphasis in training and development of their staff because of the cost involved. Lack of accountability and transparency: Many of the private sector initiatives involve high cost and incur large public debts. Thus many of these development also meant debt-led development -through political patronage, causing unsustainable lending and un-recoverable debts without commensurate benefits10 Inaccessibility for rural population: Most private hospitals in India are situated in urban areas and especially in towns and cities. This is primarily driven by the profit objective involved in it and also because of the fact that it urban areas provide better infrastructure and higher patient pool. Thus, it creates barrier in terms of access for rural people. Lack of Accreditation: Most private hospitals in India are not accredited and do not have a proper practices in place – such as, quality and safety systems, waste management system etc. This causes medical malpractice, errors, public distrust and bio-hazards. Same is true of private laboratories that are not following the proper guidelines for laboratory waste disposal. Inadequately qualified paramedics: Employment of less qualified paramedics is in vogue in private sector hospitals as they serve as a source for cheap labour.
Conclusion Medical care in India as it is today is a study in contrasts, typical of countries that have promoted segmentation in healthcare - expensive private care catering to rich and poor quality public-funded care for the poor. When poor people are forced to seek private medical services they face lot of financial problems. More than 40 per cent of patients admitted to hospitals borrow money or sell assets like land and house. 25 per cent of farmer families having a member who is in need for medical care are below the poverty line11.
DEVELOPMENT DIMENSION
As per the National Health Policy, 2002, the government will support medical tourism. Promoting of such services will bring foreign exchange for the country, which will be treated as deemed export and will be made eligible for incentives extended to export income12. Running private medical colleges is a profit making business, but the standards of education have fallen, especially at the undergraduate level. There exists no significant regulation and specification of standards of care for private medical sector and since it is now the dominant player, the absence of regulation is very risky for its clients. Hence, the private health sector has to be reined in through comprehensive regulation, which needs to be facilitated through the legal route.13 However, privatisation of healthcare in India should be encouraged as it would increase the overall standard of healthcare in the country. It will ensure a healthy competition among corporate hospitals for upgrading and providing better medical facilities to their clients. The National Accreditation Board for Hospitals (NABH) has signed a memorandum of understanding with Australian Council on Healthcare Standards (ACHS) for assistance and technical advice on upgrading quality program for meeting global standards for health clinics and medication centres in India. Such a move will make sure that Indian medical institution get recognition worldwide. In recent years, India experienced a growth in medical tourism because of the cost advantage for overseas patients and a high level service quality provided by some of the top-of-line corporate hospitals. Getting the private hospital accredited to various world health standards would add voice to it. Privatisation of healthcare in the country will attract healthy foreign investment and raise the pay package of physicians keeping them motivated to stay in the country – resulting in lesser brain-drain. The other aspect of privatisation will be education, research and training
of staff. Increase in number of private hospitals would also mean the need for more physicians which could be met by the growing number of private colleges and more funds for medical research.
References 1.
2. Maintenance, up gradation and hygiene levels of hospitals will be better under private sector. This can also help the poor if private hospitals can be made to provide some free basic medical facilities to needy sections, as a part of corporate social responsibility.
3.
Recommendations •
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•
•
•
•
Enforcement of strict ethical regulation for setting of private hospitals - as lot of small private hospitals do set up infrastructure by flaunting basic rules. Even most laboratories do not conform to bio-safety standards - the consequence of which can be dangerous, as escape of pathogens into the environment can be catastrophic. Enforcement of biomedical waste disposal system - there should be dedicated infrastructure and professional team working on safe disposal. Accreditation should be made mandatory for private sector. Designing of labs and facilities should be done transparently and government authorities should reserve the right to inspect their labs and make sure that they have been done in accordance with accepted norms. Government should also monitor that staff selection is done transparently and under-qualified staff is not employed. Private sector should be obliged to facilitate primary and preventive healthcare and public health initiatives of the government to strengthen healthcare infrastructure of the country. Government should subsidise treatment of poor people in private hospitals and make it mandatory for corporate hospitals to spend a part of their profits in up gradation of existing facilities and rendering free basic healthcare services as a part of their corporate social responsibility.
4.
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Chowdhury, F. L. ‘’Corrupt Bureaucracy and Privatization of Tax Enforcement’’, 2006: Pathak Samabesh, Dhaka. Björkman, JW. 2001. Multiple Systems, Multiple Reforms: South Asian Health Policies in Comparative Perspective in Handbook of Global Technology Policy edited by Stuart S Nagel. New York: Marcel Dekker, Inc. Pages 167-220 Björkman, JW and Kuldeep Mathur. 2002. Policy, Technocracy and Development: Human Capital Policies in India and the Netherlands. Delhi: Manohar Publishers. Public Health and Security : Global concerns http://policy. gmu.edu/oimp/courses/studentpapers/spring2004/sp04_04.pdf http://www.icrier.org/publication/Working%20Paper%20198. pdf World Bank. 2001. India - Raising the Sights: Better Health Systems for India’s Poor. (Report no. 22304, HNP Sector-India) Washington, DC Vineet Gupta . Privatisation of Health 2000 http://www.geocities. com/insaafin/Keyproblems.htm Government of India :Conference on Tuberculosis control .Central TB division , Directorate General of health services , Ministry of Health and family Welfare 1997 XDR TB :A serious Threat to India 2004 http://www.medindia. net/news/view_news_main. asp?x=21180 Human development Report 2005 :http://www.devdata.worldbank. org accessed on 4th April 2008 Health, Nutrition, Population Sector Unit India South Asia Region. Raising the sights: better health systems for India’s poor. Washington: World Bank; 2001. Ministry of Health and Family Welfare. National Health Policy, 2002. Available from: http://mohfw.nic.in Abhay Shukla and Ravi Duggal Health System in India Source Book, 2nd Ed. 2004.
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Addition of each hospital bed creates 30 new direct and indirect employments. Nearly 50,000 angioplasties are currently conducted each year in India. Health insurance industry of India is worth only 5% of the potential market.
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