Ehealth april 2017 web edition

ASIA’S FIRST MONTHLY MAGAZINE ON THE ENTERPRISE OF HEALTHCARE

VOLUME 12 / ISSUE 04 / APRIL 2017 / ` 75 / US $10 / ISSN 0973-8959

KARNATAKA

Transforming Healthcare for the Masses

November 2016 11 April, 2017, The Lalit Ashok, Bengaluru, Bengaluru th

Special Issue

SIDDARAMAIAH

Special Interview

Hon’ble Chief Minister Government of Karnataka

DR SHALINI RAJNEESH

Principal Secretary Department of Health & Family Welfare Government of Karnataka

DR RATHAN KELKAR

Mission Director National Health Mission Government of Karnataka

ARUN SINGHAL

Joint Secretary Union Ministry of Health & Family Welfare Government of India

KR RAMESH KUMAR

Hon’ble Minister for Health & Family Welfare Government of Karnataka

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ASIA’S FIRST MONTHLY MAGAZINE ON THE ENTERPRISE OF HEALTHCARE Volume 12

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Karnataka Transforming Healthcare Landscape for the Masses With a clear objective of taking quality healthcare to the doorsteps of the citizens, Karnataka is transforming its healthcare infrastructure using technology

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Upgrading Health Infrastructure in Karnataka

CONTENTS

With plans afoot to transform the health sector in Karnataka, Dr Shalini Rajneesh, Principal Secretary, Department of Health and Family Welfare, Government of Karnataka, shares the state government’s priorities in healthcare

APRIL 2017 | VOLUME - 12 | ISSUE - 04

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NHM: Strengthening Karnataka’s Health System Based on the state’s specific needs, Karnataka has fine-tuned the priorities set under the NHM, says its Mission Director in Karnataka Dr Rathan Kelkar

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Policymaker’s Perspective

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Arun Singhal Joint Secretary, Union Ministry of Health and Family Welfare

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Dr Sadhana SM Executive Director KSHSRC

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Hussan Lal Mission Director National Health Mission, Punjab

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Dr Sudha Chandrasekhar, Director (Medical Management), SAST

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Jitendra Arora Director (eHealth), Ministry of Health and Family Welfare

Healtcare Technology

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Karnataka Govt. has launched a new initiative titled “PHCMIS” in 1,000 PHCs in the state

Dr Singray Soren Adviser (Homoeo), Ministry of Ayush

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AIIMS has successfully implemented the e-Hospital Project and the OPD Transformation Project

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Industry Perspective

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SRI-B has signed an MoU with Karnataka Government to strengthen operations of PHCs

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Chander Shekhar Sibal Executive Vice President, Fujifilm India

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Jasmine Gorimar Head Information Technology, Boehringer Ingelheim India

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Sandeep Raizada Chief Technology Officer, dWise HealthCare

APRIL / 2017 ehealth.eletsonline.com

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editorial

Cutting-Edge Karnataka Leading Healthcare Revolution Determined to transform its healthcare infrastructure and health service delivery system, Karnataka is leading a healthcare revolution in India, taking technological innovations in its stride. The Healthcare Summit Karnataka special issue of eHealth magazine is an endeavour to highlight the strong undercurrent driving this change.

Our cover story, “Karnataka Transforming Healthcare for the Masses”, underlines how a slew of measures undertaken by the State Government including CSR initiatives, PPP models, telemedicine system in PHCs, teleradiology, e-Hospital, e-Arogya, PHC MIS projects, virtual clinics, and Mobile Medical Units among others, are providing a new direction to the sector which relies on the bottom up approach to improve health indicators of the state.

The magazine’s latest issue also carries a special interview of Arun Singhal, Joint Secretary, Union Ministry of Health and Family Welfare, giving useful insights into the Government of India’s plans to strengthen public healthcare delivery in India and meet increasing health workforce demand. In the special interview titled “India Ready to Witness Transformation of Health Sector”, the senior official also talks about how digitalisation is being promoted to set a new benchmark in patient care services in India’s premier institutions and health organisations of national importance.

In a bid towards highlighting key initiatives undertaken by the Government of Karnataka, we have included interviews of key decision makers and policy framers from the State. In the interview, ‘Upgrading Health Infrastructure in Karnataka’, Dr Shalini Rajneesh, Principal Secretary of Karnataka’s Department of Health and Family Welfare, highlights top priorities of the State, as she talks about reforms, IT-based initiatives and major challenges in improving health indicators across the State.

To gauge how National Health Mission is impacting healthcare landscape in the State, Dr Rathan Kelkar, Mission Director, NHM, Government of Karnataka, in the interview – “NHM: Strengthening Karnataka’s Health System” -- highlights how Karnataka has fine-tuned its priorities set under the Mission to focus on delivering quality health services based on its specific needs.

We are sure that our bouquet of features in this special issue of eHealth will provide our readers an in-depth knowledge of the key initiatives that are infusing fresh energy into the state’s health sector, making it more inclusive, reliable and cost-effective.

Looking forward to our readers’ valuable feedback.

Dr Ravi Gupta Editor-in-Chief

ravi.gupta@elets.in

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KARNATAKA

Transforming Healthcare Landscape for the Masses With a clear objective of taking quality healthcare to the doorsteps of the citizens, Karnataka is transforming its healthcare infrastructure using technology as a potent tool to provide fillip to the sector, making it more connected, inclusive and result-oriented. Having introduced a number of CSR initiatives, PPP models, telemedicine system in PHCs, teleradiology, e-Hospital, e-Arogya, PHC MIS projects, virtual clinics, Mobile Medical Units, among others, the government is providing a new direction to the sector that relies on the bottom up approach to improve health indicators of the state, writes Elets News Network (ENN).

K

arnataka is among the few states where the government is following a proactive approach to deliver quality healthcare services using technological innovations to improve health indicators across the state, bridging the wide gaps in service delivery by taking on board all the stakeholders responsible for improving efficiency across the sector. “Upgrading health-related infrastructure and human resources in public health facilities in Karnataka to im-

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plement universal health care successfully are our top priorities,� says Dr Shalini Rajneesh, Principal Secretary, Department of Health and Family Welfare, Government of Karnataka.

The Government of Karnataka, under the leadership of Minister for Health and Family Welfare KR Ramesh Kumar, has recently come out with suggestions for a policy framework to provide quality healthcare across the state. It includes provision for providing free diagnostics, medicines

The Government of Karnataka has implemented several new programmes and strengthened the existing ongoing programmes in order to improve the health care infrastructure in the state at the community level.

“

and other necessary tests to take care of rising costs of health services.

To achieve its target of making healthcare more inclusive and cost-effective, the government is committed to use information technology effectively. “We have undertaken several IT projects within the department. The e-Hospital project (linking patients with health facilities, registration, diagnostics, treatment and big data analysis) makes government hospitals more efficient. Telemedicine and tele-radiology helps in overcoming HR (specialists) shortages. Our IT projects in Karnataka include e-Hospital, tele-medicine, tele-counselling and treatment of psychiatric cases (NIMHANS Model), Janarogya, etc,” says Dr Rajneesh.

Recently, Samsung Research and Development Institute, Bengaluru (SRI-B) recently handed over 1,000 Tab IRIS to the Department of Health and Family Welfare, Government of Karnataka. Samsung Tab IRIS, the first commercial tablet to be approved by Unique Identification Authority of India (UIDAI) for Aadhaar verification, is set to provide advanced technological support to efficiently manage medical subsidies and operations at public health centres across the state.

Taking medicare to people living in rural areas has always been a challenge. For decades, the biggest question has been how to provide medicare to those feeling left out even in availing basic medical help.

Karnataka’s Department of Health and Family Welfare has come up with an idea to provide healthcare services to the needy with Mobile Medical Units (MMUs).

Karnataka Chief Minister Siddaramaiah flagged off 78 MMUs that will provide healthcare services to people living in hilly remote areas, in locations which are far off from health centres, areas with poor transport connectivity, and in vicinities which are mostly inhabited by the poor especially SCs, STs, other economic backward classes.

“The primary objective of the MMUs is to provide healthcare services to the needy in remote areas of Karnataka,” said Minister for Health and Family Welfare while launching the initiative along with the chief minister.

According to the Department of Health and Family Welfare, each mobile unit has been equipped with medical device, drugs and consumables as per the National Mobile Medical Unit Service guidelines.

Each unit is equipped with an MBBS doctor, a staff nurse, a pharmacist, a laboratory technician, an ANM, and a driver. For each unit, in a taluk, 13 to 15 eligible villages have been identified for service.

This year, the Government of Karnataka allocated

Rs 5,118 crore for the Department of Health and Family Welfare, which was more than the previous budget allocation. The budget has provided a major push to both AYUSH Department and public health centres (PHCs).

With the government focussing on tackling the increasing incidence of lifestyle and non-communicable diseases, five super specialty hospitals have been proposed in Vijayapura, Davanagere, Tumakuru, Ramanagara and Kolar towns for the treatment of cancer and heart diseases.

The Budget also aims to promote traditional systems of medicine in the state. To achieve this goal, integrated Ayush hospitals with 50 beds capacity will be set up in Chitradurga and Chickamagaluru district hospitals at a total cost of Rs 6 crore. The government will also establish an Ayush drugs manufacturing centre in the premises of Belagavi City Immunisation Centre at a cost of Rs 5 crore.

The Budget also proposes to integrate 1,538 ambulances under two different departments to make available at least one ambulance for every 10 to 15 km or 35,000 population.

Karnataka is also adopting the CSR model to deliver quality healthcare to the millions of its citizens both in rural and urban areas of the state.

“Our vision is to ensure access and availability of quality health care for all. Our mission is to provide comprehensive and quality health care services to ensure equitable access, redress regional imbalances. Stabilise population and make AYUSH systems Integral part of health care. Involve community participation in all the activities for better acceptance,” says Dr Rajneesh.

The Government of Karnataka has implemented several new programmes and strengthened the existing ongoing programmes in order to improve the health care infrastruc-

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Mobile health clinics aim to take quality healthcare delivery to the door steps of the vulnerable sections of the population in remote, unreached and poorly accessible under-served areas of Karnataka (rural, hilly, tribal and forest with poor communication facilities).

“

ture in the state at the community level. Araike Yojane, which aims to provide pure drinking water, toilet, bathroom facility and rooms to stay for the patient’s attendants, is one such programme.

The government also plans to strengthen dialysis units by identifying the non-functioning units and make them functional by inviting PPP partners (human resource support viz. specialists and technicians).

Mobile health clinics aim to take quality healthcare delivery to the door steps of the vulnerable sections of the population in remote, unreached and poorly accessible under-served areas of Karnataka (rural, hilly, tribal and forest with poor communication facilities). The government is proposing to deploying 1,000 ambulances for this purpose.

Despite good infrastructure, public health facilities in urban and semi-urban areas lack quality and reliability. The main reasons are urban poor lack of awareness about available services, poor grievance redressal system and lack of information on patient rights, privileges and responsibilities. Hence, Citizen Help Desks (CHDs) have been planned to cater to the patient’s need Karnataka is experiencing shortage of doctors and specialists of all categories in public hospitals at district, taluka and community health centre levels. To overcome the acute shortage of medical personnel, under the Department of Health and Family Welfare and NHM, the services of the doctors and specialists are hired on contract basis.

It is proposed to approach private hospitals or practitioners to come forward and spare a day or two per week for catering to the needs of poor patients.

“For Government of India, the key priorities under NHM (National Health Mission) for 2017 include availability of

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free drugs, diagnostics, dialysis units; focus on NCDs; operationalising the FRUs; strengthening of district hospitals; quality care and kayakalp; patient centric health care and toll free helplines; elimination of malaria by 2027 and filariasis by 2020 and address human resource gaps,” says Dr Rathan Kelkar, Mission Director, National Health Mission, Government of Karnataka.

According to him, Karnataka has additionally fine-tuned these priorities based on state’s needs, and the focus extends to delivering services like dialysis, ICU units, and repositioning ambulances every 15-20 km till district and taluka level. “Other priorities include reduction of health inequality amongst people, strengthening infrastructure and referral system from PHC up-till multi-speciality level and focus on universal health coverage (UHC) through participation of private sector utilising tools such as telemedicine and e-hospital management,” he adds.

The state, under NHM, has embraced Information Technology on par with the private sector. “We already have a number of software (38) pertaining to various programmes.

For example, the mother and child tracking system, Health Management Information System (HMIS), Asha software, integrated disease surveillance system software, etc.

There are ongoing efforts in integrating them on common parameters to support better access, data mining and creation of dashboard, indicators. e-Hospital software (containing 4 modules- OP, IP, Lab as well as billing modules) has been rolled out and piloted in about 7 hospitals. The same would now be extended to 47 institutions including district, taluk hospitals and CHCs. In the next one year, we are looking at implementing e-Hospital right down to the PHC level,” says Kelkar.

The concept of digital healthcare is expanding fast in Karnataka. Under a new initiative titled “Primary Health Centre Management Information System” the state government has selected 1,000 PHCs to make available real-time information, such as patient treatment, diagnosis, deliveries handled and drug availability that would be centrally consolidated.

With determination in mind to provide worldclass healthcare infrastructure in the state, the Karnataka government is making all the right moves to make quality healthcare available to the citizens by leveraging technological innovations. With success of these interventions set to change the course of healthcare sector in the state, it’s is widely hoped that the state will emerge as a role model to follow by other states in India, helping the country realise its true potential.

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Policymaker’s Perspective

UPGRADING HEALTH

Infrastructure in Karnataka

With plans afoot to transform the health sector in Karnataka, Dr Shalini Rajneesh, Principal Secretary, Department of Health and Family Welfare, Government of Karnataka, shares the state government’s priorities in health for the financial year 2017-18 and updates on IT initiatives undertaken in the state besides challenges and best practices in the health domain, in an interview with Sudheer Goutham of Elets News Network (ENN).

What are the key priorities of the state government in the area of health during 2017-18?

Upgrading health-related infrastructure and human resources in public health facilities in Karnataka to imple-

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ment universal health care successfully are our top priorities.

In infrastructure, we want to upgrade the functionalising the Model Maternal and Child Health (MCH) wings in district and taluk hospitals

and streamlining free diagnostics/ free drugs availability with online indenting/equipment availability.

In the area of human resource, we are improving the availability of manpower in health by filling the vacan-

Policymaker’s Perspective

International NGOs are focusing on reforms in healthcare. How do you see (reforms) taking place in Karnataka?

We are working on health reforms for quite some time now. The World Health Organisation (WHO) is helping Karnataka in the Measles Rubella Campaign while United Nations Development Programme (UNDP)’s ongoing strategy for tackling malnutrition will go a long way in improving health parameters in the state.

The Karnataka Health System Development and Reform Project is a World Bank-assisted project, aimed at increasing utilisation of curative preventive and public health services, particularly in underserved areas and among vulnerable groups, to accelerate achievement of the health related Millennium Development Goals.

Keeping in view the positive contributions of the project in enhancing health outcomes (reducing maternal and child mortality and communicable diseases) and understanding the need to sustain/continue the innovative programmes, an extension of the project was given till March 2016 (original closing date was March 31, 2012), with additional financing of $70 million (Rs 374.50 crore) with ef-

fect from January 22, 2013.

Other initiatives in reforms include implementing virtual clinics to facilitate the access, availability and affordability of primary healthcare to people in remote areas; C&R with rationalisation of available human resources; and streamlining of Human Resource Management Systems (HRMS).

Private healthcare is increasingly adopting IT. Please elaborate on IT initiatives undertaken by the government health sector?

We have undertaken several IT projects within the department. The e-Hospital project (linking patients with health facilities, registration, diagnostics, treatment and big data analysis) makes government hospitals more efficient. Telemedicine and tele-radiology help us in overcoming specialists’ shortages. Our IT projects in Karnataka include e-Hospital, tele-medicine, tele-counselling and treatment of psychiatric cases (NIMHANS model), Janarogya (a mobile appl that serves as a user-friendly guide to avail free government healthcare services and facilities).

We have come to know that you are using social media tools for promoting your department’s programmes. Highlight the outcome of the promotion.

We use WhatsApp for sharing information dynamically across the state. We also use Healthizen, a citizen-friendly mobile application, for raising flag about the issues concerned with health determinants.

Our multi-pronged media plan, especially for social media platforms, has helped the department to reach all age groups and sections of the society. Measles Rubella (MR) Vaccination Campaign in Karnataka has been a recent example with 98 per cent success rate.

What are the key challenges in health domain and how do you address them?

Our biggest challenge is to get skilled workforce (MBBS/specialists) to join the government services. We find solutions by motivating people to avail the health services at government hospitals so as to reduce the out of pocket expenditure.

We have undertaken several IT projects within the department. The e-Hospital project makes government hospitals more efficient. Telemedicine and tele-radiology help us in overcoming specialists’ shortages.

“

cies of all essential and critical manpower through contract/part-time or by regular recruitment. Alternately, we fill the specialist vacancies with MBBS doctors, while wherever MBBS doctors are not available at PHCs, the vacancies are filled with Ayurveda graduates with training in essential drugs used at PHCs. We have got approval for additional posts of the paramedics, i.e., Auxiliary Nurse Midwives (ANMs) to promote well-being, prevention and promotion of health. We have also got approval for the First Division Assistant (FDA) posts to improve the reporting system. We have initiated recruitment revision of all the cadres in the department. In training, we want to encourage Diplomate of National Board (DNB) courses to address the specialist vacancies. In emergency response training we are collaborating with Tamasec Foundation, Singapore to train the staff.

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Policymaker’s Perspective

NHM:

Strengthening Karnataka’s Health System Based on the state’s specific needs, Karnataka has fine-tuned the priorities set under the National Health Mission (NHM) and the focus extends to delivering services like dialysis, ICU units, and repositioning ambulances every 15-20 km till district and taluka level, says Dr Rathan Kelkar, Mission Director, NHM, Government of Karnataka, in an interview with Sudheer Goutham of Elets News Network (ENN).

What is your mandate as Mission Director of NHM, Government of Karnataka?

My mandate is to implement the vision of National Health Mission (NHM), i.e., universal access to equitable, affordable and quality health care services to each and every citizen. NHM schemes fall under three broad categories- maternal and child health, communicable and non-communicable diseases. All the targets under these categories are supposed to be met in time bound manner. My role is to supervise the implementation of all the schemes to ensure that

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we reach our targets in coordination with the Department of Health.

Further, there is a need to oversee that health facilities are strengthened as per the requirements in the Programme Implementation Plan (PIP); find out ways and means of working with private sector through innovative projects; and use information technology to the maximum extent possible in ensuring that healthcare is delivered to the door steps of the people.

It is important that decentralised health planning is done properly in the right spirit. For example, Karnataka has recently prepared district health

action plans with a bottom up approach. It involves the data collected

by Asha workers during their houseto-house survey. The plan was then vetted by all the programme managers above district level and based on that the State Programme Implementation Plan (PIP) for 2017-18 was prepared and sent to the Government of India.

Highlight the government’s priorities under the NHM for the year 2017.

For Government of India, the key priorities under NHM for 2017 include

Policymaker’s Perspective availability of free drugs, diagnostics, dialysis units; focus on NCDs; operationalising the FRUs; strengthening of district hospitals; quality care and kayakalp; patient centric health care and toll free helplines; elimination of malaria by 2027 and filariasis by 2020 and address human resource gaps.

Karnataka has additionally finetuned these priorities based on state’s needs, and the focus extends to delivering services like dialysis, ICU units, and repositioning ambulances every 15-20 km till district and taluka level. Other priorities include reduction of health inequality amongst people, strengthening infrastructure and referral system from PHC up-till multi-speciality level and focus on universal health coverage (UHC) through participation of private sector utilising tools such as telemedicine and e-hospital management.

products which will be interlinked together so that there is no duplications and the data can be harnessed to the extent possible.

The other areas that we are looking at the future include utilising IT facilities through PPP networks. CSR activities in collaboration with organisations like Samsung have already helped in distribution of tablets to ANMs/Ashas. Similarly, BIOCON has started doing pilot in some PHCs using software to ensure that IT is used to the extent possible.We are collaborating with HP through standalone clinics at remote locations which will connect the data back to the control room using information technology at the end point.

Healthcare (private hospitals) is increasingly adopting information technology. How do you see NHM in Karnataka taking initiatives in this area?

Healthcare infrastructure continues to be a challenge as population is huge and the resources are limited.

