eHealth April 2013

volume

issue

contents

ISSN 0973-8959

cover story Innovations Spurring in Indian Health IT

leaders speak “BIO-IT Has a Tremendous Opportunity”

policy

Kiran Mazumbdar Shaw, Founder President, Biocon

special feature Integrating Web Artists

Meeting the Last Point

Shally Makin, ENN

RIS, PACS Making Inroads in Healthcare

Connecting the Dots

Shally Makin, ENN

Health Insurance Covering The Uncovered

EHR: Ease & Convenience Come Together

Sharmila Das, ENN

april / 2013 ehealth.eletsonline.com

Odisha Adopted ICT as Development Tool

K N Bhagat, Managing Trustee, Orissa Trust of Technical Education & Training (OTTET)

Association of Biotechnology Led Enterprises (ABLE)

Shally Makin, ENN

Anil Swarup Director General – Labour Welfare, Ministry of Labour and Employment, Government of India

Odisha Healthcare Serving the Underserved Dr Pramod Kumar Meherda, Mission Director (NRHM)

fresh venture Walk in Clinic for Urgent Care

Dr Pervez Ahmed, the Founder-Chairman and Managing Director Aapka Urgicare Pvt Ltd

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

issue

april 2013

President: Dr M P Narayanan

Partner publications

Editor-in-Chief: Dr Ravi Gupta group editor: Anoop Verma

Editorial Team

WEB DEVELOPMENT & IT INFRASTRUCTURE

Health Sr Assistant Editor: Shahid Akhter Sr Correspondent: Sharmila Das Correspondent: Nikita Apraj Research Assistant: Shally Makin

Team Lead - Web Development: Ishvinder Singh

governance Manager – Partnerships & Alliances: Manjushree Reddy Assistant Editor: Rachita Jha Research Assistant: Sunil Kumar Correspondent: Nayana Singh

Finance & Operations Team

education Senior Correspondent: Pragya Gupta, Mohd. Ujaley Correspondent: Rozelle Laha Sales & Marketing Team National Sales Manager: Sunil Kumar, Mobile: +91-9716917950 Sr Manager – Sales: Satish Shetti, Mobile: 91-9920705534 (West) Assistant Manager: Vishukumar Hichkad, Mobile: +91-9886404680 (South) Subscription & Circulation Team Sr Executive - Subscription: Gunjan Singh, Mobile: +91-8860635832 Design Team Shipra Rathoria: Assistant Art Director Team Lead - Graphic Design: Bishwajeet Kumar Singh Sr Graphic Designer: Om Prakash Thakur Sr Web Designer: Shyam Kishore Editorial & Marketing Correspondence eHEALTH - Elets Technomedia Pvt Ltd Stellar IT Park, Office No: 7A/7B, 5th Floor, Annexe Tower, C-25 , Sector 62, Noida, Uttar Pradesh 201309, email: info@ehealthonline.org Phone: +91-120-4812600 Fax: +91-120-4812660

ehealth does not neccesarily subscribe to the views expressed in this publication. All views expressed in the magazine are those of the contributors. The magazine is not responsible or accountable for any loss incurred, directly or indirectly as a result of the information provided.

Executive-IT Infrastructure: Zuber Ahmed Information Management Team Executive – Information Management: Khabirul Islam

General Manager – Finance: Ajit Kumar Legal Officer: Ramesh Prasad Verma digital LEARNING Sr. Manager – Events: Vicky Kalra world Associate Manager – HR: Sushma Juyal education Associate Manager – Accounts: Anubhav Rana Executive Officer – Accounts: Subhash Chandra Dimri summit 2013

OUR UPCOMING EVENTS digitalLEARNING

world education summit 2013 April 23-24, 2013, Le Méridien, New Delhi

2nd Annual

Steering e-Inclusive Economy May 9-10, 2013 - Taj President Vivanta, Mumbai

Knowledge Exchange

SRINAGAR May 23-25, 2013 - The Lalit Grand Palace, Srinagar

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editorial

Innovation is full of life The increased spending on healthcare IT has been doing the rounds lately. Gartner Inc has come up with a new report that states that healthcare providers in India will be spending 57 billion rupees on IT products and services in 2013. This indicates an increase of seven percent over 2012 revenue of 53 billion rupees. This forecast includes spending by healthcare providers (includes hospitals and hospital systems, as well as ambulatory service and physicians’ practices) on internal IT (including personnel), hardware, software, external IT services and telecommunications. Indian healthcare policymakers have already started recommending Aadhaar Cards to be linked with health cards. This would be a big and right move. A health card is meant to provide a seamless access to healthcare benefits to the citizens, and if the healthcare gets integrated with Aadhaar, then it would make it easier for the hospitals to identify patients who deserve to have subsidised treatments. The merging of health card with Aadhaar will definitely ensure better disbursal of benefits like food, shelter, cloth and healthcare. The All India Institute of Medical Sciences’ (AIIMS) Trauma Centre has made successful shift from preparing manual Medico-Legal Cases (MLCs) to electronic MLCs. It has become the first hospital to go digital. Since the hospital mostly gets accident cases, it registers about 30,000 MLCs in a year and doctors end up filling around 80 forms a day. Also there is news that developers are exploring wearable devices like wristbands and sensors that use bluetooth to upload data related to heart rate, temperature, and blood glucose to a cloud repository The April Edition of eHEALTH is as much about the existing facilities in Health IT, as it is about the newer innovations that can be expected. The cover story which is on Innovation in Health IT has included a gamut of experts’ opinion. We have key stakeholders like Keshav Desiraju, Secretary Health & Family Welfare; Anuradha Gupta, Additional Secretary (AS) & Managing Director (MD), National Rural Healthcare Mission (NRHM), expressing their opinion on the subject. You can’t think of Health IT without taking the newer developments in the field of communications into account. We have also done coverage of related areas like Telemedicine, Electronic Health Records (EHR), Radio Information System (RIS), etc. You will like the interview of Biocon Founder, Kiran Shaw Majumdar. She has shed light on the latest advances that are being made by the biotech industry. The advances in biotech have the potential of revolutionising healthcare systems. So this is an area to watch out for. As usual I look forward to your feedback on this issue. Happy reading!

Dr. Ravi Gupta ravi.gupta@elets.in

APRIL / 2013 ehealth.eletsonline.com

cover story

Innovations

Spurring in Indian Health IT

Health IT is generally viewed as the most promising tool for improving the overall quality, safety and efficiency of the health delivery system. With many innovations coming up in the health IT segment, the question is how innovation will benefit the fraternity. A closer look! By Sharmila Das, ENN

hey say a country is prosperous if it has a culture of innovation. In our country’s patient-centric health system you must innovate. This does not mean adopting every fancy new piece of equipment. Over the years, Indian health IT is too bringing innovations but may be the required amount of innovations are not happening at the expected pace. Therefore, the market for Health IT products in India is too unsettled. Sumanth Tarigopula, VP, Apps Global Delivery India, Enterprise Services, HP shares, “Generally, IT market constitutes around two percent of revenue of the healthcare market. With enormous investments that are going to come through next five year plan, IT should see corresponding growth”.

Can innovation save our bacon? In the dynamic and ever changing healthcare environment, health IT innovation is one of the key driving forces for reducing costs and improving the quality of care. Nilaya Varma, Managing Director, Health & Public Services, Accenture India shares, “I feel Indian healthcare is

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not only fertile, but is a fit case for big innovations, especially those focused around increasing penetration and affordability. One thing which Indian healthcare institutions have not really been focusing on is clinical efficiency, which I feel if not addressed, would become a big problem in the coming years”. Tarigopula says, “Indian industry is fertile for innovation. The healthcare delivery has been very fragmented and inefficient. The innovation in heart health delivery and diabetes related care through mobile devices will help drive the next generation healthcare model”. Vijay Simha, Partner, Vita PathFinders LLP & CEO OneBreath Inc shares, “Indian healthcare desperately needs innovations in order to be operationalised. The constraint that we face in taking healthcare to the masses is not only about capacitating but also the tools and methods that would help operationalise the programmes. It is about time that the talent from the industry, as well as from the academia begins to team up and find solutions for our local healthcare problems. We need to understand that once we have identi-

“I feel Indian healthcare is a fit case for big innovations. One thing which Indian healthcare institutions have not really been focusing on is clinical efficiency, which I feel if not addressed, would become a big problem in the coming years” Nilaya Varma, Managing Director, Health & Public Services, Accenture India

fied the problem, we also would need innovative solutions to solve those problems thus completing the cycle of care”. M.Vennimalai, CEO, Aavanor Systems says, “Healthcare is definitely one of the most fertile and vibrant industries in the Indian context and Indian healthcare is a very exciting and high growth segment in the international healthcare industry. Many new models of healthcare delivery are being experimented within India to effectively care for a large underserved local population, and to cater to a growing inbound

international healthcare tourism market. In this context innovation is highly favoured and indeed, is a necessity. Along with innovations in the delivery models, India needs innovation in the medical devices and in IT space. Innovation to help serve the entire population as well as to speed up the process of preventive care by early diagnosis and supportive care,

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cover story

post the engagement between the client and the healthcare provider”. Vasukumar Nair, Director, Marketing & Sales, 21st Century Informatics says, “India as an emerging market is definitely fertile enough for innovations. Over last two decades, the Indian healthcare industry has witnessed advances in several fronts – whether in treatment sector or associated care services. Indian companies should definitely continue the quest for bringing in further innovations to their products and services while continuously working on incremental innovations to match the changing requirements of the field”.

“Indian companies should continue the quest for bringing further innovations while continuously working on incremental innovations to match the changing requirements of the field” Vasukumar Nair, Director, Marketing & Sales, 21st Century Informatics

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“We have launched Cisco Education Enabled Development (CEED)-2700 to educate healthcare fraternity with the help of a cloud network to train auxiliary nurses of Bihar” Aravind Sitaraman, President, Inclusive Growth, Cisco Systems

Innovations in the offing It is true that India’s innovation story has many times envied our peers/ competitors and it has proved the capability of the country to produce innovation. Aravind Sitaraman, President, Inclusive Growth, Cisco Systems shares, “We have launched Cisco Education Enabled Development (CEED)-2700 to educate healthcare fraternity with the help of a cloud network to train auxiliary nurses of Bihar. Initially, we have launched it in the remote areas of Bihar, however gradually we plan to introduce it in the other states of the country. The system works with the help of cloud network and equipments like camera, computing environment, cloud infrastructure, router etc. Using this technology, one can watch a live surgery and thus can have better knowledge sharing. The technology can be used in many training courses too. The primary objective to launch this product was to do something to combat inadequate number of paramedic and medical staffs in the country”. Tarigopula says, “We are at the forefront in terms of innovation by deploying a platform called ‘smart health in a box’ that would deliver healthcare through remote models. The remote platform would help the rural patients to step in to a health delivery van and get the medical advice from the doctors through interactive platform”. Simha’s venture OneBreath has designed low-cost, portable

ventilator. He elaborates, “The low cost ventilator falls in the category of possible solutions and addresses the need to make healthcare delivery more accessible. The need comes from the fact that most healthcare facilities suffer from an acute shortage of ventilators not only due to the high cost of capital acquisition and its attended maintenance costs but also due to their tendency to breakdown due to wear and tear and rough handling. The original intent was to address the issue of reliability, the low cost happened as a result of innovation through design thinking”. Varma says, “As for Accenture, we have some very innovative solutions, both in the clinical and non-clinical aspects of healthcare. It is a very exciting time for us, as we are deploying some of these solutions in various parts of India. Most notable among these is our eICDS solution, which we believe, has the potential to be a big enabler for streamlining of ICDS services in India. We also have several innovative solutions in the mHealth and Health Analytics space which we have customised to our clients across the globe”. Tarigopula informs, “From HP, the innovative products are mobile based

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cover story

What the Government stalwarts have to say IT is a great enabler, however it is not itself a solution. IT can help use information better; IT can be just the tool and should not be used as replacement”. Keshav Desiraju, Secretary, H &FW

“The IT initiatives are working in isolation, we should make effort to bridge the gap. Also continued ownership of data is important”. Anuradha Gupta, AS & MD NRHM

“We should keep patient in mind while developing health IT systems. Telemedicine can help the patients to get healthcare at their district hospitals, so that they don’t have to come to a tertiary care. In this regard, we can think of linking medical colleges with the district hospitals”. Dr Jagdish Prasad, DGHS

“Spending in healthcare should be in a very synergestic manner so that it can bring holistic result. For this public health, health governance and patient care should be linked in achieving good healthcare”. J Satyanarayana, Secretary, DEITY

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diabetes management solution. HP’s diabetes management solution is a mobility based solution that directly fits in to the tools that enable the patient self-management as part of the diabetes disease management programme. The key trackers for patient in a self-management programme are controlling the glucose level and the calorific intake of the food for each meal. Though there are multiple solutions available in the market to cater to the tracking glucose level or food intake, there is no single solution that would combine the two trackers as unified solution. In addition, HP solution will provide the ability for health plans to post the reading materials and videos about diabetes management directly to the user’s devices through analytics”. Nair informs, “Last year we launched our global innovation centre in Thane, Mumbai. Our innovation team is currently working on launching our new platform ‘Componium’, which is aimed at empowering the entire value chain of Business Software Application IT lifecycle. With this platform, different stakeholders will be able to contribute to enrich the habitat and build newer functionalities for a specific or generic need of businesses”. Vennimalai says, “Aavanor is focussing its R&D efforts and we are working on a number of innovations to broad base care delivery, early identification for prevention and supportive care to enhance effectiveness of care plans and the prevention of relapses”.

Intervention versus innovation (Regulations and challenges) The complex healthcare regulatory environment in India gives such impression that the healthcare professionals need to use most of their time in complying with the healthcare regulations than to their work. However, the industry experts have different opinion on the subject. Varma says, “I

cover story

Nair says, “I think there is still lack of awareness in certain segments of the provider industry about the advantages of IT automation and IT is still not considered as an effective enabler that will improve organisational performance. This lack of knowledge is reflected in the low IT budgets allocated for innovations. There are also instances where IT innovation suffers from lack of support during implementation. These are the challenges that need to be overcome. Simha adds on this by saying, “Lack of a watch dog in such an important area is definitely scary. However, this could be a double edged sword. The regulatory system could in many situations become a bottleneck in the innovation process. That is something we could ill afford at this stage. I feel an industry led self-regulatory framework would be a good starting point

“We need to understand that once we have identified the problem, we also would need innovative solutions to solve those problems thus completing the cycle of care” Vijay Simha, Partner,Vita PathFinders LLP & CEO OneBreath Inc

feel the biggest challenge which would limit the acceptance levels of the Indian healthcare fraternity is the dumping of west-focussed solutions on Indian systems. There are several firms who have developed products and solutions while working with Payers and Providers in US, Europe or Singapore and then try to implement the same ‘out of box’ solution in India without any significant alignment to local requirements. What this ends up doing is increase the skepticism of healthcare professionals, especially clinicians. However, the positive news is that I am seeing firms increasingly becoming aware of India’s unique needs and customising their offerings”. Tarigopula says, “The regulation is kind of mixed. Regulations would help if they could standardise the healthcare transactions similar what had been done in USA through HIPAA

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regulations which would help standardise the model across the industry”. He adds further by saying, “In my view, it is not the regulations which are stifling the growth of innovations/ innovative products, but their improper implementation”. Simha says, “The challenges I see would be in the standardisation and interoperability of data structures such as HL7 and DICOM. Until we have the industry formulate and comply with both interoperability and interconnectivity standards; we would be left with fragmented islands of operability. It would also be clinically very important for the Big Data Analytics to incorporate the sensitivity of data that is generated by a variety of sensor specifications such as sampling frequency, signal processing modes and the sensitivity and specificity of the modality”.

“The healthcare delivery has been very fragmented and inefficient. The innovation in heart health delivery and diabetes related care through mobile devices will help drive the next generation healthcare model” Sumanth Tarigopula, VP, Apps Global Delivery India, Enterprise Services, HP

where members can be drawn from a cross section of manufacturers, users, Governments, other related watch dog organisations, judiciary and civil society. We already have many of the manufacturers of medical technologies adopting the ISO 13485 quality management system voluntarily. However, it is also important to ensure that there exists a mechanism, such as a website, where adverse events are managed in a more transparent manner. A warning or a recall needs to be broadcast publicly in a definitive way and equipment or devices posing a threat to life should be removed from the shelves and points of use”. Vennimalai says, “Currently the lack of regulation on accountability and patient safety and the acceptance of paper as a medium of data storage are the biggest issues facing innovation in IT. Not only should it be mandated that IT must be used extensively, there must be a penalty levied on late adopters of technology who continue to deny patients the benefits of IT. As far as IT is concerned, it is the lack of effective regulation requiring technology adoption, which is restraining the growth of IT in the market”. Seetharam Malur, CEO, IdeaObject Software Pvt Ltd says, “Capturing data is critical in healthcare. Unfortunately, the mind set for the value of capturing data and usage of data for analysis to improve upon performance has not yet taken an effective root in the healthcare sector. Making end-users who input the data realise that there is critical need to enter the right data is a primary challenge”.

