Rejuvenating US Healthcare System: April 2010 Issue

ET Medical Devices, Italy announces JV with Trivitron

SoftLink signs a deal with Magnum Heart Institute

The Monthly Magazine on Healthcare ICTs, Medical Technologies & Applications Volum e 5 | I s s u e 4 | A P R I L 2 0 1 0 | I N R 7 5 / U S D 1 0 | ISSN 0973-8959

“We are now a nation of connected people” Sam Pitroda Advisor to the Prime Minister Government of India PAGE 8

“The Government is seriously engaged in developing an indigenous medical device industry” Dr. T Ramasami Secretary, Department of Science and Technology, Government of India PAGE 12

‘Monitoring’ the Growth ‘Signs’ Divya Chawla Principal Correspondent eHEALTH PAGE 18

Patient Care at Hospitals Redeﬁned through Process Optimization Tajinder Vohra Sr. Vice President, Genpact PAGE 25

“We bring in domain-led and technology-supported business solutions to healthcare” Arun Gupta Director, Healthcare, CSC in India PAGE 36

www.eheal t honl in e . o r g

C ov er Story

Rejuvenating

US Healthcare System Pg . 1 4

Can we help make the Hospital Paperless?

Certainly!

CONTENTS w w w . e h e a l t h o n l i n e . o r g | Volume 5 | Issue 4 | April 2010

8 | SPOTLIGHT

18 |

“We are now a nation of connected people”

ISSN 0973-8959

TECH TRENDS ‘Monitoring’ the Growth ‘Signs’

Divya Chawla, Principal Correspondent, eHEALTH

Sam Pitroda, Advisor to the Prime Minister, Government of India

25 | 12 | IN FOCUS “The Government is seriously engaged in developing an indigenous medical device industry” Dr. T Ramasami, Secretary, Department of Science and Technology, Government of India

PERSPECTIVE Patient Care at Hospitals Redefined through Process Optimisation Tajinder Vohra, Sr. Vice President, Genpact

29 |

ZOOM IN Optimising Claims Management in Health Insurance

14 | COVER STORY

Divya Chawla, Principal Correspondent, eHEALTH

Rejuvenating US Healthcare System EVENT REPORT

32 |

Investing for a healthy future

48 |

Transforming Healthcare with IT

36 |

IN CONVERSATION

eHEALTH Healthcare Investment Summit 2010

“We bring in domain-led and technology-supported business solutions to healthcare”

Arun Gupta, Director, Healthcare, CSC in India

38 |

SPECIAL REPORT Union Budget 2010-11 Roadmap for Healthcare in India

Saba Firdaus, Research Assistant, eHEALTH

42 |

NEWS REVIEW

44 |

DEVELOPMENT DIMENSION Key Considerations while Replacing your Current IT Solution Tushar Ratanghayra, Senior Consultant, 21st Century Healthcare Management Solution Pvt Ltd.

April 2010

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InBox “Please accept my hearty congrats on successful completion of 40 issues of eHealth magazine! During the last 24 issues of my association with the magazine and my participation in the activities of the CSDMS Group, I have perused each and every article of the magazine and benefited a lot professionally from the content of the magazine, information in emails,newsletter received, and events organized by the Group. I wish you all the best for your future endeavors and look forward to continuous professional association.” Gp. Capt. (Dr.) Sanjeev Sood NABH Qualified Assessor Certified Healthcare IT and Quality Assurance Consultant Hospital & Health Systems Administrator SMC, Air Force Station

“Congratulations to you and your team on the release of your 40th issue. This is too wonderful a moment and I guess all your efforts have started giving dividends.” Dr. Vijay Raaghavan Consultant Medium Healthcare Consulting Pvt. Ltd.

April 2010

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EDITORIAL Volume 5 | Issue 4 | April 2010

Hail Obama! The US Healthcare reform bill secured by Obama administration has given all reasons for exhilaration to the American population in particular and the healthcare community in general, across the globe. This is such a wonderful news for the healthcare scenario that it could not be bereft of attention and hence we have decided to capture the various features of the bill in the cover story of this issue. The remarkable victory of Barack Obama is definitely going to bring a renaissance of healthcare reforms in American society and specially for that section of the society that was surviving without any health coverage. The overhaul will extend health coverage to 32 million Americans, expand the government health plan for the poor, impose new taxes on the wealthy and bar insurance practices such as refusing to cover people with pre-existing medical conditions. This is a major step for a lot of middle class Americans who face bankruptcy because of unpaid health bills. Health insurance is not a developed sector in India and has till now taken a backseat among all health related reforms. But one thing sure from the American example is that there is need of government and the state machinery to intervene in health industry to ensure good quality healthcare to the citizens at an affordable price whether it is through insurance or simply primary health needs. But no one can deny that even in the best of worlds, drastic reforms in healthcare is the need of the time. In India, the approach towards healthcare is multipronged. On one hand where the government is trying to strengthen primary healthcare needs of the rural masses as reflected in the current budget through policies such as National Rural Health Mission, Janani Suraksha Yojana, Rashtriya Swastya Bima Yojana, etc.; it is also focussing on tertiary care which encompasses healthcare IT, medical equipments and technology, patient care, hospital modernisation and insurance. Significant efforts are being made in all these directions and the outcomes are awaited. We did an exclusive interview of Sam Pitroda, Chairman, National Knowledge Commission and Principal Advisor to the Prime Minister to know the policy initiatives of the government for integrating IT in public healthcare and towards developing a strong health IT infrastructure for rural India and shares insights about future initiatives in this sector. Medical technology is also gaining ground and Ministry of Science and Technology is actively engaging in bringing about a revolution in medical implants and devices in India’s healthcare. Dr. T. Ramasami, Secretary, Government of India shares his perspective on the medical technology innovation and the initiatives taken by his Ministry for development of the medical equipment and device industry in India. This issue also covers in length about the latest cutting-edge patient monitoring technologies and claims management in insurance which is now gaining momentum in India and has a huge potential for growth with almost 85 percent people uninsured. Happy reading!

Dr. Ravi Gupta Ravi.Gupta@ehealthonline.org President: Dr. M P Narayanan | Editor-in-Chief: Dr. Ravi Gupta Product Manager: Dipanjan Banerjee (Mobile: +91-9968251626) Email: dipanjan@elets.in Editorial Team: Dr. Prachi Shirur, Dr. Rajeshree Dutta Kumar, Shipra Sharma, Divya Chawla, Sheena Joseph, Yukti Pahwa, Sangita Ghosh De, Subir Dey, Dinoj Kumar Upadhyay, Pratap Vikram Singh, Gayatri Maheshwary, Saba Firdaus Sales & Marketing Team: Arpan Dasgupta (Mobile: +91-9818644022), Bharat Kumar Jaiswal (+91-9971047550), Debabrata Ray, Anaam Sharma, Fahimul Haque, Ankur Agarwal, Priya Saxena, Vishal Kumar, Gaurav (sales@elets.in) Subscription & Circulation: Astha Mittra (Mobile: +91-9810077258, subscription@elets.in), Manoj Kumar, Gunjan Singh Graphic Design Team: Bishwajeet Kumar Singh, Om Prakash Thakur, Shyam Kishore Web Development Team: Zia Salahuddin, Amit Pal, Sandhya Giri, Anil Kumar IT Team: Mukesh Sharma, Devendra Singh | Events: Vicky Kalra Editorial Correspondence: eHEALTH, G-4 Sector 39, NOIDA 201301, India, tel: +91-120-2502180-85, fax: +91-120-2500060, email: info@ehealthonline.org does not neccesarily subscribe to the views expressed in this publication. All views expressed in the magazine are those of the contributors. Themagazine is not responsible or accountable for any loss incurred, directly or indirectly as a result of the information provided. is published by Elets Technomedia Pvt. Ltd in technical collaboration with Centre for Science, Development and Media Studies (CSDMS) Owner, Publisher, Printer - Ravi Gupta, Printed at R P Printers, G-68, Sector-6, Noida, UP, INDIA and published from 710 Vasto Mahagun Manor, F-30, Sector - 50, Noida, UP, Editor: Dr. Ravi Gupta

April 2010

SPOTLIGHT

“We are now a nation of connected people”

Sam Pitroda Advisor to the Prime Minister Government of India

An inventor, entrepreneur and policy maker, Sam Pitroda spearheaded the communications revolution in India. He has been internationally acclaimed for using telecommunications in building the nation. A lot of his initiatives have been aimed towards bridging the global communications divide. In an exclusive interview with eHEALTH, Mr. Pitroda throws light on some of the key aspects of development of a strong health IT infrastructure for rural India and shares insights about the future plans of the Government in this sector. 8

April 2010

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April 2010

How do you plan to improve rural health by taking IT to the village level? I have great hope, today, because finally, we are a nation of connected people, which is a landmark in itself. How to capitalise on this, now, depends on us. It took us twenty years to achieve the first big step, which is to connect everybody. We, now, need to think about the next big step and decide whether to follow the same path or do things differently. The main challenges lie in how to structure all steps and improve health and education in governance and make a substantial dent in it. The content does not need to be created with the help of information technology, because that has already been done. The key challenge is to create the infrastructure. We first need to make sure that adequate broadband connectivity is available, because as video plays a great role and it demand good broadband connectivity. We, also, need to take broadband to the panchayat level. With this infrastructure in place, I believe the change has already begun. Panchayats across the country require good broadband connectivity and in every panchayat office, there should at least be two bright youngsters of the local level, who can organise everything.

What initiatives are being taken by the Government for development of an IT infrastructure in rural areas? We, already, have fibres in place by companies such as BSNL, MTNL, Bharti, Reliance, Tata, and many others. All these companies have their independent fibre networks and it does not matter whether they are public or private because they all chip in. The predominant vendor in this space is BSNL, simply because they have the reach. One of the primary steps that we are now undertaking is to map all these networks in GIS to track the gaps. Further, we need to go to all 450,000 panchayats to understand the additional requirements. Once this is done, we will be able to have a clear picture on what exactly is required and this is the key exercise we are doing right now.

April 2010

How does the Government plan to fund these initiatives? Fortunately, we currently have a lot of cash lying with the Universal Service Obligation (USO) fund, which amounts to almost INR 18,000 crores. Every year, almost INR 6,000 crores is being added to this fund by the telecom companies because they are not being able to meet their obligations in the the rural areas. We are now looking at using this fund for development of IT services in the country.

In spite of the high healthcare spend in the US, the country is struggling in this area. How can India learn from this and have good reforms in place? I can answer this question, based on my personal experiences. Unfortunately, I have a number of diseases and everytime I go to a hospital, I spend a lot of unnecessary time on giving my personal and health details. Each hospital visit requires a lot of protocols to be followed and the process becomes very time consuming. For getting tests and check-ups done in various departments generate several bills as each department is only concerned about making their bill. Further, the reimbursements on these bills are covered differently, which causes a lot of chaos. In the US, things became unmanageable because they had a vendor-driven system and there were no standards in place. With all due respect to all experts in the US, the situation was not being approached in the right manner. As a patient, all I need to know is details about my medications, doctors, allergies and where my data resides. It is useless to provide all these details each time I visit a hospital. Implementation of IT can be the only solution to all these problems. With the help of IT all personal health records, of a patient, can be maintained electronically. This will specially help in the case of emergencies, where with the help of instant access to a patient’s health records the care provider can provide timely and effective

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treatment. In my point of view, this is a simple approach and not rocket science, but still nobody is doing this. IT implementation will help in uncomplicating a patient’s life to a great extent. These are my views as patient, and not as an expert. There is also a need for health related information to be available through mobile. The general view is that whatever is good for the US, is good for all, but this is not true anymore.

Can the Government consider making electronic health records mandatory, in the country, to address these issues? It is important for electronic health records to be simple and not complicated, which is not the case in the US. The number of protocols followed while creating and using an electronic health record in the US, only confuses the patient. There is a need to have a simple set of electronic health records and a set of specialist health records, which the doctors can use to tag health information of different patients, which is a critical component.