Maintaining quality of equipment and buildings right down to the grassroots level presents big challenges.

Some steps to deal with these challenges include strong PPP models and CSR interventions to aid the state. Similarly, looking at IT to overcome physical infrastructure and specialists gaps constraints would be useful. For example, if we can have a technician on ground, the doctor on the other end will be able to prescribe medication and health care access could reach the last mile. Outreach activities through designated camps or thorough extension clinics in the urban as well as rural areas could be other ways of overcoming infrastructure related challenge.

The state under NHM has embraced IT just like private sector. We already have a number of software (38) pertaining to various programmes. For example, the mother and child tracking system, Health Management Information System (HMIS), Asha software, integrated disease surveillance system software, etc. There are on-going efforts in integrating them on common parameters to support better access, data mining and creation of dashboard, indicators. e-Hospital software (containing 4 modules- OP, IP, Lab as well as billing modules) has been rolled out and piloted in about 7 hospitals. The same would now be extended to 47 institutions including district, taluk hospitals and CHCs. In the next one year we are looking at implementing e-Hospital right down to the PHC level.

Additional efforts in IT include making available tablets to ANMs to capture real time data on ground and rolling out telemedicine and tele-radiology projects. The future plans aim at creating mesh of all the IT-related

Healthcare Infrastructure continues to be a challenge for service delivery in the state. What are the steps being initiated to deal with it?

Can you share with us the challenges in NHM’s initiatives?

How do you find solutions for these challenges?

Key challenges in NHM’s initiatives include the following: NHM Schemes are benefit oriented scheme; hence implementation becomes a challenge as it has dependency on various stakeholders including ASHAs, ANMs, DHOs etc. whose

coordination remains difficult.

Convergence amongst various stakeholders within the health department also remains an issue as diverse personalities handle different wings within the department and common meeting of minds is needed to overcome challenges & ensure better decision making.

Since health has collaboration with other departments in the state including rural/urban/SC/ST/backward/ education department, constant convergence and coordination amongst them is important.

Some of the ways these can be addressed would be : Capacity building and training at the level of ASHAs, ANMs, Village Health Nutrition and Sanitation Committees to ensure good preventive and promotive aspects of healthcare.

Since these actors know the customary practices within villages, their buy in through increasing their strength and incentive structure can go a long way in health care delivery at grass root level.

The emphasis of health as an investment must be realised at different levels in the state and health schemes must not be taken as routine program but those which remain critical to growth and productivity of individuals of the State. Therefore increasing motivation of staff at all levels remain pivotal and exposure and cross learning from best practices of other States. Coordination with urban department and urban health bodies for implementation of urban health programs must be emphasised to meet the targets under NHM. Each person in the state must contribute to make society healthy and prosperous and own up the activities delegated to them. Health should be perceived as a personal and individual responsibility to improve life style and avoid practices which are deterrent to individual health.

Leaders must ensure that projects are closely monitored and supervised and implemented in time bound manner. Finally there must be adequate resources that need to be committed to health and also efficient use of available resource by reducing any wasteful and duplication of funds.

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Policymaker’s Perspective

INDIA READY TO WITNESS Transformation of Health Sector

The Union Health Ministry is in the process of setting up a National Medical Commission to streamline medical education and practice in the country and make the system more transparent and accountable, says Arun Singhal, Joint Secretary, Union Ministry of Health and Family Welfare, in conversation with Gautam Debroy of Elets News Network (ENN). Excerpts: Tell us about some of the major initiatives that you have recently taken to improve the country’s health sector?

With a view to strengthen public healthcare delivery in India and meet

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increasing health workforce demands, undergraduate medical seats have been increased to over 65,000 in the country. Post graduate seats have also been increased substantially. New medical colleges are being

set up in the country at a rapid pace.

Some of these new medical colleges are being attached with existing district and referral hospitals with a vision to strengthen healthcare delivery at the grass root level and to benefit

Policymaker’s Perspective under-served areas.

The importance of allied health professionals is also being recognized and efforts are being made to set up regulatory framework for such professionals.

What digital initiatives you have taken in health department?

Do you think that India’s health sector should be equipped with skilled man power?

Yes. In fact, In India, the human resource policy direction in the last decade has focused on increasing production and retention of two extremely important pillars of health providers - doctors and frontline workers, and equipping them with the relevant skills to provide health care.

To this effect, a MoU was also signed between Ministry of Health and Family Welfare and Ministry of Skill Development & Entrepreneurship with a vision to fill the healthcare delivery gaps in the country with skilled health workforce. The National Institute of Health & Family Welfare will launch

skill training courses in 37 identified specializations as per the Skill India vision of Hon’ble Prime Minister. This would provide job opportunities and also provide trained workforce.

Are the numbers of present medical institutions in India are enough to fulfill the demand of medical education in the country?

The issue of demand and supply of medical education is a complex one and can rarely have an absolute solution. On one hand we have more than 400 medical institutions, both Govt. and private in the country, with a total number of around 90 thousand medical and dental UG seats. On the other hand we have close to 11 lakh candidates appearing for NEET-UG 2017. Quality of students being selected for undergoing UG courses in the medical field is of paramount importance as it will have a direct effect on healthcare delivery in the country.

This being said, the Ministry is in the process of opening 58 new medical colleges which will be attached with existing district or referral hospitals so that health needs of the local population may be served. Further, 8 of these Colleges are proposed to

be set up in the North Eastern part of the country so as to cater to the demands of medical education in underserved areas.

Any guidelines to keep a tab on the mushrooming of private medical institutions?

Approval for starting any medical or dental college in the country is given only after stringent inspections by statutory bodies. An Oversight Committee headed by a retired CJI has also been appointed by the Supreme Court to oversee the functioning of MCI. The Ministry is also in the process of setting up a National Medical Commission to streamline medical education and practice in the country and make the system more transparent and accountable.

Any special strategy as far as improving the health scenario of rural India?

The National Rural Health Mission is focused towards improving access to quality healthcare in rural areas. Government of India has recently come out with a new Health Policy which has universal healthcare as one of its most important objectives.

Links have been created with Unique Identification Authority of India (UIDAI) and the Department of Electronics and Information Technology (DeiTY) to promote digitalisation of patient care services in premier institutions of national importance in the country.

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Links have been created with Unique Identification Authority of India (UIDAI) and the Department of Electronics and Information Technology (DeiTY) to promote digitalisation of patient care services in premier institutions of national importance in the country.

For example, The AIIMS e-Hospital Project and the AIIMS OPD Transformation Project had transformed the premiere hospital into a patient friendly hospital saving patient wait times, facilitating maintenance of electronic records, setting up of exit OPD counters and making it easier for patients to access clinicians’ consultation rooms.

Similarly, a Nursing Registration and Tracking System (NRTS) has been launched by the Indian Nursing Council for registering and tracking existing nursing professionals in the country.

This was done with a view to achieve improved database maintenance of the nursing workforce in India, thereby creating the scope for equitable distribution of human resources for health.

Medical council of India is launching a very comprehensive Digital Mission Mode Project soon.

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Policymaker’s Perspective

INNOVATING TO ENSURE a Healthy Punjab

It’s a state that has seen remarkable improvement in its health parameters in the recent past.

From providing healthcare facilities to the needy at their doorstep and those in rural areas to delivering medical aid efficiently to the poorest of the poor, Punjab has come a long way.

Hussan Lal, Mission Director, National Health Mission , in conversation with Priya Yadav of Elets News Network (ENN) discusses how this has been achieved.

What are the innovations done in healthcare in Punjab that other states can emulate?

There are two innovations that are noteworthy. One is the urban health kiosks and the other is health awareness

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campaign – a dedicated campaign for one month to create awareness about health issues and provide outreach health facilities to the people. This campaign was launched from 5 Nov to 5 Dec 2016 and was titled “Sehat Jag-

rukta Mohim”. It was felt necessary as there is lot of lack of awareness among poor and those in rural areas – one about programmes and policies and two because they should be sensitised about preventive health.

Policymaker’s Perspective

We engaged 100 vans equipped with audio visual aids, 42 inch LED TV. Besides, there was a performing team of artistes, doctors from all streams so that people can be made aware through ‘Nukkad Natak’ (street plays), and provided medical aid on the spot and given medicine. The idea was that if they are diagnosed with some disease that requires higher level of intervention they can be referred to nearby health centres. We touched 24 lakh people across the state and we came out with their health profile, disease profile so that specialists can hold camps accordingly.

How many people benefitted from this campaign?

We touched 14,000 plus villages and wards in the whole state. We ensured that all areas that have lesser health facilities in the vicinity are touched.

Vans stood for 4 to 5 hours in one place and then moved to another location. It covered nearly five locations in a day. In the evening ‘Nukkad Nataks’ were held to sensitise people about the relevant issues. All drugs were provided free of cost. This included Allopathic, Homeopathic and Ayurvedic systems of medicine. We created a special portal for that. We could see live how many vans have reached which locations, if there has been any breakdown, fix the disruption by deputing back up van. Portal also had information about location, timing of each van. It was fully monitored from the headquarters. We sent dedicated teams one to each district over a period of one month to see if these are being held properly. I myself travelled to several places to how the vans and camps were functioning.

This was seen as one of the innovations and we got response from at least six to seven states.

How did the idea of urban health kiosks come into being?

The idea struck me when I was accompanying the mission director of NHM and there was a function at Hoshiarpur. During our chat, I discussed the idea of providing health services to

the deprived at their doorstep. A person who is depending on daily wages will think twice before foregoing wages and travelling four kilometre to address a health problem. Probably they will get medicine from the chemist or some quack. So we wanted to have a facility with flexi timing that could help people.

I thought if we could do something and have a temporary structure. We prepared a proposal and identified places where we could put up kiosks.

Initially we had problems with the local government department as they did not want to give land permanently.

We said we want it on temporary basis and will not put up a permanent structure. Now these kiosks that have come up are a fulcrum of outreach activities. The timings are flexible so that people can come after work. There are departments for labour welfare who have lot of funds for their welfare. We asked them to give us funds for running these kiosks and set up more kiosks for the benefit of workers. They have sponsored 21 more kiosks.

We identified 30 more locations and are in conversation with department of labour for setting these up.

They are given medicines free of cost.

Which is the biggest health challenge in Punjab?

Lifestyle related diseases are a big challenge. People’s lifestyle has changed and they do comparatively less physical work. In rural areas, more people from outside state are working as labourers. Local people have stopped working and feel it is below their dignity to work as a manual worker. This is a big burden on

healthcare. Diabetes, hypertension, two three types of cancer have made an appearance in a big way.

Malaria is another challenge. Punjab has started action against the disease and in three years we will be malaria free. We are already a Polio free state.

What is the status of cancer in the state and what are the facilities available to combat it?

There is no study as of date that has established the relationship between cancer and the use of pesticides that co-relates the two. The population based cancer registry shows incidences of cancer is at par with national average. The state has taken lot of measures in creating infrastructure to combat the disease. There is one legislation that has been put into place – cancer and de-addiction treatment infrastructure fund act that takes care of the resources. We have collected more than Rs 300 crore. We have been able to strengthen all our three medical colleges with state of art equipment to treat cancer. All high end equipment is available with us. Under the CM Cancer Fund anyone can get treatment done for Rs 1.5 lakh in either government colleges or 16 empanelled private hospitals. We have tied up with TMC and set up a cancer centre at Sangrur. An Advanced Cancer Institute has been set up at Bathinda with technical support from TMC. In Mullanpur, a tertiary cancer care centre is coming up with help of TMC. The state cancer institute is coming up at medical college at Amritsar and tertiary care cancer centre at Fazillka.

We engaged 100 vans equipped with audio visual aids, 42 inch LED TV. Besides, there was a performing team of artistes, doctors from all streams so that people can be made aware through ‘Nukkad Natak’ (street plays), and provided medical aid on the spot and given medicine.

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How was the campaign implemented?

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Policymaker’s Perspective

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Policymaker’s Perspective

KARNATAKA TELEMEDICINE SYSTEM in 2335 PHCs

The concept of digital healthcare is expanding in Karnataka.

The Department of Health and Family Welfare, Government of Karnataka, has recently launched a new initiative titled “Primary Health Centre Management Information System” in 1,000 selected Primary Healthcare Centres (PHCs), writes T Radhakrishna of the Elets News Network (ENN).

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he project would make available real time information of PHCs, which would centrally consolidate information such as patient treatment, diagnosis, deliveries handled and drug availability along with Global Positioning System (GPS) information.

It would be used to improve health delivery and enable taking preventive measures.

According to the department, the captured data would have the capability to provide information regarding implementation of various welfare schemes like postnatal care kit for BPL/SC/ST women, Janani Suraksha Yojana, etc, at the PHC-level. This public health surveillance of systematic data collection, analysis, and interpretation of data on specific health events would provide information support to the government to target its welfare schemes more efficiently.

According to the Karnataka Minister for Health and Family Welfare, KR Ramesh, this new initiative, based on Corporate Social Responsibility (CSR), underlines the potential of CSR funding for improving the quality of life of citizens.

“The experience gained would be useful in extending

the project to all the PHCs in the State. This would complement other initiatives like e-hospital, teleradiology and virtual clinics being implemented in the state.”

Corporate Social Responsibility for Public Healthcare

Under the Companies Act, 2013, any company having a net worth of Rs 500 crore or more or a turnover of Rs 1,000 crore or more or a net profit of Rs 5 crore or more has to spend at least 2 percent of the last three years average net profits on CSR activities as specified in Schedule VII of the Companies Act, 2013. Under this initiative, the Government of Karnataka has signed an MoU with Samsung Research & Development Institute, Bengaluru, marking the launch of the project. As part of the agreement, Samsung handed over 1,000 Samsung Tab IRIS. Samsung Tab IRIS, the first commercial tablet that is UIDAI approved for Aadhar and KYC verification would be deployed in select 1,000 centres in the first phase of the project.

CoDe Consulting Pvt Ltd had earlier entered into an MoU with the Department of Health and Family Welfare to

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Policymaker’s Perspective

Karnataka would introduce Tele Medicine System in all 2,335 Primary Health Centres (PHCs) in the state within six months

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jointly identify and implement CSR projects in healthcare and public health services.

The project being funded by Samsung as a part of its CSR obligations could be extended in coming years. CoDe Consulting is headed by the former Chief Election Commissioner, Gopalaswami.

e-Hospital

The Health Department is also implementing an e-hospital project which covers district hospitals/taluka hospitals and allows healthcare providers to collect, store, retrieve, and transfer information electronically.

This can minimise handwriting or other communication errors by having physicians or other providers enter data into a computer system. This will be extended to PHC level using the Samsung tab-based MIS software.

e-Arogya

In addition, Tejasco Techsoft has developed e-Arogya, an android tablet-based software application for digitising the work process of ANMs. It helps to collect field level data directly on tabs and send it to a central server for quick reports, analytics and dashboard. This tablet-based application will be used for enhanced telemedicine and video-based health programme awareness.

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Teleradiology

The department is also implementing teleradiology through Karnataka State Electronics Development Corporation Ltd (KEONIDS) in nine hospitals that will be extended to remaining hospitals by the end of this year. This improves patient care by allowing radiologists to provide services without actually having to be at the location of the patient. This thereby enables an efficient and effective use of doctors and specialists for rural areas.

The tabs will be provided to ANMs for the purpose of data collection and data synchronisation with various portals like MCTS (Mother & Child Tracking System), RCH (Reproductive Child Health) on real time basis.

Virtual Clinic

Virtual Clinic, a pilot project has been initiated in Tumakuru, wherein physical location agnostic treatment enables remote treatment. “We will have a robust health record platform where all patient records of virtual clinic, real clinic, real hospital and other treatment plans are hosted on a cloud,” the statement read.

The minister further said that Karnataka would introduce Tele Medicine System in all 2,335 Primary Health Centres (PHCs) in the state within six months, adding that Telemedicine would help in providing proper treatment to the patients coming to PHCs

Policymaker’s Perspective

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Karnataka Budget 2017-18

BUDGET PUSH FOR AYUSH Health Centres

Karnataka Government’s Budget for 2017-18 has given a major boost to AYUSH system of medicines and primary health centres by allocating Rs 5,118 crore to Health and Family Welfare Department. The Budget has also increased the salaries of Accredited Social Health Activitist (ASHA) workers to help promote quality healthcare at the community level, writs T Radhakrishna of Elets News Network (ENN).

T

he Government of Karnataka this year allocated Rs 5,118 crore for the Department of Health and Family Welfare, which was more than the previous Budget allocation. The Budget has provided a push to both Ayush Department and public health centres (PHCs).

An AYUSH Drugs Manufacturing Centre would be established in the premises of Belagavi City Immunisation Centre at a cost of Rs five crore. In addition, Rs six crore will be

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spent to add 50 beds to the AYUSH hospitals at Chitradurga and Chikkamagaluru.

The government also announced establishment of AYUSH treatment centres in all taluk hospitals to provide integrated, comprehensive health service. “Earlier there was just one manufacturing centre at Jayanagar. With another manufacturing unit planned, drugs can be manufactured at a larger scale,” says Dr Anant Desai, Programme Officer, State Ayush Department.

Karnataka Budget 2017-18 Budget Highlights ♦ Convergence of all health insurance schemes to include all the families under Universal Health Coverage; Continuation of Yeshaswini scheme; and all schemes to be brought under the control of Health and Family Welfare Department. ♦ Five super specialty hospitals to be established in Davanagere, Ramanagara, Tumkuru, Vijayapura and Kolar at a cost of `25 crores each for treatment of cancer, heart diseases and other lifestyle diseases. ♦ Upgradation of Wenlock hospital, Mangaluru – `10 crores. ♦ Setting up of Regional and Higher Children Health Institute in Wenlock Hospital, Mangaluru at the cost of Rs 3 crores. ♦ Establishment of 20 bedded Poly Trauma Centre and 10 bedded ICU with ventilator facility in Sanjay Gandhi Accident, Trauma and Rehabilitation Centre at the cost of `14.32 crore. ♦ Establishment of 150 Health Extension Dispensaries in villages where the distance from the Primary Health Centre is more than 10 km at the cost of `15 crore. ♦ One ambulance service to be provided in a radius of 10 to 15 km for population of every 35,000 by integrating 711 ambulances working under GVK EMRI and 827 ambulances working under Health department. ♦ 64 Mobile Health Units to be commissioned during the next 2 years to cover 1200-1300 villages having 40% or more population of SC/ ST - `25.34 crores. ♦ 200 generic medical stores to be set up under ‘Janoushadi Generic Medical Stores’ scheme. ♦ Implementation of a pilot project for using Pharmacopeia in Heggadadevana Kote – `2 crores.

“Priority has been given to PHCs by strengthening them through various initiatives like extension dispensaries having one doctor, one nurse, and one pharmacist will be established at a cost of Rs 10 lakh in villages where the distance from the PHC is more than 10 km. In order to provide health services to the people of 1,200-1,300 villages, having 40 per cent or more population of Scheduled Caste and Scheduled Tribe, 64 mobile health units will be commenced during the next two years at a cost of Rs 25.34 crore using SCSP/TSP (Schedules Caste Sub-Plan/ Tribal Sub Plan) grants,” says Dr Upendra Bhojani, Assistant Director, Institute of Public Health (IPH), adding that human resource and workforce needs to also be looked into.

The budget also increased the salaries for health workers. Asha workers will get a honorarium of Rs 1,000, in addition to the existing payment of incentive.

Projects to be taken up under National Health Mission Dialysis centres to be established in 114 taluks.

Establishment of 3-bed ICUs with ventilator facility in all taluk hospitals using funds from MPLADs, MLA and grants from NHM. Commencement of DNB post graduate course in Government colleges. Blood Transfusion Units to be set up in 10 district hospitals of Bagalkote, Vijayapura, Chamarajnagar, Chickmagaluru, Chitradurga, Haveri, Kodagu, Kolar, Tumkuru and Uttara Kannada Rs.6 crores.

AYUSH Treatment Centres to be established in all taluk hospitals, for integrated, comprehensive health service.

RO+UV drinking water facility to be set up in 21 district hospitals, 146 taluk hospitals and 21 community health centres.

Extension of e-Hospital programme to 206 community health centres and 2353 PSCs - Rs 13.78 crores.

Under National Free Diagnosis Programme, free diagnosis facility to be provided in all government hospitals. Setting up of CT scan facility in 14 district hospitals and MRI scan facility in 6 district hospitals.

