eHealth April 2012

asia’s first monthly magazine on The Enterprise of Healthcare

volume 7 / issue 4 / April 2012 / ` 75 / US $10 / ISSN 0973-8959

www.ehealthonline.org

The ‘DNA’ of Healthcare Organisations p-12

Telemedicine & the Ability to Consult Remotely

Go Green, Go Paperless p-22

Virtualise, Connect, Deliver With ongoing technological advancements and growing awareness, healthcare IT will strengthen the foundation of our healthcare systems

he sp alt ec h ia it l

p-48

Clinical information at the speed of care

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volume

07

issue

04

contents

ISSN 0973-8959

8

cover story India Needs a Giant Leap

IT is gradually picking up pace to integrate the economy from the forefront, but concerns remain on huge digital divide in the healthcare sector

By Dhirendra Pratap Singh and Shally Makin

hospital information systems

12

The ‘DNA’ of Healthcare Organisations

eletcronic medical records

22

Go Green, Go Paperless

Radiology Information Systems

33

Telemedicine & the Ability to Consult Remotely

mHealth Apps on the Go

expert corner

60

Director, CBHI and DG of Health Services, Ministry of Health and Family Welfare, Govt. of India

P Rammohan

32

Alam Singh

36

Rajiv Agarwal

41

Malav Kapadia

42

Sid Nair

68

Dinesh Samudra

70

Dr Aruna Srivastava

Managing Director & Co Founder, Healthsprint Networks Pvt Ltd

Assistant Managing Director, Milliman India General Manager, Healthcare Infomatics, Philips Vice President - Sales, Religare Technologies Vice President and Global Head, Healthcare & Life Sciences, Dell Managing Director and CTO, Palash Healthcare Consultant, National Institute of Malaria Research, Indian Council of Medical Research, Ministry of Health & Family Welfare

72

Dr Gayatri Vyas Mahindroo Dr Madhulekha Bhattacharya

Director, NABH, Quality Council of India

Sanjay Kumar Jain

14

74

VasuKumar Nair

16

75

Aditya Mani

Suchet Singh

18

76

Dr Praneet Kumar

Vennimalai

20

78

event report

Managing Director, Akhil Systems Pvt Ltd Director - Marketing Strategy & Sales, 21st Century Healthcare Soultions CEO, Srishti Software Applications Pvt Ltd

Managing Director, Aavanor

4

48

Dr Pradeep Saxena

30

Imaging Demands Digitisation

telemedicine

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april / 2012 www.ehealthonline.org

Professor & Head, Dept. of Community Health Administration, National Institute of Health and Family Welfare Director (Systems), Acuis CEO, BLK Super Speciality Hospital

Healthcare Leaders’ Forum 2012

volume

07

issue

04

asia’s first monthly magazine on The Enterprise of Healthcare

President Dr M P Narayanan

Editor-in-Chief Dr Ravi Gupta

gm Finance Ajit Kumar

dgm strategy Raghav Mittal

programme Dr Rajeshree Dutta Kumar specialist product manager Divya Chawla partnerships & Sheena Joseph

Alliances Shuchi Smita

Editorial Dhirendra Pratap Singh, Anand Agarwal, Pragya Gupta, Shally Makin (editorial@elets.in)

Sales & Delhi ncr Marketing Rakesh Ranjan Mobile: +91-8860651635 Fahimul Haque, Jyoti Lekhi, Ragini Shrivastav (sales@elets.in)

Mumbai: Rachita Jha

Pune: Shankar Adaviyar

Bangalore: Puneet Kathait

Hyderabad: Amit Kumar Pundhir

Ahmedabad: Sunil Kumar

Circulation & Jagwant Kumar, M: +91-8130296484,

Subscription Gunjan Singh, M: +91-8860635832 subscription@elets.in Design & Bishwajeet Kumar Singh, Creatives Om Prakash Thakur, Shyam Kishore

Web Ishvinder Singh, Anil Kumar IMG Gaurav Srivastava

inbox Your site offered us with useful information to paintings on. You’ve performed an impressive process and our whole community will be thankful to you.

Mark on “Castle of Care” A burst aneurysm (a local area of bulge) in the abdominal aorta—the largest blood vessel in the body -- is a deadly condition. In fact, about half of these patients don’t make it to the hospital in time.

Ramendra Kaushik on “Minimally Invasive Surgery” Wonderful! There is a dire need to make systems work in harmony with each other. It is a long way ahead. I would further like to know what Fortis and Airtel are doing in this space. With Dr Ruchi Dass on board we definitely expect to see something transformational as we saw in ZTE China.

Narayan on “Ring of Healthcare” I like your wonderful article. Brilliant stuff. I hope you release more. I will continue reading. Greeting from across the world. Great post I must return for more.

Derek Chanchuan on “Sound of Imaging” Magnificent issues altogether, you just gained a brand new reader.

What would you recommend in regards to your publish that you just made a few days in the past?

Charles Myrick on “3G is Creating Wonders in Healthcare Domain”

IT infrastructure Mukesh Sharma, Zuber Ahmed

Events Vicky Kalra

human resource Sushma Juyal

legal R P Verma Accounts Anubhav Rana, Subhash Chandra Dimri Editorial Correspondence eHEALTH Elets Technomedia Pvt Ltd Stellar IT Park, Office No: 7A/7B, 5th floor, Tower - 2 C-25 , Sector 62, Noida, Uttar Pradesh 201301 email: info@ehealthonline.org

ehealth does not neccesarily subscribe to the views expressed in this publication. All views expressed in the magazine are those of the contributors.