Is the Government looking at setting aside some part of the healthcare budget for the development of healthcare IT in India? We want to have a complete IT infrastructure for the country. Healthcare infrastructure will be virtual. We will provide broadband connectivity and all physical infrastructure will be shared by health IT, without having them pay for it because it will be a virtual network.

How do you see the future of health IT in India? In India, there is a lot of enthusiasm and talent and we need to mobilise this for the development and improvement of IT services. There is a need to start collecting data. We already have working groups in place that have set up infrastructure on health portal. More people now want to join these working groups. I am confident that by the end of this year we will have a plan in place.

April 2010

IN FOCUS

“The Government is seriously engaged in developing an indigenous medical device industry” As the Secretary of Department of Science and Technology, Government of India, Dr. T Ramasami, has been actively engaged in the development of policies and programs for science and research activities. In an interview with eHEALTH, Dr. Ramasami talks about the initiatives of the Ministry of Science and Technology towards proliferation and development of medical implants and devices and the overall growth of the medical technology innovations in India. Excerpts from the interview. Please share your perspective on the importance of medical technology innovation in India. In recent years, it has become increasingly evident that the healthcare industry has become very strongly dependent on biomedical instrumentation and engineering devices and products. In the past, healthcare was primarily in the hands of medical professionals and had more of a biological orientation and the interface between engineering and medicine was weak in our country. Today, our healthcare systems are improving but the question, whether healthcare is accessible to all, still remains unanswered. This would become possible only when the implants, the biomedical devices, instrumentation and a host of technology related healthcare systems are based on a balanced and developed indigenous industry. Majority of implants and devices, today, are outsourced and imported from elsewhere, because of which, the costs are high and many people are not able to afford them. Medical technology innovation and development in India, hence, is a crucial issue that needs to be addressed.

What are the initiatives taken by the Ministry of Science and Technology for development of the medical equipment and device industry in India?

Dr. T Ramasami Secretary, Department of Science and Technology, Government of India

April 2010

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The Department of Science and Technology has constituted a committee to develop a biomedical devices and technology vision for this country through a national consultation mechanism. Our first meet has already taken place and we are likely

to have a few more meetings in the near future. We hope to mount a technology led vision for biomedical devices for the promotion of this industry. In our other initiatives, the Department of Science and Technology tied up with Indian Council of Medical Research (ICMR), and held an expert group meeting with about 150 medical professionals. The main agenda for this meeting was to address the issue of medical technology development more holistically. We realise that we need to look at this issue beyond the compartment of the medical devices industry alone. For this, it is imperative to have a set of professionals, who take this up as a career path. There also needs to be an inter-agency commitment to go and develop this sector, across the bottom line, the public-funding situations. This, on the large requires industry involvement and the industry will only get seriously engaged if there is business in it. The business also requires proper industry standards to be in place. For this, the Department of Science and Technology in association with Sree Chitra Tirunal Insititute for Medical Sciences and Technology (SCTIMST), Thiruvananthapuram, has drafted a bill for biomedical devices regulatory

authority. To draft this bill, we have gone through various levels of consultation processes. This bill is now in complete form and the Health Ministry is now engaged in taking the programme further. The Ministry of Science and Technology will participate for development of the technical component of the bill. In this, we also have participation from the CSIR, DBT, ICMR, and colleagues from department of science and technology, among others.

Can you throw light on the initiatives of the Ministry of Science and Technology towards creating manpower for biomedical device engineering? As far as development issues are concerned both the Ministry of Science and Technology and Ministry of Health and Family Welfare are very seriously engaged in this process. Three years ago, the Ministry of Science and Technology funded a programme for M.Tech in Clinical Engineering in IIT Madras with Christian Medical College and SCTIMST as partners. This is a two and a half year programme and two batches have already been admitted for this. These are very special kinds of expert being built in this area to take care of the biomedical devices innovation process.

Unless you have a good industry, youngsters would not choose it as a career option. We are now, basically looking at 30-40 people in the best of IITs to build this process. There are several other institutions which now offer B.Tech in Biomedical Engineering in the private universities in this country, but IIT, Kharagpur; IIT, Bombay; and IIT, Madras have some viable programmes in this stream. We are also addressing the development of a pull factor for the youth, to come in this particular sector for development of manpower and give them an assured career path, through our inter-agency programme. This brainstorming meeting was held in the All India Institute of Medical Sciences on December 14. We are also planning to setup a special package for this.

What is your perspective on the recent discussion over inclusion of medical courses in IITs. Do you think this will have an impact development of bio-medical engineers? One of the transitions that we need to undertake is how to migrate across disciplines and boundaries. In the past, as you are aware, medical and engineering streams have been kept apart. However, now we are recognising that that is not a good idea. The IITs, for example, in their B.Tech curriculum are primarily mathematics driven and the biomedical and biology areas are steps apart. IIT is now expanding into medical programmes, but we need to do this with adequate amount of preparation and care. If the culture requires medical and engineering programmes to remain as separate as they are, this won’t work. A good example of amalgamation of medical and engineering streams is the Stanford Biodesign programme, because of which AIIMS and IIT, Delhi are working together. Now, there is a hunger in IIT graduates to get into medical arena as they are receiving recognition from the medicos. This transition will drive the engineers to work towards this.

April 2010

COVER STORY

Rejuvenating US Healthcare System

President Obama Creates History Through the recently passed Senate bill, President Barack Obama has taken the first step towards achieving his vision of extending affordable and quality healthcare to all citizens of America. eHEALTH brings you an overview of the current challenges in the US healthcare system and the key provisions laid down in the Senate bill, through which President Barack Obama plans to overcome these challenges. As per current estimates, the United States spends almost 16 percent of its GDP on healthcare; which is a huge amount compared to most of the other United Nations member states. Until recently, the United States was the only wealthy, industrialised nation that did not ensure insurance cover for all its citizens, according to the Institute of Medicine of the United States National Academies. In 62 percent of all personal bankruptcy cases in the country, the major reason had been medical debts. Owing to many such issues, the healthcare system

April 2010

of the country was at the receiving end of much criticism for not being efficient enough to provide adequate health services to its citizens. The stupendous costs of healthcare services in the US, coupled with an unorganised health insurance sector created a huge gap between the health services available and health services availed by the citizens. Focussing on universal healthcare, President Barack Obama proposed different healthcare reforms to improve the US healthcare system. The key factors outlined by the Obama administration, to improve

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healthcare services, included electronic record keeping, preventing expensive conditions, reducing obesity, refocussing doctors’ incentives from quantity to quality of care, payments for treatment of conditions rather than specific services, offering the most costeffective treatment and reducing defensive medicine. He further planned his strategy to include deficit neutrality, minimising out-of-pocket expenses, restricting insurance companies to discriminate on the basis of pre-existing conditions, creating an insurance exchange for

April 2010

individuals and small businesses, tax credits for individuals and small companies; independent commissions to identify fraud, waste and abuse; and malpractice reform projects, among other topics. The recent healthcare reforms under President Barack Obama focuses on the Patient Protection and Affordable Act, which was finally passed on March 25, 2010. Obama termed it as a historic move in the history of US healthcare, as after almost 100 years of debate, Americans will finally have the assurance of universal health cover through this bill. Under the revolutionary bill, health insurance will be extended to nearly all Americans, new taxes will be imposed on the wealthy, and restrictive insurance practices will be outlawed. The House was, also, set to vote on a series of proposed changes to the Senate-passed measures. If the changes are approved by the House, they would require a final approval by the senators, before they could be signed into law by Obama. The legislation majorly requires substantial insurance market reforms to bar insurers from excluding people because of pre-existing medical conditions and preventing them from dropping policy holders. Further, insurance exchanges would be created through which small

April 2010

businesses and individuals, who do not have an employer-sponsored coverage would be able to buy insurance for themselves. The plans offered on the exchange would have to meet the minimum benefit requirements. Under a major move, the planned coverage would also allow children of insured parents to remain to their parents’ health policies, until they turn 26. As required by the Senate, the insurers will have to spend at least 85 cents of every premium dollar on medical care in small group markets and 80 cents in large group markets. In addition, the Medicare Advantage insurers would have to spend at least 85 percent of their revenues on

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medical care. The Senate bill would make it mandatory for individuals to avail some form of health insurance, failing which, they would be fined up to 2.5 percent of their incomes by 2016. Firms with more than 50 workers, who do not offer medical coverage to their clients would have to face fines up to USD 2000 per fulltime employee. Federal subsidies would be provided to help people with incomes up to 400 percent of the poverty level to purchase coverage on the exchange. The bill would also have a Medicaid, a Government health insurance programme for the poor. This would be offered to everyone with incomes up to 133 percent of the poverty line. This will amount to approximately USD 10,830 for an individual and USD 22,050 for a family of four members. Many states also have eligibility requirements below these levels. In terms of the revenue measures, the final proposal makes some amendments in the Senate-passed bill. As per the Senate bill, 40 percent excise tax would be levied on the high cost health insurance plans. The proposed changes would delay the implementation of this tax up to 2018, instead of 2013. This would in turn have an affect on plans of providing insurance coverage of USD 10,830 for individuals and USD 22,050 for a family of four members. It further suggests that a higher threshold is allowed for

eHEALTH Research

plans covering mostly women, older workers and retirees as well as those in high-risk professions. The bill also calls for raising the payroll taxes for Medicare from 1.45 percent to 2.35 percent for individuals earning more than USD 200,000 and couples earning more than USD 250,000. The proposed changes would apply the tax to some investment income as

well for those high-income groups. As per the bill, fees would be imposed on medical device manufacturers, insurance providers and brand name pharmaceuticals. Again, the proposed changes would delay the implementation of this fees. As per the legislation, payments to insurers that provide coverage to Medicare patients in 2011 and

Key Elements of President Obama’s Planned Healthcare Reforms • • •

Policies to improve the affordability and accountability Policies to crack down on waste, fraud and abuse Policies to contain costs and ensure fiscal sustainabilityHealth Insurance Reforms

The Patient Protection and Affordable Care Act (Senate Bill): Key Proposals •

•

• • • •

Raising the payroll taxes for Medicare from 1.45 percent to 2.35 percent for individuals earning more than USD 200,000 and couples earning more than USD 250,000 Insurance plans participating in newly created exchanges permitted to include abortion coverage, but a separate payment should be made for the portion of the premium attributable to abortion coverage. There would be no public option; instead the Federal government will mandate that the newly-created state insurance exchanges include at least two national plans that are created by the Office of Personnel Management. Each state will create its own insurance exchange under federal guidelines. Medicaid eligibility expanded to 133 percent of the federal poverty level. Illegal immigrants cannot participate in the exchange or receive subsidies. Deficit would be reduced a total of USD 132 billion 2010-2019 after tax receipts and cost reductions.

begin reducing the subsidy in 2012 would be frozen. It would also gradually close the gap in drug coverage for Medicare beneficiaries by 2020. Those entering the coverage gap in 2010 will get a USD 250 rebate. In 2011 they would get a 50 percent discount on brand-name drugs. In the first year (2010-2011), the key provisions of the healthcare legislation passed would bar insurance companies from dropping people from coverage, when they get sick. Lifetime coverage limits would be completely eliminated, while annual limits would be restricted. Currently, many of the health plans drop dependents from coverage when they turn 19 or join college; with the newly proposed bill, dependents would be covered under their parents’ policies until they turn 26. Also, uninsured adults with a pre-existing conditions will be able to obtain health coverage through a new program that will expire once new insurance exchanges begin operating in 2014. To help companies maintain health coverage for early retirees between age 55 and 64, a temporary insurance programme will be created , which will expire in 2014. As mentioned above, Medicare drug beneficiaries falling in the coverage gap will get a USD 250 rebate. The bill eventually closes that gap which currently begins after USD 2,700 is spent on drugs and coverage starts again after USD 6,154 is spent. Also, to help small businesses provide coverage for workers, a tax credit will be available. The Senate bill’s final approval received a stunning turnaround from January, when it was considered dead after the Democrats lost their 60 seat majority. According to the Congressional Budget Office, the Senate bill will cost approximately USD 940 billion over 10 years, and will cut the Federal deficit by USD 143 billion over the same time period. Although, republicans have vowed to continue to challenge it, yet the democrats have been able to hail the approval of the legislation to the Senate bill.