Under Mother and Child Tracking System, Computer Tabs to be provided to 16,500 junior female health assistants for data collection.

Implementation of a pilot project for using Pharmacopeia in Heggadadevana Kote – Rs 2 crores.

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Policymaker’s Perspective

KSHSRC

Creating Robust Policies for Quality Health Karnataka State Health System Resource Centre, which offers valuable evidence-based inputs for framing health policies for Karnataka, does meticulous analysis of all National Health Mission (NHM) activities for identifying the areas of improvement in implementation and also provides robust solutions in a structured manner, says Dr Sadhana SM, Executive Director, KSHSRC, in conversation with Sudheer Goutham of Elets News Network (ENN).

Tell us about the vision behind inception of Karnataka State Health System Resource Centre (KSHSRC). When was it established?

Karnataka State Health System Resource Centre (KSHSRC) was established in 2009 as an autonomous so-

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ciety, as a “technical think tank” within the Department of Health and Family Welfare with a vision to strengthen the health system by giving valuable evidence-based inputs for framing health policies. KSHSRC does meticulous analysis of all National Health Mission (NHM) activities for identi-

fying the areas for improvement in implementation and also provides robust solutions in a structured manner.

KSHSRC provides support to the department in the areas of public health planning, human resource management, monitoring and evaluation, strengthening of MIS systems, infra-

Policymaker’s Perspective

What is the mandate of KSHSRC?

The mandate of KSHSRC is to provide technical support to the National Health Mission in strengthening the implementation of all the health programmes. In this regard, continuous inputs in time-bound manner are provided to the programme implementing officers based on various analytical findings. The inputs are critical and validated. For the areas of improvements simple do-able solutions are provided with pilots conducted by KSHSRC in different districts.

Please tell us about the achievements of KSHSRC since its inception.

The key achievements of KSHSRC since it came into existence include conducting various studies to gather evidence for improvement in implementation of health programmes, including study on functionality of VHSNCs in the state. Other milestones achieved by KSHSRC are: ♦ MCTS Reporting: Factors associated with human element as well as Soft ware features for improving the reporting on MCTS ♦ Performance analysis of primary health centers, community health centers/taluk hospitals/district hospitals and giving feed back to the concerned department ♦ GIS mapping of sub centers/primary health centers (PHCs)/CHCs/ taluk hospitals/district hospitals ♦ Inputs for policy on human resources in health to the government and inputs for implementation of public health cadre and revision of C&R of all cadres in the department ♦ Have drafted the Integrated Health Policy 2017 of the state ♦ Introducing innovations like Healthizen, a mobile application for citizen engagement for healthier and cleaner environment ♦ Janarogya: A mobile app as a simple guide to quality health care facilities in Government hospitals ♦ Documentation of various good

♦ ♦

♦

♦

practices in the Department of Health & Family Welfare Technical support to quality assurance programme in the Department of Health & Family welfare Implementing the “Community Action for Health”, in which the capacity building of Village Health Sanitation & Nutrition Committees (VHSNCs), mentoring and monitoring of the community involvement in health & nutrition areas at village level, convergence of ASHA/AWW and ANMs for better outcomes at Village level is done Ensuring coordinated actions of panchayats and VHSNCs in improving the community engagement at village level KSHSRC brought out a coffee table book compiling the free health

benefit schemes provided by the Department of Health and Family Welfare which was unveiled by the Karnataka Chief Minister. All Members of Parliament, Members of Legislative Assembly and Members of Legislative Council were apprised about it during the Belgaum assembly session in 2015

What else would you like to share with our readers regarding KSHSRC?

KSHSRC supports the implementation of health programmes with new ideas to strengthen the reach of all health schemes to the beneficiaries.

KSHSRC gives inputs to strengthen the areas of health infrastructure, health human resource, trainings and capacity building and innovations.

The mandate of KSHSRC is to provide technical support to the NHM in strengthening the implementation of all the health programmes. In this regard, continuous inputs in timebound manner are provided to the programme implementing officers.

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structure and other resource mapping (GIS), advanced IT solutions in health, community engagement for health, research and documentation, quality assurance and innovations.

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Healthcare Technology

E-AROGYA

Rural Healthcare Made Easy Tejasco’s e-Arogya is an Android tablet-based application, digitalising the work process of ANMs, who are significant part of the rural healthcare echo system of Karnataka, writes Elets News Network (ENN).

A

NMs are responsible for data collection as required by various healthcare programmes like CNAA, RCH, MCTS, Village Health, Sanitation and Nutrition Activities, Communicable Diseases and Non-Communicable Diseases, IDSP, Senior Citizen Healthcare and so on. They are also responsible for facilitating health services to the rural community, monitor and ensure programme benefits reaching the beneficiary. They are instrumental for providing the reports to concerned programme managers at various levels.

With the help of e-Arogya tabs, ANMs have been enabled to feed the data directly on to the tab which gets synchronised with the state government’s e-Governance server on real-time basis. This digitalised work process eliminates the need for the use of paper based pre-printed registers and increases the work efficiency and accuracy.

This public health surveillance of systematic data collection, analysis, and interpretation of data on specific health events provide information support to the government to target its welfare schemes more efficiently.

The captured data has the capability to provide information regarding implementation of various welfare schemes, like postnatal care kit for BPL/SC/ST women, Janani Suraksha Yojana, etc. at the Public Health Centre (PHC) level, according to the health department.

Health Minister KR Ramesh said in a statement recently that this new initiative, based on Corporate Social Responsibility (CSR) underlines the potential of CSR funding for improving the quality of life of citizens.

“The experience gained would be useful in extending

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the project to all the PHCs in the State. This would complement other initiatives like e-Hospital, teleradiology and virtual clinics being implemented in the state,” he said.

e-Arogya product features ♦ Digitised forms for data collection in Kannada, English and other Indian languages ♦ Supports tele-medicine and video chat facility with Doctors for effective health services ♦ Dash board for summarised data view ♦ Work-Planner for ANMs and ASHA workers to plan their routine works ♦ Inventory management for managing inventories issued to healthcare assistants like medicines, consumables, family planning products, vaccinations and so on ♦ “Jagruthi” – audio and video based health programme clippings to create awareness ♦ Integration with e-Hospital for seamless data sharing between PHCs, taluk and district hospitals with auto-portability of data to other reporting software ♦ Off-line data synchronization feature to avoid data loss when there is no data network ♦ Integrated with Mobile Device Management (MDM) for remote support and training to ANMs ♦ Web portal for report generation at various levels

Healthcare Technology

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Policymaker’s Perspective

SAST

Assuring Health for All Working with the objective to administer, implement and monitor the government’s health assurance schemes, Dr Sudha Chandrasekhar, Director (Medical Management), Suvarna Arogya Suraksha Trust (SAST) under the Department of Health and Family Welfare, Government of Karnataka, in an interview with Sudheer Goutham of Elets News Network (ENN), highlights the trust’s mandate and initiatives in healthcare delivery.

Brief us about SAST and its mandate?

The SAST was established in 2009 as a Special Purpose Vehicle as per the Indian Trust Act of 1882 under the Department of Health and Family Welfare, Government of Karnataka. Chief Minister of Karnataka is the chief patron of SAST, while Minister for Health and Family Welfare and Minister for Medical Education are the main patrons of the organisation. Principal Secretary of the Department is also the Chairperson of the trust and Executive Director (IAS

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officer) of SAST is the Member Secretary. The objective of the trust is to administer, implement and monitor the health assurance schemes of the Government of Karnataka on a project mode. To guide the trust in policy formulation, implementation and operational aspects, three committees are functional: Board of Trustees; Executive Committee; Empanelment and Disciplinary Committee.

The main mandate of the trust is to ensure reduction in out of pocket expenditure (OOP) through strategic purchasing of super specialty pub-

lic-private health care providers for easy access to quality healthcare in the tertiary sector to the people of Karnataka. With the transference of Government of India’s RSBY scheme under the ambit of SAST since April 2016, the operational domain of SAST has expanded to cover both tertiary and secondary care.

Which are the primary functions and services that SAST offers?

The primary function of SAST is to implement all tertiary care schemes in assurance mode where no insurance

Policymaker’s Perspective

What are the key challenges that you face in your mandate or functions?

We face challenges like ensuring quality of care and service delivery; uneven geographical spread of super specialty hospitals; advocacy towards preventive health care; Fraudulent practices by some service providers; illiteracy in backward rural areas making us motivate people to promptly access available health care.

How many health schemes are running under SAST? Who are your partners for public healthcare (hospitals, tpas, health insurance schemes)?

We are running the following schemes: Vajpayee Arogyashree Scheme - for Below Poverty Line families ♦ Rajiv Arogya Bhagya - for Above Poverty Line families ♦ Jyothi Sanjueevini Scheme – for state government employees and their dependants ♦ Indira Suraksha Yojana – for Families of farmers who committed suicide due to agricultural distress ♦ Rashtriya Bala Swasthya Karyakram – for 0-18 years of children in government and aided schools and urban slums ♦ Rashtriya Swasthya Bhima Yojana – for Identified BPL families and unorganised sector workers ♦ Mukyamantri Harish Santwana Yojana - for road accident victims in Karnataka irrespective of domicile or nationality

Milestones Achieved by SAST ♦ Through Vajpayee Arogyashree Scheme, accessing tertiary care benefits to BPL families in Super Specialty Hospitals is a major milestone evidenced by 10-fold increased utilisation since inception ♦ Continued sustenance of PPP model for quality service delivery ♦ Uniform distribution of beneficiaries accessing care across all four divisions of the state ♦ Special focus in predominantly SC/ST habitations ♦ Reduction in OOP and mortality rate – outcome of World Bank impact study ♦ Standard treatment regimen due to well defined benefit package/ procedures, standard treatment guidelines in oncology, neuro surgery and appropraitness of care in cardiology ♦ Follow up protocols in cardiology and neurology ♦ Ethical policy through beneficiary audits ♦ Grievance redressal mechanism ♦ Assurance mode – very low administrative cost, emphasis on pro-beneficiary and high utilisation for treatment ♦ Convergence of major health schemes under SAST ♦ Mortality and Medical Audit Cell is established. ♦ Senior Citizen’s Scheme – for people 60 years and above All schemes are implemented on a strong footing of public-private partnership. Accordingly, in the benefit package committees functioning under all the specialties to recommend appropriate procedures and pricing, the members are specialists drawn from both public and private. Rashtriya Swasthya Bhima Yojana is the only scheme being implemented through insurance companies and their TPAs.

Elaborate SAST’s plans in CSR for public healthcare.

Karnataka is the first state in the country to have implemented the Mukyamantrigala Santhwana Harish Scheme (MSHS) for free treatment in the first 48 hours for victims of road traffic accidents within Karnataka irrespective of the domicile or nationality of the injured persons. The victims are eligible for free treatment up to Rs 25,000 in any of the hospitals located closest to the accident site. For financial sustainability of this humanitarian scheme, SAST has initiated action

to enable corporate to contribute generously as part of their CSR responsibility towards society. The software for MSHS Scheme was developed by National Informatics Centre, Bangalore as CSR activity.

Please specify SAST’s roadmap and its role in healthcare reforms.

Some of the initaitives that have been undertaken in the area of healthcare reforms are: ♦ The state government has recently announced convergence of all health schemes under one umbrella of SAST. ♦ Government of India intends to pilot National Health Portal of India (NHPS) in Karnataka through SAST under assurance mode.

If the above mandate becomes a reality, SAST will be the flagship platform spearheading all health schemes entrenching the reforms agenda as the state moves towards the most important Sustainable Development Goals of achieving Universal Health Coverage in Karnataka for probable replication in other states.

Karnataka is the first state in the country to have implemented the Mukyamantrigala Santhwana Harish Scheme (MSHS) for free treatment in the first 48 hours for victims of road accidents.

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companies or third party administrators (TPAs) are involved. The scheme is administered directly through the mechanism of pre-authorisation approvals and claims settlement directly to the empanelled network of public or private hospitals. The smooth operation of the scheme is due to clearly defined 663 benefit packages or procedures under the seven tertiary specialties of cardiology, oncology, neuro surgery, genito-urinary, paediatric surgeries, burns and polytrauma.

Under the secondary care of RSBY (Rashtriya Swasthya Bhima Yojana) scheme, there 1,516 procedures covered.

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Policymaker’s Perspective

DELIVERING HEALTHCARE the Natural Way

With AYUSH system of medicines gaining prominence in treating diseases – both communicable and non-communicable – with apparently no side-effects, people’s trust has only deepened in the efficacy of this alternative medicine system over the years. Dr Singray Soren, Adviser (Homoeo), Ministry of Ayush, in conversation with Gautam Debroy of Elets News Network (ENN), tells us more about the efforts being made to help people benefit from this natural medicinal system. Excerpts:

Earlier, modern drugs use to be the first choice of people, but now the AYUSH system comprising Unani, Homeopathy and Ayurveda has gained immense popularity amongst people.

This alternative medicine system is reliable without any side-effects. It

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has attracted people who have experienced nausea while travelling on long routes, senior citizens and people who are uncomfortable taking modern drugs.

Even for chronic diseases, AYUSH has developed effective medicines.

By carving out a separate ministry for AYUSH, the government has highlighted the reach of alternative medi-

We have used tulsi, guava, aampatta in our medicines. It protects the environment and also provides natural care to the patients.

“

What has been the response to AYUSH systems of medicine in the country? How effective has it been in treating chronic diseases?

Policymaker’s Perspective are also doing research on herbs and plants used in ancient times to make new medicines.

Which initiatives have the central government undertaken to promote the AYUSH system of medicines?

AYUSH medicines are drawing people even from foreign countries, who are increasingly adopting the natural medicine system of India. The Indian government is creating awareness about this alternative medicinal system. Doctors are getting additional training in this system to serve people in rural areas.

Is government providing any incentive to attract people to this natural medicine system?

People have now started demanding incentives. We are the only system that can eradicate diseases from the root. We are making medicines from natural processes. We use tulsi, guvava, aampatta, etc, in our medicines.

It protects the environment and also provides natural care to the patients.

Are you planning some new programmes to promote AYUSH?

cines in the country more effectively.

We hope that more and more people will benefit from the AYUSH system in coming years.

We are trying our best to promote AYUSH programmes.

The government has already laid down the National Policy on Indian Systems of Medicine and Homoeopathy-2002 which among other things envisages overall growth and development of Ayurveda, Yoga and Naturopathy. The Government of India has also formulated programmes and introduced operational measures for promotion of AYUSH medical practices through centrally sponsored scheme of National AYUSH Mission (NAM) and various other central sector schemes.

How has Homeopathy evolved in the country over the years?

Earlier, Homeopathy was considered as a system of medicine for the poor owing to its cost-effectiveness. Although the Homeopathy treatment cost has now gone up, a large number of people still prefer it over Allopathic system. Several chronic diseases, diabetes, stomach related infections are easily treatable through alternative medicines. Proper diagnosis of such diseases can be undertaken by qualified AYUSH doctors.

People trust and come to us. People who are afraid of injections and side-effects of Allopathic medicines also come to us. The dosage regimen is easy to follow. There is no restriction on the patient taking homeopathic medicines, which allows therapeutic process more effective.

What kind of challenges the AYUSH Ministry is facing in raising awareness about traditional systems of medicine amongst people?

AYUSH doesn’t cover surgery. All the other medicinal therapies are taken care of by AYUSH programmes. We

How is Information Technology being used in initiatives undertaken by the AYUSH ministry?

Information Technology is the key to raise awareness about the AYUSH programme. There will be no progress without it. We are going to implement new IT technologies in our departments soon.

APRIL / 2017 ehealth.eletsonline.com

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Public Health Initiative

KARNATAKA ENSURING HEALTH SERVICES

in Remote Areas Karnataka Chief Minister Siddaramaiah recently flagged-off 78 mobile medical units (MMUs) to provide healthcare services to people living in hilly remote areas, in locations which are far off from health centres and areas with poor transport connectivity, T. Radhakrishna and Sudheer Goutham of Elets News Network (ENN) write how this pioneering initiative is set to make healthcare more inclusive in the state.

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Public Health Initiative “The primary objective of the MMUs is to provide healthcare services to the needy in remote areas of Karnataka,” says Minister for Health and Family Welfare KR Ramesh while launching the initiative along with the chief minister.

Out of 78 MMUs, launched during 2016-17 fiscal, 64 are funded by National Health Mission (60 per cent of funding is from NHM and 40 per cent from the state government) and 14 MMUs have been started from State Special Component Plan (SSCP) and Tribal Sub Plan funds (TSPFs) in 14 reserved constituencies of Raichur, Kalaburagi, Koppal, Vijayapura, Ballari, Davanagere and Chitradurga districts of Karnataka.

MMU Services

According to the Department of Health and Family Welfare, each mobile unit has been equipped with medical device, drugs and consumables as per the National Mobile Medical Unit Service guidelines. Each unit is equipped with an MBBS doctor, a staff nurse, a pharmacist, a laboratory technician, an ANM, and a driver. For each unit, in a taluk, 13 to 15 eligible villages have been identified for service. The mobile medical unit will visit these villages at least four or five times a month and provide services. From Monday to Saturday, the unit will visit one village from 10 am to 1 pm and another village from 2.30 pm to 5 pm.

From next year, all mobile medical units will have GPS. Also, 50 more units will be added to the fleet by the end of this year at a cost of Rs 48.39 crore.

“MMU services will be monitored by the management of the respective service providers, primary health centre (PHCs) medical officers, taluk health officers, district health and family welfare officers and state level officers.

Progress will be reviewed by CEOs of zilla panchayats in the executive committee meeting of district health and family welfare societies every month, and at the state level every quarter,” the department said.

MMUs is a mechanism to provide outreach services in rural and remote areas. This is not meant to transfer patients.

Primary Health Centres

Karnataka state is one of the pioneering states in the country in providing comprehensive public health services to its

T

aking medicare to people living in rural areas has always been a challenge. For decades, the biggest question has been how to provide medicare to those feeling left out even in availing basic medical help.

Karnataka’s Department of Health and Family Welfare has come up with an idea to provide healthcare services to the needy with Mobile Medical Units (MMUs).

Chief Minister Siddaramaiah has flagged off 78 MMUs that will provide healthcare services to people living in hilly remote areas, in locations which are far off from health centres, areas with poor transport connectivity, and in vicinities which are mostly inhabited by the poor especially SCs, STs, other economically backward classes.

MMUs comprise of one/two or three vehicles varying state-wise.

Where there is more than one vehicle, one vehicle is used for transport of medical and para-medical personnel and the second is used for carrying equipment/accessories and basic laboratory facilities. The third vehicle carries diagnostic equipment such as X-ray, ultrasound, ECG machine and generator.

Each unit has-one doctor, one nurse, one radiologist, one lab attendant, one pharmacist and a helper and driver.

There is provision of medicines in the unit.

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39

Public Health Initiative

people. Even before the concept of Primary Health Centers (PHCs) was conceived by the Government of Indiagovernment of India, the state had already made a beginning in establishing a number of PHCs for providing comprehensive healthcare, and a delivery system consisting of curative, preventive, promotive and rehabilitation healthcare, to the people of the state.

Karnataka, India’s eighth largest State in terms of geographical area (191,791 sq km) is home to 6.11 crore people (2011 Census) and 6.6 crore people in 2016. The state’s population has grown by 15.7 per cent during the last decade, and population density has risen from 276 per sq km in 2001 to 319 per sq km in 2011. Karnataka has made significant progress in improving the health status of its people over the last few decades.

However, despite the progress, the state has a long way to go in achieving the desired health goals. In the last 15 years, since the drafting of the first Karnataka State Integrated Health Policy and its adoption by the State Cabinet in 2004, several changes have taken place in the state.

There have been several gains in public health and healthcare, while new challenges and opportunities have also emerged. Administratively, three new districts have been added. The state has achieved several Millennium Development Goals (MDGs) in varying degrees.

NHM Vision

The vision of the National Health Mission (which encompasses the National Rural Health Mission (NRHM) and the National Urban Health Mission (NUHM) as its two Sub-Missions) is universal access to equitable, affordable and quality health care services.

One major initiative under the NRHM was the opera-

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tionalisation of Mobile Medical Units (MMUs) to provide a range of health care services for populations living in remote, inaccessible, unserved and underserved areas mainly with the objective of taking healthcare service delivery to the doorsteps of these populations. With the launch of NUHM, the MMUs services are also intended to cater to the urban poor and vulnerable population and provide fixed services in areas where there is no infrastructure.