The magazine is not responsible or accountable for any loss incurred, directly or indirectly as a result of the information provided. ehealth is published by Elets Technomedia Pvt. Ltd in technical collaboration with Centre for Science, Development and Media Studies (CSDMS) Owner, Publisher, Printer - Ravi Gupta, Printed at Vinayak Print Media, D-320, Sector-10, Noida, UP, INDIA and published from 710 Vasto Mahagun Manor, F-30, Sector - 50, Noida, UP, Editor: Dr. Ravi Gupta © All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic and mechanical, including photocopy, or any information storage or retrieval system, without publisher’s permission.

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editorial

Innovative Ideas that Click Health IT has revamped our healthcare systems. IT solutions are now engaged in strengthening the foundations of our healthcare infrastructure. IT is gradually picking up pace to integrate the economy from the forefront. Medical practices in underserved communities will continue to face challenges if they are unable to adopt IT in healthcare. Not only corporate, but also standalone small and mid-size hospitals have woken up to the adoption of hospital information systems (HIS) making it an integral part of hospital management.

Similarly, electronic medical records (EMR) and electronic health re-cords (EHR) are making their way into the hospitals, albeit at a slow pace.

While both EHR and EMR refer electronic version of records, EMR is limited to a specific institution or a group of institutions, while EHR relates to a common platform that will allow disparate institutions in the private and government sector to share medical charts electronically. Similarly, mHealth pro-vides great benefits to patient through a system of medicine reminders and appointment reminders, conducting research on confusing symptoms or connecting to systems such as iPath to ask for assis-tance in diagnosis. It enables last mile communication with the patients, who gain access health to all kinds of information.

The complexity of the current healthcare delivery system is the biggest bottleneck for communication among caregivers. It results in fragmentation of patient care. To address these issues, hospitals across the world, are now implementing processes to facilitate clinical integration in an effort to improve patient care and safety. Clinical informatics, including image storage in PACS, represents a tool by which clinical integration can be accomplished. It leads to the creation of a seamless working envi-ronment.

To gain an insight into the present scenario for IT in healthcare, and the future prospects of the industry, we have conducted a nationwide health IT survey. The respondents are concerned that there exists a huge digital divide in healthcare sector in India. In response to concerns, some panels have recommended relaxing certain standards and easing of the implementation of timeframes for rural facilities.

The current issue of eHealth covers key health IT segments such as hospital information systems, electronic medical records, radiology information systems, picture archiving and communication systems, mHealth, telemedicine, and technology in health insurance.

We hope you like the compilation!

Dr. Ravi Gupta ravi.gupta@elets.in

april / 2012 www.ehealthonline.org

7

Cover Story

India Needs a

Giant Leap IT is gradually picking up pace to integrate the economy from the forefront, but concerns remain on huge digital divide in the healthcare sector

By Dhirendra Pratap Singh and Shally Makin, Elets News Network (ENN)

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Cover Story

T

he healthcare sector has become one of the most glorified sectors of the Indian economy with launch of world-class facilities with cutting-edge technologies. Even the global meltdown has not deterred growth of this sector, which continues to see unprecedented growth rates. From the consumers there continues to be a very high demand for quality healthcare.

To gain an insight into the present scenario for IT in healthcare, and the future prospects of the industry, eHealth magazine conducted a nationwide health IT survey. The survey is an effort to help the decision-makers from the Government and leaders of national health projects, ICT experts and policy-makers separate the wheat from the chaff. The respondents consider health IT “invaluable” because it “delivers capabilities that cannot be replaced by non-IT tools;” and “significantly aids in the delivery of care.”

The findings are the result of a rigorous five-month-long exercise undertaken by our team. We have interacted with doctors, health IT professionals around the country and received their inputs regarding various parameters of the health sector. Health IT is the fastest growing field in the global healthcare marketplace. The health IT market has a combined annual growth rate of 11 percent, which is likely to continue through 2013. The report projected that the health IT sector will experience a 25 percent increase in market share as it expands from four percent to five percent of the global healthcare marketplace.

Health IT has now revamped the healthcare system by providing strength of character to the healthcare infrastructure. IT is gradually picking up pace to integrate the economy from the forefront.

Medical practices in underserved communities will continue facing challenges if they are unable to adopt IT in healthcare.

The respondents are concerned that there is huge digital divide in healthcare sector in India. In response to concerns, some panels have recommended relaxing certain standards and easing implementation timeframes for rural facilities.

The results show that 25 percent organisation’s average annual spend on IT is more than five crores rupees while 25

“Government’s ICT Initiatives are Reaching the Masses” “The healthcare sector in India is undergoing a phase of reform propelled by rapid economic growth. Over the years, India has emerged as one of the world’s most lucrative healthcare markets that are expanding rapidly. IT plays a great role in giving thrust to this growth with a wide range of solutions that aid in advanced healthcare delivery. Government’s ICT initiatives are reaching all parts of the country through telemedicine, tele-education Ravinder Raina Country Head – Private and e-governance.

Network Solutions (PNS), Unified Communications is one technology that has NEC India Pvt Ltd emerged as the next big thing in healthcare industry, enabling healthcare providers support for improved quality, enhanced patient care, and managing costs. UC technology also promises a profound effect on the way healthcare professionals conduct meetings and do trainings apart from facilitating easy communication regarding rounds presentations, staff training, patient education, and much else.