How cost-effective is Indian health IT market Every investment has a direct link to the kind of return it can yield. The health IT players are optimistic about the growth of the market and they expect good return too. However, the scenario is slightly different with Indian healthcare fraternity. The frater-

“Many new models of healthcare delivery are being experimented within India to effectively care for a large underserved local population, and to cater to a growing inbound international healthcare tourism market” M Vennimalai, CEO, Aavanor Systems

nity feels, the kind of modern medical equipment they need are little expensive and they are not cost-effective. Varma opines, “This depends on what you really mean by cost-effectiveness. I describe it as getting benefits in multiples of the amount spent on implementing the solution. This also depends a lot on the adopter as well. I feel the environment is right for firms like us to think about innovative payment structures as well, such as linked to successful adoption, of a pay-per-click model, depending on the type of solution. As Accenture, we have a very strong culture of what we call ‘value-based-deals’ where we partner our clients and our payments are linked to actual monetary benefits realised by them”. Tarigopula says, “When compared to international market, Indian market players are very fragmented and does not provide enough economy of

scale thus resulting in small investments rather end-to-end platform modernisation”. Simha shares, “The impact of IT and its role in clinical outcomes is still a concept that needs to mature in the Indian health IT markets. Most health IT products or services focus predominantly on the workflow of a healthcare process and this is understandable, since most professionals who have migrated their technologies from their enterprise planning experience. We have also seen a plethora of activity in areas of personalised medicine integrating physiological monitoring sensors, mobile telephones and offering a backend support service for guidance. Cost effectiveness should not come as a trade-off for efficacy or safety, it probably requires some form of disruptive technology or design thinking”. Nair says, “Indian healthcare services are definitely cost effective, especially in comparison with the other global market players. By combining innovative healthcare technologies, processes and vendor collaborations, we have started filling up the huge healthcare requirements such as reach, convenience and quality care. Vennimalai says, “The Indian health IT market offers some of the most cost effective solutions and the pricing of solutions in this market is very low compared to international levels. While many of the Indian IT providers have not focussed on developing clinical solutions, there are a number of companies offering very effective hospital administrative solutions. Not only are they particularly suited for the Indian market, they are also priced very attractively. To conclude, it would be safe to say that innovation is half done without appropriate execution; these are the two sides of the coin and thus we must as a growing health IT nation pay attention to both innovation and execution.

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zoom in

The Visionaries Look for

Healthcare Solutions With the increasing need for IT solutions in the healthcare segment, BT is now focusing on the rapidly growing health ICT market in the Asia Pacific region

ealth requires local delivery and it is vital to have the right capabilities and resources in place to best serve customers in the region. BTGS’s new Asia Pacific health practice has experts in fields such as interoperability, security, access control, identity management, business intelligence and data analytics, telehealth and mobility, clinical design assurance and

clinical safety management. BT’s eHospital solutions bring together the best in digital networked ICT services to help customers create a healthcare environment where they can give patients a better experience, boost organisational efficiency and staff productivity while understanding their costs and keeping them controlled. It’s not about ICT imposing change; it’s a way to support the workflow changes

“The BT’s e-Hospital is an integrated network that supports operational services and turns silos of data into productive information that connects patients, clinicians and administrators across the healthcare system” Janette Bennett, Clinical Director Asia Pacific, British Telecom Health

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that clinicians themselves are now demanding. BT’s e-Hospital provides a range of technology and services that can integrate a newly built or established hospital with business management as well as enable collaboration across the whole health community. The health IT market in India represents an important opportunity for BT and its Asia Pacific Health Practice. BT has a strong track record in Tele-health and Electronic Health Record (EHR) and areas which BT believes the Indian administration would like to progress and collaborate on. In India BT intends to initially target the healthcare IT spend of private hospital chains beginning with core BT products such as BT One, Assure. Advise, Compute and Connect. There exists huge potential for the role of IT in advancing national health programmes to millions of Indians hence BT is also interested in telehealth including e-clinic and mobile services. Innovative technologies, processes and partnerships forged by the Indian Government and private companies have begun bridging the healthcare gap. In order to achieve the best outcomes for patients and healthcare providers, it is important to include ICT planning at the design stage of hospital construction and new care delivery models. BT has planned for India to soon witness great benefits from modernisation of hospitals and general health services.

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leaders speak

“BIO-IT Has a Tremendous Opportunity” Kiran Mazumbdar Shaw, Founder - Biocon and President, Association of Biotechnology Led Enterprises (ABLE) shares her thought in a tête-a-tête with Shally Makin, ENN on the initiatives in the Biotechnology sector. She believes that we should be led by science and not by activism Being the Founding President of ABLE, with what vision you had brought this association into action? ABLE is a not-for-profit pan-India forum that represents the Indian Biotechnology Sector. It was launched in April 2003, after industry leaders felt a need to form an exclusive forum to represent the Indian Biotechnology Sector. It has over 270 members from all across India representing all verticals of the sector like agri biotech, biopharma, industrial biotech, bioinformatics, investment banks and centure capital firms, leading research and academic institutes and law firms and equipment suppliers.

What initiatives have ABLE worked towards the sector over the past decade? ABLE has initiated to accelerate the pace of growth of the Biotechnology sector in India, through partnering with the Government in their biotechnology initiatives to deliver optimal policies and create a positive regulatory environment, encouraging entrepreneurship and investment in the sector, providing a platform for domestic and overseas companies to explore collaboration and partnerships, we were able to catalyse regulatory reforms, forging stronger links between academia and industry and showcasing the

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strengths of the Indian biotech sector. ABLE has focused on regulatory issues, training programmes, connecting with media and investor community to understand the opportunities to invest in this sector. ABLE- DBT partnership encourages entrepreneur workshop and judge business plans of the next generation to provide the best to the biotech industry. We hold educational workshops and conferences, trying to build this potential bio economy to a huge size and shape through innovative ways of thinking.

Can you highlight the achievements ABLE has in its flag to vouch about? Some of the milestones that ABLE has achieved are those related to Dr Mashelkar Committee report on recombinant product, Innovative programs of the DST viz. BIRAP and BIPP, Vision document for the Indian Biotech industry, Roadmap for the biotech Industry, building the Biotechnology Entrepreneurship Students team (BEST) and North East Life Science Entrepreneurship (NEST) programs, the BioInvest Program and the International promotion of Brand India through organizing the India Pavilion in various BIO Shows. For a long time, our pharma products were approved by the “Genetic Engineering Approving Committee”, it should

Woman of Substance A successful technocrat of global standing, Kiran Mazumbdar Shaw heads India’s leading Biotechnology enterprise, Biocon. Her pioneering efforts in biotechnology have drawn global recognition both for Indian Industry and Biocon. She presently serves on the Advisory Council of the Government’s Department of Biotechnology where she has been instrumental in bringing government, industry and academia together, to chart a clear and progressive growth path for Biotechnology in India. Kiran Mazumbdar Shaw is the recipient of several prestigious awards including the most cherished awards -national awards, Padmashri (1989) and Padma Bhushan (2005) presented to her by the President of India, for her pioneering efforts in Industrial Biotechnology. Under her stewardship, Biocon has evolved from its inception in 1978 as an industrial enzymes company to a fully integrated Biopharmaceutical enterprise encompassing a well balanced business portfolio of products and services with a research focus on Diabetes, Oncology and Auto-immune disease. Her business Biocon, worth USD 800million, is one of India’s leading drug companies and employs more than 6,000 people at its vast campus in Bangalore.

â&#x20AC;&#x153;

ABLE- DBT partnership encourages entrepreneur workshop and judge business plans of the next generation to provide the best to the biotech industryâ&#x20AC;?

Kiran Mazumbdar Shaw april / 2013 ehealth.eletsonline.com

leaders speak

not be an environmental issue and so was brought under DCGI for being a healthcare issue solely. We brought out a number of white papers, biosimilar guidelines are now developed for the industry by us. ABLE has taken a huge initiative in educating the importance of genetically modified crop in agribio sector.

How do you foresee the biotechnology sector through your eyes?

About Biocon Ø Biocon, Asia’s leading biotech enterprise, headquartered in Bangalore, India, is constantly engaged in delivering affordable innovation. Ø As a fully integrated biopharma company Biocon delivers innovative solutions, across discovery, development and commercialization of biopharmaceuticals value chain, leveraging the cutting edge science, cost-effective drug development capabilities and global scale manufacturing capacities, in order to move ideas to market. Ø Biocon recognised as largest Indian Insulins company has several innovations to its credit including world’s first Pichia based recombinant human Insulin, INSUGEN®, insulin analogue Glargine, BASALOG® and India’s first indigenously produced monoclonal antibody BioMAb-

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EGFR®, for head and neck cancer. Ø It has also developed another Novel Biologic, Itolizumab for Chronic Psoriasis, which is to be introduced in India shortly much ahead of its global launch. INSUPen® based on German technology, is a next generation insulin delivery device introduced in India by Biocon. Ø The Company’s aspiration to become a USD 1 billion company by FY’18 is fuelled by five powerful growth accelerators, with a focus on emerging markets, these areSmall Molecules, Biosimilars, Branded Formulations, Novel Molecules, and Research Services. Ø Biocon, worth USD 800million, is one of India’s leading drug companies and employs more than 6,000 people at its vast campus in Bangalore.

We want some pharma companies to be part of this association and add knowledge to the members of the group. We will keep working towards improving and addressing regulatory challenges and works on how to deliver it efficiently. We need to look at inherent challenges, as the investment pay back is very long in this sector unlike others. The inherent gestational timeline gives you a very long term investment but with an exponential return. It’s about creating the right skills and training into the next generation entrepreneurs which includes a lot stakeholders starting from farmers, scientists, and engineers and technology innovators. We should also focus on the large natural advantages that we have and convert focus on these innovations which can help us to scale globally. I believe after biotechnology, India should look for opportunity in genomics and bio IT. Manufacturing is another neglected sector with an economic model that is much skewed and only contributes 15 percent in the GDP. This offers employment opportunities, as we being the largest vaccine manufacturers, largest manufacturers in generic drugs, we need to find answers if we can repeat the history in being the largest manufacturers in biologics. Can we go beyond generic vaccines, DNA vaccines is what I see the future to creep into the biotechnology sector.

special feature

Integrating

Web Artists

Information technology is playing with codes, strings, arrays and formulae to digitise operations on a single platform for the Hospital Information Systems (HIS) ---- make it eminently easy for medical estaablishments to address operational challenges g

By Shally Makin, ENN

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nnovations have only been the ladder to the new age world and integrating with healthcare upgrades the quality of care delivered. Rising demand from the growing middle class in India’s large cities is fueling growth in private sector healthcare. We expect to see providers benefit by offering cost-effective business models which show quick returns on capital by improving patient coverage and improving quality of care. Healthcare providers in India will spend 57 billion rupees on IT products and services in 2013, an increase of seven percent over 2012 revenue of 53 billion rupees, according to Gartner, Inc. This forecast includes spending by healthcare providers (includes hospitals and hospital systems, as well as ambulatory service and physicians’ practices) on internal IT (including personnel), hardware, software, external IT services and telecommunications. New Delhi will set up 50 new ‘delivery points’ to help pregnant women

“Like any other situation, transparency will call for more accountability and responsibility on the part of the providers and hospitals” Gaurav Mundra, CEO, Truworth Technologies under National Health Mission (NHM). Several schemes like Health Management Information System (HMIS) and Mother and Child Tracking System (MCTS), under which information regarding treatment is being sent to the patients through SMSs. It will also be expanded for the entire population of the district, which was earlier confined to rural areas only. The All India

Institute of Medical Sciences’ (AIIMS) Trauma Centre has made successful shift from preparing manual MedicoLegal Cases (MLCs) to electronic MLCs. It has become the first hospital to go digital. Since the hospital mostly gets accident cases, it registers about 30,000 MLCs in a year and doctors end up filling around 80 forms a day. The success of the module has made the Union Health Ministry formed a special committee to ensure the method is eventually replicated in other government hospitals as well. The current scenario demands hospitals to keep clinical workstation operating systems and web browsers up-to-date, while creating a formal process for updating clinical applications and operating systems software. This should help avoid the unintended consequences experienced in this case. Companies like Vizag steel have Vizag Steel Health Management System (VIZHMS), a software product designed, developed, tested and implemented totally in-house to take care of the holistic health related functions of not only of all the employees of Vizag Steel and their dependents, but also those of Central Industrial Security Force, schools, contract labor, etc. These services are also extended even to the people living in peripheral small towns/villages around Vizag

Source: Asclepius Consulting Services april / 2013 ehealth.eletsonline.com

special feature

Advanced

Solutions Ramesh Emani, CEO, Insta Health Solutions

Healthcare IT penetration is at a nascent stage in India and from within the small percentage of hospitals and clinics using some form of healthcare IT, Insta HMS could approximately have about 10 percent of the market share in India with over 135+ live implementations of which around 22 are international. Insta HMS is a web-based product and can be accessed remotely by authorised users on mobile devices. This solution has advanced insurance management capabilities (HIPAA compliant) and is compat-

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ible with financial accounting software packages such as tally ERP, focus or microsoft navision. Usage of Insta HMS has helped improve the efficiency of various traditional bottleneck processes such as improved and quicker discharges, better turn-around times in diagnostics report generation, reduced waiting times due to paperless operations, improved staff utilization, all of them combining to improve patient satisfaction and helping achieve better patient outcomes. It integrates data across departments in a hospital. Insta HMS supports external interfacing with lab equipment, dialyzer machines, PACS servers and is HL7 compliant. Healthcare is a slow mover of IT adoption but technology has become a key support service and the willingness of healthcare organisations to invest in IT has gone up in the recent years especially due to the pressures of accreditation and increased insurance penetration in India. Insta HMS offers cloud based solutions on Amazon or using hospitals’ own servers and dedicated network. Insta HMS is built on the open source Linux based architecture and uses a PostgreSQL database. This reduces the need to purchase additional licenses such as Windows Server/Database/Operating Systems Licenses or Anti-Virus software. This reduces the total cost of ownership and improves cost effectiveness of investing in Insta HMS.

Steel on nominal fee basis as a contribution towards VSP’s Corporate Social Responsibility (CSR). The system takes care of computerisation of the following functions out-patient treatment, ward (In-patient) management, pathological and other investigation services, radiology services, mobile messaging services and much more. Dr (Prof) D P Saraswat, CEO, Action Group of Hospitals proudly mentions, “We, at Action Group of Hospitals, use this system in order to provide better quality healthcare to our patients. We insist on evidence based medicine so that the right treatment is prescribed to the patient. All our lab reports are on HIS and so there is no question of human error and the reports are accessible to others.” He adds, “We have developed our own “Objection Software” with the help of professional programmers for our hospitals wherein customized standards of treatment are maintained. The material management, inventory optimization and issue to the patients are speedy and accurate.” Gaurav Mundra, CEO, Truworth Technologies says, “The latest buzz in the hospital management industry is the paperless and filmless consolidation of information and efficiency improvement in overall care delivery process.” He adds, “Cloud-based Hospital Information Management Systems (HIMS) is rapidly catching up to allow for continuous upgrade of software from the vendor, low upfront investment on software and hardware and anytime, anywhere access.”

HIS of Future V irtual Mult I dimensional Sha R ed Cus T omer centered Sec U re A vailable Supporting qua L ity of Care

Calculated potential annual healthcare software spend for hospitals in FY13 <30 bed

: `70,000

30 â&#x20AC;&#x201C; 100 bed

: `450,000

100- 300 bed

: `100,000

>300 bed

: `2800,000

Currently, Indian hospital spend less than 0.4 percent of its revenue on software. Globally the norm is 5 - 6 percent, in Malaysia and Thailand, it is already 3- 4 percent Mid-sized hospitals are expected to comprise over 65 percen of the healthcare software by 2014

â&#x20AC;˘ Moderate annual spend â&#x20AC;&#x201C; together with high volume growth

â&#x20AC;˘ Maximum number of new capacity addition implies higher â&#x20AC;&#x2DC;propensityâ&#x20AC;&#x2122; to buy

â&#x20AC;˘ Increased sophistication in needs â&#x20AC;&#x201C; over and above the existing HIS solutions

â&#x20AC;˘ Large hospitals (>300 beds) have highest ticket size, but lower volumes â&#x20AC;&#x201C; which however is relevant to international product price points

Vishal Rajan, Co-founder & Director, Asclepius Consulting says, â&#x20AC;&#x153;While static reports and interactive graphs have been delivered for senior managementâ&#x20AC;&#x2122;s MIS needs, Health IT has grown to offer analytic services around forecasting, trend analysis, consolidation and around the vital aspects of â&#x20AC;&#x2DC;Why it happenedâ&#x20AC;&#x2122; instead of â&#x20AC;&#x2DC;What has happenedâ&#x20AC;&#x2122;.â&#x20AC;? He adds, â&#x20AC;&#x153;The graduation of Health IT towards sophisticated analytic tools is expected to significantly strengthen decision making and drive business optimisation across the health ecosystem.â&#x20AC;? e-Svaasthya is a web-based HIS developed by Centre for Development of Advanced Computing (CDAC), which aims at catering to hospitals of any size. It will help in computerisation of all the activities of the hospital right from patient registration to adding and accessing patient data securely, online consultation and treatment by doctors, blood bank management, ward and operation theatre management, etc. Being a web-based

system, it enables data sharing across different regions. Hospitals now need to be aware of such solutions which are being offered in the market. Every time a doctor gets a wrong turn while using software, he needs to be learnt about the user friendly gadgets being provided by the web developers. The codes and the digital world may feel complicated to a health professional but this is where the web developers have worked on creating an enterprise solution for hospitals. The integrated pathway is again networked seamlessly with all HL7/ R232 compliant medical equipment and third party applications. Such innovative models provides click based sentence construction reduces the report generation time by more than 75 percent and user friendly statistical analysis tool, which allows doctors to generate reports for research. The number of information in hospital information system is huge, some of them are sensitive, confi-

â&#x20AC;&#x153;Clinical decision is arrived at the evidences made available in the form of diagnosis in correlation to the clinical findings. The software should support in making the right decision at the right timeâ&#x20AC;? Dr (Prof) D P Saraswat, CEO, Action Group of Hospitals dential and real-time information, the database server is running for 24 hours a day, if the whole network system is in the failure of man-made or accidental, this will cause huge losses and social impact. Hospitals should support the development of new IT-security experts specialising in healthcare systems. These specialists could monitor risks to HIS and IT infrastructure. Change is always resisted by humans and deploying or upgrading an may also invite employee criticism.