As of December, 2014 there were about 1,301 operational MMUs in 368 districts across the country. However, both task definition and effectiveness of MMUs show variations. Assessments and reviews show that on account of various operational and contextual factors, the deployment of MMUs, their coverage and outcomes are not commensurate with the investments in most states. Planning of MMUs has not followed the principles of inaccessibility and the range of services has not been such that it addressed the needs of the population living in remote areas. While support was provided to MMUs with diagnostic vans, state experiences also show that it was often not found feasible to provide effective X-ray services through the MMUs. Comprehensive planning and monitoring of MMUs remained a challenge in most cases.

The MMU guidelines are thus being revised in light of learnings from past experiences and existing good practices from some states. The rationale for revision is based on a number of reasons. Over the past years, the experience of NHRM, has resulted in (i) better mapping of inaccessible village clusters allowing for improved route planning of the MMUs, (ii) more opportunity for mobilisation given the presence of the ASHAs in even very remote villages, saving the MMU teams much time and energy in reaching those in need, (iii) increase in number of functional facilities has increased, allowing more opportunities for referral to facilities at shorter distances, (iv) the presence of the 108 which enabled better access in case of emergencies, (v) the more ready availability of telemedicine, and (vi) better understanding of which service packages can be rendered effectively through the MMUs. The free diagnostics services initiative under NHM is envisaged to facilitate effective use of technology in digital imaging, use of tele-radiology, and a hub and spoke model for sample collection and testing besides allowing MMUs to serve as sites for point of care diagnostics and as collection centres for blood and sputum samples. X ray imaging services would form part of the Diagnostics initiative and hence would no longer be advised for MMUs. These revised operational guidelines are intended to enable states to restructure implementation mechanisms for MMUs so as to enable optimal utilisation of vehicles and staff through convergence while ensuring that the outcome of the MMU contributes to the objectives of reaching the last mile and the unreached with more than just basic OPD services and a limited range of RCH services.

The key objective of the MMU is to reach populations in remote and inaccessible areas with a set of preventive, promotive and curative services including but not limited to RCH services, which are free to the patient at the point of care.

Public Health Initiative Suggested Package of Services to be provided at MMU Maternal Health

Early diagnosis of pregnancy, early registration, MCH cards, birth planning (and preparing mothers and families in remote areas to shift to a facility at least one week before the due date, or to a maternity hut), regular ante-natal check-ups; includes screening for hypertension, diabetes, anaemia, TT immunisation for mother, iron-folic acid and calcium supplementation, identification and referral of high risk pregnancy, post natal cases, counselling, support and motivation for institutional delivery, nutrition, enabling Take Home Rations (THR) for pregnant woman through Anganwadi workers

Neonatal and Infant Health (0-1-year-old)

Examination of low birth weight/preterm newborn/other high risk newborns and management or referral as required), counselling and support for early breast feeding, improved weaning practices, identification of congenital anomalies,other disabilities and appropriate referral, family/community education of prevention of infections, complete immunisation, vitamin A supplementation, care of common illnesses of new born, AGE with mild dehydration and pneumonia case management

Child and Adolescent Health

Growth monitoring, prevention through IYCF counselling, access to food supplementation- convergence with ICDS, deworming, immunisation, prompt and appropriate treatment of diarrhoea/ARI, referral where needed, detection of Severe Acute Malnutrition (SAM), referral and follow up care for SAM, prevention of anaemia, use of iodised salt; prevention of diarrhoea, pre-school and school child biannual screening, school health records, eye care, de-worming; early detection of growth abnormalities, delays in development and disability, adolescent health services: personal hygiene, detection and treatment of anaemia and other deficiencies in children and adolescents

Management of chronic Communicable Diseases

Tuberculosis, HIV, leprosy, malaria, kala-azar, filariasis, other vector borne disease- identification, use of RDT/ prompt treatment initiation, vector control measures, Sputum collection for TB, RDK + lab testing and treatment for all vector borne disease examination, follow up medication compliance, prevention – mass drug administration in filarias, immunisation for JE

Reproductive Health and Contraceptive Services

Identifying eligible couples, and motivating for family planning by delaying first child, spacing between two children, access to spacing methods - OCP, ECP, condoms, IUCD insertion and removal, RTI treatment - syndromic management/partner treatment, first aid for GBV-link to referral centre and legal support centre

Management of Common Communicable Diseases and Basic OPD Care (acute simple illness)

Diagnosis and management of common fevers, ARIs and diarrhoeas, urinary tract infections, skin infections. (scabies, abscess), indigestion, acute gastritis. Symptomatic care for aches and pains

Management of Common Non-Communicable Diseases Undertake screening for over 35 age group , at MMU on an annual basis or opportunistic screening for diabetes and hypertension, hypertension/diabetes mellitus medication, follow up diagnostics, refer for specialist consultation and early referral for complications, silicosis, fluorosis – follow up care, diagnosis of common respiratory morbidities (COPD and bronchial asthma) and treatment in all “chest symptomatic”, epilepsy-early case identification, enable specialist consultation through referral

Management of Mental Illness

Community education and preventive measures against tobacco use and substance abuse, identification of people for de-addiction centres, referral of cases with mental illness, follow up medication, counselling/support

Dental Care

Dental care education on oral hygiene and substance abuse, in community and schools - recognition of dental fluorosis - referral for gingivitis, dental caries, oral cancers, treatment for glossitis, candidiasis, fever blisters, aphthous ulcers

Eye Care/ENT Care

School: Screening for blindness and refractive errors, community screening for congenital disorders and referral, counselling and support for care seeking for blindness, other eye disorders -first aid for nosebleeds, recognising congenital deafness, other common ENT conditions and referral, eye care in newborn, screening for visual acuity, cataract and for refractive errors, identification and treatment of common eye problems- conjunctivitis; spring catarrh, xerophthalmia, first aid for injuries, referral and management of common cold, acute Suppurative Otitis Media, (ASOM), injuries, pharyngitis, laryngitis, rhinitis, URI, sinusitis

Geriatric Care

Management of common geriatric ailments; counselling, supportive treatment, and pain management

Emegency Medicine

Snake bites, scorpion stings, insect bites, dog bites, stabilisation care in poisoning and referral first aid, trauma of any cause, minor injury, abscess management

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41

Healthcare Technology

SAMSUNG

Gives Digital Boost to Karnataka PHCs Samsung Research and Development Institute, Bengaluru (SRI-B) recently handed over 1,000 Tab IRIS to the Department of Health and Family Welfare, Government of Karnataka. Samsung Tab IRIS, the first commercial tablet to be approved by Unique Identification Authority of India (UIDAI) for Aadhaar verification, is set to provide advanced technological support to efficiently manage medical subsidies and operations at PHCs across the state, writes T Radhakrishna of Elets News Network (ENN).

E

fficiency, transparency and productivity are needed by every institution to ensure growth, and Public Health Centres (PHCs) are no exception to this rule. Samsung India has recently entered into a Memorandum of Understanding (MoU) with the Department of Health and Family Welfare, Government of Karnataka, to help the state manage its public healthcare facilities efficiently.

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As part of the understanding, Samsung Research & Development Institute, Bangalore (SRI-B) handed over 1,000 Samsung Tab IRIS to the department. Samsung Tab IRIS, the first commercial tablet to be approved by UIDAI for Aadhaar and KYC verification, would enable Public Health Centres (PHC) in the state to build their database in a digital format.

This association, between the Department of Health

Healthcare Technology and Family Welfare and Samsung India, is aimed towards providing advanced technological support in the management of medical subsidies and operations at PHCs in the state more efficiently.

“The advanced technology of Samsung Tab IRIS will give a digital boost to the whole healthcare system. This will enable Public Health Centres to maintain and share medical databases on a real time basis,” says Dr Aloknath De, Chief Technology Officer, Samsung R&D Institute.

Samsung Tab IRIS is SIM enabled and has the capability to scan the Iris of an individual, which can then be linked to Aadhaar. This would help PHCs to generate various value added reports to facilitate decision making by the Department of Health and Family Welfare, Government of Karnataka.

This integration of technology with the help of Samsung Tab IRIS aims to centrally consolidate information related to PHC administration such as patient treatment, diagnosis, deliveries and drug availability from various locations along with GPS information.

“We are confident that Samsung’s world class technology will help us manage our public healthcare facilities more efficiently. Digitising the database is very important for our public health centres as it will lead to better planning and decision making at a state as well as central level,” Minister for Health and Family Welfare KR Ramesh says.

“We aim to connect with each and every resident of Karnataka at their door steps by upgrading the skills of our field staff and equip them with high tech tabs. We are grateful to Samsung for associating their programme with Karnataka,” the Minister adds.

“In the days to come the state will have virtual clinics with specialists on board connected to patients through these tabs,” he infers.

“The health records of patients would be analysed online to take effective steps towards prevention of diseases. Audio-visual awareness will also be enhanced through the use of these Tabs,” says Dr Shalini Rajneesh, Principal Secretary, Department of Health and Family Welfare, Government of Karantaka.

a culture of global as well as local innovation, Samsung has a number of R&D centres strategically spread across the globe. India is amongst the hotspots of Samsung’s innovation strategy. As a result of that, there are as many as three Samsung Research Institutes in India: Bengaluru, Delhi, and Noida.

These three R&D centres work on cutting-edge technologies across almost all areas of Samsung’s business, for global as well as for local markets.

While Samsung Research Institute-Delhi develops emerging solutions for high-end televisions and digital media products, SRI-Noida is focused on smartphone development. SRI-Bangalore is the centre of excellence in mobile terminal & infrastructure, multimedia, SoC, server development contributing towards smartphone, semiconductors and digital printing solutions business.

Samsung R&D Bangalore (SRI-B) is the largest overseas R&D centre of Samsung Electronics. Founded in 1996, SRI-B has grown to be a significant contributor to the cutting edge products and services of Samsung. SRI-B is a key player in the breakthrough innovation and success story of Samsung Electronics. Our engineers conceptualize and commercialise novel features, designs, products and services that differentiate Samsung as a market leader and help in delivering world-class products.

Samsung India additionally carries out R&D for product hardware at a second Noida R&D Centre. SRI-Noida is involved in the mobile commercialisation for almost all regions. SRI-Noida is leveraging best synergy efforts as R&D, official QA, internal testing and design team work under the same roof. SRI-Noida has the full ownership of feature phones and has become one of the major centres of operating system (OS) upgrade development.

Samsung India: Research & Development

Samsung’s emphasis on innovation, research and development is essential to its business. In order to inculcate

APRIL / 2017 ehealth.eletsonline.com

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Healthcare Technology

HOW 3 AM QUEUES

Vanished at AIIMS Leading the first digital revolution in Indian healthcare, All India Institute of Medical Sciences (AIIMS) has successfully implemented the AIIMS e-Hospital Project and the AIIMS OPD Transformation Project, benefitting millions of patients by reducing wait times at the country’s leading hospital by nearly six hours, writes V Srinivas, Deputy Director Administration, AIIMS-New Delhi, for Elets News Network (ENN).

B

uilding strong institutions is one of the major objectives of good governance. The ‘Digital India’ initiative represents a landmark in ushering in the first digital revolution in health care at All India Institute of Medical Sciences (AIIMS). The successful implementation of the AIIMS e-Hospital Project and the AIIMS

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OPD Transformation Project, transformed AIIMS to India’s first fully digital public hospital. In 16 months of implementation since the launch in July 2015, the AIIMS e-Hospital project has had the largest footprint of ‘Digital India’ projects. The creation of a patient friendly hospital has benefitted 35 lakh patients till date, reducing wait times

Healthcare Technology at the hospital by nearly six hours, brought transparency to OPD appointments; created digital medical records and represents a sustainable and replicable model for hundreds of India’s hospitals.

The Challenge

The very name invokes images of crowds, a sea of humanity that is present at the hospital doors, waiting from 3 in the morning, to rush for expert medical consultation at 8.30 am when the OPD opens. With an average of 10,000 OPD patients per day, 35 lakh OPD patients per annum, 55 departments, 640 faculty, 2,000 resident doctors and 5,100 nurses, AIIMS represents India’s behemoth in tertiary care super specialty hospitals. While the institute led by highly driven professionals works with clockwork precision, the overwhelming patient loads have proved impossibly challenging for a manual system and required significant systemic changes in terms of improved digital practices and process re-engineering, as millions of India’s population seeks medical care at the nation’s apex medical sciences university.

AIIMS – UIDAI - DeiTY Collaboration

It was in January 2015 that the first step in the Digital AIIMS project was taken with the creation of an effective linkage between AIIMS, Unique Identification Authority of India (UIDAI) and the Department of Electronics and Information Technology (DeiTY). A unique health identification number for every patient visiting AIIMS was generated on an Aadhar platform. The patient could log into the AIIMS OPD Appointment System (ORS.gov.in) and submit a request for an appointment online using his Aadhar number.

The verification of the demographic details of the patient was based on the one-time password for the patient being transmitted to the mobile phone number of the patient registered in the Aadhar data base. The Unique Health Identification Number gave every Patient visiting AIIMS a Digital Identity. The patient could use the UHID for his entire lifetime and every consultation visit was documented by the system.

The e-Hospital project proceeding at a modest pace, suddenly gained significant momentum with the launch of Digital India Initiative. There was a new urgency in DeiTY and NIC for expeditious development of the software so that the online registration system could be established.

This was followed by the collaboration between AIIMS and Pay Gov for creation of a payment portal.

The e-Hospital project necessitated transparency in OPD appointments. AIIMS always encouraged walk-in patients and also had several follow-up patients coming for consultation. The streamlining of the new OPD cases began with 15 percent of the total new OPD appointments being given for online registration. The out-patient appointments of each of the departments of AIIMS were placed online and every consultation room in the OPD was allotted a fixed number of OPD patients identified by name.

AIIMS –TCS Collaboration

The AIIMS-TCS collaboration for the AIIMS OPD Trans-

formation Project was conceptualised as a corporate social responsibility (CSR) project in April 2015. It was only after several months of observations at OPD followed by conceptualization, discussions, capacity building, consensus building and software development that the TCS prescribed a model of AIIMS OPD transformation. The approach was to facilitate faster registration, to dissipate crowds with larger patient waiting areas, introduction of several new measures like fresh signages, screening at the entry point, patient care coordinators at the registration or consultation areas and the rather unique exit OPD counters for all follow-up patients. Today, the AIIMS-TCS collaboration has provided the country with a role model for transforming OPD services at all major central and state government hospitals.

The newly adopted model envisaged construction of a patient registration centre, with 50 registration counters – each one equipped with a computer terminal loaded with e-Hospital software. It was constructed and operationalised in a record time of six months. Now the registration time was a mere 40 seconds for all new appointments with UHID numbers generated from the online registration system. Fast track queues were created where the patients who had already registered themselves under the online registration system could get their OPD cards and move quickly to the patient waiting areas. Patient care coordinators ensured that patients understood clearly where to visit during the entire process. The whole approach was one of empathy and efficiency. The successful operationalisation of the patient registration centre meant that the waiting time in the hospital had come down by nearly 6 hours per patient. The 3 am serpentine lines were no longer there.

They were replaced by a more orderly queue system that commenced at 8 am and reached the OPD consultation rooms by 9 am.

AIIMS attracts 10,000 patients per day but the patient waiting areas had only 2,500 seating capacity. This meant that patients rushed to consultation areas without any wait time in a comfortable environment. The TCS model envisaged creation of seating spaces for an additional 3500 patients. Air conditioned patient waiting halls were developed where the patients could comfortably wait for their turn to visit the OPD consultation rooms.

Initially, the new model was implemented in the med-

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Healthcare Technology icine and pediatric OPD areas on a pilot scale in December 2015. The clinicians would commence work at 9 am.

Patients would reach the clinician’s rooms in an orderly manner. All multiple registration counters in these departments were discontinued. The successful implementation encouraged AIIMS to introduce the model in all the five floors of the Rajkumari Amrit Kaur OPD covering all 55 departments.

The most innovative feature of the new model was the introduction of exit OPD counters. Patients who were recommended for advanced laboratory tests, radio-diagnosis, virology and pathology tests as follow-up appointments, all of which could be scheduled from the exit OPD counters. The patient thus had a very orderly journey from the point of entry to the hospital to the point of exit. Even the VIP patients including the officials at senior position in government willingly went through the entire OPD transformation process and found the entire experience quite expeditious and satisfying.

Specialised Cadres

AIIMS transformed itself into a patient friendly hospital by its willingness to adopt the modern day digital practices and create specialized cadres who enabled rapid scaling up of the new technology. The nursing informatics specialists provided the linkage between the clinical departments and the OPD appointments. Nurses with an aptitude for technology were deployed to coordinate between the departments, OPD, wards and the software professionals.

The patient care coordinators touched every patient entering the OPD with their empathy. They were the friends and guides who ensured patients followed the established protocols. They were also deployed to assist with the E-kiosks to enable literate and tech savvy patients with appointments. The data entry operators were deployed at the patient registration centre and the exit OPD counters. They were trained to handle cash collections simultaneously.

Security personnel were trained in queue management systems with a considerable degree of patience.

AIIMS – India’s First Fully Digital Public Hospital

Hitherto, the implementation of the e-Hospital project had not been orderly. For AIIMS to be a fully digital hospital, each of the e-Hospital modules needed to be implemented in an orderly manner to create a comprehensively digital hospital. By June 2016, the e-Hospital module implementation in AIIMS was completed. The NIC took a big step forward in completing the AIIMS e-Hospital Project. NIC teams from Tripura worked with each of the departments in AIIMS in a prescribed time frame to transform AIIMS as India’s first fully digital public hospital. The modules comprised of blood bank module, billing module, in-patient department comprising admission and bed to bed management, laboratory module integrating 55 laboratories, establishment of nearly 200 kiosks with net banking facilities for ease of payments, Laundry module for monitoring the central laundry operations, store management for inventory purposes, dietary module for preparation of electronic diet charts for in-patients, and RIS-PACS (Radiology Imaging System – Picture Archiving Communications System) for exchange of radiology data.

The Titanic is Saved

The transformation of AIIMS to a patient friendly hospital under the ‘Digital India’ initiative can be compared to “Saving the Titanic”. Under the Digital India Initiative, a core team of officials collaborated cordially and constructively over a long period of time to make the First Digital Revolution in Health Care possible. There was considerable resistance from every possible quarters– patients, support and administrative staff, security apparatus and even some medicos had their share of doubt during the course of the implementation of the Project. Needless to say, now everyone is satisfied and happy. As the success story unfolds benefitting 35 lakh patients, in 12 months’ time, the hours and hours of effort put in by those involved in the project, are adequately rewarded. The Prime Minister launched the Online Registration System as part of the Digital India Initiatives in July 2015. Following a year of successful implementation wherein the project benefitted 35 lac patients, the Prime Minister mentioned the successful implementation of the AIIMS e-Hospital Project from the ramparts of Red Fort in his Independence Day Address this year. The AIIMS OPD Transformation Project has enthused several State Governments. AIIMS has been mandated to conduct on-boarding workshops for replication across all 12 Central Government Hospitals.

Thus the AIIMS Transformation Project represents India’s first digital revolution in healthcare. No doubt, it is a remarkable success story.

Disclaimer: The author is a senior civil servant, an IAS officer of 1989 batch, presently serving as Deputy Director Administration, AIIMS-New Delhi. The views expressed in the article are his personal.

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Healthcare Technology

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Healthcare Technology

VIRTUAL CLINIC Bridging the Healthcare Gaps

A virtual clinic is a planned contact by the healthcare professional responsible for care with a patient for the purposes of clinical consultation, advice and treatment planning.

This technological innovation is fast closing the healthcare delivery gaps across Karnataka, observes Elets News Network (ENN).

T

he user interface is a tablet PC. The VC platform provides the dashboard of all specialists or super specialists in the district with detailed description of their clinical expertise so that patient can make assisted and informed choice of the specialists based on reputation, experience and proximity.

It is also expected that in some cases, the super specialist/specialist may conclude that the progress on the patient through VC is not satisfactory and hence the patients would move to real clinic/hospital where the specialists or super specialists are practicing. This ensures a smooth transition of patient from virtual clinic to real clinic without any loss of medical history of patient. It also ena-

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bles transfer of patients across different specialties.