April 2010

TECH TRENDS

‘Monitoring’ the Growth ‘Signs’ Patient Monitoring Technologies A fundamental segment in the healthcare sector, the patient monitoring industry has evolved over the years owing to deeper penetration of technologies that have enhanced the development of best-of-the-class products. Divya Chawla explores the emerging technologies and opportunities for growth in the patient monitoring sector in India and tries to capture the key growth indicators to provide a complete overview of this industry. Emerging technologies in the healthcare arena have created exciting opportunities for improving the way care is provided across the globe. Patient monitoring, one of the biggest occupants of the medical technology pie, has been infused with several new technologies, ever since it was developed. Emergency rooms, intensive care, and critical care units cannot function without a patient monitoring module. Patient monitoring module enables physicians to have instant access to crucial parameters that allow them to measure the severity of illness because of which they can allocate their resources in an optimum way. The technology has also proven invaluable for recovery rooms, outpatient care, transport, radiology, ambulatory and home care applications. The overall productivity of a clinical setting can be bolstered by the instantaneous information provided by patient monitoring devices at the bedside, during transport and at the point-ofcare.

Important Parameters Measured via Patient Monitoring • • • • • • • • • • • • •

• •

Heart Rate (HR) Oxygen Saturation (SpO2) Systematic Pressures (SSAP, SDAP, SMAP) Core Temperatures (Inside the Heart) Respiratory Rate (RR) Electrocardiogram (ECG) Peripheral Temperature Cardiac Output Index (CI) Central Venous Pressures (CVP) Pulmonary Pressures (PSAP, PDAP, PMAP) Oxygen Saturation in Lung Artery (SVO2) Outcoming Carbon Dioxide (ETCO2) Ingoing Oxygen (FIO) DiureticsDrip DrugsBolus DrugsPatient’s WeightFluid Balance (Incoming and Outgoing) Intracranial Pressure (ICP) Electroencephalogram (EEG)

Market Intricacies Like all other medical technology segments, growth in the market for patient monitoring is primarily driven by increasing awareness among medical professionals and growing incidence of diseases. As per reports, the global patient monitoring

April 2010

market was valued at USD 4.9 billion in 2008 and is expected to cross USD 7 billion sales by the end of 2015. The average annual growth rate can be estimated at 3.8 percent, which considering the global meltdown is a decent ascent. In India, per se,

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Srinivas Iyer, National Manager, Critical Care, Trivitron, estimated the market to be roughly around Rs. 230 crores. In all, five crucial product segments have been identified in this market, which include—multiparameter patient monitors, wireless and ambulatory patient monitors, remote patient monitoring, noninvasive blood pressure monitors and micro-electromechanical systems. A significant feature of the patient monitoring market is that certain segments within patient monitoring are developing rapidly, as compared to others, and are expected to follow similar growth patterns in future, as well. However, there are other segments that have yet not reached that level of growth and development. This has created unequal development of different segments as some are progressing faster than the others. Reports identify, wireless and ambulatory monitoring and micro-electromechanical systems to be the key segments driving growth globally. Wireless multi-parameter patient monitors are currently the hottest selling products in this market. Reasons being the multiple benefits they offer in terms of allowing the healthcare professional to monitor patients from anywhere and the increased productivity and cost-efficiency these systems offer. “Novel technologies in patient

April 2010

Patient Monitoring Systems Market

Srinivas Iyer National Manager, Critical Care,Trivitron Helathcare Pvt Ltd.

Healthcare market is emerging as one of the best business opportunities and largest service sectors in the country. Increased life expectancy, rising literacy leading to increased health awareness, rising per capita expenditures on healthcare are some of the factors leading to increase in tertiary care setups. India’s disease profile is expected to follow the same pattern as in developed economies. Based on demographic trends and disease profiles, lifestyle diseases such as cardiovascular illnesses, asthma and cancer have become the most important segments. With increase in tertiary care hospitals and other demographic factors, patient monitoring equipment, being the basic requirement, is bound to grow in its demand.

monitoring are emerging to meet the increasing demands of an aging population. A few of these latest technologies include wireless communication systems that “sort” the vast amount of data collected in order to put it into the context of a patient’s condition, portable and ambulatory monitors, webbased access to the patient record, systems that transfer data to an electronic medical record (EMR), and full-service outsourcing that includes a clinician to evaluate data

OverviewThe Indian patient monitoring systems market grew to over 240 crores in 2009 at 20% over the corresponding year. In terms of volume, Indian market is estimated at around 26000 units in 2009. The patient monitoring equipment market is divided into high acuity, mid acuity and low Acuity. Volumewise, mid acuity leads the market with almost 60-65percent market contribution. Value-wise high acuity is estimated at around 40 percent, whereas mid acuity accounts for approximately 35 percent. With change in healthcare practices, the demand for multiparameter monitoring systems has grown. Clinicians wanted patient monitors to provide more physiological measurements that are less invasive and manage informatics in a better way. Technology has played a significant role to change the patient monitoring systems market. The central station patient monitoring market has been evolving rather rapidly in the recent years. Demand for bedside and telemetry patient monitoring systems has been growing for the last few years. Novel technologies in patient monitoring systems are adding to sophistication.

life style disease especially cardiovascular illnesses and technological advancements in patient monitoring systems such as home healthcare and remote monitoring are some of the significant market growth drivers. Demand for multi-parameter monitoring systems will be on higher side. Some of the specifications in demand are heart rate, peak flow meters, etc. Primary care with improved therapeutic outcomes as well as preventive care are also contributing to the market growth.

Barriers / Challenges Low pricing, lack of regulatory authority for certification for manufacturing of patient monitoring systems in the country and government’s initiative to incentivise manufacturing within country with international standards/players.

Leading Players Nihon Kohden, Philips, GE, Draeger, Mindray, Spacelabs, L&T, BPL, Schiller.

Product Range Nihon Kohden range of products including PVM270 basic 5 parameter monitor, Lifescope I, Lifescope L and Lifescope A with unique multiconnector technology.

Increased demand for tertiary care,

Trivitron exclusively markets patient monitoring system of Nihon Kohden, Japan which is a pioneer in patient monitors and other products like defibrillators, EEG and EMG machines.

and send a report to the attending physician”, describes Srinivas Iyer from Trivitron. “Recently Nihon Kohden has launched their new Basic 5 Parameter monitor with its latest software and eC1 technology. This technology filters of the unwanted alarms and reduces the number of false alarms making it much convenient to the hospital staff. Also PVM 2701 has a unique signal separation algorithm which filters the noise to a great extent and thereby giving much reliable Spo2

reading. Nihon Kohden monitors have a very unique technology to calculate the pulse wave transit time (PWTT). By doing so, it automatically triggers the measurement of non invasive blood pressure whenever the patients’ other vital parameters show abnormality thus it gives the doctors an additional perspective to the patient’s condition”, he adds. There is also a constant rise in demand for continuous pulse oximetry monitoring. Technologies such as sophisticated algorithms,

Key Drivers

(Continued on page 23)

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April 2010

Patient Monitoring Market in India Leading technologies in patient monitoring segment

manufacturers/suppliers of monitoring equipment in India

•

Opportunity: Patient monitoring market is steadily growing at 20 percent on an annual basis. Insurance sector and government funding for healthcare are the actual boosters for growth of this market. Challenge: Too many players are in the market. However, companies having good customer service will eventually succeed.

Wireless technology to transmit data to central nursing station – the advantage is that the monitor can be moved around, along with the patient in the hospital from ICU, OT, recovery rooms with complete data reception at CNS. GSM data transmission for ambulances transmitting real-time data to the receiving centre at the hospital enabling immediate treatment.

•

V. Balakrishnan Sr. Vice PresidentSchiller Healthcare

Opportunities

and

challenges

for

patient

Leading players in this segment Philips, GE, Schiller India, L&T, BPL, Mindray and Draeger.

Your product range Product

Segment

Features

Truscope® mini

Low Acuity

Configurations available: ECG + RR, ECG + RR + SpO2, Only SpO2, ECG + RR + SpO2 + NiBP, ECG + RR + NiBP, ECG + RR + SpO2 + NiBP + Temp (all five parameters) • •

Standard monitoring parameters: ECG, SpO2, NiBP, temperature and RR Optional Parameters: ETCO2 (mainstream/side stream), dual channel IBP, anaesthetic gas monitoring

• •

Standard monitoring parameters: ECG, SpO2, NiBP, Temperature and RR Optional Parameters: ETCO2 (mainstream / sidestream / microstream), dual channel IBP, cardiac output, anaesthetic gas monitoring

Argus LCX

• •

Standard monitoring parameters: ECG, SpO2, NiBP, temperature and RR Optional Parameters: ETCO2 (mainstream), dual channel IBP

Truscope® Elite

Multi-parameter touch screen modular monitor with: • Standard EMS module providing monitoring of 3/5 lead ECG, RR, SpO2, dual temperature, NIBP • Modular upgradations: ETCO2 (mainstream / sidestream / microstream), Nellcor SpO2,, dual IBP, cardiac output, anaesthetic gas monitoring

Truscope® II

Truscope® Classic

Mid Acuity

High Acuity ARGUS PRO SL

Multi-parameter monitor with 17” colour TFT touch screen. Parameter box: • ARGUS PB-1000: HR, respiration rate, NIBP, peripheral oxygen saturation (SpO2), peripheral pulse, transcutaneous CO2 measurement, invasive pressures P1, P2, endocranial pressure measurement with CPP calculation, ETCO2, FiO2, N2O and all standard anaesthetic gases, cardiac output • ARGUS PB-2000: standard: two invasive blood pressure; optional: second SpO2 interface, a transcutaneous CO2 pressure • ARGUS PB-2200: mainstream or sidestream CO2 measurement or both measuring techniques combined.

Schiller is developing a special multi-parameter patient monitor, which can transmit real time data of vital parameters via wireless communication. When a patient is taken in an ambulance the doctor at the hospital will be able to see the real-time data of the patient and accordingly suggest immediate treatment and thus save the patient’s life.

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(Continued from page 20)

reduced level of false alarms, easeof-use and flexibility of the remote alarm management solutions, ability to adjust the alarm levels on a patient by patient basis and the easy to follow patient vital sign display at the central nursing station enables healthcare workers to provide better care with existing resources in this segment. In terms of region-wise market, although, till now the US has been contributing for maximum sales in the global patient monitoring market, yet the future may witness a shift in this as several emerging economies are now accounting for larger shares than ever before. Countries such as India and China, with their huge populations comprising of an increasing number of chronic disease patients and rising number of healthcare delivery centres are expected to grow at a higher than the average global growth rate. In future, these countries may surpass the current overall patient monitoring market spread in the US to account for largest share of the global patient monitoring sector. However, certain key impediments to growth in the developing countries include old equipment and hardware,

trend of maintaining records on paper, lack of proper communication channels, and shortage of information and skills. These countries are required to make an effort to address these issues through developing low cost monitors, reengineering cheap electronics to monitor crucial parameters in a cheap and efficient way, and developing and implementing solutions for maintaining and retrieving data provided by these systems. It, therefore, becomes imperative for developing countries to focus on developing their internal infrastructure to be able to achieve the optimum level of growth they are capable of. To enhance their individual sales and have a larger footprint in the market, manufacturers are now increasingly focussing on providing strong and efficient customer support services. Owing to the importance of patient monitoring equipment in various clinical care settings, this component is highly crucial as breakdown of equipment can cause dire results in case timely repair services are not provided. Success for vendors, also depends on implementing unique sales tactics coupled with providing efficient after-sales and maintenance services to have an edge over other suppliers. With the accelerating growth in technology, it also becomes imperative for all vendors to emphasize on product development by incorporating new features backed by the latest technology in their products. This not only provides them to be able to have a better hold over over the market owing to the unique products

they offer, but also provides the users with the best technologies available globally to enhance the quality of care offered by them. Latest developments in patient monitoring equipment are now focussed on enhancing interoperability within various departments within a clinical setting. Development of IT-integrated patient monitoring systems is already taking place and vendors across the globe are rolling out such products into the market. Although, some research papers also suggest that manufacturers are limiting market growth because of their reluctance towards interoperability, yet there are availability of products which are able to communicate with each other within a clinical setting. Suggested reasons for vendors to limit interoperability options include lack of incentives to allow this to happen more quickly than technology permits and have a control over the market by making customers dependent on proprietary systems that do not integrate with systems manufactured by other vendors.