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special feature

Customised HIS is the Need

Sanjay Jain Managing Director, Akhil Systems

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The benefit of web based HIS is that it allows the application to run on single server and at various locations suitable for chains of hospitals, clinics, diagnostic centers and pharmacy. It is designed based on service-oriented architecture (SOA) allowing applications to bind to services that evolve and improve over time without requiring modification to the applications that consume them. HIS providers hold more than 60 percent market share in healthcare IT industry. Hospital administrative solutions for finance, billing, HR and materials management have a huge market in Asia pacific. In India, around 65 per cent of the HIS market is made up of in-house implementations and legacy systems. These solutions benefits in several ways to the patient vis a vis the hospital. IT automates hospital operations, improves work-flow and easy access

to information, reduces medical and billing errors, provides more satisfaction and a better hospital visit experience to patients, and all the processes are streamlined. Through this, patient can be able to see online test results, schedule appointment, access online patient clinical records etc. Providers should be always active in research and development of the software to get updated with the latest technology and current market demand. Akhil Systems since last 17 years developed its product from DOS based system to cloud based systems as per market demand. New releases strengthen the market as per demand. To increase market share providers must cater as per market demand. Through new release providers can easily strengthen the market by providing what customers need in current scenario.

Barco - India A38, B&C, Sector-64, 201301, Noida, UP, India Tel: +91 120 4020000 Mob: +91 99714 41118 Email: sales.in@barco.com rahul.sethi@barco.com

www.barcomedical.com

special feature

Meeting the

Last Point

The innovation seems to reside at entrepreneurs brains and so do the story featuring latest innovations and tie ups in the telemedicine sector

By Shally Makin, ENN

atched by a doctor on the other side of the Indian subcontinent, a man leans back as far as he can before he feels the arthritis pain. â&#x20AC;&#x153;Where does it hurt?â&#x20AC;? a rheumatologist asks. The scene is similar to that of any conventional medical consultation, with one fundamental difference: the doctor and patient are nearly 2000 miles apart. This could be the future for healthcare in India, where both the public- and the private health sectors are devoting substantial amounts of money and effort to mainstream telemedicine. Proponents of telemedicine see it as a solution to some of the deficiencies in the countryâ&#x20AC;&#x2122;s health sector. India faces shortage of doctors, particularly in rural areas, where nearly 70 percent of the population lives. Doctors and hospitals are largely concentrated in cities, and as a consequence, health care in rural India is inadequate or absent. In the developing world, however, India is not

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“Live streaming of videos from Kumbh Mela region to other places and streaming operation theatre videos from SGPGIMS and multipoint conferencing were made possible through the school of telemedicine hub” S K Mishra, Nodal Officer, School of Telemedicine & Biomedical Informatics & Head, Department of Surgery, SGPGIMS, Lucknow

the only country that is experimenting with this new technology. Pilot projects have been initiated in Mozambique, Uganda, Senegal, and Kenya. The Chinese Government, too, has become interested in the potential of the technology, initiating a large-scale project linking its vast rural population with medical expertise in its cities. Telemedicine in India is, however, generally seen as being more advanced than in these countries and technologically on a par with the developed countries. Indian Telemedicine market is estimated to be USD 7.5 million and is expected to grow at a CAGR of around 20 per cent over the next five years. It is estimated that 1.5 lakh people are benefited of telemedicine every year. Increased use of wireless and web-based services and adoption of 3G and HSPA has given a boost to the market in recent years making it key growth drivers.

Tele-innovations The telemedicine industry gets the encouragement from the schools such as the Mobile Telemedicine System (MTS). Blueprint of this system was developed and designed under the supervision of S K Mishra nodal officer of School of Telemedicine & Biomedical Informatics & Head, Department of Surgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS), Lucknow. MTS has four sections, one for driver and passenger seats, second for ICT section equipped

with video conferencing system for visual communication with doctors in remote places, a public address system used for mass awareness among rural population using projection system and external tuning with projectors. The third section has Xray units and an operation table to perform minor surgical operations. Section IV has a laboratory equipped with devices used for capturing vital parameters and ophthalmic imaging and for laboratory tests. It is a fully independent unit equipped with generator and UPS, apart from regular power source with multiple connectivity options that has BSNL WIMAX

connectivity linkage and can connect to any of the telemedicine-enabled medical hospital and super-specialty hospital for expert opinion. There is a sharp increase in the acceptance of such technology among the students. Academic activities in Patna University (PU) went hi-tech with the organisation of a lecture series on bioinformatics and database through videoconferencing. Taking the level higher, portable devices for serving telemedicine purpose is what the next generation is looking at. 3nethra is a low cost, portable, and highly integrated ophthalmology device for pre-screening and identi-

“Arogya Vani -The helpline ensures that people get basic information on their health conditions and the available medical facilities through a process which is easy and accessible, throughout the year.” Dr Balaji Utla, CEO HMRI

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special feature

“Since 2009, KIDROP covers more than 75 percent of the State of Karnataka in multiple zones. Thus far over 31,000 imaging sessions, with over 844 babies have undergone laser treatment preventing blindness in them” Dr Anand Vinekar, Program Director, Karnataka Internet Assisted Diagnosis of Retinopathy of Prematurity (KIDROP)

fication of potential eye diseases. It has a retinal camera with inbuilt refractometer that captures the images of the retina and, through its image processing algorithm, generates an automatic report about the problem it has detected. The ruggedised system, which can easily be transported to rural communities for a temporary eye-check clinic, works by scanning both the anterior and posterior segments of the eye in five minutes, without dilation. The system also connects primary care centers to secondary or tertiary care centers over telemedicine for remote diagnosis. Moreover the device is low-cost and hence greatly reduces direct and indirect cost of screening, making it available to rural populations. A huge foundation like Piramal Foundation’s Swasthya Project, Health Manage-

ment and Research Institute (HMRI), has signed an agreement of service with the Government of Karnataka that aims to provide health information help line services in the state through 104 BSNL telephone number. This service is being named as “Arogya Vani” which will assist people living in rural areas of the state, who face difficulty in accessing a qualified doctor. To achieve this objective, Government of Karnataka, with HMRI as nodal agency, is establishing this 100 seat facility at IT Park at Hubli, and plans to scale it upto 300 seats soon. The Government of Maharashtra has also approved the establishment and operation of Primary Health Centers (PHC) in the tribal areas of Thane District, equipped with facilities for telemedicine. HMRI has been handed the responsibility of implementing

the telemedicine solution in these 10 PHCs of Thane District by linking them to the Health Advice Call Center operated by HMRI from Pune. Karnataka Internet Assisted Diagnosis of Retinopathy of Prematurity (KIDROP) is India’s first and now the world’s largest telemedicine network to tackle infant blindness. Using cutting edge technology, an award winning, indigenously developed, customized tele-ophthalmology platform, KIDROP screens the retinae (the nerve of the eye, which lies at the back) of babies a few days old in their rural hospitals, provides remote diagnosis of these images by experts and provides for treatment of these babies in the periphery without the need for these babies to travel to the city. Two million are at risk each year, in India alone. Every day,

“There are very few successful and scalable models of delivery of primary health in India so far. We believe that our partnership with eHP will demonstrate successful use of technology and social entrepreneurship can lead to a massively scalable model to provide clean water and primary healthcare services from a single point of contact in a village or a small town” Dr Ajay Bakshi, CEO, Max Healthcare

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First in the Market

Among the solutions introduced in the telemedicine market, a plethora of hardware applications can be appended to a web-based telemedicine platform that include digital stethoscope, otoscope, ophthalmoscope, and digital BP, Oximeter and EKG apparatus.

These today allow for every aspect of the patient medical examination to be performed remotely with the exception of palpation. We have been using Ciscoâ&#x20AC;&#x2122;s health presence telemedicine platform which is integrated with Telrad techs teleradiology software (RadSpa). Workflow tools and schedulers that optimise the utilisation of physician time are a timely new addition. In teleradiology the use of mobile devices such as the iPad and iPhone is revolutionising image access and collaboration on the part of both radiologists and clinicians. The use of the Internet cloud as a repository for imaging data is a welcome trend as it promotes universal access to images (while still preserving security), and also allows for a pay per click teleradiology model, such as we offer through Radspa, which can significantly reduce startup costs. Given that teleradiology is at the forefront of the telemedicine revolution and US is far ahead of the rest of the world in its utilisation, this indicates that the corresponding numbers in other parts of the world would be proportionately lower. There is a lot of opportunity for providers and

the technicians visit neonatal care units in remote villages with a portable digital camera and image the eye of new-born infants, which is also less stressful for the baby boy or girl at that stage. Then the images are uploaded via e-mails to a dedicated server, maintained by a Bangalorebased company, with a simple data card attached to his camera device. As the technician moves from one centre to another, these live images of infantsâ&#x20AC;&#x2122; eyes get reported and doctors viewing them online are able to the advise the parents of the babies, through the technicians.

As many as 81 neonatal centres in as many hospitals in Karnataka have been linked as part of this network, Dr Vinekar, has trained 18 government teams to work on this model. Many hospitals have taken initiatives towards developing on a healthcare delivery model that could be made cost-efficient at all levels â&#x20AC;&#x201C; village, mid-, secondary care and super-specialty. ITbased, tele-medicine and mobile health will be the most vital links from ground up. Hospitals are partnering with telecom partners to offer tele-medicine services and will soon be getting into mobile tele-medicine. Apart from Indian

Arjun Kalyanpur, Director, MD, DABR, CEO/Chief Radiologist/ Chief Pusher, Teleradiology Solutions

Brief us about the latest solutions introduced in the market of telemedicine.

that the future of telemedicine is bright.

How is new technology providing greater accountability for providers? MIS systems and QA/Peer review modules forms a part of the latest teleradiology workflow solutions that are geared to provide data to teleradiology providers allowing them to track their report quality, report turnaround time, and other key performance indicators. As the telemedicine market becomes more competitive, such indicators will be shared with clients, creating an environment of greater transparency and accountability.

Do you think remote healthcare can strengthen the market and in turn the healthcare delivery? Absolutely, by reducing cost of care and improving service level efficiencies. In many places, teleradiology has raised the bar for radiology report quality and turnaround time, and onsite providers have been obligated to step up their own services to meet the new benchmarks and standards of care.

players, foreign telemedicine providers like SHL are also offering services to Indian hospitals. The MOU signed between Max Healthcare and HealthPoint Services India Pvt. Ltd will be available for rural patients of Punjab via eHP telemedicine network. HealthPoint Services India Pvt. Ltd has established the E Health Point (EHP) model which is a rapidly growing chain of rural health kiosks that targets millions of low-income people who currently lack reliable access to safe drinking water and legitimate healthcare services by leveraging technology. This model

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special feature

Electronic Health Delivery

Vivek Sharma, Regional Vice President, Greater China and South Asia Region, India Operations Director, India Design Centers, STMicroelectronics

‘Body Gateway’ –is an integrated remote monitoring solution from ST for an advanced telemedicine platform. It is a lightweight and low-power electronic system for the measurement of physiological parameters within the body, such as heart rate and breathing rate, eye pressure monitoring, blood analysis and insulin therapy. The body gateway supports, among others, a wearable patient monitoring system in a tiny module that can be taped to the patient’s chest. This telemonitoring approach is particularly

beneficial for elderly patients, patients in nursing homes in remote locations with no access to a hospital or nursing home who need to be watched or monitored closely. The remote monitoring solutions from ST based on the most innovative MEMs devices, detect even the slightest physiological movements which are processed by an internal microcontroller, and sent via bluetooth, zigbee, Internet, GSM or local network etc to a control station for monitoring, diagnosis and urgent life support therapy.

“We appreciate the efforts of Max Group to expand their high quality healthcare expertise to low-income and underserved rural communities. This collaboration is expected to close the gap in achieving the public health goal” Amit Jain, CEO of HealthPoint Services India Pvt Ltd has been created to cater to the twin objectives of preventive and curative services and creates a high social impact whereby clearly delivering economic, health and financial benefits for low-income communities. Though the cost of telemedicine is often lower, the infrastructure cost to provide telemedicine facility is often high. This high cost acts as a hindrance to the development of the market along with the lack of interest from patients and doctors restraints the growth of the market. There are still certain legal hassles in telemedi-

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cine, which have not yet been solved. Major roadblocks for telemedicine would be shortage of computer savvy healthcare personnel, high capital requirement (approximately USD 10,000) and less replicability. The BRIC report suggests telemedicine market is expected to grow with a CAGR of 15 percent. Another driving factor for the telemedicine market is the requirement of medical facilities in rural areas. Rural areas lack good medical facilities and hence the concept of telemedicine is very well accepted in the developing areas. The Indian Gov-

ernment has been investing in telemedicine in a bid to make health care more accessible to the country’s rural communities. But sceptics are wary about the limitations of the technology when it comes to diagnosis, care, and surgery. The opportunity lies in developing a knowledge sharing platform to enhance the scope for telemedicine market. Also the support of the Government in promoting the telemedicine market would be crucial for its development. Increasing the awareness of patients about the advantages of telemedicine is crucial for sustained growth.

Special Feature: ris/pacs

RIS, PACS

Making Inroads in Healthcare

Conventional X-ray reports are passĂŠ. With technologies like Radio Information System (RIS) and Picture Archiving and Communication System (PACS), modern healthcare is approaching more towards smarter infrastructure that not only benefitting the users but the patients alike. A closer look! g

By Sharmila Das, ENN

he market for RIS-PACS solutions in India is price sensitive. The focus of RIS-PACS solution is ease of use, price-performance and virtualisation of patient image records. RIS-PACS virtualisation solution ensures collaboration between specialists at different locations. This helps in having multiple faculty consultations in remote locations especially in cases involving multiple organs injury. By integrating RIS, PACS to Operation Theatre (OT) cameras, live OT images can be streamed live for cross consultations. We all know the benefit of virtualisation. It enables referring doc-

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tors to view the same images that the remote doctor is viewing. The RIS-PACS solution makes life of a PACS administrator a lot easier, as there is only one server to maintain. The best feature is that it enables patient x-rays and other images to be digitally attached to patient electronic medical record and be sent outside or within the hospital to consultants/ experts for second opinion within minutes.

Adopting RIS & PACS Mostly Indian urban hospitals have adopted RIS and PACS efficiently. However, larger acceptability is still a constraint because Indian hospi-

tals and healthcare industry normally is price sensitive. Hence, the key requirement is that the solution should be cost competitive. Other than that it is also necessary that the solution should have interface with third party applications, it should offer ease to use for end users and it must conform to global standards of healthcare. These solutions store images electronically thus hospitals can save a lot on operational costs. With RIS-PACS, hospitals can vastly improve their efficiency. Since these solutions enable attaching patient medical records and report electronically to their files, it is easier for doctors to send them within the hospital

“An integrated PACS viewer works to eliminate the emphasis on where a test is performed, since all results are shared electronically with other facilities” Arup Mukherjee, COO, Binary Spectrum

to experts / consultants for second opinion. They can also store for their record and reference. Also, electronic storage of data enables healthcare institutions to store the images in their archive and can be revisited by them at any point later for reference without the fear of physical damage to reports. RIS-PACS solution can be completely integrated with external Hospital Information System (HIS) solutions. Implementation of RIS / PACS sometimes requires integration with third party solution. Appropriate technical support from the vendors is required. Any inadequate support and coordination leads to delay in the implementation time line and would create a possible risk to the project. Sunder Natrajan, CEO, Ashva Technologies shares, “The RIS/PACS marketplace is evolving globally and in India the adoption of IT is in high gear. These are very exciting times both for the RIS/PACS vendors and adopters of the technology. The productivity gains and improved patient care by technology adoption is well documented”. Ashish Dhawad, Founder & CEO, Medsynaptic Pvt Ltd says, “Today we see a lot of hospitals opting to deploy a PACS because the advantages have been clearly demonstrated by the previous generation of users. Hospitals can derive both financial and non financial advantages by deploying PACS. Reduction of spending on consumables and film provides a direct and real ROI for the hospital recovering the cost of the solution itself in a short span of time. Improved workflows, better staff management, 24 X 7 tele-radiology, data mining, academic research and higher equipment utilisation are some of the other benefits that a hospital can get from installing a PACS. Finally all of the above lead to customer delight and higher quality of patient care which is the final goal of any hospital”.