Therefore, unlike few other similar web-based application, AHMVC is unique and realistic. It puts more responsibility and accountability on the clinicians to treat the patients as some patients would visit the clinician in his or her real clinic or hospital, and thus it becomes reference for the specialists and super specialists to start new patients through virtual clinic.

The Social Problem that VC is trying to Solve

The patients in rural India are worst affected due to non-availability of specialists along with prompt and ac-

Healthcare Technology curate diagnostics to manage the disease early. In spite of huge effort by the government, it had become almost impossible to reach specialist care to rural population where most India lives. With huge shortage of specialists or super specialists (just because our medical colleges do not produce as many numbers yet), this problem of availability of clinicians (even GPs) will continue to remain for long time. Wrong treatment of disease at an early stage creates huge social burden for patients or government and over all on society. This also prompts quack practice which is a huge menace in the country to suck money from innocent patients.

Virtual Clinic – a social initiative by Asian Health Meter (AHM) – is one significant step towards mitigating this health and social crisis. Our attempt is to bring a reasonable level of care as close as possible to patient by leveraging technology.

The Key Players of this Unique Project

Asian Health Meter (AHM) is the lead member which conceptualised the entire project. AHM, a sister concern of Asian Heart Institute, Mumbai – a world class cardiac hospital – is a social enterprise for delivering sustainable healthcare services at affordable cost in rural India. AHM currently operates in North Karnataka through affordable diagnostics service network.

BSNL has provided the FTTH 8Mbps connectivity at each PHC’s location and has confirmed feasibility across the entire district.

H5C, a technology company in Bengaluru, has provided the technology solution in close collaboration with AHM. Asian Health Meter (AHM) is a social enterprise for delivering sustainable healthcare services at affordable cost.

AHM’s mission is to provide affordable, accurate, advanced and easily accessible diagnostic service in lower tier towns and underserved population. AHM currently operates in Karnataka. AHM virtual clinic is another sig-

nificant step towards connecting patients to clinicians early enough to reduce the disease burden on the patients as well as on the society. AHM virtual clinic is a technology-backed initiative that provides a platform for cloud based unified health record and virtual interactions with patients and doctor through a low bandwidth environment of audio and video communication.

AHM virtual clinic solution provides relief and benefits to every stake holders – patients, doctors and society and being launched at government hospitals, private hospitals and clinics. In executing this prestigious project, AHM has partnered with H5C as technology partner, BSNL as provider of Fibre Optics Connectivity across each of the PHCs. FOR PATIENTS: ♦ Patients at PHC or government hospital have opportunity to interact with doctors in the nearby town at early stage of disease. ♦ Tests that are needed to support the virtual consultation are done without patient travelling elsewhere - samples collected and transported to nearest AHM lab and results uploaded. ♦ In case the treatment through virtual clinic does not provide satisfactory outcome, patient moves to the real clinic/hospital of the doctor involved in virtual consultation ♦ Specialists/super specialists available on the platform can also provide virtual consultation to patients needing advanced care. ♦ Instant accessibility to qualified doctors, specialists, super specialists ♦ Minimise cost burden and uncertainity in disease management FOR DOCTORS: ♦ Can run virtual consultation from the comfort and convenience of his or her own real clinic ♦ Gets access to large patient base which so far was inaccessible to him ♦ Opportunity to examine the patient at an early stage of the disease and provide right clinical advice ♦ Access to the complete medical record of the patient to provide compete treatment history ♦ Can exercise options for hospitalisation or reference to super specialists early enough FOR SOCIETY: ♦ Preventing patients to resort to quacks and unscientific treatment ♦ Early detection of disease prevents further poverty ♦ Partially mitigates the crisis of non-availability of specialists or super specialists in semi-urban area ♦ Reduces overall cost burden of public health care system ♦ Through this initiative, major departments of district hospitals will be connected to PHCs over the AHM VC platform. This will help build confidence in the PHCs and take through the complete cycle of the virtual clinic.

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Public Health Initiative

FRESH APPROACH

to Quality Healthcare in Karnataka

The Department of Health and Family Welfare, Government of Karnataka, is committed to provide essential quality health services at all stages to 6.20 crore citizens of the state, particularly to the poor, writes T Radhakrishna of Elets News Network (ENN).

T 52

he Government of Karnataka under the leadership of Minister for Health and Family Welfare KR Ramesh Kumar has come out with suggestions for a policy framework to provide quality healthcare across the state. By providing free diagnostics, medicines

APRIL / 2017 ehealth.eletsonline.com

and other necessary tests, the government aims to allay concerns of the poor and needy over the exorbitant costs of health services. It is with this objective in mind, the Government of Karnataka has committed to make quality public healthcare affordable by taking a number of revo-

Public Health Initiative lutionary steps that are expected to transform the state’s healthcare system.

Constituting Legislation

In the interest of the public, the Government of Karnataka has realised the need of bringing suitable amendments to the prevailing Karnataka Private Medical Institutions Act 2007. A committee would be constituted with experienced, senior doctors, senior government officials, retired officials, and representatives of renowned private hospitals, various voluntary organisations and those who are involved in the public movements to improve the healthcare system.

The main objectives of the committee are: to critically view the problems faced by patients in private medical hospitals and to resolve their grievances; to constitute a statutory committee, include representatives with expertise in medical and legal fields and the concerned organisations; make it mandatory to fix the price of various diagnosis/procedures/ medical services and display them; to make provision for strict action against those medical institutions which are found to indulge in embezzling citizens; and ensure that established private medical institutions should not be limited only to making profits.

The committee’s report would be prepared as per the above formulae within eight weeks for official implementation.

Use ASHA Volunteers as Bridge to the Community

In the current system, ASHA volunteers (recognised social health workers) function as an important pillar of the healthcare system. The government would provide all necessary encouragement to avail their services comprehensively.

Establishment of Dialysis Centres and ICUs

Dialysis Centres would be started in all taluk hospitals of the state. The government also aims to set up intensive care units (ICU) with ventilators at all taluk hospitals to cater to emergency needs.

Establishment of Blood Banks

Blood bank facilities will be established at all taluk hospitals across the state. Blood bank facilities with Blood Component Separation Units will be established at all district hospitals across the state.

Tele Medicine Facility

The policy also envisages optimal use of telemedicine and virtual clinics online to support healthcare delivery at all levels irrespective of the location and human resource constraints. In this regard, the telemedicine facility will be provided to link all primary health centres, community health centres and taluk hospitals to KIDWAI, Institute of Nephro-Urology, Jayadeva Institute of Cardiology, Sanjay Gandhi Institute of Trauma and orthopedic Centre, Indira Gandhi Institute of Child Health, Minto Eye Hospital and Rajiv Gandhi Institute of Chest Diseases.

Providing Equipments to Government Hospitals

Depending upon the level of care in the facility the required equipment will be provided and AMC will be provided for proper maintenance of the existing equipment. For effective utilisation of scanning and X- ray machines in taluk

Filling up Vacant Posts

To fill up all vacant medical and paramedical posts and ‘D’ Group posts in the government primary health centres, community health centres, taluk hopsitals and district hospitals within time limit. Open provision would be made for treatment of patients by opening AYUSH divisions in all taluk hospitals of the state.

Ambulance Services

The government also proposes to make ambulance service available in the radius of 10 km of all villages in the state.

Provision of Medicines in Government Hospitals

To make generic medicines available in all government hospitals of the state from PHCs to district hospitals; to provide mandatorily all essential medicines free in all government hospitals of the state, i.e., from PHCs to district hospitals; doctors in all government hospitals of the state to submit online demand for all essential medicines of the department as per the demand of patients from time to time and provide medicines to patients when need arises; to prohibit for government doctors in government hospital to prescribe branded medicines to patients.

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Public Health Initiative and district hospital across the state, the required staff will be provided.

Staff Quarters Facility

It is mandatory for the medical officers and paramedical cadres to stay at head quarters wherever good quarters are available. Wherever such facility is not available, the house rent at market rates will be provided to ensure headquarter stay.

Establishment of Canteens

At all taluka and district hospitals of the state the canteen facilities will be made available with maximum discount rates for essential food requirement of patients and the attendants in association with department of Food & Civil Supplies and Mysore Sales International Ltd (MSIL).

Establishment of RO Drinking Water Units

RO plants to provide clean drinking water in all taluka hospitals will be set up in coordination with Department of Rural Development and Panchayati Raj.

Establishment of HOPCOMS and KMF Stalls

At all taluka and district hospitals of the state, the availability of fruits will be ensured through Horticultural Producers Co-operative Marketing and Processing Society (HOPCOMS); milk and butter milk will be made available through Karnataka Milk Federation (KMF) outlets.

Barber Shop Facility

At all taluk and district hospitals space would be provided for barber shops for the benefit of the patients.

Forming of Taluk Level Committee

At all taluk level government hospitals, a committee with local member of legislative assembly as the president will be constituted with the representatives from all the categories of community specially minorities, backward castes and backward tribes, town municipalities, women representatives, labour unions, self-help groups. The roles and responsibilities of this committee will be notified.

Distribution of Tricycles and Other Equipment to the Disabled

The tricycles and other equipment to all the disabled in the state will be distributed successfully in coordination with the Department of Health and Family Welfare, Social Welfare, Women and Child Development and Department of Labour.

Organ Transplant

To simplify, expand and implement organ transplant facilities in the district hospitals at Hubli, Mysuru, Kalburgi, Mangalore, Shivamogga and Ballari.

Biomedical Waste Management

Government aims to implement Biomedical Waste Management Policy 2016, at all taluk and district Hospitals across the state.

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Providing Mortuary Facility

The government will also provide mortuary facilities at all the primary health centres and community health centres across the state.

Health Helpline 104

To replicate a toll-free health help line No.104 (Arogya Sahayavani) centers at all revenue divisions of the state.

Medical Re-imbursement

All cadres of the government employees and public representatives have to seek the health services on priority at first instance in government hospitals only. In the scenario of non-availability of such treatment/services at government hospitals, may avail the treatment/services in private health sectors. In case of those who approach private hospitals directly for treatment they will not be entitled for medical re-imbursement.

Distribution of Health Smart Cards

To distribute health smartcards among all the families in the state to facilitate the reach of existing health schemes.

Through this card, the essential treatment procedures will be simplified. All the families in the state will be covered through Health assurance and the cost for the same will be borne by the government in the form of premium. Special emphasis will be given to unorganized labourers, agricultural labourers and other weaker sections of the society so that an assured atmosphere will be created to avail quality health services.

Starting of DNB Course

To address the shortage of specialists, especially the critical cadre of obstetricians, pediatricians and anesthetists, an in-house DNB course will be started as per the need in all government district hospitals across the state.

Super Speciality Hospitals

The existing district hospitals at Mysuru, Ballary and Davanagere will be provided with super specialty facilities in oncology, cardiology, nephrology and orthopedics and the hospitals in Bengaluru, Belagavi and Kalaburgi will be upgraded for super specialty in the speciality services.

Research and Training

To improve health services through the department of Health & Family Welfare and the Department of AYUSH in our state, it is necessary to develop effective treatment procedures in traditional system medicine. In this regard, the Karnataka State Health System Resource Centre to be strengthened.

Re-organisation of the Department by Implementing Public Health Cadre and Revision of C&R Rules Creation of public health cadre will lead to reallocation of the existing cadres and new positions at state level. This needs restructuring of organisation at state, district and taluk levels. Accordingly, based on the profile of the position and the job responsibilities revision of existing C&R rules will be done.

Public Health Initiative Healthline

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Healthcare Technology

INTEGRATED HMIS for Effective Surveillance

The HMIS in Karnataka is designed primarily to capture data for monthly reporting from lower health facility level to district levels. The system is supported by annual community needs assessment survey and other programme specific surveys in setting the annual targets, observes Elets News Network (ENN).

H

ealth Management Information System (HMIS) is a web-based application to capture accurate, upto-date, and timely information from health institutions. Under National Health Mission, Karnataka’s facility-based reporting was initiated in Karnataka from August 2010. It captures facility- wise data and it creates a single / common platform for reporting and reducing multiple reporting formats.

This report is available in HMIS portal and can be viewed at all the levels. As many as 255 data elements are uploaded by 12,216 facilities every month in HMIS portal in the prescribed formats. Human resources, infrastructure including medical equipment related data are uploaded annually by the facilities.

The star rating (Grading) of Health facilities are prepared based on criteria fixed by Government of India-based on the Infrastructure data. It will help to take a decision at various levels for better Implementation of the health programmes.

Uses of HMIS

At the National and State level, HMIS is primarily a tool of policy and strategy making. It is useful for assessing the progress of national health programmes.

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At the state and district level, HMIS is a tool of programme monitoring and management. A robust HMIS helps Programme Managers to track the progress of implementation of various programmes. It enables them to distinguish well performing areas from those that require more support and resources. Thus, HMIS helps in planning and designing specific interventions that can strengthen a programme.

At the sub-district level such as block, PHC, sub-centre, and other facilities, HMIS facilitates efficient and effective registering and collation of data; improvements in data quality; systems for complete reporting; timeliness and accuracy; provision of data analysis tools; interpretation and translation of data to guide action and intervention at local level.

The HMIS new formats have been designed and will be rolled out to capture data from April 2017. The new formats designed in a view of monitoring programmes like Rashtriya Bal Swasthaya Karyakram (RBSK), Adolescent Friendly Health Clinics (AFHCs), Weekly Iron and Folic Acid (WIFS) Supplementation Programme, Janani Shishu Suraksha Karyakram (JSSK), Menstrual Hygiene Scheme, National Vector Borne Disease Control Programme (NVBDCP).

Healthcare Technology

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Healthcare Technology

E-HOSPITAL

Ensuring Accountability in Health Services

Expanding the scope of eHospital programme, Karnataka Chief Minister Siddaramaiah has announced to implement the project in all government hospitals across the state.

The government has envisaged implementing e-Hospital software in all the facilities across Karnataka by 2017-18 from PHC level to district hospitals to provide accountable and transparent health services to the community across the state, observes Elets News Network (ENN).

H

ealth status of the community has engaged the attention of the public as well as the private stakeholders from the beginning of this decade. Rapid progress in achievement of health indicators has been made after implementation of National Rural Health Mission (NRHM) in state with adequate strengthen-

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ing of the public healthcare system. Still display of available services, accountability and transparency lack in public health system. This has led to inadequate access for essential healthcare services which is a key step towards achieving of Universal Health Coverage (UHC). Community often depend on the unorganised, and at times, unqual-

Healthcare Technology ified private providers leading to heavy out of pocket expenses. Realising this significant gap for improving access for public health care, the Government of Karnataka has launched the e-Hospital programme to provide accountable and transparent health services to the community.

Karnataka Chief Minister Siddaramaiah announced in his budget speech on March 15, 2017, to implement the project in all government hospitals across the state. Earlier, the state has implemented the project in three state-level hospitals as pilot under the guidance of National Informatics Centre (NIC). The software has been provided by NIC, Tripura with data storage facility in local servers.

In financial year 2015-16, with directives of the Health Minister, state government is scaling up the project to other district hospitals and general hospitals which are under health department under guidance of NIC, Bengaluru, with secured connectivity from Karnataka State Wide Area Network (KSWAN) of e-Governance Department. State has envisaged implementing e-Hospital software in all the facilities across Karnataka by 2017-18 from PHC to district hospitals with online registration system and Namma Hospital implementation for providing patient centric Health services.

IT enabling services for improvement in hospital based services, included in e-hospital modules are: ♦ Electronic health record/ Medical record system. ♦ Laboratory information management system (LIS) ♦ Pharmacy information system (DDMS-e-aushadhi) ♦ Patient registration or scheduling system including Online Registration System(ORS) ♦ Monitoring, evaluation, and patient tracking system ♦ Clinical decision support system (CDSS) with adoption of ICD-10 Classification ♦ Patient reminder system ♦ Assured Referral Services ♦ Research/data collection system ♦ Namma Aspathre for documenting patient feedback to improve the quality of care The following technologies will be practiced in the e-Hospital programme in state for strengthening efficient health care in state.

Electronic Health Record (EHR): As an electronic file cabinet for patient data from various sources, viewed as real-time access to patient data, which will improve continuum of care.

Computerised Provider Order Entry (CPOE)

Medication ordering & fulfilment system is incorporated for use in lab orders, radiology studies, procedure, discharges, transfers, and referrals. CPOE significantly reduced (55 percent) serious medication errors (Bates et al. 1998).

Clinical Decision Support System (CDSS): Will be utilised for real-time diagnostic and treatment recommendations by doctors using updated version of ICD 10 classification software. This technology helps us for uniform follow-ups at various hospitals across the state. Suitable protocols and alerts prescription drug interaction (e-prescription) will be practiced in CDSS and CDSS is used as part of CPOE and EHR.

Picture Archiving and Communications System (PACS): Will be used in all major hospitals for disseminating integrated, stored radiological images and also between the hospitals in implementation of tele-radiology services.

Bar coding: Optical scanner is used extensively to electronically capture information encoded on a product. In the state we are using to have paperless event recording, additionally, in reception software will be designed to Adhaar card enabled health services implementation.

Radio Frequency Identification (RFID): This technology will be adopted for a wireless communications system. An alternative to bar coding links lab and medication tracking to patients throughout the hospital stay.

Automated Dispensing Machines (ADMs): This technology distributes medication doses and will be linked to the Drug Distribution Monitoring System (DDMS) software.

This will provide drug dosage and drug utilization methodology information to the patients.

Electronic Materials Management (EMM): Used to track and manage inventory of medical supplies, pharmaceuticals etc. This will be linked to the Drug Distribution Monitoring System (DDMS) software. This will able us for auto indenting, alerts for drug stock out, prevents wastage of drugs, recommends First in First out drug management and auto report generation services.

Interoperability: This concept will be implemented through secured KSWAN connection for effective referral services between the hospitals across the state for referral services. Interoperability focuses on development of standards for content and messaging development of adequate security and privacy safeguards.

Data Portability: existing reporting and other service delivery software’s will be inter connected for data portability. Presently health system is utilizing HMIS, MCTS, Nickshay, IDSP, NCD, RBSK, DDMS, and Civil registration software which will get data portability through e-hospital programme software using universal data operability code for accurate data and ovoid duplication in reporting. This process will be done in subsequent years in phase-wise manner. Utilization of IT in health care can significantly improve the patient care as well as Human resource & Inventory Management. The process will considerably reduce the work process time & improve the efficiency of the institutions in state.

Currently project stress mainly on implementation of e-hospital programme by adoption of ICT equipment’s, Human Resources and free open source software in all 20 district hospitals, 3 state level hospitals and 24 taluk hospitals with emphasis on IT. Further patients can register themselves in online registration system portals (ors.gov. in) to get online appointment with Specialists and to get Lab reports to their mobile.

State is also implementing Namma Aspathre as Patient feedback documentation through ors.gov.in for making exist interview for the patients through mobile applications or emails or web portals or mobile phone interviews so that it will provide insight for further improvement of patient centric health services in the hospital and grade the services of the facilities offered by hospitals.

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Policymaker’s Perspective

eHEALTH

Providing Healthcare Digitally The Ministry of Health and Family Welfare is progressively using Information and Communication Technology to make government services available to citizens in a convenient, efficient and transparent manner, says Jitendra Arora, Director (eHealth), Ministry of Health and Family Welfare, in conversation with Gopi Krishna Arora of Elets News Network (ENN).

How has the Ministry of Health and Welfare leveraged technology to provide better services to citizens?

The Ministry of Health and Family Welfare has undertaken various initiatives using Information and Communication Technologies (ICT) for im-

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proving efficiency and effectiveness of the public healthcare system. The ministry is continuously working on planning and introducing more ICT initiatives. These initiatives are grouped under four categories: e-governance: ICT for delivering government services, exchange

of information, services like government-to-citizen, government-to-business, government-to-government etc. eHealth: Use of ICT for health services like for treating patients, conducting research, educating health workforce, tracking diseases, monitoring public health etc.

Policymaker’s Perspective mHealth: edical and public health practice supported by mobile devices for patient monitoring devices, personal digital assistants (PDAs), and other wireless devices.

Tele-Medicine: It is the use of telecommunication and information technology to provide clinical healthcare from a distance. It helps eliminate distance barriers and can improve access to medical services that would often not be consistently available in distant rural communities. It is also used to save lives in critical care and emergency situations.