“Scope for Indian healthcare is immense” Healthcare has emerged as one of the most progressive and largest service sectors in India.

Indian healthcare sector is Subir Bhatnagar expected to VP & Global Head – reach US$ 280 Solutions, AGC billion by 2020 Networks Ltd and the industry is growing at a healthy rate of above 15 percent. In India scope for healthcare is immense. At one hand we have 1,225 million lives which are far more educated and aware; we have reduced number of people BPL from 407 million in 2004-05 to 354.7 million in 2009-10 which talks about improved affordability levels in India. Finally we have a lot of large enterprise also entering into this sector thus promising a more structured approach to the industry. These private players are actively taking best-in-class facilities to tier II and tier III cities as well.

“BI creates a competitive environment within healthcare organisations” Health IT market is growing, wherein healthcare companies are growing around 20-30 percent every year, the organisational energies are lot more Sanjay Mehta focused in that di- CEO, MAIA rection. The need Intelligence for BI (Business Intelligence) tools and services has remained high in this sector too.

Healthcare organisations have already spent on ERP and now it is time for them to invest in BI. Healthcare organisations are facing an increased need to improve their operations, increase transparency, modify business processes, and thereby drive their overall performance. In order to achieve this, it is necessary to integrate, cross and inter-departmentalise processes and information. The rate of clinical data collection is growing exponentially, with more providers adopting clinical information systems and using ambulatory electronic medical records.

april / 2012 www.ehealthonline.org

9

Cover Story

Highlights of Health IT Survey 2011-12 What IT is supposed to provide for your organisation?

What kind of Software do you go for?

50.0% 71.4%

28.6%

Flexibility Standardisation

Commercially available off the shelf (COTS) software

Both

Customised software

Others

Mix of both

50.0%

28.6%

What is your basis of choosing an IT vendor

What is your preferred level of interoperability of the software?

55.6% 37.5% 44.4%

37.5%

The cheapest solution provider The best quality provider

To interoperate only with my existing IT solution

The end-to-end deliverer Others

To interoperate only with IT solutions in affiliated/ partner hospital To interoperate with IT solutions of any and every hospital

37.5%

How do you measure the success of your IT project?

What is your requiremet of standards-based software?

90.0%

75.0%

75.0% Should be compliant to all/most common Health IT standards

Increase in revenue Increase in services

Should be compliant to ICD

Increase in overal quality and customer satisfaction

Should be compliant to IHE

Others

Should be compliant to SNOMED

37.5% 20.0%

Should be compliant to HL7

50.5%

Should be compliant to DICOD Need not be standard based

50.0%

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87.5%

Cover Story

“Wireless technology is the way forward” Lots of discussions needs to be conducted with users and big companies have to step up their investment. Government too has to come up with policy and regulations for benefit of the industry and users. As of now, there is no dearth of opportunities, but there is lack of direction and leadership. We mostly use non wireless technology in this space. The technology is available and wireless which can reach masses in very optimal way. Wireless technology is the optimal way to move forward.

The challenges being faced by the healthcare companies in India today are majorly lack of funding, lack of direction from the government and the lack of big players to drive this programme. IT can do only basic things like automating hospital management systems for easy and fast access of data and transparent environment. Also it is able to reach rural India with wireless means. It has also provided preventive information and knowledge to consumers. Again it is based on direction and vision from government and big time players entering this market space. If these things happen this can be a billion dollar opportunity. Growth will be basic health service, remote monitoring, optimising hospital and healthcare institutions and processes. The industry still does not have any set of defined standards.

Charles Antony CIO, Apollo

“Opportunities abound in the cloud”

“Health IT offers good opportunities”

In a country like India, technology plays a vital role in providing comprehensive healthcare services across different geographical regions. At NationWide, we use technology as a tool to provide continuity of care through our EMR (Electronic Medical record) facility, which ensures systematic main- Dr Santanu tenance of patient’s medical records Chattopadhyay (including doctor’s comments). These Founder and MD,NationWide records can be accessed from anyPrimary Healthcare where in the world through Internet.

Services Pvt. Ltd talks We have sensibly embraced the Networks Ltd ‘Cloud’ without compromising on security, yet keeping the operational costs low. On the applications side, we are moving slowly, but surely towards the “Cloud”. Having said that, we are looking at implementing a cloud based standards-compliant EMR system that will provide secured and reliable access to health registers.

Global market of healthcare IT is estimated at USD 100 Billion, whereas domestic IT marketing is of USD 250 million. Contribution of leading IT companies of India in global healthcare IT market is about USD 500 million. Healthcare IT market, both in India and worldwide is growing very fast. The growth of Devendra Patel healthcare systems in both urban and CEO, Medisoft rural areas is mainly due to high growth telemedicine and reach of mobiles and internet. Healthcare IT, particularly innovative solutions like telemedicine and ehealth, require understanding of healthcare and IT field and need to plan properly, the same is lacking at policy maker end, which results in under-utilised project. At present we have high quality equipments and connectivity, which makes it possible for doctor to treat patient remotely with equal efficiency as he is treating patient in the same room. Policy makers need to come forward and provide policy to regulate the market.

percent organisation’s average annual spend on IT is mere 25lakhs.