The Road Ahead Sales of patient monitoring products that are currently in the pipeline, will be driven by effective monitoring parameters and increased acceptance of technologies aimed at home care settings. Factors such as awareness, affordability and an ever improving healthcare infrastructure in developing economies will drive the global market for patient monitoring equipment. The challenges that will always remain include reimbursements and lack of awareness and limited innovation issues in certain segments of the society. Device manufacturers across the globe are struggling because of limited reimbursements being provided by the government. While the government is required to take an initiative, the industry must look at including the best technologies in their products and make them available at the best possible price.

April 2010

TECH TRENDS

Patient Monitoring Devices Product Matrix

Pulse Oximeters

Single Parameter Monitoring

Micro-Electromechanical Systems

Non-Invasive Blood Pressure Monitors

Remote Patient Monitoring

Akas Medical

√

Allied Medical

√

Advanced Micronic Devices Ltd

√

Bangalore Medical Systems

√

BPL Healthcare

√

Clarity Medical

√

Criticare Systems

√

Concept Integrations

√

Draeger Medical

√

GE Healthcare

√

Hospimedica International

√

Huntleigh

√

Instromedix

√

L&T Medical

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EMCO Meditek

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Life Plus Medical

√ √

√

Maquet Medical

√

√ √

Mindray

√

Nasan Medical

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Philips Medical

√

√ √

√

Schiller India

√

Trivitron

√

Zeal Medical

√

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√

Recorders and Medicare

April 2010

√

√ √

Spacelabs Healthcare

√

Maestros Mediline

Medical Engineers

Wireless and Ambulatory Monitoring

Vendor

Multi-Parameter Patient Monitoring

Central Monitoring Stations

Product Categories

√ √

√

PERSPECTIVE

Patient Care at Hospitals Redefined through Process Optimization One of the leaders in managing business processes, Genpact offers a broad portfolio of enterprise G&A and industry-specific services, coupled with strong IT, analytics and reengineering capabilities. The company has a strong presence in the healthcare space, as well. In a conversation with eHEALTH, Tajinder Vohra, Senior Vice President at Genpact, provides key insights into Genpact’s offering in the healthcare space in the Indian market and highlights the emerging business opportunities. Please share your perspective on the healthcare scenario in India vis-a vis the global scenario?

Tajinder Vohra Sr. Vice President, Genpact

We have operated in both the markets – US & India and it wouldn’t be fair to compare the two. The healthcare BPO business in the US is more evolved; however it is still at a very nascent stage here. There is an increasing need to optimize patient care services at hospitals by utilizing existing resources, leading to an increased demand for process optimization services. Also, I believe that once healthcare insurance takes off in India, there will be a rise in the number of transactions, which might provide the requisite impetus for growth of healthcare outsourcing. We at Genpact focus on both healthcare providers’ and healthcare payor’s space. In the providers’ space, hospitals require more analytics for expanding their revenues. New hospitals need guidance on how to price their packages and how to reach to the target audience. However, these services currently don’t exist in a sophisticated form. Further, there are health insurance bodies that take care of the entire back-end managing of the insurance policy. Genpact has very well established and strong insurance capabilities. A lot of work on how to make hospitals better is

being done by us in the US. We plan to get more aggressively involved in these services in India as companies here are becoming more open to growth and experimentation. We have actively participated in the Indian healthcare market and in terms of growth this market is very good. Also, in the future, the Government will be spending more on building infrastructure in hospitals because of which, there is further scope for growth here.

Can you share some figures on the estimated size of the healthcare market? It is difficult to estimate the overall size of the market. In hospitals, except for doctors and nurses, everything is highly segmented. According to industry sources, the Indian Healthcare market is expected to touch USD 77 billion by 2013. The several segments in the overall market comprise of the pharma sector, health insurance, analytics, and clinical research organisations, among others. Again, to estimate the share of the BPO market in this is difficult.

In terms of healthcare services, how are you positioned in India? As a company, we have been

April 2010

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April 2010

providing healthcare services for about 17 years now. We do most of the work for the hospitals in US, from India. Also, we have certain teams working in hospitals in the US and we are also using that talent for the Indian market. This is not to reduce the cost of operations, but to optimize services and provide a better patient experience. For perspective, Genpact has over 200 doctors and medical experts on staff, works across 30+ healthcare information systems and has completed over 28 hospital projects globally including in India, the US, Canada, Scotland and Ghana.

Please provide an overview of the services offered by you in the payors and the providers segment. The services offered by Genpact in the provider space are based on the extensive healthcare expertise and experience that Genpact has to optimise and enhance provider operations. We are leveraging our Smart Enterprise Process (SEP) methodology to provide solutions across the entire Visit to Cash (V2C) lifecycle. We have deconstructed the provider space into three segments—patients flow, supplies flow and cash flow—which gives us a deep understanding of the needs of this space. We offer a complete range of services in this segment including—end-to-end hospital operating system implementation, capacity optimisation and asset utilisation, patient/employee safety, training, medical and non-medical supplies management and revenue cycle management. In addition, we focus on business outcomes like patient wait time, cash flow and total spend. The expertise we offer in this segment makes us a trusted partner of global healthcare providers. In the payors’ segment, Genpact helps its clients to create a bottom line impact by reducing administrative and medical costs, increasing member enrollments and enhancing customer satisfaction in line with government rules and regulations. Genpact’s process centred approach helps in improving workflow and

April 2010

administrative processes that employ a combination of custom technology, trained staff and strict adherence to quality management. This helps the clients in increasing productivity and decreasing costs. Our solutions in this segment include—claims administration, cost optimisation, health economics, membership management and process transformation services. We provide end-to-end claims administration to help optimize administrative processes including claims receipt, imaging, Optical Character Recognition (OCR), data entry, error resolution, medical review and real time adjudication focused on reducing cost per transaction. In addition, we analyse claims and identify recovery potential. In the health economics space, we offer solutions for predictive modelling, disease management and outcome measurements that aid in decision making. For membership management, Genpact offers solutions for enrollments, premiums and credentialling. Genpact has the resources, tools and domain expertise to partner with payers to drive efficiencies, improve key business metrics and deliver business impact.

Can you share about your recent service implementations at some of the major hospitals in Delhi? I am glad to share that, Genpact has successfully implemented process optimisation programs to enhance efficiency and improve patient experiences at Dr Ram Manohar Lohia and Lok Nayak Hospital in Delhi. The implementation of the pilot projects was done using the hospital operating system based on our Smart Enterprise Processes (SEPsm) methodology. We have effectively optimised the hospitals’ layout to improve core clinical processes including optimising doctors’ time in order to enhance the care provided. The services offered by us have improved the patient flow by 30 percent and the doctors’ capacity by 20 percent in these hospitals. All this was achieved over a period of just 12-14 weeks.

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We are excited about the opportunity that the Indian healthcare industry presents and believe that Genpact is best positioned to partner with hospitals in the country to create centers of excellence that will deliver premium patient care to citizens. Further, leveraging our unique Smart Enterprise Processes (SEPSM) methodology, we will be able to deliver significant value to this endeavor.

What are your services offerings in terms of RCM? Hospitals in the US, especially the big players, have very complicated billing cycles. A large chuck of the payments in hospitals is tied to the cash collected. By implementing process optimisation, the hospitals can save somewhere around 2025 percent. We at Genpact, have a huge analytics team that actually helps in managing policies thereby enhancing processes. Including insurance requires a lot of off-shoring and transaction work. The problem is to bring in a new policy and manage it effectively. Issues like the yearly insurance subscription fee are difficult to address. Genpact, as a company has immense knowledge and expertise in this segment as over the past ten years, we have built specific capabilities on how to optimise these processes and run them better.

As the demand for health insurance in India is increasing, the requirement for services offered by you in this space will also rise. What are your comments on this? Today, health insurance is gaining importance for an average Indian. If you are not insured, you must analyse the cost implications of availing good healthcare services. In the past, care was only available in government hospitals, but now one can experience the same level of care (if not better) at private hospitals. Higher costs at private hospitals have already pushed the demand for healthcare insurance; creating new business opportunities in the healthcare BPO industry.

ZOOM IN

Optimising Claims Management in Health Insurance Emergence and growth of health insurance has given rise to a need for maintaining and optimising claims processing and management to enhance services offered by the health insurance companies and healthcare providers with the ultimate aim of providing maximum benefit to the insured. Divya Chawla brings out the importance of claims management in the health insurance space and highlights key issues that impede the growth and evolution of health insurance in India. Health, in all aspects, is a key parameter that defines growth and prosperity in a country. Considering the growing costs of healthcare, worldwide, because of infusion of newer technologies and better care delivery methodologies, coupled with increasing awareness of people towards better and efficient healthcare services, India is experiencing a significant transformation in its health patterns. The Government is also making due efforts by introducing several health programmes and policies to improve citizens’ health and standard of living. Over the past decade or so, there has been a consistent improvement in the life expectancy of the Indian population and decrease in infant mortality rates, both of which are key indicators of good health in a country. The Ministry of Health and Family Welfare with its three departments— the Department of Health, Department of Family Welfare and Department of Ayurveda, Yoga, Naturopathy, Unani, Siddha and Homeopathy—is dedicated to implement key reforms that can bring about a complete change in which healthcare is provided in the country. Better health services, however, are accompanied with higher medical costs, which can be a crucial impediment on road to achieving the vision of a healthy country. The only

solution to this issue is to avail health insurance or mediclaim policy in the interest of making life hassle free for all. Although, the penetration of health insurance in India is still very low, yet the industry is now gaining momentum as more and more people are getting their health insured. Figures suggest that less than 15 percent of India have some form of health insurance—the rest of the population is yet to benefit from these services. The health insurance industry, therefore, has a huge scope for growth with almost 85 percent of the population that is still not insured. Health insurance has, over the past few years been, has emerged as one of the fastest growing non-life insurance segments in the insurance industry. In fact, health insurance is emerging as one of the key line of businesses for the life insurance companies as most of the large insurance companies are now jumping into

this segment by offering products in the health insurance space. Going back, health insurance in India, was first marketed by non-life insurers as mediclaim in 1986. The products, then had an annual limit of indemnity chosen by the insured beforehand and the premiums were largely based on the chosen limit and the age of the prospect. Still, even after more than two decades, the health insurance industry is faced with many complexities, which are difficult to understand. The private healthcare insurance industry has opened up because of establishment of the Insurance Regulatory and Development Authority (IRDA). This has posed a lot of challenges that include increase in claim amounts, need for