What are the various ICT initiatives that the ministry is taking to improve the public healthcare system?

The ministry is progressively using ICT to make government services and information available to citizens and business groups in a convenient, efficient and transparent manner and also in improving transactions with other government departments and agencies. In line with the ‘Make in India’ and ‘Digital India Programme’, the ministry has undertaken various initiatives with focus on online services through different technology platforms such as mobile, internet, telephone, etc. Some of the online services available are: Online Registration System (ORS): It is a system to offer services for online registration, appointment and other patient centric services like lab reports, blood availability status etc.

Till now, 71 hospitals are on board with the service and around 6,83000 appointments have been given online.

National Health Portal (NHP): It serves as a single point access for information on health schemes and diseases including health regulations, standards, policies, programmes and commissions, directory services, hospitals, blood banks, ambulances etc.

NHP also has a toll free national number 1800-180-1104 for providing information related to health, diseases, lifestyle, first aid, directory services, health programmes etc. More than 26 lakh people have used this portal to avail health services.

Mother and Child Tracking System

(MCTS) / Reproductive Child Health (RCH) application: It is a tracking system across all the States and Union Territories to facilitate timely delivery of antenatal and postnatal care services and immunisation of children with an objective to improve Infant Mortality Rate, Measles, Mumps and Rubella (MMR) rate, providing alerts to health service providers about the services due and service delivery gaps etc. Approximately 11.84 crore pregnant women and 10.13 crore children were registered on MCTS / RCH portal since its inception till 17th November, 2016.

The central government is promoting cashless economy. What new initiatives have the Ministry of Health and Family Welfare taken to promote it?

The ‘Digital India’ programme is the flagship programme of the Government of India with a vision to transform India into a digitally empowered society and knowledge economy. The focus of the centre is on increasing digital payments through five modes namely: United Payments Interface, Unstructured Supplementary Service Data, Aadhaar Pay, Immediate Payment Service and debit cards.

What new ICT initiatives are you planning to introduce soon?

Some of the new initiatives we are planning to launch this year are: Interoperable Electronic Health Records (EHRs) System: The ministry has envisaged a system for interoperable EHRs of citizens to be created, made available and accessible online to facilitate continuity of care, better affordability and better health outcome.

Setting up of Integrated Health Information Platform (IHIP): It has been envisaged to work in the direction to avoid a situation of data getting trapped in multiple silos and to enable EHRs of citizens to be created, made available and accessible nationwide.

Last mile connectivity is a major concern for many states. How are you planning to bridge this gap?

It is certainly an issue in rural and far flung areas. However, under the Na-

tional Health Mission, provisions have been made to provide internet connections upto the block level. In many states, the provision of internet connectivity is made available upto primary health centre level and even at sub-centers. The National Optical Fibre Network which intends to connect gram panchayats would help bridge connectivity issues across states.

What are the key features of the new health policy?

The new health policy has comprehensively covered eHealth. For the first time, the eHealth goals for the country are outlined in the National Health Policy (NHP). It has goals towards creation of district-level electronic database of information on health system components by 2020. In addition, the policy intends to strengthen the health surveillance system and establish country-wide health information exchange network by 2025.

The NHP 2017 has promoted use of eHealth for ensuring continuity of care, digital tools to support national health programmes, medical education, supportive supervision and epidemic and disaster response.

The major policy recommendation is the creation of National Digital Health Authority to regulate, develop and deploy digital health across the continuum of care. The policy aims to use e-health to serve the needs of all stakeholders and improve efficiency, transparency, and citizen experience.

Specific policy recommendations are establishment of federated national health information architecture and linking of systems across public and private health providers at State and national levels consistent with Metadata and Data Standards (MDDS) and EHR. The policy advocates use of Aadhaar for identification and creation of registries (i.e. patients, provider, service, diseases, document and event) for enhanced public health/big data analytics. Use of National Optical Fibre Network and smartphones/tablets for capturing real time data, are key strategies of the National Health Information Architecture as suggested in NHP 2017.

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Industry Speaks

BIOCON BUILDING

eLAJ Smart Clinics in Rural India

Biocon Foundation, the corporate social responsibility arm of biotech company Biocon, has been working in India in the preventive and primary healthcare sector. The Foundation’s objective is to build a strong primary healthcare system by leveraging simple low cost technology, so that public health indicators are improved and the burden on tertiary centres can be reduced, says Rani Desai, Head of the Biocon Foundation, in conversation with Sudheer Goutham of Elets News Network (ENN). Excerpts: How did Biocon Foundation come into being?

Biocon Foundation is a registered charitable trust that was established in 2004. Our main focus is to

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strengthen the delivery of preventive and primary healthcare. We want to build a strong primary healthcare system so that burden on hospitals can be reduced. In Karnataka, we

have been running 8 eLAJ Smart Clinics, which provide medical consultation, diagnostics and medicines to communities living around these clinics. Over the last 12 years, these

Industry Speaks clinics have treated over 4,00,000 patients, and we have reached more than 1 million people through our preventive health programmes.

We conduct early detection and prevention of oral cancer, breast cancer and cervical cancer, through our community health network and with the assistance of our tertiary partners. We also have regular NCD camps in our clinics when days to help patients manage lifestyle related illnesses like diabetes and hypertension. We run community cardiology clinics to assist patients with follow up care.

Biocon Foundation has signed a Memorandum of Understanding (MoU) with the Rajasthan government. What are the key points of this partnership?

In November 2015, Biocon Foundation and the Government of Rajasthan signed a Public Private Partnership agreement, under which Biocon Foundation adopted five primary health centres (PHCs) in 3 districts of Rajasthan – 2 in Jhalawar District, 2 in Sawai Madhopur District, and 1 Urban Health Centre in Jaipur.

Under the agreement, Biocon has taken over the entire management of these 5 PHCs and the 31 sub-centres attached to these PHCs. In addition to recruiting staff, we have implemented the eLAJ Smart Clinic program, which combines a robust EMR with high end diagnostics. Making eLAJ integral to the operations of the PHC strengthens the primary health care services in a number of ways – the PHC becomes a single point treatment centre thus reducing stress for patients, out of pocket expenses of patients is reduced since lab tests are available at the PHC free of cost, and live data is available for health administrators to monitor the operations of the clinic as well as to understand the disease profile of the community that the clinic serves.

This data is made available to the health administration through live dashboards.

We have also started our Oral Cancer Screening, breast health screening and cervical cancer screening

programs in the PHCs that we have adopted.

Please give us details about your MoU with the Government of Karnataka.

We signed a Public Private Partnership agreeement with the Government of Karnataka in January 2017, under which where we are installing the eLAJ Smart Clinic model in 15 government PHCs across multiple districts. The eLAJ model includes the software which Biocon Foundation has developed, and the hardware required to run the program. The hardware comprises of 3 laptops, a biochemistry analyser, a hematology analyzer, and the accessories required to connect the entire system.

These are donated and installed by Biocon Foundation in each of the allocated PHCs. In addition Biocon Foundation will recruit and train data entry operators, and lab technicians to manage the eLAJ programme.

With the data from these clinics, the government will be able to monitor patient footfalls, design targeted health interventions, and implement strong preventive measures for underserved communities in rural and urban areas.

From eLAJ data we have observed that a higher proportion of patients in Karnataka have high Body Mass Index (BMIs) and high diabetes, when compared to the data from Rajasthan, where, especially in rural Rajasthan, we see more people with LOW BMIs.

Brief about the various programmes run by Biocon Foundation.

Biocon Foundation works in three verticals – health, education and community support and development.

In health, as mentioned above, our focus is on primary and preventive health, as we believe that a strong primary health system is necessary to improve public health indicators in the country.

Education – 10 years ago we introduced the Chinnara Ganitha Math programme in government primary schools in Karnataka. Today, we distribute 100,000 Chinnara, Ganitha math workbooks in five districts in

Karnataka.

In order to support and develop strong communities we have built drinking water plants, rejuvenated lakes, and built schools and proper roads. In Bagalkot district we have built a 411 houses for a community that was displaced by floods in 2009.

Each house has been provided with a toilet and solar lights. In addition to the houses we have also built an eLAJ Smart Clinic for the community and we have provided a drinking water plant in the layout.

Which IT interventions have you taken up to provide healthcare to patients in a faster and better manner?

Our focus is to use the power of technology to strengthen the delivery of health care services to underserved and remote communities. The eLAJ SMART Clinic model illustrates this focus. The eLaj model includes telemedicine consultation when required by a patient living in a remote community.

Our mHealth Oral Cancer Screening programme is a community screening program that can be implemented by an ASHA worker. People who chew tobacco are at risk for developing intra-oral lesions that can become cancerous if not detected early. When the ASHA or the clinic staff see such a patient, they use a simple mobile app to collect demographic data and take pictures of the lesions. These pictures are then transmitted to a web application and a remote specialist provides treatment advice to the patient. iBreast Exam – harnesses the power of innovative sensor technology and software computing that enables any doctor or health worker to offer effective and simple breast examinations with ease and comfort.

Biocon Foundation has completed more than 2500 breast scans and is committed to extending this service to patients in our clinics and PHCs. Our cervical cancer screening program uses the Pap Smear which is the gold standard for cervical screening. The foundation collaborates with tertiary centres close to primary health centres.

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Policymaker’s Perspective

UNANI

The Traditional Science of Health & Healing People in urban areas have realised the benefits of Unani and Ayurveda over the modern medicine system. Unani medicines are present in the kitchen of every home, says Professor Rais Ur Rahman, Advisor (Unani), Ministry of AYUSH, Government of India, in conversation with Gautam Debroy of Elets News Network (ENN). Excerpts: How is the Ministry of AYUSH engaged in providing healthcare across the country?

AYUSH stands for Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homoeopathy system of medicine. India

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is the home for these traditional forms of medicines. Our country has officially recognised these six systems.

The Indian government is making tremendous efforts to promote these systems across the globe. The entire

world is looking towards us for the treatment of non-communicable diseases through AYUSH system. People are dying of obesity, cancer, hypertension, heart diseases, etc, all over the globe. The conventional system

Policymaker’s Perspective

How is the Unani system working in India?

As far as Unani system is concerned, it is a very important component of the AYUSH system of medicines. Unani is being taught at 50 educational institutions across the country. Out of these 50, 15 are post graduate institutions.

We have a wonderful research council – Central Council for Unani Medicine – with 23 centres all over the country for conducting research on various aspects of Unani medicines.

We also have a national-level institute at Bengaluru. This institution is spread over an area of 50 acres, imparting education at post graduate and doctorate level. We are offering treatment for those diseases where treatment is not possible in any other medicine system. Take the example of paralysis. In conventional system, there is no way to properly treat it. But we are successfully treating paralysis for the past many years. We will come out with new programmes soon to make our presence felt at the international platform.

For international recognition of AYUSH, which steps are being taken by you?

The World Health Organisation (WHO) and other such institutions across the

The weakest area of the Unani system is education. Educational institutions are not up to the mark, especially in the private sector. More emphasis should be laid on the appointment of teachers through eligibility tests.

“

of medicine, i.e. allopathy, does not offer permanent solutions for these problems. The entire world is looking towards us with hope because we are treating our people through the AYUSH system for ages.

It has been in existence for the past 5,000 years. The only problem is that the global acceptance of this system is low. After our Prime Minister Narendra Modi came into power, extra attention is being paid on the AYUSH system of medicine. The first such achievement was the declaration of International Yoga Day on 21st June every year. It was acknowledged by none other than the UN. In 2015, the first International Yoga Day was organised on a grand scale at Rajpath in Delhi. That day, around 35,000 people practised yoga simultaneously, which was recognised by the Guiness Book as a world record. Rajpath was transformed into the ‘Yogapath’ that day.

globe do not challenge the efficacy of our system because they know these systems have survived over centuries.

You can still see large queues outside the OPDs of any Unani and Ayurvedic hospital. International organisations have demanded scientific data to gauge significance of AYUSH, which we are compiling these days.

We have conducted clinical research as per the guidelines of WHO. The organisation is also concerned about the safety of the drugs we offer. Our drugs may or may not cure a person but they should not have any side effect on the patient. In this regard, we are trying to test the toxicity of every drug. Acute and chronic toxicity has turned out to be safe, and as such safety of such drugs has been established. WHO doesn’t approve a drug without testing its toxicity.

The third aspect is the quality of drugs. We have herbal drugs. A Unani or Ayurvedic drug has more than 10,000 molecules all together. Every time the product is manufactured, it should have the same property and elements. To ensure the quality control, we are trying to establish the standards for drugs. When these steps are completed, the efficacy of AYUSH drugs will be proved internationally.

What are the challenges that Unani medicine system is facing in the country?

The weakest area of the Unani system is education. Educational institutions are not up to the mark, especially in the private sector. More emphasis should be laid on the appointment of teachers through eligibility tests. Similarly, students should be screened thoroughly by conducting tests. At the same time, the government should promote more research, development of equipment and machines for producing Unani medicines. The Ministry

of Ayush is doing everything to promote this system.

What is the scenario of Unani medicine system in rural as well as urban areas?

Unani medicines are present in each and every household in India. Ayurveda and Unani medicines are available in every kitchen. Take the example of haldi, we are using it for so many years. The absorption of haldi in the body is not possible without fat. If you take haldi with fat, it is a wonderful drug to prevent cancer. It is a wonderful hyper anti-lipid drug. Similarly jeera, which is easily available in our houses, is really beneficial for our health.

Due to the failure of modern medicine system, people in urban areas have realised the benefits of Unani and Ayurveda. In the modern system, you keep on taking the medicine, but the disease somehow keeps progressing.

For example, India is becoming the capital of diabetes. Despite people trying different Allopathic drugs, the disease keeps on progressing. Even after switching over to insulin, the patient has to die prematurely. So, we are focusing on such diseases. Urban population is turning to this system which is able to control the disease.

Ayurveda is a way of life. Unani is the science of health and healing. So, with lifestyle changes and proper drugs, Unani is helpful in many diseases.

What is the scope of Ayush in years to come?

It will rule the world in the next 10 years. I am sure the Indian government is already undertaking a lot of initiatives in this regard. After 10 years, Ayush will be able to provide a number of solutions to the problems which conventional system of medicine is not able to provide.

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Policymaker’s Perspective

SUPER TECHNOLOGIES Changing Pharma Industry

Pharmaceutical industry is more reactive than pro-active in technology adoption, primarily because of tight regulations and domain complexities. As it is related with individuals’ health, all such data of these industries are very sensitive. Theft of such important data is a big risk, says Mayur Parmar, Drug Inspector, Food and Drug Administration in conversation with Elets News Network (ENN).

How innovations in technology space are changing the pharmaceutical industry?

As you know the pharmaceutical industry is the second most regulated industry after civil aviation industry, adaptation to new technologies has

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to go parallel with the regulation.

However, the industry is continuously evolving and adapting with the latest technologies like IOT, 3-D printing, Cloud computing, smart manufacturing, etc. These innovations are still in pipeline phase and hold the potential

to change the basics of the industry by offering value propositions such as improved patient and healthcare professional engagement, cost optimisation, faster time to market, higher productivity and improved service for patients. Moreover, as a regulator,

Policymaker’s Perspective

Information, research and new manufacturing techniques are some of the important drivers of growth for the pharmaceutical industry and theft of such important data can be a real-threat.

So, how does company develop and implement potential security solutions to identify and mitigate such risks?

Well, pharmaceutical industry is more reactive than pro-active in technology adoption, primarily because of tight regulations and domain complexities. As it is related with the health of individual, all such data of these industries are very sensitive. Theft of such important data is a big risk.

Implementation of this new ecosystem is not hassle free. It is imperative for a pharma company to conduct a detailed due diligence to analyse the people, process and technology readiness for such innovations. Data privacy, security and vulnerability management is something the company should work on.

What kind of latest innovations are you implementing in your manufacturing facilities and R&D Centres?

I am not directly involved with manufacturing facilities and R&D centres.

However, I do visit such facilities for inspection. I see that many companies have started this transformation process toward these super technologies. I personally feel, if properly managed and regulated, the IOT will change the way of living of each and every individual of this globe. Well, not limiting to this, we can see lot of new changes like, Use of Auto-ID with AIDC (automated information data collection) for smart serialization, Real-time logistics visibility using RFID & sensors to capture and report parameters including temperature, smart warehousing and routing, Predictive maintenance of machines and equipment.

Artificial Intelligence (AI) and machine learning have brought a fundamental shift in drug devel-

opment, how have these technological advancements brought in new opportunities to drug manufacturing or to bolster R&D efforts in the sector?

Honestly, I am hard pressed to think of areas where it will not be possible for AI to be a key driver. Now, with the advent of ‘big data’, companies are harnessing the power of AI to deliver more focused solutions in a variety of areas; AI helps them understand data in real-time. We can put machine learning under the broad umbrella of AI. On current date, we are just scratching the surface when it comes to AI and machine learning in pharmaceutical industry. I believe that AI can solve “n” number of problems related with the drug discovery process.

The more than 10 year long process can be reduced to few 100 days with quite less expense. Apart from it, it has lot to do with genomics, cancer treatment and other frontiers of pharma industry. Even we should mention about the big players in this game like WATSON by IBM, DEEP MIND by Google etc. So, I feel that with these technologies tomorrow will be different than yesterday.

An adoption of cloud computing has granted pharmaceutical industry with enhanced scalability potential. Kindly apprise us on the major issues linked to the increased usage of cloud computing in the pharmaceutical industry.

There is no doubt that Cloud Computing offers an opportunity to the pharmaceutical community to innovate quicker, manage change faster and deliver new medicines to the market.

According to few reports, nearly half of all pharma manufacturers are currently using a form of cloud-based infrastructure, or are at least considering it.

One can state many issues with

this technology like Data security, Data migration issue, spying of private data, irreversible nature of data etc.

But the major issue I see as a regulator, with the cloud based infrastructure is “Cloud Validation”. It is undoubtedly a challenge, however by approaching Computer System Validation in a different way, organisations are demonstrating that it is possible to utilise the Cloud in our regulated environment and thus reap the benefits that this innovative technology offers. The future really does favour the brave – now is the time for pharma organisations to rise to the challenge.

How are you leveraging ICT to enhance your offerings and what could impact the growth of pharma - IT?

The government has to implement any change with great care. Still, all the governments of the world are now leveraging the benefits of ICT. E-governance is the talk of the town. The Government of India has done great in recent years for making governance smooth and easy. But I believe that much needs to be done. As an example, I would state about USFDA over here. The US Food and Drug Administration (FDA), with AWS, have used Cloud computing to reengineer the process for handling of their Adverse Drug Affects reports. By utilising AWS cloud, they have been able to quickly turn manual reports into machine readable information with 99.7 per cent accuracy, whilst at the same time reducing costs from $29 per page to $0.25 per page. Our current government is vibrant and accepting the innovation at ever-faster rate. I believe that there are huge possibilities for incorporation of these super technologies in government machineries and that will make betterment in the life of every citizen of India

There is no doubt that Cloud Computing offers an opportunity to the pharmaceutical community to innovate quicker, manage change faster and deliver new medicines to the market.

“

I view it as a very good tool for enhanced compliance adherence.

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Policymaker’s Perspective

PHC MIS PROJECT

Setting Milestones in Karnataka Public Health System Aimed at making available real-time information of PHCs, the Primary Health Centre (PHC) Management Information System (MIS) project in Karnataka is centrally consolidating information such as patient treatment, diagnosis, deliveries handled and drug availability along with GPS information, writes Dr Sumeendra, Managing Director of CoDe Consulting, Bangalore, for Elets News Network (ENN).

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Policymaker’s Perspective

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E:info@oncostemdiagnostics.com W: www.oncostemdiagnostics.com APRIL / 2017 ehealth.eletsonline.com

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Policymaker’s Perspective

P

rimary health centres, popularly known as PHCs, are the basic units of the public health system in Karnataka. Located at selected towns or villages, these centres are accessible easily by the population in the vicinity.

Being the first tier of the public health system, the PHCs serve as the primary stop for treating minor ailments, handle regular delivery cases, decide on referral cases, take curative and preventive action in cases of epidemics, administer various welfare schemes meant for the poor and underprivileged, etc.

Despite being the vital institutions serving the poor and the needy, PHCs are far behind as far as the use of digital techniques is concerned in managing their operations.