The results show that various IT applications installed in the companies are HIS from Intersytems, PACS, Oracle eBiz Backend, Share Point, EMR, CR, Tally and PayRoll. Major IT vendors providing the services are HCL Infosystems and Intersystems, PACE SOFTRONIX, Charly Computers, Ahmedabad for HIS, Datat-

ech for server, Communica Engineers for networking. The respondents told that installing health IT software can run into several pages, in short provides visibility into all functional data real time, controls including managing points and checkpoints, dashboards for quick decisions, improving patient experience and improving clinical outcomes. They told that participation, change management, train-

ing and lack of policy framework were the challenges faced during and after installation. The future plans for installation of more software applications included housekeeping, HR, CSSD management, integrated solution for Hospital and College and Mini PACS. We hope this survey offers critical clues to our readers in analysing health IT scenario in India and across the globe. april / 2012 www.ehealthonline.org

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hospital information systems

The ‘DNA’ of Healthcare Organisations

By Shally Makin, Elets News Network (ENN)

T

he healthcare industry is now looking at implementing systems which help streamlining records to create a framework which offers transparency to the patient, doctors and the administrators. The various enterprise solutions designed, act as basic units of healthcare organisation to access information with just as click, install and run format.

The only reason why many software implementations shows discrete and incomplete, abandoned or over time procedures along with the overpriced implementation costs is lack of expertise to understand the hospital processes. The hospital information systems (HIS) provide an organisational structure

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to improve clinical and financial processes. It is an interface to exchange information effectively in seconds inside and outside hospital. IT solutions allow hospitals with large areas and multiple locations to bridge distances, thus saving time and manpower. HIS can further be collaborated with various other IT applications such as EMR, RIS/PACS, LIS and more to effectively connect the requisite amount of information about the patient from every department.

We have opinions from various experts, vendors and healthcare professionals who discuss about the plethora of applications being used in the healthcare industry.

hospital information systems

Health IT market in India is close to `1300 Crore IT solutions allow hospitals with large areas and multiple locations to bridge distances, thus saving time and manpower Mallika Kapoor, Director, New Gen eSolutions

The Healthcare IT market in India is close to `1300 crore; it is projected to grow at 22 percent annually. The healthcare IT application market is currently pegged at `370 crore. Less than 5 percent of Indian hospitals have shifted to an IT based infrastructure so far. NextGen eSolutions has introduced a variety of new software systems in healthcare.

The list of solutions includes Hospilogix, a flagship web-based enterprise.

HIS/ EMR solution, with implementations in medium and large hospitals. Cardiologix’s unique data analysis and reporting features aid rapid reporting and research. Schedulogix is an online scheduling and appointment management solution and Ambulogix is a multi-locational clinic, diet and personal health management solution.

Healthcare IT is redefining the way that care is delivered in hospitals. While the industry is in transition, hospitals face a number of challenges. Escalating IT costs, both for hardware and software, put a burden on hospital finances. The

Indian courts are yet to admit an EMR as evidence in a medicolegal case – thus most hospitals must maintain both paper and electronic records. Until Indian hospitals confirm to quality standards, HIS/ EMR implementations will continue to be challenging and non-uniform.

The HIS cuts manpower costs, reduces the possibility of potentially fatal errors, allows faster delivery of medicines to the patient and helps prevent/ avoid stock outs. The HIS also enables efficiency in other hospital processes, such as purchase order and materials management, admissions, discharge, billing, etc.

In one Indian hospital, our HIS solution has reduced material cost by 18 percent, by eliminating pilferage. Barcoding and HIS solutions together can reduce medication errors by up to 86 percent. Adoption of EMR can free up space in hospitals. Patient privacy goes hand-in-hand with the adoption of Quality Accreditation, such as NABH or JCI. However, EMR adoption is yet to gain acceptance in India.

“Implement Patient Interface Applications” In India, primarily the focus has been on systems on patient centric applications. In order to make healthcare and care delivery more patient friendly, cost effective and accountable, the healthcare industry has to implement patient empowering and patient interface applications.

We have seen some growth in India in areas of patient portals and some hospitals are also adopting EMR applications; however, most of the EMR vendors in India are not growing at the expected rate due to sluggish adoption of

Sunil Boyini

Managing Director Pluralsoft Limited

these technologies by healthcare providers.

PluralSoft offers CareQuotient to track patient population identified as chronically ill

or requiring specific wellness/ prevention services over a period of time. ONTOS -Clinical Text Mining addresses the need of maximising value of all information by bridging the gap between structured and unstructured data. It enables information integration, retrieval and business intelligence with its unique, multi-tier, multi-platform operable flexible ontology-driven knowledge recognition-extraction-visualisation framework called ONTOS. Insufficient data on consumers and disease patterns,

absence of standardisation of healthcare costs and significant levels of frauds leading to under-pricing of insurance products and higher value of claims.

The opportunities are more on the programme management/administrative side of the healthcare business in areas such as HIS, billing and revenue management.

India has huge potential for tele-medicine and chronic disease management that is not being tapped into for lack of infrastructure and quality standards. april / 2012 www.ehealthonline.org

13

expert corner

“Soon, all Hospitals will have EMR system�

Real automation can be achieved only when clinical records get automated, says Sanjay Kumar Jain

I

n the 1990s, when Akhil Systems was launched, IT in healthcare was neglected to a large extent. We generated Enterprise Resource Planning solutions for healthcare in the 1990s.

We achieved very high success and gained around 40 customers in three years. In 1994-95, we got associated with reputed hospitals like Jaipur Golden Hospital and Moolchand Hospital.

The changeover came in the year 2000, when we did a very big project for Almana Group of Hospitals, Saudi Arabia and in 2004, we did a very big implementation for Apollo Hospitals, Dhaka, which is 95 percent paperless.