April 2010

Health Insurance Claim: Making it Easy for the Customer

Health insurance in India came in vogue in 1986 when Mediclaim by four public sector general insurance companies was introduced and since then the product continues to be a highly popular, yet controversial product. Popular, because of need to protect oneself financially in view of ever rising healthcare costs in private hospitals, changing life styles, income levels, etc., and controversial because of issues surrounding servicing of the product, especially the claims service part. When Mediclaim was launched in 1986, the claims service followed the prevailing pattern of other insurance products — customer incurring the expense in the first place and then lodging claim with insurance company for reimbursement of the same as per terms and conditions of the policy. The delay in processing and payment of claim and deduction in claim amount were the primary reasons for customer dissatisfaction and continued to be so for a very long period. As per published data, the

average time period for settlement of claim was 121 days in 2001. During 1999-2000, the insurance industry in India witnessed setting up of IRDA followed by entry of private players, keen to offer more customer friendly products and services. Thus the concept of ‘cashless’ hospitalisation was introduced in health insurance and a new entity-Third Party Administrators (TPAs) was born to facilitate the same. Under the scheme of things, TPAs empanelled various hospitals (meeting the criteria laid down in the policy), wherein a health insurance customer could avail of treatment and walk off without having to pay bill, only those minor expenses which are not covered under the policy need be paid from pocket.The advent of cashless hospitalisation brought a big relief and convenience to customers as they did not have to shelve out a huge sum in first place and wait for reimbursement of same from insurance companies. Customer also had the choice of various healthcare providers to avail treatment. Not only the cashless treatment choice, but average claim settlement period also came down drastically. As per published data, more than 75 percent claims were settled within one month in 2009 by the TPAs. The customer experience could further be enhanced and the frequently encountered issues and complaints could be addressed quite effectively through various measures by different stakeholders starting with proper orientation of sales force to educate the customer at the time of sale. It often happens that agents/ sales force themselves are not clear

about terms and conditions of policy or avoid detailing, what in their own view might be, a negative feature of the product. Further, sometimes the customer is not made aware of coverage and exclusions under the policy and on top of that, the process to avail cashless treatment is projected almost akin to swiping of credit card to purchase a product in the market. This gave birth to a host of customer issues arising out of ignorance of key coverage/exclusions and misplaced expectations in terms of process to claim, while simple knowledge of these could make a world of difference to customer experience.As regards claims management whether done in-house by the insurance company or through TPA, the areas which make the process hassle free and add to customer convenience include-24x7x365 accessibility, use of technology facilitating information flow to customer during various stages of claim/cashless approval (e.g. system based SMS alerts at defined triggers/events), online information regarding hospitals offering cashless facilitylocation, address, facilities, tariffs etc, member profile and claim status update, polite and helpful staff with adequate training and knowledge, strict adherence and monitoring of turn-around-time for various subprocesses from intimation of claim to dispatch of cheque or approval of cashless authorisation and lastly a defined process for redressal of customer issues/grievances which includes and presupposes senior management’s attention to this vital area.

rationalising the cost structure of treatment in private hospitals, lack of data, standardised billing and under reporting of information by the private hospitals, and slow claims processing. To address these issues, the health insurance sector assumed a new

dimension, with the advent of third party administrators (TPAs). The primary function of the TPAs was to infuse efficient management systems to offer benefits to the insurance companies as well as people insured. Further, their presence is aimed at insuring standardisation

and improving penetration of health insurance in the country. TPAs manage standardisation of charges and cashless services in health insurance. TPAs are expected to develop an appropriate system and management structures for controlling costs, developing

Malti Jaswal Chief Executive OfficerE-Meditek (TPA) Services Ltd.

April 2010

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Features of an Efficient Health Claims Management System

Over the next decade, the insurance industry will witness continuous evolution in health insurance products and processes. The trend to move the claims function in-house may also be adopted by more insurers. This will create a unique opportunity for claims system vendors who can offer systems and applications with a high level of flexibility and automation. The starting point is a well defined and intelligent work flow management module to ensure optimum work routing and distribution, in-built escalation and strong external communication features (like auto letter generation for various scenarios or SMS gateway). The ability to easily configure new products at a granular level is a vital requirement—this enables the automation of various validation checks on policy, claimant, benefits and provider. A product configurator interacts with a rules engine to define product benefits and exclusions to facilitate automated adjudication of

claims. Appropriate pre-processing edits before the adjudication can substantially increase efficiency and process claims faster. In fact in the US, auto adjudication rates of 65-85 percent are not uncommon, albeit a very high percentage of these are simple primary care claims. Since new products will attempt to differentiate themselves with new service models, the claims systems will require business process builder to build operational workflow compatible with the product. In summary, the product configuration module, business process builder and rule engine are already becoming the core of the new generation claims systems. Such integrated solutions enable the claims teams to achieve significant automation of validation checks at the policy and the product level including verification of benefit and coverage limits to streamline prior authorisation for cashless claims. Access to data in the policy administration system and provider module is vital at this stage. Once the claim data is in the system, pre-defined rules and product specific processes can be applied. After ensuring that all mandatory information is provided and is valid, the first step would be to match the claim against prior authorisation. The second step would be to conduct checks for medical appropriateness, compliance with provider contracts and variation from usual and customary practices. Much of this can be automated through the use of standard treatment guidelines

embedded in the system to identify excessive or unwarranted billing item, therefore generating cost savings for the insurer. An ideal claims management system should also include a fraud management module that identifies possible fraudulent patterns based on policy holder profile, underwriting information and provider profile. Since fraud or abuse patterns frequently reoccur, such a tool can be very useful.Once a claim has been processed the claim payment process starts. Integration with payment gateways is a common feature now and significantly simplifies this process when paying network hospitals. In case of nonnetwork hospitals or reimbursement claims, it helps to have a good cheque printing module. Finally, an effective claims management system can provide excellent insight to management. Not only can past trends be identified and leveraged, the vast amount of claims data can be combined with enrollment data to be efficiently used in actuarial pricing and underwriting.In summary, underwriting and claims handling are two core functions of an insurer and technology offers a lot to streamline both these. The recent advances in claims system ensures that in a few years a significant portion of claims in India will be processed without any significant manual intervention. Technology, business practices such as contracted rates and standardised processing guidelines will do much to change claims management in the near future.

protocols and improving quality of services that can ultimately lead to lower insurance premiums. The IRDA has also laid down certain regulatory standards for TPAs to perform optimally. The emergence of TPAs, hence, has allowed for settling claims in a

much faster and efficient way and eliminate most of the challenges that were being faced by the health insurance industry earlier. However, general awareness about the existence of TPAs and the services they provide is still low. In future, hospital administrators will

recognise the immense business potential that their association with TPAs will have. This also gives rise to the need of IRDA to have a greater control over TPA activities to enhance the benefits of TPAhealthcare provider and TPA-insurer associations.

Alam Singh Assistant Managing DirectorMilliman India Pvt Ltd.

April 2010

EVENT REPORT

Investing for a healthy future Healthcare Investment Summit 2010, March 16, The Claridges, New Delhi

3 2

1) Mukul Singhal, Associate Saif Partners delivering the ‘tutorial session’; 2) J. Sunder Rajan deliberating on investing at the bottom-of- pyramid; 3) 2nd session of panelists on dias; 4) Dr. Dharmider Nagar & Dr. O.P Manchanda narrating their hospital’s success stories; 5) Panelists receiving mementos & 6) Delegates networking among themselves

Healthcare Investment Summit 2010, an exclusive event on investment scenario in healthcare industry in India was organised by eHEALTH magazine on March 16, 2010 at The Claridges, New Delhi. The aim of this summit was to provide a prolific interface between investors and investees of healthcare sector who are aspiring to be a part of the emerging growth story of the country. Particularly, the summit intended to help stakeholders of the industry to explore newer potential of growth by understanding funding mechanisms and investor priorities, while building sustainable partnerships and invigorating ongoing collaborations in the health ecosystem. To achieve this objective, the summit brought together senior management executives from private

April 2010

equity funds, venture capitalists, institutional investors and policy makers to discuss in an open and amicable forum with potential investees from hospitals, healthcare service providers, diagnostic labs, health IT vendors, equipment manufacturers and R&D institutions. The event started off with a morning tutorial session by Mukul Singhal, Associate, SAIF Partners. Designed for potential investees in healthcare provider and technology space, the presentation emphasized on winning strategies for successful investments, while underlining essential elements and prerequisites for developing successful business plan for investors. The main event was divided into four sessions, focusing on different aspects of investment landscape in

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healthcare, including – hospitals, medical centers, diagnostic labs, equipment manufacturers, health IT vendors and rural healthcare deliverers. The first session was chaired by Dr. Rana Mehta, Vice PresidentHealthcare, Technopak Advisors, with distinguished panelists including - Vikram Gupta, COO, India Ventures Advisors; Nitish Agarwal, Executive Vice President, Religare Venture Capital; Alok Gupta, Investment Director, HSBC Private Equity Advisors and Deepak Gaur, Vice President, SAIF Partners. Discussions in this session focused on challenges and opportunities of PE and VC investment in healthcare sector. The deliberations brought out how private equity and venture capital can catalyse a paradigm shift

(L to R): Alok Gupta, Investment Director, HSBC Private Equity Advisors; Deepak Gaur, Vice President, Saif Partners; Dr. Rana Mehta, VP-Healthcare, Technopak Advisors; Nitish Aggarwal, Executive Vice President, Religare Venture Capital and Vikram Gupta, COO India Venture Advisors

in the industry, both from provider’s as well as consumer’s perspective. Indian healthcare market is huge on account of the fact that healthcare needs of over a billion population has to be taken care of with a clearcut distinction among consumers/ patients across population segments spanning - liberalisation children, transition children and midnight’s children. These three different categories have different healthcare needs and investors have to keep this in mind before venturing into such a diverse market. The spotlight was also put on some of the other concomitant issues in healthcare such as the growing and ageing population of the country, increasing burden of chronic diseases, diabetes, inadequate infrastructure and poor affordability and accessibility of healthcare services for masses. seventy percent of financing is out of pocket as public spending is very low. The government has a very limited role at the level of tertiary care and therefore there is a felt need of the government taking on the role of a financer besides being a provider. Healthcare opportunities are big in India and are soon expected to grow but the lack of entrepreneurship in the industry provides the inertia to growth. Hence, the question that

remains is how to accelerate growth? The simple answer that emerged out of the discussion was that there are innovative partnership models needed with active participation of government sector, as private investment is in a very nascent stage in India. The second session was chaired by Dr. Ajit K Nagpal, ChairmanHealthcare Advisory Council, Feedback Ventures and the panelists

included - Dr. Dharminder Nagar, MD & CEO, Paras Hospital, Gurgaon; Dr O P Manchanda, CEO, Dr. Lal Path Labs, Mohit Bhatnagar, CEO, Sequoia Capital and Vishal Gandhi, VP-Corporate and Institutional Banking, YES Bank. Healthcare provision is a passionate subject and the challenges lie in tracking the VC and PE players and bring them on board. There is a need to create more beds rather than bringing about amalgamation. Dr. Nagar emphasised on the fact that there is a growing need to build assets in healthcare and to make it happen, partners from banks, insurance and government are required. While Dr Nagar shared his personal success story in establishing the Paras Hospital and providing it the much needed organisational leadership, Dr. Manchanda from Dr. Lal Path Labs talked about his experience in diagnostics and that how it is different from the hospital industry. The growth in this sector is high and opportunities very large. Commenting on the aspect of technology, he also said that IT is integral for the growth of this sector and that future of healthcare lies in efficient utilisation of technology. Mohit Bhatnagar from Sequoia Capital, one of the investors at

(L to R): Mohit Bhatnagar, CEO Sequoia Capital; Vishal Gandhi, VP-Corporate & Institutional Banking, Yes Bank; Dr. Ajit K.Nagpal, Chairman-Healthcare Advisory Council, Feedback Ventures; Dr. O.P Manchanda, CEO, Dr. Lal Path Labs; Dr. Dharminder Nagar, MD & CEO, Paras Hospital, Gurgaon

April 2010

Dr. Lal Path Labs said that investment is a fuel that goes into the growth engine of a company. The concept of microfinance was also brought out well in this session, based on the premise that most of the rural population in India does not have access to finance. However, the panel agreed on the opinion that sufficient rigour and discipline has to be maintained for providing loans. Hence, combining social responsibilities with commercial aspects is the current need of the industry. Vishal Gandhi from YES Bank said that healthcare market in India is US$ 77 billion but the picture is hazy in terms of who will invest, how much to invest and when to invest. Multilateral agencies and venture capitalists are investing in commercially viable projects and not much success is seen in publicprivate partnerships. What emerged out of the session is that, along with the need for capital investments, there is an equal need for building lasting partnerships. The government not only has to provide equity but also land and cash, along with access to capital through soft loans in order to fill in the gaps. Delivering the final

( L to R): Vikram Gupta, COO India Venture Advisors; M. Vennimalai, CEO Aavanor Systems; Jayant Singh, Industry Manager-Medical Technologies, Frost & Sullivan; Anupam Anand, CEO Healthizen and Dr. Mallika Kapoor, Managing Director, NextGen eSolutions

comments, Dr. Nagpal asserted that public-private partnership is the future of the industry. Nobody is bothered about the population which is not able to access good quality of healthcare at an affordable price. This session brought out many facets on healthcare investment scene and highlighted the need of a sea change in the way investors look at the industry.