Record keeping of day-to-day work, monitoring disbursal of medicines and the availability of stock, reporting trends pointing to epidemics, accounting for welfare schemes implemented and a score of other activities at these centres are still paper based. Due to this, decision making at these centres gets delayed.

The Primary Health Centre (PHC) Management Information System (MIS) project in Karnataka The PHC MIS project in Karnataka is set to make history. First of its kind in the country, this project would initially capture four critical aspects of the functioning of the PHC in electronic form. The activities identified to be captured are: ♦ Birth monitoring – delivery cases attended to with relevant details; ♦ Drugs monitoring – capturing drugs indented, issued and current stock levels; ♦ Outpatient module – capturing details of outpatients attended on a given day ♦ Disease monitoring – capturing diseases reported during a given day. ♦ Assist for Reporting under Health Management Information System (HMIS) ♦ Provide online data for Maternal & Child Tracking System (MCTS) In addition to electronic record keeping, the regular activities of the centre namely implementation of welfare schemes like post-natal care kit for poor and underprivileged women, Janani Suraksha Yojana, etc., would also be maintained.

Electronic data updation is not the sole activity which is contributing to the unique quotient of the PHC MIS project.

It is the deployment of Tablets with the capability to scan the iris of the individuals and linking to Aadhaar, is what that makes the project the first of its kind in the country.

Under the project, the data generated at the PHC level would then be transmitted to a central server through the mobile network, almost on a real time basis.

Analysis of the data received would make invaluable MIS reports near instantaneous, which can facilitate decision making by the Government. Thus, quick intervention in reported cases of epidemics, avoiding stock out situation of drugs required by the needy, better targeting of welfare measures and monitoring of schemes are some benefits of the project.

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Sending alerts to neighbouring areas in cases of suspected epidemics, facilitating preventive action would be another major benefit of the project.

The project was taken up as a pilot in 1,000 selected PHCs that are working 24\7 for providing delivery services in the state.

The project was inaugurated by KR Ramesh Kumar, Minister for Health and Family Welfare, Karnataka.

Under the project, preparatory activities like development of an app and training of master trainers have been completed.

The state data centre has hosted the application and is all set to receive and store data generated by the centres.

Training of users by master trainers and other activities are underway and the pilot would go live shortly.

Just as the deployment of Tablets has made the project unique, conceptualisation and bringing the project to implementation has its own unique dimensions. As a major initiative under the Corporate Social Responsibility, the project underlines the potential of public-private partnership in garnering resources and skills for public benefit.

The project is supported by Samsung R&D Institute, Bangalore, which has donated 1000 Tablets along with the app support.

CoDe Consulting, a company endeavouring to garner CSR resources for public projects, is supporting the implementation of the project through training users and data analysis.

Once the pilot implementation is completed, lessons from this phase would be useful in bringing remaining PHCs under the project and capture more data from for improving the health delivery system in the state. Another example of the Silicon Valley of India showing the way!

The author is Managing Director of CoDe Consulting, Bangalore. The views expressed in this article are his personal

Policymaker’s Perspective

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For sales Inquires, please email info@uelifesciences.com or call: +91 22 2610 2610 ISO 13485

WHO-GMP

APRIL / 2017 ehealth.eletsonline.com

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Industry Perspective

FUJIFILM INDIA Committed to Make-In-India

Fujifilm India Pvt Ltd was established as a wholly owned subsidiary of Fujifilm Holdings Corporation, Tokyo in India during December 2007. A leader in a broad spectrum of imaging industries, operated in India through its branch office and Indian dealers, the company is completing 10 years of operations in India during 2017. Chander Shekhar Sibal, Executive Vice President, Fujifilm India, in an interaction with Elets News Network (ENN), shares the market experience of Fujifilm India and its achievements.

How does Fujifilm India view Prime Minister Narendra Modi’s ‘Make In India’ campaign? Are the incentives enough to make high-end medical equipment in

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India for both local and export markets?

We are committed to ‘Make in India’ campaign and have started getting our mobile DR manufactured through

Skanray, named as MicroSkan DR, which provides exceptional image quality at lower dose and enhances efficiency of point of care X-rays. Right now, there is no big incentive for ‘Make

Industry Perspective

Digitalisation has played a major role in the evolution of precision radiology and imaging. How is this reflected in Fujifilm’s products and research innovation?

We at Fujifilm India are at the forefront of digitalisation. We are installing CR in every nook and corner of the country and this digitalised X-ray means convert analog X-ray to digital. Digitalisation helps in better resolution, reduce repeat examination and thus reduction in X-ray dose. These images can be transmitted with the help of PACS/ tele-radiology to competent radiologist for reporting fast and efficient workflow. We have DR panel and full room DR mobile DR for direct digital radiography. The equipment improve workflow and bring down dosage to a very low level. We have FFDM which detect cancer on the onset with 50 micron resolution at 1 mgy dose.

Fujifilm Synapse is a one-stop shop.

With an integrated mammography, RIS and PACS solution, high-end FDA approved 3D post processing applications cater to entire hospital’s departments right from radiology, cardiology, surgery, orthopaedics, neurology, urology, dental and maxillofacial, podiatry, forensic science for virtual autopsies. Oracle database embedded in PACS helps better management of patient records. We have recently introduced Synapse VNA (Vendor Neutral Archive) for DICOM and non-DICOM modalities in hospitals so that patient’s record is stored and archived in a seamless manner. This can also help in research and development of new procedures and data analysis of disease. We also specialise in POC point of care ultrasound sonosite.

What is Fujifilm India’s revenue mix, between various sectors that it operates in? What is the share of medical systems’ business?

Fujifilm India holds the number one market share in some of its photo imaging and medical products.

Fujifilm’s medical division has been the key contributor in the company’s growth in India with its X-ray devices, mammography and medical

informatics. Medical division contributes approximately 50% of business in Fujifilm India.

In which other segments Fujifilm has a leading market share?

This fiscal year, our medical division grew by 15 per cent as compared to the last fiscal. Our main driving force in this segment is our CR, imager and dry film. Our installation base has more than 20,000 units and we have sustained the number one market share in CR and imager market with approximately 50 per cent share. Furthermore, we have 30 per cent plus market share in DR segment and 25 per cent share in PACS. We always try to go an extra mile to meet our customers’ needs and provide best in class services. With these initiatives, our aim is to strengthen our presence in the Indian medical diagnostic space.

On a broader note, what is Fujifilm doing to increase patient access to its products and services? Are there PPPs with state governments etc?

Fujifilm is taking technology to masses by digitalising X-ray rooms interconnecting hospitals and diagnostic centres through PACS. We have recently joined hands with PPP customer KRSNA Diagnostic for supplying CRs for their India wide requirements.

We have supplied over 100 CRs to the Government of Andhra Pradesh for digitalising their small scale hospitals and large scale medical colleges. We have also received orders from Government of Turkey for their mammo screening programme and have supplied 100 FFDM for that purpose.

Our CR and PACS are at Medall which connect almost 50 diagnostic centres for high quality reporting through teleradiology. Also, we have installed FFDM at medical colleges like IGMC Shimla, Sri Ramachandra University,

Chennai, Aurangabad Medical College, Tata Memorial Hospital Mumbai, Mahajan Imaging Delhi, NM Medical Hospital Mumbai for early detection of breast cancer.

We have created a promising future for ourselves in the Indian market. Each category that Fujifilm has its presence in is driven by long-term commitment towards our customers and partners. Our growth drivers are coming from new age customers who are well aware of what they want and are quality conscious.

We have made an effort to investigate the Indian market and we realised that Indian customers require not very low price but affordable product that best suits their need. Taking account of that, we are exploring the possibility of developing value for money products made especially for the Indian customer.

What are the growth prospects for the segment in 2017? Which new products/ services are scheduled to be rolled out to achieve these targets?

At Fujifilm, we are continuously innovating, creating new technologies, products and services and depending on the market demand where we will introduce our new products.

Public Private Partnership (PPP) is important as the government is moving towards digitalisation and various state governments are digitalising their X-ray departments. DR and FFDM markets are growing at a fast pace, approximately at 20 per cent plus. We will launch new products in digital radiography and flat panel detector, which would definitely reduce the X-ray dose and enhance the image quality. Also, there are plans to launch Synapse 5.0 PACS with faster archiving time while utilising 50 per cent less bandwidth. We are expecting to grow by more than 15 per cent since last year.

Fujifilm is taking technology to masses by digitalising X-ray rooms interconnecting hospitals and diagnostic centres through PACS.

“

in India.’ We will also start exporting mobile X-rays from India this year.

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Industry Perspective

BILLROTH

Ensuring Continuity of Care Spectrum Billroth Hospitals believes in continuity of care spectrum. Most of our surgical cases, we believe, can do better with the provision of trained healthcare provider at the home, post- discharge, says Dr Puneet Mehta, Medical Superintendent & Head of the Unit, Billroth Hospitals, in conversation with Elets News Network (ENN).

What are the focus areas for Billroth Hospitals in the healthcare sector?

time for the care provider by providing solutions like decision support systems, ready reference material from across the world including the latest researches, automation of pharmacy and certain diagnostic modules.

Billroth Hospitals are a group of tertiary care multi-specialty hospitals.

We provide a range of preventive and curative medicine services for all major illnesses including coronary heart disease, comprehensive cancer care, multidisciplinary care for stroke patients, renal diseases and transplants, infectious diseases and multidisciplinary trauma management.

Home healthcare plays an important part in ensuring better patient outcomes and the concept is a gaining a lot of popularity in India. Kindly tell us about the services provided by your hospital in this regard.

We at Billroth Hospitals believe in continuity of care spectrum. Most of our surgical cases, we believe, can do better with the provision of trained healthcare provider at the home, post-discharge. To provide for the same we have a pool of professionally trained nurses and physiotherapists who are deployed for care at patients’ homes. These personnel are picked and trained especially to perform and provide care independently, in absence of direct supervision. We take utmost care in the grooming of our homecare staff to bring them up to the mark. Owing to our strict selection criteria, we do fall short on the re-

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Tell us about the IT based services provided by your institution.

quirement of sufficient manpower for the same. To handle such scenarios, we have tied up with a few selected providers who, we feel, have a training program that can groom the nurses to provide acceptable quality of care.

For providing better access for patients to our home care services, we are now in the process of integrating technology with our regular operations.

In what ways can IT help bridge the existing Healthcare gaps in the country?

Medicine is a diverse and ever evolving field. I don’t think IT can replace the care provider in near future. But it can definitely play a crucial part in overcoming the shortfalls in certain areas. It can also supplement the ability of the care provider to reach a larger population base. It can also save

We have adopted the usage of technology into our regular operations.

Some of the channels where we optimise our work with the integration of tech tools are: ♦ Connecting with the patients and knowledge sharing ♦ Documentation and coordination of care ♦ Business analytics ♦ Remote monitoring and reporting

How has technology adoption impacted your operations?

We have had a lot of positive impact after adopting technological innovations, and it has helped us in a lot of ways, from admission/discharge processes to costing analysis. We can now track and breakdown a lot of our processes to study costing. We now know with a lot of confidence, how much, let us say, our dialysis cost is.

Another beautiful and a simple solution we have integrated is usage of WhatsApp for real-time patient feedback and response. It has helped us drastically in improving patient satisfaction.

Industry Perspective

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Industry Perspective

TECHNOLOGY SHAPING FUTURE of Pharma

Recognising and rewarding personnel who innovate as well as integrate risk and aligne the management to the entire tech innovation process, have become very critical for pharmaceutical companies especially to keep up with the innovations that patients want and investors expect, says Jasmine Gorimar, Head Information Technology, Boehringer Ingelheim India, in conversation with Elets News Network (ENN).

How innovations in technology space are changing the pharmaceutical industry?

Technological innovations in pharma have deeply impacted health and wellness of millions of patients as well as the bottom lines of companies providing it. Today, technological innovations that support or promote

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both product and business model innovations are a critical element of a corporate strategy and mission. The pharma sector is facing challenges in keeping up with the innovations that patients want and investors expect.

Pharma companies are becoming more customer-centric. This means that planning and execution of cus-

tomer centric strategies need to be boosted by an internal culture that promotes tech innovation. This also means recognising and rewarding personnel who innovate, integrating risks and aligning the management to the entire tech innovation process.

Pharma companies have long established relationships with phy-

Industry Perspective

How have Artificial Intelligence (AI) and machine learning brought in new opportunities to drug manufacturing and bolstered R&D efforts in the sector?

Both AI and machine learning provide pharmaceutical industry with immense opportunities to do R&D differently, so that it can operate more efficiently and substantially improve success at the early stages of drug development. This means that vast resources will be deployed more effectively not only to give a better ROI but also bring in a substantial increase in the delivery of new drugs and invariably shorten the drug discovery process.

An active researcher deals with a huge amount of new information every hour of the day.

AI and machine learning have a vital role to play in augmenting the work of drug development by researchers.

Pharma is still at the inception phase at using AI and machine learning for drug discovery.

However, they can be used extensively for selection of patients for clinical trials, enable companies to identify efficacy and safety issues with compounds much earlier and the ability to tap into a much broader chemical space

An adoption of cloud computing has granted pharmaceutical industry with enhanced scalability potential. Apprise us on the major issues linked to the increased usage of cloud computing in the pharmaceutical industry

Low cost and on-demand availability of computing resources are the two key drivers to move to cloud computing in any organisation. However, some of the major issues include: ♦ Lack of trust in data security and privacy in cloud service providers.

A service level agreement (SLA) may not offer or allow the ability to audit your company data. The decline or loss of company data governance could have a deep impact on prevailing company strategy. ♦ Technical challenges include resource exhaustion, unpredictability of performance, data lock-in, data transfer bottlenecks, and bugs in large-scale distributed cloud systems. High competition amongst cloud providers can cause an over commitment of computing resources, and hence they cut corners towards delivering value to customers. ♦ Data lock-in is also an important challenge. Most cloud infrastructures provide very little capability on data, application, and service interoperability. Hence it is difficult for a company IT team to migrate and move data and services back to an in-house IT environment from one cloud provider to another. ♦ Data security risks that are owned by the company despite having engaged a cloud service; specific risks to cloud computing are separation failure, public management interface, poor encryption key management, privilege abuse, nat-

ural disasters, political unrest, etc.

These are all finally owned by the company. ♦ Legal issues: Contract law, intellectual property rights, data jurisdiction, and data privacy are important and major concerns.

How should pharma companies leverage the digital health market to enhance their offerings?

The growing mobile health market is one of the main contributors towards doubling the pharma digital health market. This includes small apps, mobile solutions, cloud applications and services. Following core topics should be addressed by pharma companies to succeed at the above: ♦ Digital Strategy: Digital strategy derived from the marketing strategy and company strategy ♦ Patient Value Offering: Ability to target unmet needs and improve patient life, utilising the full potential and broad spectrum of digital solutions ♦ Innovation: Redefinition of innovation metrics for digital developments and offerings to prioritise investments In order to leverage the full potential of digital health solutions available, IT and digital marketing teams in pharma companies need to develop smarter designs (technical and use case) that target specific patient needs leveraging existing technologies and making use of accessible patient data whilst incorporating all parties along the treatment pathway.

Additionally, pharma companies eventually face the need to reorganise or redesign the respective organisational responsibilities and hence the business model deployment to be adapted.

Engagement of cloud solutions should involve strategic planning to determine the solution’s or objective’s benefits and risks, assessment of the cloud solution’s capabilities to acheive company objectives and identify strategies designed for its correct implementation

“

sicians and healthcare units. However, the role of payers is becoming increasingly important as they start to tie reimbursements to patient outcomes. That’s a radical challenge for pharma companies to further innovate. Strategic partnerships with external collaborators to boost tech innovation and growth have become critical. Joint development of new molecules through an open portal, hard data for drug effectiveness and measurement, licensing agreements, expanding service offerings, rethinking business models, investing in a start-ups exploring new ideas or working together, etc, is becoming absolutely important.

Additionally, pharma companies are also impacted by “dark innovations” in the cyber or virtual world.

Therefor, focus needs to be shifted towards IT security and IT compliance.

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Industry Speaks

dWise HealthCare Solutions for Care Anywhere

Healthcare information technology is significantly changing the healthcare delivery system in India, making it more convenient to track medical history of a patient and facilitating reduction of long queues at doctors’ clinics. Sandeep Raizada, Chief Technology Officer, dWise HealthCare tells Elets News Network (ENN) about its healthcare IT solutions that are changing the healthcare delivery landscape in India and the world.

H

ow often have we seen doctors look through all past prescriptions and lab reports that a patient carries in a folder (many, including me who do not even have all records in one place). This is not due to lack of will in a doctor but simply the paucity of time and the pressure to meet as many patients that are waiting in the queue seeking help.

How often have you been able to tell the doctor, all your current or past conditions, medications, etc and so missed unintentionally (as a combination of lack of time, not remembering or simple ignorance), mentioning a condition or a current medication that may have an impact on what the doctor is about to prescribe.

Is this a viable system? Persistence of this existing method does not mean it is the best - it is like the warning in mutual funds - “past performance is no guarantee of future results”. In this case it is of future failures.

Let us paint the future. One is able to walk to a doctor’s office with minimal waiting time. If someone has made

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an appointment then he or she will be made aware before leaving home to the doctors’ clinic, if the doctor is out or running late. As this not a social visit, one is looking to minimise the wait time and discomfort.

The appointment happens to be with a new doctor in another hospital where the patient has not been before. Invariably, one forgets to carry their records. Imagine one’s surprise, when upon validating their identity the hospital can view details of previous visits to doctors. One is assured that they can now carry their health records on their mobile app and do not have to worry about forgetting their medical file.

The new doctor can now see the patient’s family history, allergies, current medications and relevant information to make a diagnosis, prescribe tests and medication. All this can be done while enquiring with the patient on their current reasons for the visit.

Without informing the patient, the system quietly alerts the doctor, that the drug prescription given has a drug in-

Industry Speaks teraction to the patient’s allergies or conditions such as pregnancy or to another current medication. The doctor can now quickly change the drug, saving the patient from a potential grievous situation.

If the patient is unaware of the prescribed strange sounding test, he or she can check from within the app about this test. Apart from that, it also advises the patient on how to manage this disease.

On completing the test, all the results are in the patient’s health record which is also viewable on their mobile.

"Is this real or year 2025? The good news, it is possible today"

How is that?

A suite of products from dWise Healthcare, a company rated as the leader in healthcare information technology by both “Siliconindia” and “CIO Review”, makes all these scenarios and more possible. A quick look at some of our unique offerings: ♦ The Lifertrenz platform is a patient centric, workflow enabling, standards compliant, highly configurable and scalable platform that has:♦ Drug Information Framework and Clinical Decision Support System (CDSS) - A comprehensive Drug Database covering more than 120,000 drugs sold in the country, with a Drug Information Framework built ground up by the team and based on Indian Pharmacopoeia is one of a kind in India. The CDSS offers real time alerts on various drug-drug, drug-allergy, drug-disease, duplicate therapy, drug-food, pregnancy/lactation, hepatic/ renal dosage adjustments, geriatric, and paediatric interactions and adjustments to the doctors. ♦ Operations Management - for managing the entire operations of a healthcare delivery organisation irrespective of size and lifecycle of a patient including complex billing scenarios that exist with co-pay or insurance payments and integration gateways. ♦ Electronic Health Record - Ensures that for longitudinal care, all patient healthcare records are captured and maintained compliant to Indian and International EHR standards, with point of care appropriate clinical decision support, in both PC and mobile platforms. Also offers, seamless transfer and interoperability of health records using CCDA standards. ♦ Quality Management - With complete support for NABH/ JCI accreditation. ♦ Tertiary care back office - A comprehensive Enterprise Resource Planning software to take care of procurement, inventory, financials, assets, human resources and payroll. ♦ Patient applications - portals and mobile applications to integrate patient from making an appointment, viewing their health record, capturing home based vitals and individualised context based patient education. ♦ High scalability - Foundation, unlike any other software today in the country, is based on all international standards in healthcare - SNOMED CT, ICD 9/10, RxNORM, LOINC, DICOM, CCDA, HL7 etc, giving it the flexibility to integrate with any standards compliant third party

solutions and scale up to handle large patient volumes.

What makes it Possible?

Taking a different route, dWise hires only freshers and invests on training and grooming them into outstanding engineers. The company believes that the burning desire amongst young people to make a mark in the industry has helped them to build a highly productive team and great products at very competitive costs. While the engineering team is home grown, the management and the domain experts each has an average of 25 years industry experience. dWise is an Indian company that started early and made its mark in the US market, before anyone even heard of it.