The main vision of Akhil Systems is to float technologies that fulfill all requirements in a hospital. Hospitals still have paper record systems and we aim to have a completely automated medical record system in all hospitals.

Challenges in achieving complete automation Hospitals generally go for automation of admin processes, only. But this is not real automation. Real automation can be achieved only when clinical records also get automated. We are pushing that agenda in India. Unless the doctors get involved, the clinical aspect cannot be automated.

The second biggest challenge is standardisation as there are no guidelines provided by the government for maintaining patient records. Government or the hospital authorities need to come out with some specific set of standards for maintaining clinical information.

Further, hospitals are completely lacking in their understanding of the IT part.

The biggest challenge that all middle level IT vendors face is that the user does

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Sanjay Kumar Jain, Managing Director, Akhil Systems Pvt Ltd not understand the value of IT. Hospitals usually have very low IT budgets and it is difficult to provide good solutions at such low cost.

Awareness in tier II and III regions Hospitals in tier II and III cities have now started to realise the importance of IT. However, we need to have products that suit their budgets as products in tier I segment are extremely costly for these hospitals. Also, standardised products suit the needs of these hospitals. We are also bringing out solutions on the cloud, which are more apt for hospitals in tier II and III cities.

The future All new hospitals are very keen on implementing electronic medical record system, right from the beginning. The transformation has already started happening

and in the next five years almost all hospitals will have an EMR system in place.

Product portfolio We have three products for the hospital industry—Enterprise for corporate hospitals of above 300 bed capacity, Premium for 100-300 bedded hospitals, and Standard for less than 100 bedded hospital.

We have also released a product in the US for doctors called EnableDoc and the same will also be launched in India.

We have a major expansion plan for 2012, as we will launch our EMR product throughout India. We, now plan to launch new offices throughout India, as well as overseas. We are already having a good position in the market with more than 150 installations and we now want to become the number one health IT provider in the country.

expert corner

“Every Organisation should have an IT Roadmap” The increase in willingness and acceptance of healthcare IT will drive the overall growth in this market Overall market Studies show that the software segment of the healthcare IT market is valued at `150 to 200 crore in 2012. Our market share in this space is around seven to eight percent. Our flagship product is Apex Enterprise Health Information system, which comprises of hospital information system, clinic information system, laboratory information susyem and electronic medical records with clinical decision support system and advanced imaging solutions.

The industry should look at the intrinsic value of products and solutions rather than just looking at the number of ‘modules’ and ‘reports’ available in the application. Every healthcare organisation should have an IT roadmap with respect to their business goals that can help them assess their current IT maturity to decide the route to be taken. Top management should take initiatives to change their IT department from a cost centre to a profit centre and this is very much possible with the new innovative products coming in the market. Hospitals with more than 100 beds and above are moving towards IT based infrastructure.

Benefits of automation Hospitals with higher levels of EMR adoption have higher direct benefits, when it comes to improving clinical efficiency and clinical service excellence.

While IT investment may initially appear to have a cost-increasing effect, due to high improvements in the business process efficiencies, there will be a visible result on actual reductions in hospital operating expenses. Our experience in HIS implementation of automating the revenue cycle management is that most

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VasuKumar Nair, Director - Marketing Strategy & Sales, 21st Century Healthcare Soultions hospitals show a decline in costs after two and three years.

On radiology information systems RIS/PACS provide radiologists with the environment to perform their work smoothly and efficiently. IT Increases the quality of care with immediate access to specialists in the other end. It speeds up

diagnosis and treatment with instant access to data and images. Consultations are sent via a secure Internet connection to specialists for online diagnosis.

Future plans In future, we plan to focus on the clinical side, analytics, integrations and telemedicine. We also plan to penetrate into the mobile health market.

expert corner

Workforce is not IT Trained

Healthcare Industry is evolving fast and offering tremendous opportunity to Health IT Vendors

Suchet Singh CEO, Srishti Software Applications Pvt

H

ealthcare business has shown tremendous surge in recent years. To take advantage of the wave, two major trends have been noticed. One- corporate giants have started chains of hospitals across the country. Second being emergence of chains of single super specialty hospitals. Managing these chains of hospitals has necessitated a common multi-location HMIS platform that can be accessed at multiple levels. In the multi-location space, our healthcare solution suite, PARAS is the leader.

Our healthcare solution suite, PARAS is an integrative platform that has helped hospitals manage their costs at activity level and substantially improve their revenues. It allows high interoperability of entire spectrum of healthcare technologies enabling client hospitals to deliver best-in class service. Most unique feature of PARAS is the activity based costing approach which has allowed client hospitals to right price their services.

PARAS conforms to all global and industry standards including HL7, HIPAA, NABH, JCI, ITIH, etc.

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Despite the promise that Indian IT Sector holds, a majority of SME workforce are not trained in IT and hence they resent the adoption of IT. Most of the branded IT products, fail to deliver in a typical Indian scenario on the grounds of relevance. Srishti, being an Indian company has known market more closely and hence, the PARAS is built to deliver in a Indian hospital ecosystem.

With IT sector developing fast, hospitals fear technology obsolescence. We have offered a solution to this problem by making solutions adaptive and modular, which allows hospitals to choose a customised solution based on their requirement to enhance clinical care without the fear of technology obsolescence and functional outgrowth.