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Special Feature: ris/pacs

“Public Health Foundation of India says, “The availability of Indian Health Care Professionals (HCP) is a state of “plenty and poverty” depending on the location. RIS and PACS if implemented can link and rationalise the availability of HCPs” Dr Suresh Munuswamy, Faculty for Health Informatics, Senior Lecturer, Indian Institute of Public Health - Hyderabad

Arup Mukherjee, COO, Binary Spectrum says, “An integrated PACS viewer works to eliminate the emphasis on where a test is performed, since all results are shared electronically with other facilities. A PAC web viewer is a perfect example of how information can be shared through the Internet. Radiologists, referring physicians and clinicians can access a chronological view of a patient’s radiology history. It also slashes costs related to the managing of film and tests previously affected by lack of access to relevant priors, or lost films”. Dr Suresh Munuswamy, Faculty for Health Informatics, Senior Lecturer, Indian Institute of Public Health Hyderabad, Public Health Foundation of India says, “The availability of Indian Health Care Professionals (HCP) is a state of “plenty and poverty” depending on the location. RIS and PACS if implemented can link and rationalise the availability of HCPs. However, even the availability of basic imaging services for X-ray, CT Scan, MRI, Ultrasound etc in India is patchy and not dependable. Digital medical imaging services need digital diagnostic equipment, support infrastructure and screening algorithms to make the best use of RIS and PACS systems.

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Innovations on RIS & PACS In days to come we are surely going to see a lot of improved RIS and PACS solutions. As per the industry experts the existing RIS will get better resolution images. Bhavesh Thakker, VP, Chowgule Mediconsult Pvt Ltd feels,

“The RIS/PACS marketplace is evolving globally and in India the adoption of IT is in high gear” Sunder Natrajan, CEO, Ashva Technologies

“Innovations are currently focusing on RIS and PACS which is propelling growth. Improving image quality and resolution on one hand and speed of data transfer on the other hand are the aspects under focus. Image analytic space is also seeing a lot of interest and activity as it adds a lot of value to the end user. Coming years should see clinical data capture, apart from images, secure transfer across platforms and interoperability as the key drivers of growth”. Dhawad says, “Technology is a fast changing business and vendors need to innovate continuously to ensure that the customers get the best solution. PACS technology has also evolved tremendously in the last couple of years. Lot of interesting innovations are happening and I see most of the hospitals now prefer to go for a fully web based PACS. Apart from that I see a lot of new technologies being deployed like a) integrated advanced visualisation, b) cloud PACS sharing the same infrastructure between group hospitals, c) zero foot print viewer, d) tab and mobile based viewing of images, e) full workflow integration”. Dr Munuswamy says, “Innovations may result in three outcomes; reduction of size of imaging devices, continuous imaging in real time and

continuous analysis in real time”. Natrajan says, “The single most important technology and innovation happening today is the advent of cloud computing infrastructure. Cloud computing is remaking the RIS/ PACS technology in many ways. Major impact can be seen in the cost of ownership, significant increase in adoption rates, efficiency and productivity, anywhere, anytime access to data on demand. Combined with the penetration of the Internet to rural India, there would be a significant increase in access to good healthcare for the entire population”.

Supporting factors It is not that the popularity for RIS & PACS processes has taken place over a day or night. The demand was there already. Mukherjee says, “As per the analyst, healthcare service providers’ eagerness to be competitive in the market, improve their facility and better manage their imaging is a huge boost to the RIS-PACS market. There is a significant increase in the number of patients, while there is not enough medical staff to attend to them. This scenario has encouraged hospitals to automate their functions to ease the burden on their medical personnel. The proliferation of sophisticated medical devices compels hospitals to deploy advanced PACS to enable the seamless exchange of information. Furthermore, there is a rapidly rising demand for storage, as more devices produce images in the digital format”. Market dynamics Market grows as per the demand. Although there is no authentic data available on the market size of RIS & PACS, the demand curve for adopting more such solution is surely on the rise. Dhawad informs, “The RISPACS market has started maturing in last few years and will continue to grow substantially in coming years. The market is big enough to sustain

“24 X 7 teleradiology, data mining, academic research are some of the other benefits that a hospital can get from installing PACS” Ashish Dhawad, Founder & CEO, Medsynaptic Pvt Ltd

many players both Indian and foreign. Companies which ensure good quality develop new technologies and maintain high levels of service will gain more market share and revenues. At the same time companies like Medsynaptic are taking a leap into the international market and have been successful in several countries across the globe”. Mukherjee says, “Declining costs of RIS-PACS encourage their adoption by low and mid-tier hospitals. RIS-PACS used to be adopted exclusively by the top-tier hospitals in the 1990s because they were prohibitively expensive to the smaller ones. However, with the decline in costs and advancements in applications, smaller hospitals have begun to implement them in various medical disciplines such as cardiology, dentistry, and orthopedics”. RIS & PACS have answered many issues relating to delays in diagnostic procedures. However, in days to come, with newer developments these solutions will just get better in serving healthcare.

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Special Feature RIS PACS

An Advanced RIS & PACS Solution

Agfa HealthCare has come up with a sound RIS PACS solution that gives lot of benefits to its end users

gfa HealthCare was one of the first companies to introduce PACS & RIS to the global market. Based on its experience in radiology, Agfa HealthCare has developed a number of IMPAX solutions for hospital departments that work intensively with medical images, including cardiology, orthopedics and nuclear medicine, as well as for certain specialised medical disciplines, such as women’s care and digital pathology.

IMPAX 6 IMPAX 6 is a next generation PACS tool, designed to streamline the enterprise workflow and deliver increased efficiency and productivity to the hospital or care facility. It is a single workflow-based system that can serve your needs within and outside the walls of your facility by providing an electronic workflow system, streamlining study reviews, offering a persona-based design, and enabling improved reporting and results distribution. IMPAX 6 adapts to your specific needs, by working the way you want to work. It can scale from a single box solution to a multi-facility environment capable of fulfilling the needs of any enterprise, radiology department or imaging center. The benefits of using IMPAX 6 solution are: a) Better workflow management, b) web-deployable for access to data from local or remote, c) maximum patient privacy and data security is ensured, c) easy, centralised management of users, system and software, d) connectivity for an integrated view of patient

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data e) seamless integration at the desktop, pulling together disparate information systems, f) role-based access based on IT standards (NIST), g) prior report handling h) scheduled worklists for rounds/demonstrations, i) key image creation/display scanned documents available on Text Area (with IMPAX RIS) j) IHE support etc. IMPAX solutions support advanced visualisation tools such as Virtual Colonoscopy, Volume Viewing, Angio Analysis, Orthopedic tools, Nuclear Medicine, SPECT, PET and Breast Imaging.

IMPAX RIS IMPAX RIS is a comprehensive and scalable solution that streamlines your workflow. It lets you electronically manage your radiology operations from patient registration through work list generation and transcription, to medical reporting and business intelligence. IMPAX RIS is suitable for small to multi-facility hospitals. It supports the complete radiology workflow and integration with management reporting. It gives full range of reporting and result distribution tools to minimise report turnaround times. The solution gives full integration with any hospital’s current and future IT infrastructure. Integrated with IMPAX and Reporting solutions, it delivers a consolidated view and centralised management of patient image and information data.

Workflow and integration Agfa HealthCare’s leading PACS technology customised to integrate with

existing in-house solutions. Built-in flexibility that guarantees the solution will continue to meet needs, as they evolve. Integration with existing solutions like HIS, third-party desktop applications, eliminates the time needed to cross-reference access numbers, patient IDs and multiple sign-on passwords. It ensures improved physician productivity and workflow, simplified workstation use by eliminating multiple sign-on passwords and reduced report turnaround time. During the last 20 years, imaging informatics has morphed from an island owned and populated by radiology to a series of enterprise systems. The march of progress continues with widespread adoption of PACS and the increasing role of imaging in taking the best and making it better. Agfa HealthCare believes combining clinical images with relevant patient data provides greater insight for improved delivery of patient care. From acquisition through management, sharing, publishing, storing, distributing, managing, archiving and more, Agfa HealthCare delivers with proven technology and worldwide expertise. This fuels a more comprehensive 360 degree view of patient health that empowers informed decisions at the point of care. IMPAX is a key part of our vision for a highly integrated healthcare record across the healthcare continuum. And we are bringing that reality to life every day, around the world.

special feature

New AGE Solutions

for Radiologists RIS and PACS has eliminated the need for the dark room processing and hard copy films and have brought high quality images, stable X-ray imaging and immense benefits in terms of saving costs and enhancing quality Chander Shekhar Sibal, Executive Vice President, Medical Division, Fujifilm India Private Limited

Tell us the current trend of using RIS & PACS in todayâ&#x20AC;&#x2122;s healthcare? What are the new innovations coming up? PACS is now essential equipment for radiology departments and practices. With PACS Radiologists can compare the images taken during last visit of patient and this can help in better patient management. An RIS is especially useful for managing radiological records and associated data in a multiple locations and is often used in conjunction with a picture archiving and communication system (PACS) to manage the work flow and billing. RIS+PACS is becoming a single integrated solution. PACS application is becoming more clinical including 3D features than review applications. Accesing images through mobile device are becoming increasingly popular and vendors are embedding these in their solutions. Application Service Provider (ASP) or cloud based PACS and teleradiology models are evolving, saving the upfront initial cost to the buyer if they are ready to live with slightly slower retrieval timings.

Share us an innovation model devised by Fujifilm. Synapse (PACS) has revolutionised the management of radiology imaging services, supporting image diagnosis with high-quality images, numerous image processing features and easy operation with new possibilities in this rapidly developing medical field. The best PACS would need to accommodate multiple physical locations with disparate RIS and HIS systems with multiple Radiology reading groups across the facilities in an enterprise. Synapse (PACS) was the one to address all of these needs and more. Fujifilm Synapse (PACS) is a webbased medical imaging and information management system that integrates image and diagnostic information with in a medical institution over a specified network. Operation has been made simple so that doctors, technologist, and hospital personal can readily obtain required information anywhere and anytime. It allows effective filmless diagnosis with high quality image processing. It is a collection of software modules which together provides the core software functionality known as Synapse - FUJIFILMâ&#x20AC;&#x2122;s next genera-

tion PACS. Server modules work with the workstation software to provide powerful foundation technologies that serve the radiology department, the healthcare enterprise and beyond. The same exact Synapse (PACS) code runs a 30,000 exams per-year outpatient imaging center can run a multi-server, multi-site configuration with greater than a million exams a year.

In what ways do you think RIS & PACS benefits Indian caregivers? The PACS viewer is a software that is installed on the workstation to receive and display the radiology images. This has both software and hardware components, which directly interfaces with imaging modalities and acquires the digital images from the modalities. It reduces the cost of radiology by eliminating the tradition process associated with storage space required for the same. Peer review of the reports & subspecialty second opinions are much faster. PACS+RIS increase productivity, a system for digital storage, significant improvement in accuracy, rapid diagnosis, and fast report turnaround. This ultimately results in improved patient care.

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specal feature mHealth

Connecting

â&#x20AC;&#x192;â&#x20AC;&#x192;the Dots

From commercialisation of health apps, to reaching an increasingly wider audience, connectivity is now driving various innovative models in healthcare. A sneak peek into the world of dynamics of connectivity

By Shally Makin, ENN

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he booming mHealth market will grow to USD 26 billion by 2017, reaching a worldwide market of 1.7 billion users looking to use their smart phones and tablets to take care of their health. Currently, there are about 97,000 mobile health applications available from a number of different application stores, with 15 percent of them dedicated to medical professionals instead of patients and popular consumers as predicted by a new study by Research2Guidance. With more and more traditional healthcare providers joining the mobile applications market, the business models will broaden to include healthcare services, sensor and advertising and drug sales revenues. However, as smart phones become ever more powerful and tablets saturate the landscape, revenue from the mobile market will continue to increase. The study predicts that up to 84 percent of revenue will not come from paid downloads, but from extra equipment such as sensors and monitoring devices that patients and providers will link to their phones and tablets. Developers are already exploring wearable devices such as wristbands and sensors that use bluetooth to upload data such as heart rate, temperature, and blood glucose to a cloud repository. In richer countries, meanwhile, money is pouring into ‘mobile health’. The main aim is to let people with chronic illnesses better manage their conditions day-to-day and reduce time spent in hospital. According to PwC, by 2017 mobile health services could save USD 400 billion a year out of a total annual health expenditure of USD six trillion in the leading industrialised nations of the OECD. Several smartphones now offer applications that link with diagnostic tools, for example to perform urine analysis or check the blood sugar levels of people with diabetes. GlucoDock, which connects to an iPhone, allows diabetics to check their blood sugar levels before and after eating.

Healthy Connections

Vishal Gupta, Vice President and GM, Global Healthcare Solutions, Cisco

Latest solutions introduced Mobility is here to stay and according to economists, the number of mobile subscriptions exceeded the number of fixed line connections for the first time and there is estimated to be over six billion mobile subscriptions today for voice and data services. Given the very adoption of mobile devices like tablets and smart phones, it is natural that they will play a key role when it comes to mhealth since they are ubiquitous. At Cisco, we are looking to support mobility across all our key solutions so that we give more choices to our customers and users. There are three key mobile health solutions from Cisco: Mobile Tele-health which we support via Cisco Health Presence. Here, Cisco has a unique technology called Jabber which can run on Iphone, IPADs, and in a couple of months also on android phones and android tablets in addition to running on desktops and various operating systems. Work Your Way via BYOD – As part of our suite of offerings for a

smart hospital; Cisco has released very exciting technology called Cisco BYOD (Bring Your Own Device). This allows a healthcare company to give choices to their patients and clinicians on any phone to use and any laptop or desktop to use while still maintaining control of what information and application can be accessed by whom and enable the enforcement of policies without actually the devices being supplied by the company. Healthcare Service Exchange Platform (SxP) will be released in June 2013 and is in pilots today. This platform will enable any process within healthcare to be supported via a cloud and here again, the clinicians and patients can access the data to their work on any device which will be supported via advanced security, role based access, and supporting healthcare standards like IHE.

Accountability is crucial There were 30 billion applications downloaded on mobile devices last year alone and we believe at least 5fivepercent of those were for healthcare and so you are looking at one and a half billion mobile healthcare applications downloaded. In healthcare, it can be sometimes harder to get objective information on providers to enable the decisions from consumers and hospital administrators to be more objective. In all our three mhealth offerings, we support deep analytics and reporting for easier determination of metrics at individual doctor level which can in turn drive accountability. We have thus done over 28,000 speciality consultations in one year alone just for 20 primary health centers though our target was only 1000 speciality consults.

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specal feature mHealth

mHEALTH A Mammoth Just Born! Dr Pankaj Gupta, Partner, Taurus Glocal Consulting I think we are at an inflection point where the large HIS/EMR/RIS/PACS client-server products could just die out and be replaced by apps on the cloud. We are entering an era of apps to capture small data which collectively becomes big data on the cloud! Lots of apps are being offered on the mobile/tablet for - appointments, EMR, CDM etc. As for now, mHealth is fledgling with maybe under 10 percent share of the total Healthcare-IT market in India (~ USD 500M per year). New technology is heading towards

a connected healthcare ecosystem where all stakeholders can monitor each other based on published key performance indicators and dashboard. Soon there will be a rating engine for doctors and patients will have options to go to 3 star or 5 star rated doctor. Old guard has to adapt to new technology or quit the bastion. Only providers who adopt cloud technology will survive this onslought. We are entering an era of connected healthcare ecosystem that will be connected by apps and cloud.

“Since launch, the service has been experienced by more than 50 million people across India. With the rapid growth of mobile penetration, campaigns such as mDiabetes have the potential to reach millions of people, helping build awareness” BV Natesh, Director – Emerging Market Services at Nokia There are applications, which works with android-powered phones and links via a wireless bluetooth connection to a device that can check blood pressure, pulse, cholesterol levels and a patient’s weight, all of which can be relayed to medical staff. For those who want to lose weight, there are applications that allow users to count calories by selecting photos of various foods and discover how much effort it would take to lose them.