Back in 2010, Bengaluru-based dWise developed a cloud based Ambulatory EHR Solution for primary care and an inpatient EHR product for hospitals for the United States.

This solution received Meaningful Use (MU) Stages 1 and 2 certifications, making it the first Indian company to achieve this milestone. With 20+ hospitals on the platform, it was acquired by a leading Healthcare IT player in the U.S. in January 2015. From 2012, dWise leveraging their domain expertise in healthcare IT, went on to develop several other Healthcare IT products to address the requirements of the healthcare sector in India and international markets under the brand “Lifetrenz”. These products are fully compliant to both international and Indian Healthcare IT (HIT) and Electronic Health Records (EHR) standards approved by the Ministry of Health and Family Welfare (MOH and FW), Government of India.

Proof is in the Pudding

Today, more than 40 hospitals in India run their Hospitals on Lifetrenz suite. AIIMS, New Delhi has opted to run its entire OPD services using the Lifetrenz EHR platform. In our effort to return to society, the Lifetrenz primary care platform is being offered to primary care physicians, on a charge free basis.

About the Author Sandeep Raizada has extensive experience in business process consulting, process automation and mathematical modelling systems with applications in multiple industry domains.

Prior to joining dWise Healthcare as its CTO, he completed an IT de-merger programme at Dupont/Axalta (Carlyle owned).

Before that he was a Director at Logica CMG (now CGI) and AVP at HCL Technologies. He has lived and worked extensively in Europe and America during his tenure with HP, Siemens AG and ABB in various capacities.

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79

Public Health Initiative

PPP EMERGES

as a Potent Tool to Achieve Excellence in Healthcare

Karnataka has made tremendous gains in the delivery of healthcare to the majority of its population. However, access to healthcare is only of value if the care is of high quality. It is in this regard that the public-private partnership (PPP) has emerged as an effective tool, observes Elets News Network (ENN).

P

ealth status of the community has engaged the attention of the public as well as the private stakeholder from the beginning of this decade. Rapid progress in achievement of health indicators has been made after implementation of National Rural Health Mission (NRHM) in state with adequate strengthen-

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ing of the public healthcare system. Still display of available services, accountability and transparency lack in public health system. This has led to inadequate access for essential healthcare services which is a key step towards achieving of Universal Health Coverage (UHC). Community often depend on the unorganised, and at times, unqual-

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Public Health Initiative ified private providers leading to heavy out of pocket expenses. Realising this significant gap for improving access for public health care, the Government of Karnataka has launched the e-Hospital programme to provide accountable and transparent health services to the community.

Public-private partnerships (PPP) are increasingly seen as playing a critical role in improving the performance of health systems worldwide by bringing together the best characteristics of the public and private sectors to improve efficiency, quality, innovation, and health impact of both private and public systems.

While partnerships can be an effective force toward achieving these results, they are not a complete solution to the many problems that now face health systems. If partnerships are to be effective in addressing the issues of poverty reduction and equity, quality improvement, and cost containment, considerable work will need to be done to develop the accountability and transparency, the legal and regulatory framework, and the mutual trust that is necessary for partnerships to succeed.

In today’s scenario of complexity and rapid pace it is almost impossible to do anything alone. This is especially true in health where constantly rising prices, changing disease patterns, and increasing use of sophisticated technology for diagnosis and treatment have made it virtually impossible to imagine any single organisation providing services without some type of institutional partnership.

The partners, too, may vary from private—for—profit companies, not—for—profit organisations, Governments, donor organisations, to community groups. Partnerships may vary in terms of financing of crores of Rupees to the sharing of non-financial resources. However, all partnerships have one thing in common: they have come about because both partners believe they have something to gain from the partnership agreement.

However, financial gain is not the only benefit of partnership, and in many cases of partnership, other considerations provide the incentive. A common one is the transfer of technical knowledge between partners. This is often the case in partnerships between the public sector and NGOs, where both partners have knowledge and skills that is useful to the other are able to learn from each other Karnataka has made tremendous gains in the delivery of health care to the majority of its population. Today, most people have access to health care. However, access to health care is only of value if the care is of high quality.

This has been more difficult to achieve, and is one of the hopes for partnerships.

In order to provide quality health care and to operate, manage and redevelop the existing Government Mother and Child Hospital complex which is spread over three plots of land in Udupi town, KM Marg Road as well as development of a centre of excellence hospital and preventive and community health facility in this premises, the philosophy of public-private partnership was thought of.

There was a 70 bedded government mother and child hospital, which building was in a very dilapidated condition. The average outpatient per day in this hospital is around 150 and the average inpatient per day is around

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100. The existing place had become acutely insufficient to meet the current demand. Since it is a government hospital, it invariably needs to cater to all sections of the society who come for relief. However, the institution was not in a position to respond to the aspirations and the needs of local population.

Under the said circumstances a proposal was submitted to the department by a philanthropist, expressing his interest and commitment to construct a 200 bedded mother and child hospital, which thereby enhances the bed strength from 70 to 200. He had also expressed 100 per cent free service to all the health assurance beneficiaries.

He had further made it clear that the entire cost of construction of this structure would be borne by the service provider, besides the required quarters for doctors and allied staff along with hospital structure. It is also represented that the entire management of the hospital such as the wages to the working staff and supply of medicines was also offered to be taken care by the service provider.

The service provider (BRS Enterprises) run by an NRI, who originally belonged to Udupi town and did this work in memory of his late father, had suggested that the Institution be named after his beloved father and the department felt that the said proposal looked credible and it could be appropriate to re-name the hospital.

The proposal to put up 400 bedded centre of excellence hospital in the same locality on the land that belongs to the said mother and child hospital was also examined which is spread over three plots of land in Udupi town measuring 3.88 acres and leased the land for the project for a minimum period of 30 years .

For patient seeking emergency treatment, the services for any mother and child hospital is proposed to be completely free of cost in centre of excellence hospital. Besides this various groups of people covered under different Government Schemes will have the priority as per guidelines of Government of Karnataka.

This hospital is proposed to offer free medical care to mother and child patients residing in Udupi district. It is also proposed to set up residential quarters for staff accommodation on the said plot. The proposed hospital offers specialised and super-specialised medical services free of cost to Memorial Hospital patients and to other BPL families and proposed to provide services as per government schemes to health assurance beneficiaries. The pricing for other patients it intended to be transparent and ethical. A preventive and community health facility also proposed in the hospital complex.

Public Health Initiative

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Years

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Industry Perspective

CHRONIC DISEASES DEMYSTIFIED

BY DATA

A connected health platform can seamlessly integrate with a large set of health sources that track variables like biometric vitals, physical activity, behavioural traits, sleep patterns, diet, medication, genetics – every possible digital trace that a consumer leaves, writes VitaCloud, for Elets News Network (ENN).

C

hronic health conditions affect millions of people in our country every year and the numbers are only growing. Diabetes, cardiac diseases, hypertension and obesity are among the most common and complex yet preventable of all health problems.

According to the National Family Health Survey results announced earlier this year, it is estimated that over 10 per cent of Indians suffer from diabetes and an equal number are hypertensive.

By now, it has been largely established that genetic disposition, lifestyle and diet are the main contributing factors creating this health crisis. Current systems designed

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to tackle these diseases revolve predominantly around episodic events, with over-reliance on sparse data generated from clinical encounters. The current trends in today’s digitally inspired world present an opportunity to solve some of the biggest challenges in healthcare — cost and quality of care, patient-centricity and continuous engagement.

Connected Health

Against this backdrop, the connected health model promises to usher in an era of personalised medicine and improved outcomes. By empowering both the patient as well as the caregiver with the relevant digital tools, data and in-

Industry Perspective sights, it is possible to improve the quality and cost of care.

To make the overall healthcare process more effective, a technology-enabled care model provides various opportunities like: ♦ Delivering continuous and linked care, from the clinical context to the home setting ♦ Bridging the time and distance gap between the caregiver and the consumer ♦ Addressing the complete care continuum, from preventive strategies to curative episodes ♦ Engaging other stakeholders like insurers, employers and the community, in extending healthy lifespans

VitaCloud’s Approach

In this context, VitaCloud enables caregivers to offer personalised care, and empowers patients to make informed health choices.

VitaCloud’s secure and scalable cloud-based platform seamlessly integrates with hundreds of health sources including smart medical devices, wearables, mHealth apps etc - enabling caregivers to dynamically collate real-time data from daily health events, into a single story of consumer well-being.

A connected health platform can seamlessly integrate with a large set of health sources that track variables like biometric vitals, physical activity, behavioural traits, sleep patterns, diet, medication, genetics and others –every possible digital trace that a consumer leaves. By being able to follow such health parameters in real time, it is possible to track physiological changes that occur during an illness or over the course of a normal day - allowing for the creation of a smart health baseline for every individual.

Interventions can be triggered by recognising critical signals from these vast troves of data. Cognitive engines will detect any outliers and deviations from the normal, to notify both the consumer and care provider.

Case Example 1

Continuous Care Technology-enabled care can help chronic disease patients by supporting self-management and treatment adherence. Smart recommendations could remind hypertensive patients to take a blood pressure measurement immediately after an exercise, or inform diabetic patients to adjust insulin intake prior to workouts.

Case Example 2

Transitional Care One of the best use cases of connected health is remote patient monitoring of individuals in post-operative care.

Physicians can have ongoing touchpoints with the patient, and get alerted in real time if significant deviations are detected in their vital indicators, measured via in-home medical monitors and a mobile smartphone.

A connected health ecosystem holds the promise of reducing the cost and complexity of managing chronic diseases so that patients can stay well, remain digitally engaged with their caregivers, self-manage their condition and thus have total control of their health.

VitaCloud offers three options for businesses to get started: ♦ Fit: to track physical activity and fitness levels of their end-users ♦ Care: to effectively manage chronic conditions like diabetes and hypertension ♦ Heal: to monitor high risk patients who require close support Each of these options comes with a configurable Healthcare Kit that includes both applications as well as optional smart health devices. Businesses can also use an API-only version, in order to integrate the VitaCloud offering directly into their own software.

VitaCloud’s goal is to help businesses manage, motivate and incentivize consumers, to extend their healthy lifespans. By deploying VitaCloud, physicians can offer better treatment to patients, Insurers can provide their policyholders with incentives to stay fit, and corporates can drive towards improved workplace wellness.

Disclaimer: The views expressed in this article are solely those of the authors (http://vitacloud.io)

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Industry Perspective

TECHNOLOGIES TO DRIVE CHANGE in Pharma Industry

Technological innovations like Artificial Intelligence are set to change the way clinical trials are conducted in the pharma industry. Besides this, 3D printing and new innovations like portable ECG machines are also going to help patients to have early detection of heart disease, says Ravi Sharma, CIO of Marksans Pharma Ltd, in conversation with Elets News Network (ENN).

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Industry Perspective How the pharmaceutical industry is being impacted by innovations in technology?

In pharmaceutical industry, one has to innovate keeping in mind the ‘Right First Time’ concept because rewards for success are very high and the failure of innovation is linked to the very survival of the company. For every molecule, filing first for the patent pays a very high dividend.

Information, research and new manufacturing techniques are some of the important drivers of growth for the pharmaceutical industry and theft of such important data can be a real-threat. So, how do you develop and implement potential security solutions to identify and mitigate such risks?

Please apprise us on the major issues linked to the increased usage of cloud computing in the pharmaceutical industry.

Presently, there are some regulatory requirements like the data should be stored within the country and proper backup schedule is acceptable to the data owner. However besides that, there should be more stringent SLAs (service-level agreements) with the vendor with proper exit clause. It should also be ensured that the data is recoverable in the format that you

can read at the time of contract termination. Data security is another concern which needs to be looked into.

How ICT is being leveraged to enhance the industry’s offerings and growth?

Mobile technologies can potentially act as a catalyst to increase the impact of digital offerings when they are applied. Digitisation of data and its availability when it is needed is another offering which will helps pharma industry’s growth.

Intellectual property is the bread and butter of the pharma industry. Therefore, it is imperative to protect the intellectual property using technology.

We have been using data leak prevention tools in our organisation to secure such data.

What kind of latest innovations are you implementing in your manufacturing facilities and R&D centres?

We are in the process of setting up a full-fledged R&D centre. But in the meantime, we have implemented solutions like document management system, empower systems and lab solutions software, etc to boost our efficiency.

How technological advancements have brought in new opportunities for drug manufacturing and to bolster R&D efforts in the sector?

Intellectual property is the bread and butter of the pharma industry.

Therefore, it is imperative to protect the intellectual property using technology. We have been using data leak prevention tools in our organisation to secure such data.

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Currently, clinical trials are carried out on subjects. But in near future using Artificial Intelligence the trials may be conducted through simulation models. 3D printing will also help in proper diagnostic and accurate treatment of patients. Recently, new innovations like portable ECG machine that can fit into palm and send the ECG report to your doctor have also gained popularity. This will help patients to have early detection of heart disease.

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Industry Perspective

EMPOWERING MEDICAL TRAVELLER

with Seamless Care The idea of India Virtual Hospital (IVH) was born to create an organised and professional process of decision-making by empowering patients with the right and relevant information and facilitating them at every step for smooth and seamless patient care experience, says Swadeep Srivastava, Founder & Managing Partner, India Virtual Hospital, in conversation with Elets News Network (ENN).

How did you come up with the idea of India Virtual Hospital (IVH)?

What is the vision behind it?

In my 20 years of professional career in healthcare sector, there have been numerous cases, probably 1012 cases every month, where people have approached me, especially medical travellers, to seek guidance

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“IVH has a robust technology along with a state-of-art specially designed hybrid mobile app which comes with dual interface, one for the channel partners/ IVH patient care partners and the second one for the patients and their families.�

Gaurav Pandey

Co-Founder & Lead, IT & Technology, India Virtual Hospital

Industry Perspective and advice to select the right doctor and treatment in Delhi. Due to lack of credible information and trust on the existing referral system, every month several patients go back home unsatisfied because of bad experience in their whole patient journey.

Hence, the idea of India Virtual Hospital (IVH) was born to create an organised and professional process of decision-making by empowering patients with right and relevant information and facilitating them at every step for smooth and seamless patient care experience. IVH is a tech-enabled specialised medical concierge service addressing the needs of medical travellers (domestic and international) looking for quality medical treatments in Indian hospitals and health care centres.

How does IVH help patients map their medical travel plan as per their needs?

A medical traveller or his family member has to just call us at our health line number 09999-668-222 or visit our website, www.IndiaVirtualHospital. com, to inform about his tertiary care treatment requirement. Thereafter, the IVH team takes over either through tele-consultation or the Patient Care Champion (PCC) enrolled under our Expanded Patient Care Programme who works as a caregiver to patients in their city. IVH PCP is backed by our robust module of ‘Patient Education’ and counselling programme run by our in-house doctors and patient counsellors. He is aptly supported by our five core services: IVH Expert, IVH Health Assistance, IVH Concierge, IVH Patient Education and IVH Recovery Assistance.

All the patient’s queries are responded in a neutral and unbiased

“There are glaring gaps in the patient care services that leave patients and their care at a disadvantage leading to sub optimal services and low patient satisfaction level. The services of India Virtual Hospital are game changer in the healthcare industry of India as it empowers patients at every stage of their journey. The whole objective of IVH is to provide seamless and smooth experience to patients and their family members, right from the diagnosis to treatment to follow-up stage.”

Dr Jatinder Kumar

Medical Advisor, India Virtual Hospital way helping him to make an informed decision through multiple options of doctors, hospitals & their costs in the comfort of his home. Once the patient has decided, he is further given a choice to speak to the selected doctor or his team member for any query to make him more confident and aware of his choice and his ensuing treatment journey. Once a patient lands in Delhi, he is attended by IVH health assistant and concierge professional and is guided through the whole patient journey till he is discharged and heads back home. Each step of services is going to be integrated on our specially designed hybrid mobile app which comes with Dual Interface, one

for the Channel Partners/ IVH Patient Care Partners (IVH Care Giver App) & the second one for the Patients & their Families (IVH Care Seeker App).

IVH PCC through the app plays an important role in maintaining continuity of care. For international medical travellers, we have also added value-additions like free yoga for patient and family, Ayurveda and other AYUSH therapy options.

What kind of an impact do you see post IVH?

It is too early to say that we have already created an impact. But for sure, our objective at IVH is to create an impact on the medical travelers

“Information is power. IVH Patient Education Series strive to create an organised and professional process of ‘decision-making’ by empowering patients with the right and relevant information in an unbiased and neutral way and facilitating them at every step for smooth and seamless patient care experience.”

Rai Umraopati Ray

Co-Founder & Lead, Patient Education, India Virtual Hospital

A medical traveller or his family member has to call us at our health line number 09999-668222 or visit our website, www.

IndiaVirtualHospital.com, to inform about his tertiary care treatment requirement.

decision making, treatment seeking and treatment experience process by working with them closely at each level. We have for the first time introduced a concept of Patient Happiness Index, which is calculated by adding up feedback of the patient at all the five levels of our support and intervention which becomes a parameter to judge the success of our care module.

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Healthcare Technology

GIS MAPPING for Health Infrastructure’s Location

Mooted by the Karnataka Knowledge Commission (KKC), Karnataka Geographical Information System (K-GIS) has facilitated faster decision making by the Department of Health and Family Welfare by helping it map various departmental assets, observes Elets News Network (ENN).

T

The Karnataka State Remote Sensing Applications Centre (KSRSAC), under Department of Information Technology and Biotechnology, Government of Karnataka, is entrusted with the implementation of Karnataka Geographic Information System (K-GIS).

As part of the K-GIS Programme, the Department of Health and Family Welfare in coordination with the KSRSAC completed mapping of various departmental assets like location of hospitals – District hospitals, PHCs, CHCs, trauma care, ambulances, blood banks, etc. Following data sets are available on KGIS portal: ♦ Arogya Kavacha Ambulance ♦ Nagumagu Ambulance ♦ State Ambulance ♦ Trauma Centre ♦ Scanning centre ♦ Primary Health Centre ♦ Community Health Centre ♦ Sub Centres ♦ District Hospital ♦ Taluk Hospital ♦ Private Hospital ♦ Training centre DTC HFWTC ♦ Health Dashboards

Benefits of K-GIS

Citizens: Explore various facilities and assets across various government departments and public utilities. Useful for Navigation, Information needs.

Enterprises: To utilize the benefit of multi departmen-

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tal datasets and develop applications for various business and citizen needs.

Government Departments: Enhance efficiency of governance, decision-making, planning and development actions on the Karnataka GIS DSS Applications.

The K-GIS has the querying capability on various data based on location (buffer query) and attributes within specific geographical area of interest (administrative or electoral boundaries of Karnataka). It also provides dashboard with a display of statistics of various assets or facilities in GIS which may be useful to extend the planning objectives for the department.

A dedicated mobile application is developed wherein the citizens can use it to identify the nearest emergency response facilities like hospitals, police station, blood bank, etc. KGIS portal (www.kgis.ksrsac.in/kgis) is also developed to allow visualisation and querying of various thematic data and assets of various departments.

This Android-based mobile application can be used by the users or general public which can help them to identify the nearest hospital locations, its distance and route for navigation from their current location. It is requested that the citizens can make use of this application for identifying the nearest government health center facilities. The vaccination and other immediate treatments are available in these centers. The mobile application can be currently downloaded from the web-link – www.mobile.ksrsac.in/ nearbyservice. Android users can download, install and use the application in their mobile. The same is made available on the Google Play Store also. .

AKHIL SYSTEMS

iracle His

Digitizing the Healthcare Since Decades......

Industry Leader in Healthcare IT Rated as “10 fastest growing “Healthcare solution providers 2017 by Insight Success

Rated as Top 15 MEDTECH Leaders of the country 2017

by Medgate magazine

Winner of “Best HIS and HIMS Provider of the Year -2013” by e-India Award

Recognized as “20 Most Promising Healthcare Solution 2016”

Winner of “Best HIS and HIMS Provider of the Year -2015” by e-Healthcare

Recognized as “Company of the Year ‘14 – Healthcare HIS by CIO Review Magazine

Serving Nation from last 2 Decades Domain Experts

Pan India Presence

Global Presence..

22+ years of Experience

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Implementation in 200+ hospitals

Miracle HIS handles more than 3.5 million admissions per year

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