Healthcare Industry is evolving fast and so, offers a lot of opportunity to Health IT Vendors like us. To manage their patient load, hospitals require HMIS software, which is interoperable, conforms to international healthcare standards and can handle their day to day operations efficiently. Chain of hospitals also requires a common HMIS platform that can be accessed at multiple levels. Further, most of them require a technology that does not get obsolete when business grows.

IT has revolutionised the way patient care is delivered. From usage of Electronic Health Records to store patient data, to usage of RIS, LIS modules have reduced human intervention to minimum and hence, have lessened the chances of careless errors. Further IT has automated most of the procedures in hospitals. This has led to them treating more patients and discharging them faster.

Indian Healthcare market has been showing a promising future, thanks to country’s economic growth. The rise of income among middle class has led them better access to healthcare.

Further in the wake of competition from healthcare industry in the west, hospitals in India are feeling the pressure of stepping up the quality of service delivered.

While the growth of healthcare Industry and HMIS adoption has surged ahead, policy development has not kept pace.

Hospitals deal with extremely sensitive patient data including medical, demographical, insurance, family history, etc. A breach in any of these data could jeopardise the security of the patient. Absence of clear policies makes them vulnerable to access to data by fraudulent means. World over, hospitals have adopted Health Insurance Portability and Accountability Act (HIPPA) as a standard to share patient data across different departments of the hospital.

expert corner

“High tech gadgets attract doctors” What, according to you, is the size of the healthcare IT market? What are the leading segments that fuel growth?

The healthcare IT market is now catching steam in India. With the markets in the west heading towards maturity, Indian providers are slowly waking up to global trends. Numbers such as an annual IT spend of around `500 crore by Indian healthcare providers are spoken about, but this is still very low compared to international spends. Over the next three years, the Indian market will see significant growth and market spend will easily double.

Large deals such as the `1000 crore plus ESIC deal with Wipro, conducted couple of years back and hardware/ software deals for a few hundred crore coming up in a few states are likely to increase general activity. While large IT companies will be strong contenders for mega deals, there will be significant activity for the mid-sized and smaller companies in the sub-10 crore deals.

Being one of the oldest and most coveted, healthcare IT companies in India, how do you see Aavanor’s progress in this market? Who are your key competitors in this space?

Aavanor is being perceived as a significant player in the Java/Open Source healthcare IT space. We are receiving an increased number of enquiries for EMR, HIS and BI solutions. As new players enter the healthcare space, they see technological superiority as a marketing advantage. This is largely good for the industry as overall standards are brought closer to international levels. It is now proven that

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Vennimalai Managing Director, Aavanor

quality of patient care and safety is vastly improved with good IT systems in place and the key drivers for IT acquisition are transitioning from accounting/billing, to medical perspectives.

Competition in this space is both from the large and mid-size Indian companies. We expect that the larger players will soon exit the sub-10 crore deals, as they will find them unviable, can bog them down and distract from the larger governmental deals.

While health IT experts across the globe promote the concept of paperless hospitals, very few Indian hospitals have actually adopted paperless functions. How can this change be brought about and when can we expect Indian hospitals to go completely paperless?

Most healthcare professionals in India simply don’t believe that going paperless is possible or even desirable.

However when presented with scientific

expert corner

Vennimalai, Managing Director, Aavanor, says that cutting edge technology has a big role to play in the life and profession of healthcare professionals

evidence that this is both possible and helps improve patient safety, they take to it with vigor. Their professional pride is also pricked when they see their class mates in the US making the change to EMRs. While we have found doctors to be initially resistant, we also see them as being most interested in upgrading their systems once convinced.

Most successful doctors have high confidence levels and are quite willing to learn new things. We have had little resistance from this group and once we show them that our systems actually save them time and help them see more patients, they are sold on the idea.

It is also our experience that doctors are ‘Gadget Freaks’, who love to get their hands on the latest technology. So high-tech offerings immediately attract their attention.

What is the impact of the global meltdown on the healthcare IT market?

Growth between 2008 and 2011 was muted or flat in healthcare IT. It appears that global trends have helped slowdown growth in the Indian market. However, pressure on costs for western organisations and the improved acceptance of Indian products is now making international healthcare organisations look seriously at product offerings from India.

We expect that over the next three years, the European, African and Latin American markets will become more receptive to Indian offerings. The combined effect of cloud based offerings becoming more popular and Indian products maturing will drive growth for companies positioned in this space. The traditional American and European markets will continue to generate the greatest amount of sales for the next few years, but will quickly be caught up.

What are the key challenges faced by health IT vendors in the Indian market? What are the opportunities for growth?

Although there are a number of companies in this space, the serious and focussed players are limited to about ten.

I am impressed by the maturity of many products from these companies and am quite confident that they will do well, both in India and internationally.

One of the biggest challenges we faced was not to lose hope, as this market has been notoriously slow and stingy. I have seen a few good companies simply fade away into other verticals. But for those who stay the course and continuously innovate, offering new features just when the market wants them, and being agile on revenue models, huge growth opportunities await over the next few years.

What is your view on the penetration of health IT in various healthcare set-ups in India?

I am quite sure that of the 15,000 odd hospitals in India, more than 60 percent are using IT in some manner, especially in their pharmacies and laboratories. This is

very good, as they now only have to cross the other half of the bridge to get the entire hospital wired.

The challenge for our hospitals, however, is that most of these systems are stand alone – often written for a few desktops. So our – cycle powered IT now needs to get serious. By tending to project upwards based on the rudimentary systems now being used, many of our institutions fail to see the order of magnitude increase in complexity that will come with a large integrated server based solution. Apart from under budgeting, they also tend to overlook the serious training and infrastructural requirements this change will necessitate.