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Novartis has added two more mobile apps to its existing constellation of digital offerings. This time, cancer patients are the beneficiaries. The Swiss drugmaker rolled out an app to help oncology patients find appropriate clinical trials and an app specifically for patients with neuroendocrine tumors (NET). The app for NET patients is a sort of disease-management app that’s increasingly common in the diabetes field

but less so in cancer. NET Manager is a full-fledged app that allows patients to log their symptoms, set reminders for treatment appointments and drug refills, and track their test results. Sanofi recently launched a text-based program for men with prostate cancer to push lifestyle tips and coping techniques to patients on chemo. Arogya World and Nokia India have enrolled one million people into mDiabetes, the groundbreaking dia-

“We are encouraged by the positive consumer feedback we have received for our alerts to date. If effective, mDiabetes will add to the evidence base for mHealth and become the cornerstone of a chronic disease prevention model for the developing world” Dr Sandhya Ramalingam, Head, Program Evaluation, Arogya World

betes prevention mHealth initiative started in January 2012, in India. As part of mDiabetes, an ongoing Clinton Global Initiative (CGI) send alerts in 12 regional languages, informing Nokia mobile phone users in India about diabetes and its prevention with lifestyle changes. It is also estimated that more than 70,000 consumers have completed the six-month program, having received free-of-charge mDiabetes alerts twice a week. Todate, Nokia Life services covering topics such as health, education and agriculture have been experienced by more than 95 million people across India, China, Indonesia and Nigeria. To cater to the growing number of elderly people living alone in urban cities, a personalised telecare service which helps senior citizens to manage their health and safety while staying connected with family is also launched in the market. ’HelpSOS’ offers services like medication and doctor appointment reminders as well as informing the family of an elderly living alone in case of an emergency through automated calls, SMS or email on a daily basis. Once you have registered with HelpSOS with the details, an exclusive number would be provided to the person which he can use to avail the service. This service is present across India in 11 regional languages as well as English. The services are offered under three

categories, health reminders; which include medication, vaccination and doctor appointment reminders. Care calls, under which the elderly remain connected with their family members, offer an automated call, daily requests confirmation of the senior’s well-being and notifying the family if the person is unwell or does not respond to the calls. The third is the emergency notification, which allows a senior to notify multiple family members when an unexpected event occurs anywhere, anytime. According to HelpAge India, an estimated 100 million elderly live in India and by 2025, 40 percent of the population, over 75, is likely to live alone and therefore there is need to focus on the needs of the urban elderly. It’s often the only device they can access; an SMS text information cam-

paign can significantly improve the impact and efficiency of organisations’ disease prevention programmes. In maternal, newborn and child health, we are witnessing the game-changing effects that mobile technology has to offer through services such as pregnancy and birth registries, immunisation and nutrition tracking. These services could prove useful in sub-Saharan Africa for instance, where more than 1.2 million newborns die each year and one in nine children do not reach the age of five, according to the report by GSMA and PwC. But the financing of mobile health in the developing world is still uncertain.”The question of financial sustainability and ultimately ‘who pays?’ poses persistent challenges in this sector.

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specal feature mHealth

Empowering

Rural Health Workers

Intel has conceptualised four vectors that need to be considered in order to ‘Empower Mobile Health Workers’. It talks about achieving a single technology platform- ‘Sashakt’

ashakt is an ‘Open Access / No Charge’ data acquisition and analytics solution that enables rural health workers to collect relevant health information anywhere, anytime and make meaningful use of the data in order to better serve their beneficiaries. Architected to circumvent key constraints in rural environments and designed with a user friendly interface with first time users of technology in mind. Sashakt platform provides a crucial capability for ministries of health to help improve health indicators and focus on the well being of their citizens. One of the key challenges to attain the goals is ensuring that the capacity of rural health workers is commensurate with the health needs of the country. In addition to that, existing rural health workers should have access to an information system that helps them in continuously assessing their communities’ health care needs, setting their priorities and planning their work more efficiently. This will help them in contributing to an effective public health surveillance system that can be used for need based health planning and timely response to needs in the community. The solution enables health department tocollect preventive health data in an ‘Offline mode’, as prescribed by the government at the sub primary healthcare center level but adhering to standard data definitions (UIDAI, census 2011) in order to ensure interoperability with other government systems. It will also develop public health indicator dashboards that are specific to the region or based on the state priorities providing decision making capabilities around planning and scheduling. Ashok Chandavarkar, says, “After years of

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“Empowering field health workers and the medical officers with relevant and actionable public health information, helps them in taking meaningful decision on the health of the beneficiaries they care for”

Ashok Chandavarkar, WA APAC Regional Manager, Intel corporation

“Technology is a key enabler to drive efficiencies within Health systems. This project would help in empowering mobile health workers to make decisions faster, prioritize their efforts on high risk cases and improve productivity resulting in better job satisfaction”

Srinivas Tadigadapa, Director- ESS, intel Corporation

“This solution would help drive improved service levels in public health delivery through point of care data capture in the field, to assess their communities’ health care needs and set their priorities and plan their work more efficiently” Debasis Bharadwaj, Lead- Solution Architect APAC, Intel corporation

“At VIIT, we explore the ways in which information communication technology is being used as a tool to empower the poor. With a mission to provide world class infrastructure and teaching to reduce the digital divide, VIIT aims to provide technical solutions and persuade the entire society to take new leaps towards globalization” Dr Amol Goje, Director, VIIT

field research and needs gathered from innumerable workshops with public health officials, Intel worked with Vidya Prathisthan’s Institute of Information Technology (VIIT) and Innominds to architect these requirements into a user friendly, service catalogue based ‘Open Access’ solution, Sashakt.”

policy

Odisha Adopted ICT

as Development Tool K N Bhagat, Managing Trustee, Orissa Trust of Technical Education & Training (OTTET) speaks to Mohd Ujaley, ENN about the ICT initiatives the state has taken Where do you see Odisha, in terms of ICT implementation in healthcare? Odisha has gone ahead as it would be the first state in the country which has adopted ICT as a state development tool for providing healthcare services at the door step of the citizen. OTTET is implementing the ICT based telemedicine project under PPP model in collaboration with Government of Odisha and National Resource Center for Telemedicine & Biomedical Informatics at SGPGIMS, Lukhnow in a systematic manner to meet all challenges.

How can we serve the SC and ST in India?

better healthcare services at grass root level?

Telemedicine network which Odisha has developed on hierarchical manner will become the assets for such community which will have indirect reflection on the literacy rate. This tribal belt due to poor sanitary living conditions, insufficient potable water, illiteracy and ignorance sometimes become endemic to Malaria, Dengue, Anthrax, HIV and other viral diseases through noninvasive blood tests by use of appropriate strips. The telemedicine technicians at the facility centre can quickly identify the situation of medical emergency so that doctors or specialist can reach the area with much reduce reaction time.

While respecting the different levels of subjective and objective readiness of stakeholders within the system and in terms of available health technologies, the country is thinking to facilitate the transition, the information process etc. Government of Odisha has taken proactive steps first of its kind by using telemedicine network in PPP mode and making it available at all health institutions and the linkage of doctors to the people at the remote end.

Young doctors are reluctant to serve in rural areas, what is the best way forward to provide

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What is your vision for OTTET Telemedicine Network and how successful have you been so far? OTTET Telemedicine Network envisaged for providing the healthcare services at the door steps. Pilot project has been successfully done in number of

states like Gujarat, Himachal Pradesh, Bihar, Jharkhand, and Karnataka and there is a plan to take it nationwide, and filed deployment has been initiated after MOU and Standard Operating Protocol (SOP) with Government of Odisha. The SOP for implementing the project on PPP mode has been developed. All the Government and private medical college, district hospital, CHC, PHC and registered private practitioner are taken into the network. A computer with Internet connectivity should be ensured in every PHC and all higher health facilities in this plan period. Connectivity can be extended to sub centers either through computers or through cell phones, depending on their state of readiness and the skill set of their functionaries. All district hospitals should be linked by telemedicine channels to leading tertiary care centers, and all intra-district hospitals should be linked to the district hospital and optionally to higher centers. The composite HIS developed and deployed in OTTET Telemedicine Network based on the PPP mode can regularly track the progress of the state in achieving the national health outcome indicators, and in identifying areas and populations which lag behind on health indicators, with sufficient accuracy, so as to enable remedial action. To achieve this goal, the HIS has to necessarily rely on universal vital registration and the networking of all health service providers, public and private laboratories.

zoom in

Productivity Enhancers Cloud Apps The existing IT providers have to think beyond providing HIS solutions. Prabhat Kumar, Co-founder, DreamSol TeleSolutions and Over2Cloud.com talks about customising solutions for hospitals What do you think is current perspective of ICT in healthcare? The perception of management towards adaptability of ICT has changed by 360 degree in last decade. IT automation which was considered to be as back office managing billing etc or maximum to be part of standard ‘conventional’ HIS has now become the center stage. CTO’s/ CIO’s / IT Heads have been made ‘captains’

to make a winning team and they too are introducing solutions that are ‘auto-innovating the exiting processes’ to enhance productivity.

What are the opportunities for ICT players and how are you leveraging it? The ground is set for any ICT player who has innovative offering that eases the existing process, reduces the operating cost, optimises the man-

Productivity enhancers l Feedback Management System: It is a unique Call / Online based inter departmental as well as patient complaint communication system. It ‘transparently’ identifies the workers with non-workers as the MIS is built up for ‘analytics’. It is integrated with real time SMS/ mail and existing EPBX. l Compliance Management System: Manages all the preventive maintenance and other scheduled tasks for multi-department configuration with action status management. l Asset Life Cycle and Inventory Management: Manages complete stages: registration, procurement, support, preventive maintenance, allotment, free/re-allotment, repair, and free shared asset, spare. Time line vs. ROI management of each asset up to expected life provides assets wise intelligent MIS.

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l Referral Patient Tracker: Manages all the referral patients with respect to various area consultants mapped with departments like patient care, admission, and marketing etc. l Patient Delight Management: Tab based mobile app to record feedback records various parameters ratings score to have an access to analysis to the management directly. l Work (Sales) Force Activity Management: KRA-KPI based activity targets, incentive parameters & reporting formats are defined for effective resource planning. l Business Message Exchanger: HIS integrated text (SMS) based alert system via transactional routes to patient/ attendants, doctors and other staff related to important notifications on real time basis.

power potential, enhances the productivity by creating a transparent & accountable system. We too have identified these gap areas and offered niche productivity applications to major players like Max Healthcare, BL Kapoor Hospital, Fortis, Indraprastha Apollo, PSRI, Batra and others respectively who although were already using HIS but had requirement of applications that may value add to their existing systems. These applications are customized by their HODs with our expertise.

What is the USP of applications offered by DreamSol or Over2Cloud? We study a process that is not covered under HIS and simplify them by implementing an automated web based application integrated by real time text (SMS), voice (IBD/OBD), mail and mobile apps offered over public or private cloud and further this gets integrated with any existing HIS.

www.aimsindia.com

A SUPER

SPECIALTY HOSPITAL & CANCER

CENTRE

Asian Institute of Medical Sciences is a 350 bedded Super Specialty Hospital & Cancer Centre located in Faridabad, Delhi NCR. The institute brings together state of the art technology along with some of the most talented medical professionals in India.

Asian Cancer Centre

Asian Heart Centre

Asian Centre for Advanced Surgery

Asian Centre for Mother & Child

Asian Centre for Neurology & Neurosurgery

Asian Centre for Renal Diseases

Asian Centre for Urology & Kidney Transplant

Asian Centre for Advanced Imaging

Asian Centre for Bone & Joints

Asian Centre for Bariatric & Metabolic Surgery

Asian Centre for Gastroenterology

Asian Centre for Aesthetic Surgery & Medicine

Asian Institute of Medical Sciences Badkal Flyover Road, Sector - 21 A, Faridabad, Delhi NCR â&#x20AC;˘ Tel: +91 129 425 3000

E-Health/0313/c-infiniti.in

CENTRES OF EXCELLENCE

fresh venture

Walk in Clinic for

Urgent Care

In conversation with Shally Makin, ENN, Dr Pervez Ahmed, the Founder-Chairman and Managing Director Aapka Urgicare Pvt Ltd puts together his thoughts of coming up with his new venture What was the inspiration behind the launch of this centre? The question was what we can do in the healthcare delivery system, the thought was to come up with tertiary care hospitals with such system that can benefit the patient. A concept of emergency medical care was initiated so that the nation has one number to call. With accidents

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increasing in the late night, roads are clearer and there is no medical emergency centre available to take care of them. To recognise critical care availability and accessibility, the delivery systems in neighbourhood was set up. In case of urgency, say breathlessness or asthma attack, conventionally there were only two options – to go to the neighbourhood doctor who may not have the equipments, medicines or staff support to provide relief; or else visit the emergency ward of a hospital. Most state-of-the-art hospitals that provide quick and quality care are either expensive or out-ofreach for many. This leads to much avoidable suffering, deterioration of the condition and even fatalities that can be reduced to a greater extent if the patient is brought to a quality medical facility within the ‘golden hour’ – the hour after the actual medical emergency, say for instance accidents, when it is crucial to extend the correct diagnosis and treatment to the affected person.

About the hospital A pioneering model in India promoted by healthcare industry veterans, the chain of Urgent Care Clinics will be accessible 24x7. Also known as Immediate Care or Walk-in Medical Care, Urgent Care Clinics expand the healthcare options of the primary care doctor, the hospital emergency rooms and other healthcare clinics, serving to bridge the gap between these options too. The clinics deliver ambulatory care through dedicated facilities for immediate medical treatment outside a hospitalâ&#x20AC;&#x2122;s emergency department, on an unscheduled time or walk-in basis

We are open 24x7, along with OPDâ&#x20AC;&#x2122;s. We are the only specialised centre to offer pediatric emergency training system. We provide minor operating procedures, injuries, cuts and we can take care of all minor injuries at the centre itself. We work with other doctors and train them for emergency medicine. We work on data which can be transferred online; data is stored on cloud, with IT partner as Ohum providing EHR service and Shristi as HIS healthcare provider.

What are your expansion plans?

How was the model conceptualised? The pioneering model of neighbourhood urgent care facilities that are open round-the-clock to attend to emergency medical situations originated in the US in the 1970s in response to the need for medical centres that would act as half-way house between the primary care doctor and the hospital emergency room. On similar lines, we have moulded these four centres with most trivial medical patient need, stabilise patients and transport the patient in a well equipped ambulance to the required hospital or home. Emergency care is based on economics and this model is differently studied when it comes to acute care. A concept of primary health care is not here, the models of delivery will change, depending upon the urgent care centre success, unlike the

presence of tertiary hospitals at every 5-10 km radius in the coming times. The emergency patient needs immediate care so that it doesnâ&#x20AC;&#x2122;t get protracted and end up spending days in the hospital, this will in turn increase cost of care. We want to provide a value in our services, which seems to be missing in terms of healthcare.

What value added services do you provide apart from the emergency cases? Transporting a patient for further treatment generally opts for 50- 50 ratio to public and private hospitals respectively. We are adding value to the services by consulting and advising the right hospital for the patient. There are currently 38,000 doctors and India requires 1, 40,000 of them to treat the illness prevailing in India so far. We are adding value to the healthcare fraternity.

We need a strong model of providing accessible and affordable walk-in emergency care to patients in their neighbourhoods to progress in our healthcare goals. Many such fatalities can be avoided and many accident victims helped without wasting any time if urgent care centres are present in densely populated neighbourhoods and are accessible 24x7 in places that report more accidents. These are equipped with the latest technology and offer life-saving procedures by trained doctors, nurses and other paramedical staff who can handle all kinds of emergency health situations. We have decided to make impact in the deliveries, we have mapped clusters. In Delhi 30- 34 centres are projected. We have signed up for a third centre in Okhla, Delhi which will be ready by the end of the March and the forth one in North Delhi will be coming up by the first week of April . The criterion to map the location of the centres primarily depends on population, number of hospitals in the nearby area. Secondly, the mid tier level people as affordability is what we offer at our centre. We need to create awareness and spread the concept of emergency care, work directly with customers. We have strategically worked in creating Delhi as the first preferred destination for developing the chain. To start with, we need to create a national brand with a vision of creating 110 centres in 4-5 years in Kolkata, Varanasi and Uttar Pradesh.

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Futuristic Face of Healthcare Online Our experience and know-how about healthcare has made us a leading web solution provider in the industry today g

Deepak Sahni, Director, Sai Webtel Technologies Private Limited

simple search on Google with â&#x20AC;&#x153;Healthcare Indiaâ&#x20AC;? gives about 19.8 million results today. Undoubtedly the industry has already recognised the importance of Internet and new media to connect with patients. But having an online presence not merely means having a beautiful website or a blog that can provide information about your services, there is a lot more possibilities in terms of functionality and information that one expects to be able to do online. We have analysed plenty of healthcare websites and studied patient browsing habits over number of years. As a result we have been continuously innovating new products along with online marketing and branding tools that are patient centric and proven to bring results.