(L to R): Dr. Erna Surjadi, Regional Advisor-Gender, Women and Health, WHO; Dr Itamar Offer, Managing Director, Elbit India Healthcare; Dr. Ashok Kumar, DDG & Director, Central Bureau of Health Intelligence, Ministry of Health & Family Welfare, Govt. of India; J. Sunder Rajan, Head-Strategy & Business Development, Siemens; Rajive Gulati, Sr. Technical Manager, Haryana State Electronics Development Corporation and Dr. Naveen Jain, Medical Director Pushpanjali Hospital

April 2010

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The theme of the third session was investing in healthcare IT and medical technologies. The session was chaired by Jayant Singh, Industry Manager-Medical Technologies, Frost & Sullivan and panelists included - Anupam Anand, CEO Healthizen; Dr. Mallika Kapoor, Managing Director, NextGen eSolutions and Vikram Gupta, COO, India Ventures Advisors and Dr M. Vennimalai, CEO, Aavanor Systems. The session began with a unanimous consent from speakers as well as the audience that IT has a huge role to play in healthcare. Dr. Mallika Kapoor brought to notice a very important fact that educating the providers about IT benefits is not an easy task. She added that, affordability is no longer a challenge for most hospitals, rather, it is the difficulty in making them appreciate long-term benefits of technology. It is important to realise that health IT is markedly different from general enterprise IT and that it needs to be evaluated in a totally different way. Vikram Gupta from India Venture Advisors very well asserted that spending in health IT solutions is going to be meaningless if there are no significant buyers. For this we need infrastructure in the form of hospitals, diagnostic centers, labs etc. so that IT solutions can

14-16 april 2010

Med Tel

be employed for meeting healthcare needs of patients. Currently, healthcare IT spend is 1.0-1.5% of the total spend in India. How people see value coming out of the IT in healthcare is the first important thing to determine. Average size of any health IT company is very small and people have found their niche areas where there is lot of competition. The stage is set for investment in India and people have started making investments in this segment. Dr. Mallika Kapoor conceded that health IT is becoming very commoditised and for small companies it is difficult to adopt standards based practices. She made a very interesting comment that penetration of health insurance Med-e-Tel is the Meeting place with a proven potential for Education, Networking and Business should drive standards rather among a global audience of medical and care professionals, healthcare institutions, patient organisations, industry representatives, researchers, educators and government agencies. than standards driving IT adoption. The deployment JOIN US AT THE 8TH ANNUAL MED-E-TEL IN LUXEMBOURG AND EXPAND YOUR GLOBAL TELEMEDICINE of interoperable software AND eHEALTH NETWORK! has to be consumer driven as hospitals have no commercial motive to create such systems. In this context, Vikram Gupta highlighted that there is no healthcare insurance regulator in India and unless healthcare standards and health information portability is in place, the situation is going to be worse from bad. Therefore, it is imperative Manager, Haryana State Electronics sustainable partnerships, investing to first educate the government Development Corporation; J. Sunder in sound health information system about the need of standards-based Rajan, Head-Strategy & Business and investing for adoption of ICT in practices in healthcare and then Development, Siemens and Dr Itamar primary care delivery. The concluding take the agenda ahead with private Offer, Managing Director, Elbit India presentation by Dr. Erna talked in length about the Integrated Hospital players. Overall, the session was Healthcare. Dr. Ashok Kumar gave the Management Information System very enlightening and left the thread for discussions in the last session audience a glimpse of the entire (IHMIS) and also about information and complete the full circle in healthcare structure in India right analysis and decision making aspect from the primary to tertiary level. He in healthcare. healthcare. In nutshell the event was a The fourth session was chaired said that majority of the population by Dr. Ashok Kumar, DDG & occupy the bottom of the pyramid highly successful endeavour on part Director, Central Bureau of Health and therefore good healthcare at eHEALTH magazine to bring an Intelligence, Ministry of Health & primary level is sine-qua-none array of issues relating to investment Family Welfare, Govt. of India and for building a sound healthcare needs in healthcare with exhaustive panelists included - Dr Erna Surajadi, edifice in India. In the course of his discussion of each of them. The Regional Advisor-Gender, Women presentation the ideas that emerged solutions which emerged from and Health, WHO; Dr. Naveen pointed towards three essential this summit can be our guidelines Jain, Medical Director Pushpanjali elements of healthcare investment towards building a sound healthcare Hospital; Rajive Gulati, Sr. Technical in India, they are – investing in system in India.

LUXEMBOURG

April 2010

IN CONVERSATION

“We bring in domain-led and technologysupported business solutions to healthcare” CSC has been serving customers in the healthcare domian, across the globe, for more than 35 years now. The company’s services span the entire healthcare spectrum including healthcare IT and business services for life sciences industry and provider and payer space. In conversation with eHEALTH, Arun Gupta, Director of Healthcare Verticle at CSC in India, talks about the organisation’s key healthcare offerings in the global and Indian markets.

Arun Gupta Director, Healthcare, CSC in India

Please provide an overview of the organisation framework. We have had the healthcare vertical in place for the last 35 years and have done a lot of work for different clients in this space. We have very strong service offering across the entire segment including the providers, payers and life sciences. In the provider segment, we work with most of the major hospital networks. In the payer , we work with enterprise health insurance companies. In the life sciences, we have an established footprint with most top life sciences companies. Apart from these, we have several other products in all these segments in the healthcare industry. We

April 2010

bring in business solutions, across all healthcare segments, which are domain-led and technologysupported. While, CSC Healthcare practice has several recognitions such as being ranked number 3 in “Healthcare Informatics Top 100 2009 rankings”, number 1 in ERP implementations by healthcare executives in KLAS 2009 report (a leading analyst in healthcare), and the leaders in CPOE, our key differentiators that benefit our clients are that we understand the business domain of our customers through years of service experience, by having a global workforce that consist of domain or subject matter experts (with 10-30 yrs experience in healthcare), product experts and technology experts who work from our global delivery locations as one team to deliver from the world to our world-wide customers. Our customers benefit from us, as we help them with systems that are “Built to Last”. We design life saving systems. Being a healthcare leader, we have a legacy of early adoption of healthcare trends to help our clients build their next generation healthcare systems. We leverage our global footprint to serve our clients across the globe. Our workforce uses cutting edge technology to deliver our services and products to our clients. The business outcomes our clients gain from us are, reduced medical

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errors, improved quality patient care, making healthcare affordable, accessible (electronic patient records) and efficient to end users. We have our own established research group of emerging practices and have strong participation in the regulatory framework. In that sense, we are well positioned to bring leadership in the domain.

Please give a brief about your offerings in the healthcare domain. Our offerings combine business and technology. In the provider side we work mostly in consulting and application services, bringing in hospital management expertise to select, implement, run and maintain, and test third party products/ applications. We provide custombuilt solutions, which are driven by domain knowledge. We also provide business infrastructure support to various hospitals and some of the core infrastructure required to run the business is supported by us. Some successful examples include the EPIC solution for report development, Meditech and other Hospital information systems, which are all evolving products and comprehensive and complete systems that take care of all requirements in a hospital. Apart from this, we are engaged in one of the most ambitious health delivery programmes in the U.K, and we have already had two releases

that have been implemented. This product is still undergoing phased development and we will start rolling it out to a large number of hospital trusts shortly. In India, we have a parallel development going on in Chennai. We also do a lot of work in the R&D for the public sector department in the area of drug discovery.

Please tell us about your global presence and plans for entering India, if any, in the future? Our offerings are primarily in the Europe and the U.S. In the Asia Pacific region, we are doing work in Singapore and Vietnam. We work with major global Life Sciences companies, many of which have an India presence; this is how we service India. We have a large healthcare footprint in India that includes technical, functional, doctors, nurses, pharmacists. The plan to service the Indian market is definitely there, but we are looking at the market selectively. We have participated in a couple of opportunities that emerged in the Indian market in the

life insurance space. We are keen on working with the mutual fund companies in India in the financial services space.

What is your expertise in EMR development? We have a good amount of expertise in the custom EMR development. The U.S market is less matured compared to some of the European clients that have more EMR, healthcare informatics and eHealth initiatives that are probably not being leveraged very well. Larger network of hospitals would probably get into custom EMR development. Netherlands is one of the leaders in health information exchange space, with high rate of electronic health record adaption that can be easily accessed by a network of physicians. In Sweden, too there is a bigger push from the state because of which a lot of health informatics initiatives are active. In U.K, we have already implemented a comprehensive product based solution for which the testing effort required deployment of a few hundred people as it is a highly

complex product. So, with the kind of expertise we have, we are able to offer independent testing services as well. This is again an example of a technology based service driven out of the domain.

How many centres do you have in India and how are they positioned in terms of service offerings? CSC operates out of seven centers in India. In terms of size, the largest centre is located in Noida and the second is in Chennai. In terms of our healthcare practice, we operate from Chennai, Bangalore, Hyderabad and Noida. Our largest location in terms of headcount is Chennai that also hosts a dedicated offshore development center for one of our major provider client. Bangalore is our second largest location for Healthcare. In Bangalore, going to the history of healthcare vertical, we have come together as a combination of provider, payer and Life Sciences streams. Our third major location is a customer built location, that of a large Life Sciences company.

April 2010

SPECIAL REPORT

Union Budget 2010-11 Roadmap for Healthcare in India

Healthcare, expected to reach over US$75 billion by 2010 and US$150 billion by 2017, has a huge potential for growth in India. Saba Firdaus, eHEALTH, attempts to analyse the prospects that the current budget unfolds in terms of financial allocations and policy measures to give a boost to healthcare industry in India. Healthcare undoubtedly is one of the pillars of social sector reforms in India. Ensuring right to food, health and education to all citizens has been the prime objective of our government since independence. Good health implies ensuring right to life which is universally acclaimed fundamental human right under the 1948 Human Rights Declaration of the United Nations. But a big chunk of our population lack affordability and proper access to healthcare facilities in the country due to which death due to diseases, epidemics, birth and accidents occur at a high rate in India. The Government of India has been unable to fulfill its

April 2010

commitment of ‘Health for All by 2000 A.D.’ till now. In fact, primary health care services are difficult to obtain for people living especially in urban slums, villages or remote tribal regions. The condition of government hospitals has worsened over time. In many of the government hospitals there is inadequate staff, the supply of medicines is insufficient and the infrastructure is also inadequate. There are very inadequate facilities for safe deliveries or abortions in government hospitals. Given the fact that women do not even get adequate treatment for minor illnesses such as anaemia, services for problems such as the health effects of domestic

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violence remain almost completely unavailable. At the village level, there is no resident health care provider to treat illnesses or implement preventive measures. All hospitals are located in cities, and here too public hospitals are increasingly starved of funds and facilities. Thus there is lack of availability of government health care services on one hand and the exorbitant cost of private health services on the other. This often leaves common people in rural areas with no other option but to resort to treatment from quack doctors who often practice irrationally. Thus most of the population is being deprived of the basic right to health

care, which is essential for healthy living. In this backdrop, the Union Budget 2010-11 has unleashed a new wave of optimism for the healthcare industry which is welcome by almost everyone associated with the sector. However its no denying the fact that the budget still has some ‘hits as well as misses’ which are clearly spelt out in the document. The Indian Constitution has granted the ‘Right to Life’ as a basic human right to every citizen of India under article 21. In article 47 of the Directive Principles of the Indian Constitution, the Government’s responsibility concerning public health has also been laid down. In this light budget is not merely a financial statement but also an expression of the government’s intent and commitment that it

Dr. Pervez Ahmad CEO and Managing Director Max Healthcare Institute Ltd

“The healthcare industry appreciates Finance Minister’s focus on improving healthcare systems in the country. Steps such as increased budget outlay for the Health Ministry will go a long way in improving the overall health scenario of India and the uniform, concessional 5% duty on all medical appliances will also have a mildly positive effect. The absence of tax holiday extension is a bit disappointing for the industry though.”