I have seen some very well planned and operated IT departments in our hospitals but for many, it is still knee-jerk.

What is your current product portfolio? Do you have any products in the pipeline?

Our latest offering is a phone based transaction system for hospitals that adds on to our current product portfolio. This includes EMR, HIS, Pharmacy Management System and Laboratory Management System. DOC99.com is our cloud based EHR (Electronic Health Record) Portal.

This can potentially bring about a radical improvement in the usage of EMR in the country, as it will be offered to the entire doctor community in the country.

The EHR allows all components of the healthcare vertical to collaborate on a unified record for all patients. With increased adoption, rapid and widespread penetration into the industry is possible in a very short time.

What is your future roadmap and where do you see Aavanor and the Indian healthcare IT market, 10 years from now?

While the future is always misty, it is quite obvious that consolidation and acquisitions will become more common over the next few years. Aavanor is looking closely at opportunities for growth via this route as a means of targeting large deals and new markets. The market is going to grow exponentially over the next 10 years. april / 2012 www.ehealthonline.org

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eletcronic medical records

Go Green, Go Paperless

By Shally Makin, Elets News Network (ENN)

T

he go green format has penetrated greatly into healthcare with the introduction of systems which encourage paperless practices in the hospitals. With such initiatives, there are various systems devised such as client-server based EMR systems for hospitals and larger health systems, web-based EMR for smaller healthcare practices because of lower implementation costs are popular. The development of interoperable EMR systems is one of the largest focus areas for health IT vendors attracting a large number of healthcare professionals. The idea of going paperless has increased efficiency, streamlined processes, reduced the revenue leaks across the value chain. The long-term usage of EMR will lead to reduction in cost by reducing the administrative expenditure and increase in data accuracy. The steering committee on

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health, in its recent report to the Planning Commission, has proposed to adopt EMR in its 12th plan (2012-2017). They have proposed a biometric based health information system which will constantly update health records of every citizen-family. We see the EMR is increasingly accepted by the private hospitals unlike in the government organisations for the simple reason that it is not into the federal standards. Privacy is a major concern but we are sure that the technocrats can surely break the spell and design secure systems in the future.

Experts in the domain provide insights in the following pages about the industry, market, challenges, and its future.

We have opinions from various experts, vendors and healthcare professionals who discuss about the plethora of applications being used, challenged and implemented in the healthcare industry.

eletcronic medical records

“We are witnessing a steady increase in adoption of technology” In the coming years, the amount of data entry work will probably reduce as healthcare systems get more sophisticated and data transfer between various systems becomes seamless Healthcare is among one of India’s largest sectors, which is rapidly expanding in terms of revenue and employment. It is, however, largely driven by efficiency imparities, necessity to reduce costs, disorganised hospital systems and increase in healthcare awareness among the citizens. All these factors play a critical role in the growth of healthcare IT. Based on World Health Organisation projections, over the next 10 years, 60 million people in India will die of chronic diseases. Overall deaths due to chronic disease will increase by 18 percent and deaths due to diabetes by 35 percent.

VitalHealth provides software collaborative health management solutions for chronic disease such as diabetes, COPD and CVRM, as well as web based, personalised health management solutions, all based on the generic VitalHealth platform. Healthcare IT is increasingly penetrating health delivery in India to meet the need for an efficient and convenient disease management tool.

Products offered In India we offer, Vital for Diabetes Lite, a product which is based on evidence based protocol treatment resulting in improvement of quality of care to the patient. The solution provides individualised treatment plan specific to each patient, while also providing rich support to all care disciplines involved in the care process. Furthermore, the patient can actively participate in their own care process through an individualised patient portal experience.

VitalHealth EMR Lite is a web based electronic medical record solution for small and medium size primary care

Darayus Bharucha CEO, Vital Health

practices. The solution provides improved medical and economic outcomes, improved collaboration within care delivery teams, quality improvement through outcome management and increased patient satisfaction. On the other hand, in Europe and North America, we offer various products such as VitalHealth CHM – Diabetes, VitalHealth CHM – COPD, VitalHealth CHM – CVRM, VitalHealth EHR, VitalHealth Quest Manager, Vital for Health Management and VitalHealth Platform.

Future and challenges The clinical side of the healthcare industry faces numerous difficulties while adopting technology due to the absence of standardised formats. However, a steady increase in acceptance and adoption of technology for the administrative functions has been noticed.

Today health IT vendors have focus on HIS and EMR/EHR solutions, the next opportunities are in the areas of collaborative health management and wellness management solutions.

According to consultancies like IDFC and McKinsey, Indian healthcare industry will be worth USD 125 billion in the next five years.

India presently falls short of approximately 30 lakh beds as per the WHO recommendation of four beds per 1000 population. Even if a basic consideration of a 250 bedded hospital is made, India will require almost 12,000 more hospitals in the near future. This definitely opens more doors for the healthcare IT industry.

The healthcare infrastructure in India is currently under invested, with more than a 50 percent gap compared to its global healthcare market. This highlights an urgent need to scale up the infrastructure to cater to a population of over a billion which in turn creates huge opportunities for SaaS models and paving the way for clinical data analysis. In this era of extensive social networking, patient portals are here to stay. They will aid in self-monitoring of chronic disease patients and allow patients to interact with healthcare providers.

The Indian government has launched patient awareness on NABH quality. Regulatory approaches based on functioning local institutions seem to work best in India. The discord between regulatory bodies and the private healthcare providers, and their inability or unwillingness to reveal relevant information, makes healthcare to function on their own.