Appointments and pre- registration Today, almost no hospital or clinic website in India offers online appointment confirmation where patient can just not request but actually make an appointment confirmed by paying the fee online. This reduces lot of hassles for patient to make phone calls and wait in call centre queues and finally wait again at the billing counters today. The solution offers integration with almost all HIS Systems, integration with payment gateways to confirm appointments and integration with SMS gateway for alerts. In more advanced version an integration for

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CRM & response handling We have developed an exceptional CRM and response handling mechanism for healthcare industry that keeps record with status and escalation for every request made online so that none of them are left unanswered. On the other hand CRM helps to automate messages via email on regular intervals up to six months from the date patient is discharged. As a result one can expect better patient satisfaction and patient to patient referrals.

Medical travel expertise doing online pre-registration to get an OPD number and get the OPD card ready. It reduces the queue to great extent hence have better customer satisfaction.

Web nursery Web nursery is one of the most innovative products with a web version. It allows the hospital to post the first photograph of a new born baby online. Thereby giving access via secured password to family and friends allowing them to upload photos, send personalised gift and greetings online. The tool also offers complete vaccination chart with alerts for parents for next five years. One of the leading hospitals in Delhi has already clubbed the product with its prenatal package for attracting expectant couples.

The solution offers entire online marketing strategy by selecting the targeted countries and regions for specific key specialities for which the patient is searching online. The patient landing pages are separately developed in multiple languages keeping the trust factor in mind. The solution also includes marketing techniques like SEO, SMO, Paid Campaigns to generate responses. Sai Webtel claims to have many of such innovative solution in pipe line which they are developing for their clients that includes some of the top healthcare brands they have worked for including Fortis Healthcare, Max Healthcare, BLK Hospital, Jaypee Healthcare, Rajiv Gandhi Cancer Institute, Rak Hospital Dubai, Panacea Biotech, Metro Groups of Hospitals, GM Modi Hospital, Centre for Sight, Axiss Dental and many more.

Special Feature: health insurance

Health Insurance

Covering The Uncovered Health insurance seems far cry in our country where we are yet to adequately address issues like Roti, Kapda, aur Makan (food, cloth and shelter). IT enabled health insurance schemes give a ray of hope by offering un-served rural population a healing touch. An analysis!

By Sharmila Das, ENN

ith a reach of just about two percent of the country’s 1.2 billion population, India offers a huge potential in health insurance market. There are over 30 health insurance products in the category offered by both life and non-life insurers. And for both the Insurers IT is crucial Shreeraj Deshpande, Head - Health Insurance, Future Generali India Insurance Company Ltd feels, “IT has a very major role to play in the Indian health insurance sector. The major adopters of such applications are the insurers, the TPAs as well as brokers (intermediaries). IT in health insurance sector has made the availability of various products much easier to the common man with web based applications, online premium payments, online policy issuance and renewals. IT has played a big role in under-writing for the insurers as well as claims settlement has become very quick and easy making it very customer focused”. Antony Jacob, CEO, Apollo Munich says, “The use of IT applications in the Indian health insurance segment

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“The growth of the mobile platform, the increase in the country’s telecom infrastructure and web penetration are all forces that are boosting the adoption of technology by the health insurance industry

has been growing rapidly over the past decade. With changing demographic base of customers across the vast expanse of the country, it is critical to deploy technology to serve the customers. The growth of the mobile platform, the increase in the country’s telecom infrastructure and web penetration are all forces that are boosting the adoption of technology by the health insurance industry. Customers now demand faster, cheaper and better solutions that can only be attained through a combination of innovation and technology. Adopters of technology include the entire insurance ecosystem - customers, insurers, providers, TPA’s, regulator, etc. The efficiency of integrated processes lies in the efficient collaboration across

Antony Jacob, CEO, Apollo Munich

this network and therefore technology adoption has been apparent across all these entities”. Suresh Sugathan, Head-Health Insurance, Bajaj Allianz General Insurance says, “IT forms a backbone of the operations for Bajaj Allianz and serves as a key enabler to a lot of hassle-free transaction and related servicing aspects. We have deployed several applications for an enhanced customer service experience. When a customer contacts us through call center, information about the customer such as policy details, claim history, previous complaints, status of any pending requests etc. is provided by an “intelligent” CRM application. This information is available in a singlescreen view which equips the Bajaj Allianz Customer Service Executive for proactive communication and service. The other area where Bajaj Allianz uses IT effectively is in ensuring the pre-authorisation of cashless claims at the hospitals is completed in less than an hour. Pre-authorisation is a crucial step in case of cashless claims which used to take more than three hours earlier.

In addition, IT applications also enable agents and distributors to respond to customer’s requirements on a real-time basis as all information is available at their fingertips. This is enabled through applications on mobile and Internet platforms that allow the sales team to access information on products, targets, achievements etc. at their convenience. Agents also receive SMS alerts for renewal of their customer’s policies and our portals serve as a mini-office for them”. Mukesh Kumar, Member Of Executive Management & Head HR Marketing & Strategy Planning, HDFC ERGO General Insurance Company Limited shares, “Use of IT applications in Indian health insurance sector has gained significant importance especially in retail space, implementation of Government health schemes as well as in group health insurance schemes . Today, end to end product offerings, service delivery and feedback mechanism operates on various IT platforms. Various IT applications are also available to maintain individual health records. This in turns helps the insurance companies in data analy-

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Special Feature: health insurance

ses, product innovation, multi channel distribution,consumer wellness programmes, value added services, health risk management and hospital /TPA management. The three pillars of successful innovation are wider range of health insurance products covering risks, financial mechanism and preventive care along with health advisory servicesâ&#x20AC;?.

Role of RSBY Rashtriya Swasthya Bima Yojana (RSBY) has been operational since 1st April, 2008. The objective was to cover the pitfalls of various existing national and state level health insurance schemes. It has been launched by Ministry of Labour and Employment, Government of India to provide health insurance coverage for Below Poverty Line (BPL) families. Anil Swarup, Director GeneralLabour Welfare, Ministry of Labour and Employment, Government of India says, â&#x20AC;&#x153;The RSBY came into being consequent to an announcement made by the Prime Minister to provide health insurance cover to the poorest of the poor in the country. Consequent to the announcement, a Task Force was set up to formulate the scheme which was subsequently approved by the Government. Till March 2013, more than 34 million families have been covered under the scheme and around five million persons have received hospitalisation benefit under the scheme. The scheme has now been extended to many such categories of unorganised workers as well who are not below poverty lineâ&#x20AC;?. RSBY uses IT in its different payment structures. Swarup adds, â&#x20AC;&#x153;IT applications have enabled cashless and paperless benefits that are portable throughout the country. There are 24 sets of software that are making this scheme happen. The IT platform is now gradually stabilising and the smart card is now also being used for delivering other services like life insurance and Public Distribution

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Growth drivers for health insurance market in India Higher affluence of the Indian middle class Increase in various lifestyle-related diseases Rising healthcare costs growing awareness about the benefits of health insurance Availability of quality healthcare Community-based health plans Increased awareness about healthcare and preventive care in the country Government initiatives Rise in numbers of patients visiting India for medical treatment

System (PDS)â&#x20AC;?. The scheme allows a beneficiary from Bihar to get treated in a Mumbai or Kochi hospital and the bills are paid in his home state by the insurance companies linked to the scheme.

Growth drivers Apart from the rise of lifestyle related diseases the factors that have contributed to the improved health insurance portfolio of insurers are more options in coverage, employers including health insurance for employees as an attraction, increase in medical care costs driving people towards insurance, introducing cashless hospitalisation, quicker turnaround times for claim settlement and competition created by standalone health insurers.

â&#x20AC;&#x153;IT in health insurance sector has made the availability of various products much easier to the common man with web based applications, online premium payments, online policy issuance and renewalsâ&#x20AC;&#x153; Shreeraj Deshpande, Head - Health Insurance, Future Generali India Insurance Company Ltd

Strength and weakness of Indian health insurance sector As per industry experts, despite the growth factors Indian health insurance has not been able to create ex-

Use of IT applications in Indian health insurance sector has gained significant importance especially in retail space, implementation of Government health schemes as well as in group health insurance schemes” Mukesh Kumar, Member Of Executive Management & Head HR Marketing & Strategy Planning, HDFC ERGO General Insurance Company Limited pected turnaround because lack of willingness to get insured. Mostly, the masses are dispirited about taking a health insurance scheme as there is no immediate benefit. Therefore, they look at health insurance as expense rather than a life saving investment. Kumar says, “Indian health insurance sector has huge potential as it is under penetrated. Post privatisation of Insurance sector, the general insurance penetration in India has grown from 0.55 percent in 2001 to 0.7 percent in 2011. However, the health insurance portfolio has grown more than 20 percent over last few years and it is estimated that in the coming 6 to 7 years, it might overtake motor insurance in terms of the overall premium. The core weakness of the health insurance sector is lack of awareness and low penetration level as compared to the other developed countries. Further, there are limitations in distribution network / reach as compared to the population spread in the country. The inequitable growth pattern also is not helping wider spread of the general insurance products in general and

health insurance in particular”. Deshpande says, “Indian Health Insurance sector is now the second largest line of business among the General Insurance or non life insurance companies and also the fastest growing segment with a very high potential for growth. The only drawback is that the retail line of business is still not growing at the rate it has been accepted to grow. Health Insurance Industry on the whole is still not generating profits though some companies have broken even. One major reason is the unregulated healthcare sector in this country”.

Newer developments As they say, necessity is the mother of invention; market demand will surely give room for fresh and customised health insurance schemes. Meeting the need of the market, fresh initiatives are on the way. Jacob says, “The health insurance industry is growing rapidly and is poised to become the largest contributor in the non-life sector in the years to come. As for the industry, insurers have innovated,

researched, developed and marketed products that cover maternity benefits, cashless hospitalisation, no claim bonus, sum insured restoration facility and also covers such as critical illness riders, top up plans, senior citizens plans. We have come a long way from the basic mediclaim product. Our customer research shows that there isn’t a single product that has been able to garner widespread acceptance, as people’s requirements have changed over the years. One size doesn’t fit all and hence the need for customisation has become the norm today in the insurance segment. Customers now demand individual attention and products that cater to differing needs. With the rising level of awareness and income levels, customers would seek specific benefits suitable for their lifestyle and requirements. Insurance companies are using customer research to develop much needed products with features such top up covers, restore benefits, multiplier benefits, OPD coverage, lifelong renewal, critical illness covers, etc”.

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Special Feature: health insurance

“When a customer contacts us through call center, information about the customer such as policy details, claim history, previous complaints, status of any pending requests etc is provided by an ‘intelligent’ CRM application Suresh Sugathan, Head-Health Insurance, Bajaj Allianz General Insurance

Deshpande says, “We do have a wide range of products in place for corporate clients. The market has seen new products being introduced into the market for retail lines on a continuous basis which are innovative in terms of coverage and also wider in coverage and sums insured offered. We still have to see a true comprehensive cover which includes true out-patient cover, preventive covers, etc on a wider basis. Some insurers have introduced covers to this effect including wellness programmes however we still have a long way to go. One major impediment is the unregulated healthcare sector”. Sugathan says, “As compared to other countries, health insurance in India is a relatively new market. Although there is still much to be desired from awareness point of view, even in urban towns, health insurance has gone through an evolution in the last decade. The industry has today moved beyond the ‘mediclaim’ mindset and features like OPD, dental cover, ben-

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efits like hospital cash etc have been introduced in the portfolios of health insurers. Geography wise pricing is another innovation which will catch on in the future. Gender-specific benefits such as maternity covers, cover for women specific illnesses and gender based pricing are other upcoming trends”.

Galore of opportunities for IT vendors With each passing day, the scope of IT in different aspects of healthcare has been increasing. In health insurance too, the scope is tremendous. For this, the IT vendors should understand the need of different health insurance companies and then should develop their products and solutions. To understand the need, better authentic market surveys, R&D initiatives should be the way forward. Deshpande feels, “IT has a major role to play. Good integrated software from policy administration to claims settle-

ment, web based applications, fraud detection software, work flow management, etc is a basic requirement. IT has a major role to play to make data flow from insurers to providers/ hospitals/ TPAs flow easily and quickly to allow quicker service levels”. Jacob says, “With a burgeoning health insurance industry, IT solutions providers will be able to introduce a plethora of solutions that fit the needs of the segment. IT products that are developed for life and other general insurance streams are being customised to fit the needs of health insurance, as there is a need for tailored products and not basic solutions anymore. There is great opportunity ahead for IT companies to create integrated opportunities through software solutions that can bind and seamlessly connect insurers with their customers, providers, Insurance Regulatory & Development Authority (IRDA) and TPA’s for better customer services. IT companies can use this opportunity to leap-frog technology with solutions, by borrowing best practices from the more mature western world and fit them for local requirements”. Kumar says, “Going forward, IT intervention would be required to aid distribution in the untapped markets. Low cost solutions for transmission of data and funds needs to be developed. The transmission would need to not only ensure correct data / fund transfer at the time of enrollment, but also accurate and efficient distribution at the time of claim payment. Essential to the development of such solutions would be standardisation and seamless networking of various stake holders’ viz. insurers, banks, service providers, hospitals etc”. Taking all these under consideration, it would be safe to conclude that Indian health insurance with required level of IT involvement and a customise approach can shape the future better and sound.

Special Feature: Health Insurance

Building a Healthy Nation Rashtriya Swasthya Bima Yojna (RSBY) came into being in 2008. Within a limited span, RSBY has garnered an enviable position in India’s policy space. The United Nations Development Programme (UNDP) and International Labour Organisation (ILO) picked it up as one of the top 18 social security schemes in the world. Anil Swarup, Director General – Labour Welfare, Ministry of Labour and Employment, Government of India gives an account of different initiatives taken by RSBY to Sharmila Das, ENN covered under health insurance. In the past one decade, the coverage has gone beyond 25 percent. This is perhaps the fastest growth in absolute numbers anywhere in the world. The number is likely to grow even further as the insurance modules are gradually stabilising and the Government itself is committing more and more funds.

What steps do you think are required to achieve affordable healthcare? In this respect, what else RSBY is doing?

Kindly update us about the successful healthcare schemes initiated by RSBY? Till March 2013, more than 34 million families have been covered under the scheme and around five million persons have received hospitalisation benefit under the scheme. The scheme has now been extended to many such categories of unorganised workers as well who are not below poverty line.

What are the developments you have noticed in this domain? Till the turn of the century, less than five percent of India’s population was

As per the available data, around 80 percent of the expenditure in healthcare is borne by individuals themselves and the Government is contributing only around 20 percent. This is gradually changing on account of increased Government intervention through schemes like RSBY and investments made by the Government under National Rural Health Mission (NRHM).

Do you think affordable healthcare can be achieved with the help of health insurance schemes? With the increasing commitment of the Government in terms of expenditure for healthcare, including the commitment to extend RSBY to more and more categories of workers, it is expected that out-of-the-pocket expenditure will come down.

What are your views on the rising trend of corporate healthcare? The rising trend of corporate healthcare will benefit primarily those who can afford such healthcare. Thus, it will be limited to a certain segment of Indian population. Whereas the quality of healthcare in such hospitals would be as good as anywhere else in the world, the cost of healthcare will be prohibitive for the masses. Controlling cost of healthcare would be one of the key factors in providing universal healthcare in the country.

Don’t you think the big healthcare players should now start serving rural India by forming collaboration with bodies like RSBY? It is unfortunate that big healthcare players, driven purely by commercial considerations, are not participating in schemes like RSBY. RSBY provides an institutional framework to such hospitals to serve the poor. The RSBY plans to engage with such hospital chains and willing to participate under the scheme on the basis of costs that are determined for each of the procedure. The number of hospitals empanelled is growing by the day and it presently stands at more than 12,000 hospitals. Attempts are also being made to convey to the big healthcare players the necessity to attend to the needs of the poor in the country.