Budget Proposals • • •

• •

•

An Annual Health Survey to prepare the District Health Profile of all Districts shall be conducted in 2010-11. Increase in planned allocation for the Ministry of Health and Family Welfare from Rs.19,534 crore in 2009-10 to Rs.22,300 crore in 2010-11. Reduction in customs duty on all medical, surgical, dental and veterinary equipment (including parts and accessories) from 7.5% to 5%. These goods are also being exempted from special CVD. Imposed CVD of 4% on the imports of hospital equipment for use in specified hospitals and life-saving equipment. An excise duty of 4% is imposed on blood glucose monitoring system (Glucometer) and test strips and patent ductus arteriosus/artial septal defect occlusion devices. The basic custom duty is exempted on specified inputs used for the manufacture of orthopedic implants.

wants to fulfill for creating a socially equitable society. Before getting into the details of what the proposals imply vis-vis healthcare-comprising of both private and public health there is need to first take account of what already exists in healthcare in India so that the task of analysing the implications of the current budget on chalking out a roadmap for this sector is an easy exercise. Healthcare is a US$35 billion industry in India, is expected to reach over US$75 billion by 2010 and US$150 billion by 2017. Therefore there is a huge potential of growth in the sector. Hospital industry is an important component of the value chain in the Indian healthcare industry rendering services and recognised as healthcare delivery segment of the healthcare industry. A rapid growth in the past three years in India has brought about a health transition in terms of health demographics, socio-economic transformations and changes in disease pattern. The healthcare infrastructure is poorly developed to meet the needs of the ailing population. 1.1million additional beds were required in the financial year 2008-09 and this number would rise to 3.1 million by 2018. India requires an immediate investment of US$85 million over the next 15 years to make up for the backlog. India is also lacking in terms of medical manpower. Currently there are 6 lack doctors and 1.6 million nurses in India. As

per the World Health Organisation guidelines, it translates into a gap of approximately 1.4 million doctors and 2.8 million nurses. The major growth drivers identified for the sector are growing and ageing population, growing urbanisation, rising income levels, increasing burden of chronic diseases, healthcare finacing transition and medical tourism. The Budget 2010-11 proposes to conduct an annual health survey in 2010-11 to prepare a district health profile of all districts. This survey will enable the industry identify business opportunities in rural markets. On the healthcare side the government has continued with its agenda of boosting primary healthcare. The total allocation for the Ministry of Health and Family Welfare has been increased from INR 19,534 crores to INR 22,300 crores. Health insurance has been extended to more than 20% of the Indian population covered by the National Rural Employment Guarantee Act. The uniform customs duty of 5% plus CVD of 4% on import of medical equipment has been introduced against current general maximum rate of 16.78%. An excise duty of 4% is imposed on blood - glucose monitoring system and test strips and patent ductus arteriosus/artial septal occlusion devices. The basic custom duty has been exempted on specified inputs used for the manufacture of orthopedic implants. The increased

April 2010

outlay would favourably impact companies involved in healthcare sector. Further, the simplification of duty structure for the medical equipment and exemption provided to specified inputs for the manufacture of orthopedic implants from import duty would be positive for the sector; however increase in MAT rate from 15% to 18% would have an adverse impact on the hospital projects owing to their long gestation period. As far as taxes are concerned, budget 2010 did not unfold any significant change for the industry. However the government recognised the last decade as a decade of innovations and steps taken in the direction of incentivising research and development activities. As regards the pharma industry this year’s budget proposes an increase in weighted reduction from 150% to 200% on expenditure incurred on in house R&D activities and from 125% to 175% on activities outsourced to specific institutions. The pharmaceuticals space in India has witnessed action, transaction and growth in the past few years. The industry has achieved a growth of over 25% in the last year; but it is yet to achieve its optimal. The pharmaceutical industry is still on its growth path, the key drivers being market expansion and development and innovation. To ensure the continual double digit growth, more government attention than what came forth in this budget is warranted. There is also a partial roll back in excise duty from 8% to 10%. The increase in weighted reduction on R&D activities is positive for the industry and would continue to support higher investments by research-led pharmaceutical companies in areas of NCE/NDDS related R&D activities. The move is likely to be positive for contract research organisations as well. The findings of the Health Survey that the budget proposes should be of immense benefits to major public health initiatives especially the National Rural Health Mission which successfully addresses the gaps in the

April 2010

delivery of critical health services in rural areas. Over Rs.139 billion have been earmarked for this programme (NRHM), launched in 2005, to improve availability and access to quality healthcare for people living in remote areas. The amount was for carrying out various schemes under the NRHM and has gone up from Rs.120.96 crore. The main focus is on 18 states that have weak public health infrastructure - Arunachal Pradesh, Assam, Bihar,Chhattisgarh, Himachal Pradesh, Jharkhand, Jammu and Kashmir, Manipur, Mizoram, Meghalaya, Madhya Pradesh, Nagaland, Orissa, Rajasthan, Sikkim, Tripura, Uttarakhand and Uttar Pradesh. Equal focus has also been given to public health with the government allocating money for the AIDS control and mental health programmes and the prevention of diabetes and cardiovascular diseases. Of the total budget, about Rs.3,181 crore has been earmarked for vari-

S.L.Narayan Chief Financial Officer & Director - Strategic IT Max Healthcare Institute Limited

“The fiscal deficit goals of this budget is dependent on the success on the disinvestment plan and the timely closure of 3G licensing process; any slippages in these two activities can create huge risks in terms of deteriorating public finances.”

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ous schemes to benefit the health of the people - up from Rs.1,928 in 2009-10. While India’s AIDS control programmes saw an increased allotment of Rs.403 crore - up from Rs.888.15 crore to Rs.1,291 crore this fiscal - the National Mental Health Programme saw a rise of Rs.103 crore, up from Rs.50 crore - an increase of Rs.53 crore. Also, the national programme for the prevention and control of diabetes, cardiovascular diseases and stroke got Rs.90 crore - an increase of Rs.73 crore from the previous budget. As the country faces a shortfall of trained doctors, nurses and paramedics, the government has earmarked Rs.323 crore for creating more trained human resource in the health sector. According to a Planning Commission report, India faces a shortage of about 600,000 doctors, one million nurses, 200,000 dental surgeons and a large number of paramedical staff. However, top hospitals and medical colleges like the All India Institute of Medical Sciences (AIIMS) in Delhi and the Post Graduate Institute (PGI) in Chandigarh have got substantially less money in the coming fiscal as against the current financial year. As per the 2010-11 budget allocation, the AIIMS will get Rs.800 crore in 2010-11 as against Rs.886.5 crore in 2009-10, while the PGI Chandigarh has been allocated Rs.82 crore less in the new budget. In 2009-10, the medical college got an allocation of Rs.392 crore. The budget has a whopping 46% of plan allocation for infrastructure development, but healthcare infrastructure is yet to make its place in the Finance Minister’s agenda which will take years in bridging the affordability and accessibility gap in the sector. Healthcare is unaffordable to most Indians and by adding additional taxes on medical equipment, the situation is not going to get better. The government still needs to do more by creating policies, regulation and tax benefits to make healthcare more affordable for the common man. Achieving health standards similar to those living in urban India

Dr Shakti Kumar Gupta HOD, Hospital Administration & Medical Supritendent (Dr. R P Centre for Ophthalmic Sciences), AIIMS, New Delhi, India

“The Union budget 2010-2011 increased the allocation for health care by Rs.2,700 crore increasing the allotment to Rs.22,300 crores. This budgetary allocation is only 2 per cent of the total budget, and is still very far from the target of three percent of GDP. Through increased allocations in the flagship public health programme, NRHM, an overall directional continuity has been maintained. The budget aims at benefiting all sections of the society but lacks specific provisions to boost private investment in healthcare sector especially in rural areas. Considering that there is a severe shortage of health infrastructure and health human resources there remains a lot that can be achieved through PPP models, which are the need of the hour. However, the five percent reduction in tax while importing medical equipment will be of some benefit. The expansion of the service tax net to include health check-ups undertaken by hospitals for employees of business entities, and for health services provided under health insurance schemes may prove to be a deterrent at a time when preventive health care has to be promoted. The Annual health survey is a welcome step under which the district health profile of the rural populace would be prepared. This would be a very useful tool for the authorities to objectively monitor the effectiveness of various health programmes being run in the district over a period of time, particularly the National Rural Health Mission (NRHM). The proposal to extend Integrated Child Development Services (ICDS) to every child by March, 2012 is also a welcome step as it would ensure nutritional security to the children under the age of six years. Inclusion of all BPL (Below Poverty Line) families under Rashtriya Swasthya Bima Yojana (RSBY) through increased budgetary allocations is a step in right direction to increase overall health insurance coverage of Indian population which is abysmally low at present. The hike in excise duty on cigarettes is very encouraging step, as it will discourage tobacco consumption. Although the issues of availability and access to quality healthcare for people living in remote areas are being addressed through NRHM, the bigger issues of creating more & better health infrastructure with skilled manpower still remain to be addressed.”

in the foreseeable future should be the goal of the government. To change the current status-quo of neglect in healthcare will bring about social justice for human rights of all people. The year 2009 presented a lot of uncertainties and grave challenges for the Indian economy because of the financial and economic crisis that the world was facing and India was no exception to it. Growth had started decelerating and business sentiments were weak. The economy’s capacity to sustain high growth was under serious threat and it was not clear to the policy makers about its impact on the pace of growth of the Indian economy. But to the delight of the countrymen, India emerged from this crisis after having weathered all odds only to usher in an era of sound economic situation aiming for a consistent 9% growth. The aim of the government outlined in the budget 2010-11 is to achieve inclusive growth by bringing the rural masses within the ambit of the development agenda. Strengthening food security, improving education opportunities and providing health facilities at the level of households, both in rural and urban areas are sine-qua-none for inclusive growth to which the government and policy makers have attached utmost significance and priority. The financial year 2010-11 marks the beginning of reverting to a high growth rate and moving towards greater fiscal consolidation and economic vibrance. This is going to be a new beginning for all the sectors of the economy and thus there is new hope and optimism for each of them. Healthcare industry has been one of the largest and most critical one for healthy people, healthy country and an healthy economy. The last few years have seen consistent growth in the Indian healthcare sector, which has a promising future. And it is expected that the reform proposals enshrined in the budget would help in accelerating and sustaining the growth path in the industry. Undoubtedly healthcare sector would help India become a global giant over the next decade.

April 2010

NEWS REVIEW

ET Medical Devices, Italy announces joint venture with Trivitron Healthcare Trivitron the largest technology provider of Indian origin has announced its joint venture with ET Medical Devices Italy to manufacture and market advanced technology cardiac diagnostic instruments which includes ECG systems, Stress Test ECG, Holter ECG, ABPM recording units, Monitoring systems and Telemedicine IT Solutions. This tie-up will facilitate ET Medical Devices to set up a manufacturing facility at Trivitron’s Medical Technology Park in Chennai. The JV will be named ET Trivitron Medical Technologies and it will promote the solutions under the global recognized brand Cardiette – Cardioline. The company has been present in the Indian market since 1997. Over 20,000 units of various products have been sold with major share being from ECG recorders. The Managing Director, Trivitron said that the prime focus in setting up a medical technology park is to manufacture medical equipments in the areas of cardiac care, critical care, imaging, operation theatres, renal care, implantable medical devices and

laboratory diagnostics. The objective is to manufacture quality and costeffective medical technology products suited to the needs of emerging countries. As these products, once manufactured in India, would be at least 30 to 40 per cent cheaper than imported and even hospitals or institutions in rural areas of the country

would be able to afford. According to Mr. Velu, the Managing Director, Trivitron said that India being the capital of world diabetes and cardiovascular diseases, increased awareness and quality healthcare providers, there is an increased demand for cardiac diagnostic instruments like ECG machines, Holter systems etc.

SoftLink International signs a deal with Magnum Heart Institute for implementation of HIS-CIS-PACS SoftLink International, a leading Software Product company with core focus on Hospital Automation and Medical Imaging, has bagged the prestigious order for implementation of fully integrated automation solution for Magnum Heart Institute comprising of Hospital Information system, Cardiology Information System and Picture Archival and Communication System. With more than a decade of indepth experience of product development in the field of ‘Healthcare Information Technology (HIT) and Medical Imaging, Softlink has garnered 150 plus installations globally that today span

April 2010

across more than a dozen countries! The core strength of SoftLink lies in its product portfolio, which comprises of a fully integrated suite of HIS/CIS/RIS/ PACS, making it a one-stop shop for an end-to-end enterprise class solution approach for any hospital. Magnum Heart Institute, which was inaugurated by Dy. Chief Minister of Maharashtra Hon. Shri Chaganraoji Bhujbal in January 2010, is a first of

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its kind Cardiac Hospital in Northern Maharashtra. It is a state-of-art hospital project developed by Chopda Medicare & Research Centre Pvt. Ltd. under able leadership of its Chief Cardiologist Dr. Manoj Chopda. MHI has latest equipment like Flat Panel CathLab, modular cardiac operation theatre, fully equipped ICU, Cardiac ambulance and is fully networked to harness the potential of integrated healthcare IT solutions. Hospital has a capacity of 100 beds and can perform all the major cardiac procedures like angiography, angioplasty, valvuloplasty, pacemaker, CABG, open heart surgery et al.

CATCH UP WITH latest news, articles, interviews and case studies at

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DEVELOPMENT DIMENSION

Key Considerations while Replacing your Current IT Solution The objective of this article is to give the right direction to all healthcare organisations to choose the best IT solution.

Tushar Ratanghayra Senior Consultant 21st Century Healthcare Management Solution Pvt. Ltd

IT is the necessity of the day. Organisations running on efficiently managed IT solutions benefit by improved control over exceptions, efficient processes, higher efficiency of staff and policy driven systems. However, it is crucial for them to have adequate knowledge about the right IT solution that can benefit their organisation, the right vendor to engage with and the most accurate way of implementing it. Solution providers are mushrooming in every corner of the country and not all organisations benefit from IT. I am sure everyone goes through similar issues which, most organizations face while deciding upon a new software solution. Also, organisations which have implemented LIS/RIS/HIS have been in this dilemma in the past. In such situations users generally give up

April 2010

expecting an ideal solution as very few organisations have a CIO / CTO to take this challenge. The objective of this article, hence, is to give the right direction to all healthcare organisations to choose the best IT solution. It is important to have a good software, but other equally important factors include efficient training process, users’ expectation management and adopting SOPs, among other factors, which have more to do with management of operational issues rather than core software issues. Thus, while selecting a new IT solution vendor, it is imperative to not choose freelancer software programmers or a software company that does not have adequate knowledge of the helthcare sector because they either fail to understand the user’s requirement or spend too much time understanding them that causes unneccessary delays. Adopting a structured selection process with involvement of key members from all related functional areas would help in identifying the actual requirement, the right vendor and the best way to make the solution successful.

Need Analysis Selection Process List, Categorise & Prioritise Each user department must first list expectations from new software, reports, alerts and alarms required, features expected and issues faced due to inadequate/non availability of information from other departments. If some IT solution

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already exists then one also needs to list the software and non software issues and the good features available in the existing software, which are expected in the new software. Consult the Prospective Vendor Search for the IT solution provider from your network or make a Google search and select a few software product companies. Check the credentials of these companies and request them to provide product details with exact features functionalities available. Shortlist some companies on the basis of this search. Confirm Expectations are Met During this process each user department first needs to confirm that their requirements are met. Most of the expectations are fulfilled by matching their lists with features and functionalities of various products under consideration. Consider Financing Options If initial budget is an issue, one can request the vendor for options like SAAS (Software as a service), packaged offer along with server and system software which can help reduce investments and derive benefits with minimal initial outlay.

Team Building Team Selection - Cross Functional Since ownership is the key to success, select a team from each major function in the organisation which should be responsible right from selection process till the successful implementation.

April 2010

Need Analysis

Define Responsibility Beginning with general team responsibility, specific responsibility of each team member needs to be documented and formally adhered to. Communication Plan Lack of communication or inadequate communication can be disastrous leading to failure either in selection or implementation. And as part of the communication plan, one also needs to identify how issues would be resolved.

Vendor & Product Selection Software Product The provider needs to have a ready product build on latest technologies which is implemented in some places. One also needs to visit the place where the same product is running successfully before deciding. Product Company Many software companies or freelancers take up software development and develop the IT solution as per the user’s need. Whereas on the other hand there are many software product companies which have a ready to implement product and focus on serving the healthcare segment only. One should preferably deal with such product companies only. Future Support The vendor should be in a position to provide online support with adequate use of technology and a knowledgeable support team.

April 2010

Escrow The source code of the software is the IPR of the vendor, thus he will not part with the same in normal situation. However, in case the vendor looses interest in the product or closes down the business, then he needs to hand over the source code which will help is resolving future issues.

Training Training Plan When implementation starts, there should be a clear day-wise plan with intermittent milestones. The plan should be made by members of the vendor’s team and confirmed by all concerned team members. This also needs to be reviewed regularly. Importance of Master Data Master data is the one time initial setup information, which needs to be created with utmost care, as this comprises of setting up of business policies and creating re-usable information of system entities. This should be one of the prime responsibilities of the team. Target Early Wins Rather than going big bang and going live in all areas, one should consider to start implementing in areas, which will give faster results and will be showcase-able to all stakeholders. This brings confidence and motivation for the entire team. Certification After training is completed, it is very important to confirm that all users are adequately trained on using the new

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software. The best way to confirm this would be formal certification of all users before going live. This certification should be based on theory questions and practical sessions, which are observed by a team of assessors. Final Preparation & Go Live After confirmation of successful training, one needs to plan the data required for going live, communicate the long term benefits and initial challenges that could be faced and the support required for going live. Then Go Live on the software as planned.

Review Confirm- Objective Met After a few weeks of implementation one should review whether the basic objective of implementing is achieved and decide the future course of action as per the feedback. Benefits from New Solution One should also measure the benefits to the patient, the users and the management as these benefits help to justify the investments and guide the team for further improvement to be planned for future. Regular Review Plan Finally, the process does not end here. In order to maintain the benefits achieved and ensure continued trust in the software, the selected team needs to conduct monthly/quarterly reviews both internally as well as with the vendor and continue the good job.

EVENT REPORT

Transforming Healthcare with IT A post-show report of the first International Conference on transforming healthcare with information technology organised by the Apollo Group during March 8-10, 2010 in New Delhi.

Sam Pitroda inaugurating the event along with Dr. Prathap Reddy, Chairman, Apollo Hospitals Groups; Chandrajit Banerjee, Director General, CII; and Som Mittal, President, NASSCOM.

Organised by the Apollo Group, the agenda for Transforming Healthcare with IT, comprised of three days of active conferencing and exhibition. The conference aimed at bringing together key players in the healthcare sector on a global platform to participate, propagate and promote the various technologydriven transformational approaches, solutions and their benefits to the grassroots, administrators, providers, and research community, among others. Through this event, Apollo aimed at achieving the goal of equitable, sustainable and quality healthcare system. Spread over three days, the conference comprised of key-

April 2010

note addresses, plenary sessions, workshops, demo showcasing of products spanning the entire spectrum of healthcare, IT and telecom sectors. The major objectives of the conference were to: • Showcase technology-driven transformational approaches and solutions to solve the healthcare jigsaw • Address the innovations, infrastructure and information in the healthcare landscape • Proliferate, promote, propagate benefits to the grassroots, administrators, providers and beneficiaries • Create working groups to deliberate on formats for the

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National EMR, filling format and standards Eminent speakers from all over the world participated in the event and shared some thought provoking ideas and interesting experiences that can be implemented in the Indian healthcare landscape for improving the accessibility and quality of services offered. Key speakers at the conference included Dr. Alverson, Dale C from the American Telemedicine Association; Dr UK Anathpadmanabhan from the Kovai Medical Centre and Hospitals, Coimbatore; David K Aylward from mHealth Alliance United Nations Foundation; Denis Gilhooly from Digital Health Initiative, New

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York; Prof K Ganapathy from Apollo Telemedicine Networking Foundation; Dr. Karanvir Singh from Sir Ganga Ram Hospital, New Delhi; Dr. Prathap Reddy from Apollo Hospitals Group; Prof Ricky Richardson from International Society of Telemedicine and eHealth; Sam Pitroda, Government of India; and Sangita Reddy from Apollo Hospitals Group, among others. Dr. Alverson, Dale C threw light on the status of telemedicine and eHEALTH at an international level, and how the care systems can be transformed in the global community. Bringing in the Indian experience, Dr. Ananthpadmanabhan, spoke about emerging ICT applications for better employee empowerment and patient care in Indian hospitals. mHealth also emerged as a topic of discussion, as David K Aylward spoke to the audience about energising the global mHealth ecosystem. Denis Gilhooly shared his experiences about creating a digital health and development dynamic. Bringing forward Apollo’s vision of healthcare for all, Prof. K Ganapathy focussed his presentation on IT enabled healthcare in 2020 and talked about a futuristic approach for development of this industry. Talking about health IT at the hospital level, Dr Karanvir Singh brought out key implementation issues faced by a healthcare delivery organisation in the implementation of an EMR. The emerging scenario of eHealth was also discussed by Prof Ricky Richardson, who holds a key position in this industry. A special video address was also delivered by Archbishop Desmond Tutu from Anglican Archbishop Emeritus of Cape Town, who has also been the Nobel Laureate (Peace) from Milnerton, South Africa. Some of the key topics of discussion at the conference include: Future of Global Health • – Emerging Technologies: Capitalising experience with Innovation – Outlook (Developed Nations) • Healthcare Information Systems – Research & Initiatives • Transforming Healthcare – A

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Shri Dinesh Trivedi during the valedictory session

Macro Perspective EMR – The New Enabler Digital Healthcare: The promise to reach out to millions, provide support and solutions to many of the most vexing healthcare related issues • Standards and Trends in Healthcare IT • “Live Focus” - Special Session Apart from these, an inaugural function was also held on the first day, which focussed on Technology Enabled Healthcare Vision 2020. Special Health Secretaries Conclave and CIOs Conclave were also organised on the first day. On day 1 and 2, a half an hour slot was allotted for a unique session named Brilliant Bytes and Telecast – Success Stories. A showcase demonstration on new age hospital information systems was made by TCS, which marked the launch of TCS’s latest product Hospital Management System (HMS). A forum for discussions between the speakers and delegates was also organised towards the end of day 1. On day 2, a special session focussed on the celebration of Apollo Telemedicine Networking Foundation’s (ATNF) X anniversary. During this session, Prof K Ganapathy, the President of ATNF demonstrated live teleconsulting with the use of cutting-edge yet simple technologies. A special demonstration was also • •

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made on day 2 by Health Super Hiway that focussed on health information exchange solutions. The valedictory function for the conference took place at the end of day 2. The Chief Guest of this session was Sri Dinesh Trivedi, Hon’ble Minister of State for Health & Family Welfare, Government of India. Sri Trivedi enlightened the audience with key efforts being made by the Ministry of Health and Family Welfare toward development of eHealth in India. A special address during this session was made by Ms Sujatha Rao, Secretary of Health, Government of India. Day 3 of the event was loaded with product and solution demos by some of the key industry players in the health IT space in India. Several parallel sessions were being conducted on this day that focussed on multiple product demos of different organisations. The consortium partners for the event were TCS and CISCO, while supporting industry partners were HIMSS, CII-India Healthcare Federation and several other wings of Indian Government establishment. The event successfully provided an ideal opportunity for all stakeholdres in the technology and healthcare domain to meet and exchange knowledge and ideas for growth and development of the health IT industry.