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Envisioning the Health Cloud Cloud Computing has come a long way to be a true enabler today that organisations of all sizes can benefit from. The case study examines the story from the perspective of the software company, the cloud enablement platform and the key decision makers from two customer implementations with a very different set of requirements Aditya Mani, Director, acuis For any technology to sustain in an organisation it must continuously deliver value. The technology should be capable of continuously innovating to the organisationâ&#x20AC;&#x2122;s changing needs. It is important for an organisation to always keep in mind why they have adopted these technologies in the first place. Today, many organisations may be managing cost centers associated with a technology that are not in line with their core service offering. These could be capital costs associated with real estate or other capital assets as well as monthly fixed costs like electricity, uninterrupted clean power, air conditioning and manpower cost that often escalate with time if not monitored closely. As a technology evolves, it begins to present itself as a set of functional widgets that the organisation can derive value from. In order for CIOs to make good bets in the long term about the technologyâ&#x20AC;&#x2122;s return on investment, they need to constantly evaluate the fiscal value of each functional widget as well as the cost in-

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curred in keeping such widgets alive. Mindlessly keeping an old technology alive without evaluating present alternatives is what leads to legacy technology and obsolescence. In the last few years, the software industry has been revolutionised by the concept of cloud computing. Cloud computing is much more than just web enabling or web hosting a technology to make it available across the Internet. Cloud computing is broadly characterised by ubiquity, elastic scale and device independence. If we think of the most rudimentary and commoditised functionality the web has to offer us today: email; we are able to understand the phenomenon of cloud computing better. There was a time when software companies used to sell you a mail solution to manage your corporate email that you hosted on premise in your server room. With time, many web portals and web hosting companies began offering this as a value added service (VAS). Today, this application is offered to both the consumer and enterprise space by large, efficient tech giants like Microsoft and Google. If you are a large multinational behemoth, it may still make sense to own, host, manage and serve such an application internally to contain the costs. However, if you are an

agile organisation not in the business of managing software and data centres, it makes sense to sign up for such a service (Software as a Service) as you justify the marginal value of empowering your employee at work and home on any tablet or smartphone. As long as you subscribe to the service, you can avail customer support, software updates and technical assistance without having to host expensive hardware or maintain teams. It makes sense. Shantanu Mane Cloud Evangelist, Microsoft. Cloud computing today enables a fast and easy deployment model without the need for any large upfront investment in computing resources paid for in a pay-as-you-go model (thanks to the elastic scale concept whereby you pay for only those resources that you use) which enables software companies to centrally host and manage data securely thereby amortizing the cost across multiple customers. Cloud computing platforms available today offer software companies massive compute

and storage resources on tap whilst the baseline activities like server management etc. are performed seamlessly as part of the company’s back end services. Organizations like acuis have taken full advantage of Cloud and offer their software today in either an on premise deployment or Cloud. With traditional licensing models these deployments are generally installed on the client’s on-premise server equipment and with the addition of the cloud offering customer can choose to deploy either on their own private cloud or use of a secure public cloud. The team at acuis has worked closely with us to integrate their solutions to our cloud platform. Our platforms are very robust, scalable and are configured to handle high peak loads during a medical emergency or epidemic. This is where proven support needs to be in place to cope with an unexpected emergency. This case study is a great example of their solution using the same software in differing configurations by two very different kinds of consumers. Max Healthcare has deployed a single instance of the application and database across five hospitals across the country via their own private cloud whereas Adlakaha Hospital uses the managed services of acuis to take care of their IT needs. The same solution is able to scale from 20 beds to 2000 beds across multiple locations. That’s the dynamic scale our customers demand in today’s times.

up well with the support of acuis team. The team has a deep understanding of the Blood Bank processes honed over multiple implementations, which gave us an excellent starting point for implementation at our NABH certified Blood Bank.

Dr Dinesh Jain Head of Medical Applications, Max Healthcare We implemented acuVena system at Max Super Speciality Hospital, Saket Blood Bank in the year 2011 and have subsequently rolled it out at four more Max Blood Banks, using a centralised application and database. The application has scaled

Sahil Adlakha Director, Adlakha Medical Centre Our journey in IT began when we procured a comprehensive software called acuVena to manage the workflows of our blood bank. The software company, acuis, guided us on all the hardware requirements and trained our staff. They currently assist us in software upgrades and manage our systems. Using acuVena software has resulted in better donor recall and safer blood for patients. In our organization, ICT solutions have been adopted in the

What are the health IT innovations coming up in Indian healthcare? In terms of impact, the availability of mobility and cloud infrastructure are enabling Indian Healthcare to innovate at a lower cost and risk.

What benefits you are getting from the solution/technology/ equipment? How cost-effective it is? Some benefits like real time availability of information across the chain of workflow, better communication, and elimination of duplicate data entries are common benefits of the technology. While others like mobility, electronic data capture and decision support are unique benefits being derived.

What are the benefits you have derived from a single instance implementation of an application? A central repository of data, easier infrastructure and application maintenance as well as an easier sharing of information across the enterprise

blood bank in a phased manner and the company keeps guiding us on what we can do next. We are now going to be providing an sms service wherein anyone in need can send an sms and know our stock without even calling since the system will directly reply to the sms.

What benefits you are getting from the solution? How costeffective it is? Who has given you the solution? We decided to have a managed service approach for our software rather than setting up an IT department. We wanted a solution that helps us solve our problems rather than creating a new department. We have seen many hospitals beginning their efforts in Health IT with good intentions but very early down the road, we find them grappling with departmental issues because of the traditional approach that departments become silos. Most organisations believe there is a cost benefit in performing tasks themselves. However, for non-core activities one needs to ask oneself if they have the organisational structure to support continuous innovation in these non-core activities and if they are able to derive the returns to scale. In large organisations, it makes sense to develop skills in noncore activities that can be federated across multiple locations. In leaner organisations, it’s better to be nimble and guided by functional expertise. We are currently using acuVena blood bank software to manage our processes and the teams at acuis manage the software maintenance. If you look at the costs saved by not employing personnel, the savings are sizeable for a growing organization. Moreover such an approach shifts your focus to concentrate on your customer’s needs rather than a department’s needs.

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Launch Pad

Virtual Dissection Table â&#x20AC;&#x201C;

A Breakthrough in Medical Education The table offers 3D visualisation of human anatomy which can be used by medical students as well as by surgeons

S Biomed Services has brought to India a Virtual Dissection Table for the first time with a vision of advancement in medical teaching and excellent option of surgical patient management. The table is designed and developed by Stanford Medical University, USA and manufactured by Anatomage, USA. The Virtual Dissection Table is designed for human anatomy studies and live case reviews.

table. It delivers accurate anatomical details and can be used before or after cadaver-based dissection courses. For anatomy courses without cadavers, the table offers the most realistic virtual cadaver. This cutting edge technology would help raise the standards of medical education. The Virtual Dissection Table has applications in various departments in medical institutes.

3D visualisation of anatomy

One can cut open the body, peel off soft tissues or remove an organ with their fingers. The table allows students to redo and undo the dissection, visualize on its screen skeletal tissues, muscles, organs and soft tissues. The body parts and views can be customized by virtually slicing, layering, and segmenting the anatomy. This adds a new dimension of indepth teaching and hands-on training to medical education. Custom annotations can be easily added to the visualizations of anatomical structures. With flexible annotation tools, institutions can create innovative programs, quizzes, and new methods of study that have only now become possible.

The 8-feet long Virtual Dissection Table offers an unprecedented realistic visualization of human anatomy in 3D with facility to interact with data on-

Kaushik Shah, Proprietor, K S Biomed Services, Ahmadabad

Anatomy department

Radiology department and surgeries A DICOM image can be imported to the table and viewed or dissected in life-size. Details of images of CT/MRI/ CBCT can be reviewed on the screen of table. Live CT/MRI of any patient

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can be imported to table. The table can restructure the same image reading the raw data of DICOM image. It helps surgeons plan and perform a virtual surgery before performing actual surgery. Surgeons or medical students can view depth and size of any tumor and pathology at any location. It can also help surgeons decide about orthopedic implants on the patient or discuss critical cases in 3D environment inter-departmentally. Dental implant planning can also be performed on real patient images. Advance dental implant planning modules are available.

New-age technology As part of on-going new drive of virtual skill laboratory development in medical institutes, the Virtual Anatomy/Dissection Table is the most advanced instrument available in new age of medical technology. K S Biomed Services is a trusted name in radiology in India with excellent success track record since last 16 years. Mr. Kaushik Shah, Proprietor of K S Biomed Services feels that India is no more lagging in any technology and Indian medical Institutes will certainly welcome such revolutionary product as a part of virtual skill laboratory. Himanshu Bhatt, Head, India Sales Operations, strongly believes that the Virtual Dissection Table will change the face of medical education in India bringing at par with the techno-savvy new-generation medical science.

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Objectivity Redefined

IdeaObject provides enterprise healthcare IT solutions to hospitals across the globe using its flagship product “HealthObject”

ealthObject is a comprehensive healthcare solution that has scalability, performance, usability, localisation, multi-tenancy and integration capabilities at the core of its offerings.

HealthObject provides a comprehensive range of clinical, administrative and laboratory capabilities to hospitals. It allows hospitals to bridge distances in patient care-saving time and manpower while enhancing collaboration between doctors, hospitals,

Seetharam Malur, CEO, IdeaObject Software Pvt Ltd Do you think Indian healthcare is fertile enough for innovations? What are the IT innovations coming up from you? The Indian environment is different from developed nation’s healthcare system. Given that, innovations are happening even within the Indian healthcare IT but possibly at much lower scale than that what can be done. We also see innovation in the form of improvisation of some of the international innovations deployed in developed countries. We are looking at some key concerns that some of our customers and prospects have sought answer to. Some of these are to address the connectivity and accessibility to information, easier way for care provider to provide better service and for patients to have better visibility.

Do you think the healthcare regulations are not giving a positive environment to grow innovations/innovative products? It is not just healthcare regulations. We have challenge in patenting as well. A cohesive and faster process can offer a positive environment for

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growth in innovations/innovative product.

How cost effective is Indian health IT market? Any innovation is a costly affair and there are continuous challenges throughout the innovation process. Such innovation can become cost-effective only when there is a reasonable volume of opportunity that translates into business, which means a pan India success. This is where many of the Health IT companies are trying to find a right solution for themselves. Many health IT companies claim pan India presence, but if you see their customer base one will see regional centric.

hospital services and patients. The product follows multi-tenant architecture and thus making it easy for large chains to adopt and implement healthcare solutions quickly. Some of our implementations are regarded as the fastest in the healthcare industry. HealthObject has been implemented in world-class specialty chains across India. The product also addresses the needs of multi-specialty hospitals and has been implemented in hospitals with 30 to 750 beds. The product’s international acceptance came in the form of a leading chain of hospital having about 25 hospitals in South East Asia. They have replaced an internationally reputed healthcare product with HealthObject. We completed the roll-out in four months for the first hospital and subsequent roll-outs are under way. Innovation is at the core of everything that IdeaObject does. Innovation to us means doing something completely new, improving on what exists, and custom workflows that are suited to the needs of the healthcare setups. Benefits of the innovation mindset: • Improved user adoption of the solution through usage of Rich Internet Solutions - ensuring the success of the product. • Scalability and performance addressing high volume transactions. • Federated architecture, hosted solution and on-premise solution – flexibility of delivery options. • Speciality EMRs – addressing the needs of Ophthalmology, Dental and IVF and adding more to it. • Fastest implementation timeframe in the industry.

Special Feature: ehr

EHR: Ease & Convenience

Come Together The rigmarole of carrying pile of medical reports is no longer being practiced in modern healthcare, welcome to the world of Electronic Health Records (EHR)

By Sharmila Das, ENN

uring our visits to doctor’s clinic or hospitals we often come across people waiting with their medical reports. While this practice has been in place still now, many hospitals and private clinics have started getting benefits of using EHR. An EHR is an IT enabled solution that keeps ones medical records saved in computer for further reference. It is a digital and portable version of the current paper file system that would be accessible to all doctors. That means that whenever you see a new physician, you could stop filling out endless paper forms, as your doctor could access everything about you on the computer. Sumanth Tarigopula, VP, Apps Global Delivery India, Enterprise Services, HP shares, “An EHR is sys-

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tematic collection of electronic health information about individual patients or populations. Patients’ treatment often happen at multiple locations like initial investigation with a primary care provider, lab tests with a lab provider and pharmacy intake with the pharma providers. Due to this distributed care the care records are stored in multiple systems or as paper records resulting in limited access to the records when a provider has to review past records to provide treatment”. A recent study says an accountability tool embedded in an EHR system could help reduce unnecessary CT scans among emergency department patients with abdominal pain. Arup Mukherjee, COO, Binary Spectrum says, “Although EMR has

tangible positive outcomes, the adoption rate of EMR/EHR/PHR in India has been low so far. The market comprises handful of hospitals using EMR but the usage of EMR is mainly limited to corporate hospitals in the various metro cities of India. Several large hospitals in India have announced extensive expansion plans during 2012-2015 in response to the increasing healthcare needs of the country’s growing population. Research firm projects that the hospital services market, which represents one of the most important segments of the Indian healthcare industry, is expected to grow at a compounded annual growth rate of 15 percent for the period of 2010-2014 and thus being worth USD 81.2 billion by 2015. Further, the healthcare segment of-

“An EHR is systematic collection of electronic health information about individual patients or populations. Patients’ treatment often happen at multiple locations like initial investigation with a primary care provider, lab tests with a lab provider and pharmacy intake with the pharma providers” Sumanth Tarigopula, VP, Apps Global Delivery India, Enterprise Services, HP

fers an attractive growth opportunity for the information technology (IT) and business processing outsourcing (BPO) industry. Bhavesh Thakker, VP, Chowgule Mediconsult Pvt Ltd says, “The market for EHR – which covers both EMR and PHR - may be relatively smaller as compared to the developed markets, but the growth rate demonstrated in the last few years is very encouraging. Even more encouraging is the positive outlook shown by most healthcare providers on the need to integrate these as standard industry best practice criteria”. Dr Suresh Munuswamy, Faculty for Health Informatics, Senior Lecturer, Indian Institute of Public Health, Hyderabad, Public Health Foundation of India says, “The state or perhaps the centre has to take the lead, in developing a central EHR back bone and enable or incentivise private healthcare facilities to set up infrastructure to link up to the central EHR. Facilities which are receiving state insurance payments could be the starting point. An example would be the Medicare EHR Incentive Program in USA provides incentive payments to eligible professionals, eligible hospitals, and CAHs that demonstrate meaningful use of certified EHR technology. Projects like AADHAR card and National

Optical Fiber Network (NOFN) would need to be greatly leveraged to make EHR, EMR & PHR work across India”. Dr Annie Stanley Thakore, Hospital Administrator, CARE Hospitals says, “IT will re-define healthcare. Most of us are moving towards an EHR system that unifies patient records. But the new-era EHR will provide the clinician with systems that could dispense the course of action through analysis of the past history and assessment of the present health issue. Doctors should be able to focus on making real decisions that require human judgment aided by IT”.

Benefits The use of standardised EHR and the secure exchange of health information improve healthcare quality and safety, and reduce healthcare costs by: a) making health information available to authorised healthcare providers wherever and whenever a patient gets care, improving the coordination and continuity of care and promoting informed decision-making b) giving consumers more complete and accurate information to inform decisionmaking about their own healthcare c) reducing preventable medical errors and avoiding duplication of treatments and procedures d) lowering ad-

ministrative costs and reducing clerical errors e) enhancing research by facilitating the collection of standardised data to evaluate promising medical techniques, devices and drugs and f) reducing the time it takes to bring safe, effective products and practices to the marketplace.

Future need Dr Munuswamy says, “EHR, EMR & PHR when fully developed will change the entire healthcare service architecture. Healthcare consists of four broad and slightly overlapping vertical components; surveillance, diagnostics, management and follow-up. An efficient EHR, EMR & PHR can make surveillance proactive, make way for continuous diagnostics, real time evidence led decision support systems for health professionals and automate follow-up leading to enhanced their quality of care, reduced healthcare errors, increased collaboration, and hopefully adoption of healthy behaviors”. Mukherjee says, “Healthcare IT in US is very much controlled and driven by different Healthcare Acts. Unfortunately, it is not the same in India. In India, patient safety has always been overlooked and hence there is an urgent need of addressing this matter. The EMR, Interoperability, CCHIT

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Special Feature: ehr

“The state or perhaps the centre has to take the lead, in developing a central EHR back bone and enable or incentivise private healthcare facilities to set up infrastructure to link up to the central EHR. Facilities which are receiving state insurance payments could be the starting point” Dr Suresh Munuswamy, Faculty for Health Informatics, Senior Lecturer, Indian Institute of Public Health, Hyderabad, Public Health Foundation of India

Elements of EHR The following forms parts of an EHR: Health information and data: The system holds what‘s normally in a paper chart – problem lists, medication lists, test results Results management: An EHR lets you receive lab results, radiology reports, and even X-ray images electronically Order entry: No more prescription pads, all your orders are automated. Decision support: An EHR is smart enough to warn you about drug interactions, help you make a diagnosis, and point you to evidencebased guidelines when you ponder treatment options. Electronic communications and connectivity: You can talk in cyberspace with patients, your medical assistant, referring doctors, hospitals, and insurers securely. And your system interfaces with everyone else‘s. Interoperability is the key word. Patient support: Patients can receive educational material via the EHR and enter data themselves through online questionnaires and home monitoring devices. Administrative processes: The system lends a hand with practice management. Patients can schedule their own appointments and staffers can check on insurance eligibility. Reporting and population health management: How many patients did you treat for tuberculosis in 2013? An EHR will spit out the answers, thanks to a searchable database.

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certificate, Telehealth and use of ‘meaningful use” is among the most discussed topics today”.

On the flipside Its one thing to have your financial information online, but your health information is another story altogether. Many people have real fears about what could happen if their medical records fell into the wrong hands. Technology must play a central role for proposed healthcare reform to contain costs, improve access, and save lives. A smart, ubiquitous electronic medical record system is certainly a big part of the package, but will we have to sacrifice our privacy to reach these lofty goals? An EHR is only as good as its availability. All these benefits are only possible if the information is in an open network and everyone with permission has unfettered access. We need to be able to implement an electronic medical record where physicians can talk to each other about patients, and hospitals and physicians can communicate back and forth and share critical information on tests done and previous diagnoses, so that everyone involved has the patient’s medical history at their fingertips. This will ultimately save money by reducing unnecessary, repeat tests, and cutting back on the time it takes to make diagnosis.

Event Report

Indian Health Summit

Cosmos Forums, a leading global knowledge company, had organised the Indian Health Summit at the JW Marriott, Mumbai on March 14th 2013

he event kicked off with the first panel moderated by Karthikeyan, Director, Private Equity Insights. Brig. Joe Curian, CEO, Seven Hills Hospitals stressed on the importance of financial planning and ensuring that business decisions are made on the basis of financial prudence rather than emotions. He also highlighted the importance of having the right metrics to measure costs and effectiveness of a hospital. The panel discussed the importance of technology systems to capture and analyse information for better managerial decisions. Vikram Vuppala, Founder & CEO, Nephorplus drew on his personal experience of Nephroplus to highlight the importance of transparency especially with relation to pricing to build trust and connect with consumers. Vikram Mahajan, Director, Dolphi Techno Consultants emphasised the need for detailed planning at the drawing board level before the start of the project to minimise risk of cost and time overruns at the execution stage. Regulatory risks, bureaucracy and delayed approvals remain a significant cause of concern for the panelists, as it greatly hampers the growth and development of this sector. The second panel discussion was focused on ‘Building a successful healthcare business’ witness participation from imminent panelists. Dr Velumani, CEO, Thyrocare shared his entrepreneurial journey of building a company focused on thyroid care and how this focus has helped him build a sustainable PAN-India organisation. Sanjeev Vashishta, CEO, SRL diagnostics offered his insights on following an inorganic strategy for growth.

He also shared his views on the differences between the approach and growth strategy of SRL as compared to Thyrocare. Vishal Gandhi, Founder, Gandhi & Associates stressed on the importance of proper documentation and processes from an initial stage of the company’s life so as to enable a smooth transition to faster growth. Overall, the panel agreed that the chances of success for a healthcare entrepreneur have increased significantly over the past decade and things will improve as we move ahead. The post-lunch panel dealt with the increasing utilisation of technology in the Indian healthcare sector and how technology investments will help organization to scale-up and become successful in the longer run. The panel comprised of Madhubala Radhakrishnan, Founder & MD, Mcura Inc; Arvind Kumar, Founder & CEO, Attune Technologies and Dr BK Murali, MD, Hope hospitals. The

panelists agreed that technology adoption is no longer a choice but a necessity for healthcare companies which are looking to grow in the Indian marketplace. The last panel witnessed focus on “Capital raising for healthcare companies – working with PE/VC funds”. The panelists agreed that PE/VC capital is an excellent option for promoters looking at rapid growth but one should understand the long term implications of bringing in a financial partner. The Indian Health Summit was a great platform for CXOs and promoters from the healthcare industry to participate, network and learn from each other. The summit was well organised by Cosmos Forums and was supported by PE Insights as Private Equity Partner, Attune Technologies as the Technology Partner, Mcura as the Platinum Partner and BioRx advisors as the investment banking partner.

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policy

Odisha Healthcare Serving the Underserved Dr Pramod Kumar Meherda, Mission Director (NRHM), Department of Health & Family Welfare, Government of Odisha, thinks technology is all invasive as it can help healthcare reach the masses. In conversation with Nayana Singh & Manjushree Reddy, ENN How do you think ICT is helpful in Health & Family Welfare Departments? The Health Department deals with a lot of complex systems. Added to that, every task here is urgent and has to be done in a time bound manner. For instance, whether you are procuring drugs or dealing with logistics and supply of consumables, vaccines etc, you need to know whether they have reached the desired destination within the desired time or not. In my opinion, ICT is very important for Health & Family Welfare Department to manage complex systems with the much needed accountability and transparency.

How has Health & Family Department in Odisha leveraged ICT to manage these complex systems? Under the initiative, which we call eSwasthya, we took up several e-innovations in the last few years. One of our major accomplishments has been e-Blood Bank, the first of its kind web based MIS to improve management and functioning of blood banking system. By linking all the blood banks in the State, the public interface under this initiative allows real time accessing of data relating to availability of desired blood group. By doing away with the manual system of accessing information on required quantity

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of blood units from specified blood banks, the initiative has brought in the much needed transparency in the blood banking system. Likewise, we also have Odisha Drug Inventory Management System (ODIMS). Here, we track, in real time, if all the procured drugs have reached the destination, the stock position of various drugs at any given point of time, information on expiry of drugs, further requirement of drugs, etc. Similarly, the Drug Testing and Data Management System, a web based application has helped automation of the day to day work processes of the State Drug Testing and Research Labarotary. We have also launched Human Resource Management Information System (HRMIS) and e-Attendance to manage and keep track of employees. HRMIS facilitates a GIS based HR planning and management. In Odisha, we have the State Malaria Information System, a GIS-based application, which helps in providing information on epidemiological and surveillance parameters related to malaria. Apart from this, with the help of C-DAC, we have introduced telemedicine facilities upto District Headquarter Hospitals. We are now in the process of integrating all these initiatives with a more comprehensive Hospital Management Information System (HIMS).

Please tell us how you manage the order requirements? The entire planning is being done through web based applications, integrating them with GIS platforms. GIS has very strong foot forward in public health management under NRHM. I have already mentioned about ODIMS, the drug testing and data management system, and e-Blood Banking, which help us in managing order requirements in their respective fields. We have placed adequate staff at various levels for timely data entry and analysis.

One of our major accomplishments has been e-Blood Bank, the first of its kind web based MIS to improve management and functioning of blood banking system How can we address the consistent challenge of connecting to the people in remote and rural areas? This requires a multi-pronged strategy. In Odisha, we have tried to provide differential incentives to doctors to encourage them to serve in rural health centres. Besides, we are taking care of the need for adequate and quality infrastructure at our delivery points, including staff quarters for health personnel serving in rural areas. It is also important that we reach our rural and tribal population at their doorsteps to reduce their out of pocket expenditure on health and to build their confidence in public health systems, such as through Mobile Health Units (MHUs). At present, 354 Mobile Health Units are operational to provide primary health care services at the community level in 7850 most difficult villages on a fixed day every month. A Mobile Health Unit has five persons: a doctor, an ANM, pharmacist, attendant and a driver. These mobile units take care of minor ailments and if there is anything beyond their control, they refer them to the senior doctors. We already have two such units in all the blocks of tribal areas. Free referral transport services through 466 Janani Express and 422 Ambulances have helped us in providing access to rural population during critical situations. More than four

lakh pregnant women and 35,000 sick newborn babies are being benefitted annually in this way. We have also set up maternity waiting homes (Maa Gruha) in remote tribal areas, where mothers arriving early for institutional deliveries are kept under medical supervision till they are shifted to the health institution for actual delivery. Similarly, over the years, steps have been taken to provide health care services through active involvement of the people. This has been achieved with the help of more than 43,000 ASHAs and formation of Gaon Kalyan Samitis in all the revenue villages. To cite an example; last year, at the village level, 2.50 lakh persons were diagnosed and treated for Malaria by ASHAs. Likewise, in the same period, ASHAs successfully followed up 20,000 TB patients and 2500 suspected Leprosy patients at village level. Community involvement has now become the mainstay for public health service delivery in rural areas.

Please tell us about the training for the IT. Are Ayush doctors being considered for those programmes for telemedicine? Not yet but sooner or later they will have to be trained in ICT. At present, they have been trained in other maternity and child healthcare services and outreach programmes like school health, mobile health units, etc. As part of another ICT initiative, we are putting GPS on all our vehicles to track how they move.

Tell us about your ICT initiatives ahead. I have already mentioned about the comprehensive Hospital Information Management System (HIMS). The backward linkages under e-blood bank, linking of prescription audits with ODIMS and an integrated referral transport system, tracked in real time through GPS are other initiatives that we are currently engaged with.

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news

Tabletop Laser Imager for Radiology and Imaging Applications Carestream launched its new DRYVIEW 5950 Laser Imaging System which is now available for order in India. The advanced imager produces 508 pixels-per-inch output for general radiology and mammography images. The new imager can support efficient printing and time-saving film cartridges that can benefit healthcare providers of all sizes in India. The DRYVIEW 5950 laser imager also can deliver an enhanced quality control system for mammography images. This innovative internal quality control system that includes a built-in densitometer will produce test prints and display data needed to support mammography quality control chartingâ&#x20AC;&#x201D;which can eliminate the need for an external densitometer and can greatly reduce the time required for mammography quality control.

Telehealth Unlikely WIPRO Wins USD 200 mn Contract To Be Cost Effective from US Healthcare chain Telehealth does not seem to be a cost effective addition to standard support and treatment for patients with long term conditions, finds a study published on bmj.com today. The findings follow a BMJ study published last month showing that telehealth does not improve quality of life for patients with long term conditions. Telehealth uses technology to help people with health problems live more independently at home. For example, blood pressure or blood glucose levels can be measured at home and electronically transmitted to a health professional, reducing the need for hospital visits. Telehealth has been promoted to reduce healthcare costs while improving health related quality of life, but there is very little good quality evidence on the effect of telehealth on service use and costs. The study is part of the Whole Systems Demonstrator Trial - one of the largest ever conducted.

Wipro was awarded a USD 200 million contract by Catholic Health Initiatives, the biggest healthcare outsourcing order for Indiaâ&#x20AC;&#x2122;s thirdlargest software services provider. Under the contract, Wipro will manage computer systems, networks, data centres and servers for

more than three years for Catholic Health Initiatives, the second-largest nonprofit healthcare chain in the US, two people familiar with the development said on condition of anonymity because they are not authorized to discuss details.

Google to pay USD 7 mn fine for Privacy Breach With a view to strengthen the drug regulatory system in the country, the Central Drugs Standard Control Organisation (CDGoogle has agreed to pay USD7 million fine to settle complaints from dozens of U.S. states about its unauthorized collection of private data from home and business networks obtained through Street View vehicles. Between 2008 and 2010, these vehicles, equipped with antennae and open-source software, collected names, passwords, addresses, emails and other personal information from millions of unencrypted home and business Wi-Fi networks, said Connecticut Attorney General George Jepsen, who spearheaded the investigation.

Fifth Attempt on Telehealth Bill Passage Introduced in the Senate A telemedicine bill aimed at expanding remote patient monitoring technology in rural and underserved communities was re-introduced in the Senate (mid March), making it the fifth time the bill has been proposed since 2005. If passed, the bill would establish pilot programs under Medicare to provide incentives for home health agencies utilizing telemedicine technologies. Officials say the bill would allow for improved monitoring of Medicare patients and further reduce program expenditures over time. In a push toward value-based care, many hospitals now face readmission penalties when a Medicare patient is re-admitted to a hospital within a specific time period. Currently, nearly one in five Medicare beneficiaries are re-admitted within a 30-day period. The billâ&#x20AC;&#x2122;s cosponsors say telemedicine could bring those numbers down significantly.

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Mole Detect Pro iPhone app: Unearthing Fujitsu Develops Real-Time Pulse Early Signs of Melanoma Monitor Using A new smartphone app has been launched for the UK market that can detect warning signs of skin Facial Imaging cancer and offer its users a remote professional diagnosis within 24 hours. Mole Detect Pro securely stores photos of moles and uses an advanced algorithm to grade the likelihood of a potential melanoma, based on the ‘ABCDE method’ of detection. If you visit a dermatologist, they will often mention this acronym and ask you to track symptoms at home. It stands for: Asymmetry (irregular shape), Border (ragged, notched or blurred), Colour (more than one in a single mole) Diameter (larger than 6mm), Evolution (changing size, shape or colour).

WebMD, Qualcomm Build Consumer Cloud for Mobile WebMD and Qualcomm have partnered to offer consumers a way to upload biometric data from wireless home medical devices. That data can then be shared with healthcare providers. WebMD’s new Health Cloud platform is due out this fall and will be based on Qualcomm’s 2net platform, a cloud-based system designed to be interoperable with different wireless medical devices and applications, allowing medical device users and their healthcare providers to access biometric data online. While the 2net platform existed prior to the collaboration, WebMD brings with it 117 million unique visitors who log onto its site each month, according to WebMD CTO Bill Pence.

mHealth Application Poised for Growth The mobile health application market is headed for explosive growth, according to a new report by Research and Markets, which has projected the market will swell 61 percent by 2017, reaching USD 26 billion. Officials forecast the market will reach more than 3.4 billion smartphone and tablet users with access to mHealth applications. Fifty percent of these users will have downloaded mHealth applications, according to report findings. The global mHealth market will grow at a compound annual rate of 41.5 percent in the next five years to reach $10.2 billion by 2018, according to a recent report from market research firm Transparency Market Research.

Fujitsu Laboratories has developed a technology that detects a person’s pulse by measuring variations in the brightness of the person’s face thought to be caused by the flow of blood. It is based on the characteristic of hemoglobin in blood, which absorbs green light. It requires no special hardware and can measure pulse rate simply by pointing a camera at a person’s face for as little as five seconds. It also automatically chooses moments when the person’s body and face are relatively still to minimize the effects of irrelevant data on measurements. This technology has a wide range of potential uses, including health monitoring and maintenance as well as security applications. As part of a health-support service that can be customized to each person’s needs, Fujitsu Laboratories is aiming to create a way for people to track their health and store the resulting data in the cloud for analysis, helping them better understand their health and how it changes over time. One fundamental indicator of human health condition is pulse. However, pulse monitoring typically requires specialized equipment that must be worn and operated with some care. These inconveniences make it more likely that users will fail or forget to have their pulse monitored.

Are Cloud Based Record Banks Superior to HIEs? Health information exchanges, as currently constructed, are an “inefficient” means of sharing healthcare data due to interoperability issues, according to a commentary published recently in the Journal of the American Medical Association. A better solution–according to authors Edward

Shortliffe of Arizona State University, Latanya Sweeney of Harvard University and William Yasnoff of consulting firm National Health Information Infrastructure Advisors–would be to use cloud-based health record banks that could allow patients more control over their information.

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news

Novartis Loses Indian Patent Case India’s Supreme Court has rejected a plea by Novartis to patent an updated version of its cancer drug, Glivec. The Swiss drugmaker had been denied a patent by Indian authorities on the grounds that the new version was just slightly different from the previous one. There were concerns that a patent could threaten access to cheap generic versions of drugs in poorer countries. But some Western companies had warned that a decision against Novartis could discourage investment in research. Glivec, which is used to treat chronic leukaemia and other cancers, costs about USD 2,600 a month. The generic equivalent is currently available in India for as little as USD 175. However, the Indian patent authority rejected the application based on a law aimed at preventing companies from getting fresh patents by making only minor changes to existing drugs, a practice known as “ever greening”.

Software Updates can be Hazardous to a Health IT System’s Health A study published in the Journal of the American Medical Informatics Association shows how a simple software update can create unintended consequences that can have an adverse impact on patient and patient care. Doctors from Boston’s Brigham and Women’s Hospital in Boston, led by Adam Landman, M.D., were inspired to explore the problem when the hospital’s information systems help desk was inundated with calls from physicians who could no longer access a web-based image viewer from the emergency department’s tracking board. The link from the ED tracking to the web-based image viewer was lost on workstations running Microsoft Explorer 6. It turned out the cause was a security update Microsoft had released days earlier. According to the authors, it took 10 days to restore the link–the solution was to update all emergency department workstations to Internet Explorer 8. In the 10 days after the link loss, 450 emergency department radiology studies were performed, compared to 52 during the previous 10 days. The web-based image viewer was used to review images just 1,281 times during this period, compared to 2,098 times in the 10 days before the link was lost.

Ranbaxy Resumes Atorvastatin Ranbaxy Laboratories has resumed the supply of Atorvastatin calcium tablets, a cholesterol lowering drug, in the U.S. market. The company had stopped production of generic version of cholesterol lowering drug Lipitor last year as it investigated the issue of potential glass particles in certain lots of the drug. On November 9, 2012, Ranbaxy had informed customers of a voluntary recall of certain lots of the company’s 10mg, 20mg, and 40mg dosage strengths of atorvastatin tablets from the U.S. market.

Chinese Hackers Targeting the Health Industry Cyberespionage is gathering momentum and becoming everyday norm. It’s no surprise that the healthcare and medical industry would come up on the list — but, to date, it has been a field more abused by hackers motivated by medical identity theft and other financial fraud. Many of these victims have technology or drugs that are a monopoly. If you are the first to market with some great new technology breakthrough or drug, and you get a profit from that research … it would definitely be an issue for the Chinese to target some of these firms.

Drug Prices Continue to Remain Out of Control The proposed drug pricing policy is riddled with a host of anomalies. Extending price control to all “essential” medicines will mean an arduous task, translating into a massive regulatory overreach, especially given the widespread problem of substandard and spurious drugs in the over Rs

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1-lakh-crore Indian pharmaceuticals sector (40% of which is exported). Now, as per the last Drugs (Price Control) Order 1995, the prices of almost more than 70 select bulk drugs are to be regulated, but out of these, only 47 were actually under production

as of last year. The rigid cost-based approach in the present drug-pricing regime has discouraged output, and the new policy seeks changeover to market-determined prices. And the ceiling price envisaged is the simple average of all brands having market share of 1% and above of the total turnover in any particular medicine.