Due to the information asymmetry concerning the appropriateness of healthcare, quality, price, the medical and financial effects on patients, healthcare markets depend highly on trustbased institutions to function well. april / 2012 www.ehealthonline.org

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eletcronic medical records

Healthcare IT is now a USD 3.5 billion industry The usage of EMR is limited to select high end organised hospital chains and corporate hospitals in metro cities of India. With aim of standardising services and IT enabling clinical interactions have been adopted Healthcare IT is now a USD 3.5 billion industry, of which the software/application constitutes around USD 800 million - 1 billion size. Asclepius Consulting has done several studies for select financial institutions and the data is corroborated on the industry growth factors (healthcare software growth of 30 percent YoY).

EMR Software digitises the complete hospital processes, which can be classified as the administrative and clinical workflow. It assists the entire healthcare delivery process by reducing cost and maximises the profit.

Asclepius product ‘Charak’ captures the patient’s entire medical information right from OPD to post discharge, including history, examination, diagnosis notes, ICD codes, OT notes, progress notes, ICU charts, bed head tickets, order details, medication administration records, radiology images etc. Such consolidated EMR allows a patient to have a visit wise analysis – thereby making the medical software much more useful.

Vishal Ranjan

CEO, Asceplius Consulting

Such systems also address your need to be flexible on hardware interface and supports PDAs, pocket PC, mobile phone, graffiti boards, laptops, tablet PC, touch screens, keyboard and mouse and seamlessly integrates with standalone third party software for non-patient processes like accounting (Tally integration, SAP integration) and

human resources (payroll integration).

Multiple modules are built and can be configured based on individual hospital processes considerably reducing the customisation efforts. Records can be accessed by multiple independent entities like the physicians, hospitals, insurance companies, and patients.

Adoption rate of EMR is low due to lack of awareness about the benefits of having an EMR solution. There is a lot of resistance to change by doctors who are in general observed to be hesitant with the use of technology and they require an easy to use interface that they can deal with easily. Security and privacy are one of the major concerns when it comes to EMR. The known hospital chains Fortis and Apollo have been using EMR in a few of their hospitals. Comparatively, the adoption of IT in Indian mid-sized hospitals is prevalent in digitising the administrative services only. Depending on the criticality of the data, engineers can set backup processes for the data on tape, discs or another storage server.

EMR Market has Bright Future Due to the challenges felt in the demanding healthcare delivery model, more importance is being given to the adoption of EMR/EHR. There are many disconnected or non-standard systems/devices and it is a challenge to get a complete EMR/EHR to go paperless. Full power of the system and cost savings are not realised because of this scenario. For the best result, vendors, modality, EMR/ EHR and system integrators must work together to get a common standard and connected systems.

EMR market is believed to be valued at `150-200 crore in 2012. Hospitals are

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Siva Vageesan

CEO, Ambalsoft Infotech

gradually migrating and seeing ROI in long run. Most Indian hospitals have no question of using HIS/HMS and the same will happen for EMR/EHR soon.

We do not have enough rules/regulation to maintain privacy of the patient.

We need similar bodies like US-FDA to regulate medical devices and medical systems/ICT in India. We also need custom standards (inline with IHE, HIPAA) to help create an excellent healthcare network and delivery model.

If such systems are in place, the value it can bring to medical community will be enormous.

eletcronic medical records

“Paper is being replaced by digital records” Paper clinical records are being replaced with digital records, e-prescriptions are being directly transmitted to pharmacies, and there is a greater emphasis on delivering more connected, value-focused healthcare With healthcare gaining mindshare in most countries, health IT has emerged as one of the fastest growing areas in technology today. The need to make quality healthcare available to all while lowering costs has attained a significant urgency.

Driven by regulatory changes as well as market forces, healthcare players have been transforming at a rapid pace. Providers are in the middle of implementing new clinical and administrative systems.

Health insurers have been moving to a more consumer-focused paradigm. All of this translates to significant IT changes.

Marlabs is a key player in the health IT consulting space for many years now.

The company provides a number of healthcare IT services and solutions that enable providers and payers to accelerate their transition to the new integrated, digital context. For instance we support

Raj Menon

Global Director Sales, Marlabs Software

healthcare players in deploying and testing EMR systems, developing complex analytics that increases insight from data, modernising claims systems, raising efficiency of back office operations, and increasing regulatory compliance.

The opportunities to product vendors

like the EMR players has been huge. The big EMR players have seen their business accelerate at a rapid clip with more and more providers signing on, motivated by the promise of stimulus funding. This has in turn led to increased demand for associated consulting services. Similarly the changes on the payer side have meant increased demand for the implementation of new products and services.

In terms of treatment procedures, the changes are nothing short of dramatic.

The paper chart is fast disappearing and digital records are taking their place.

Physicians make notes, enter data into EMR screens, and review past records on the computer as they are seeing patients. Health information is being shared across organisational boundaries, as more and more players come together to exchange digital data.

“EMR adoptability in Government Hospitals is slow”

Arup Mukherjee

CEO, Binary Spectrum

Indian Healthcare industry is growing at a rapid pace and is expected to become USD 280 billion industry by 2020. The Indian healthcare market was estimated at USD 35 billion in 2007 and in expected to reach over USD 70 billion by 2012 and USD145 billion by 2017. According to the investment commission of India, healthcare sector has experienced phenomenal growth of 12 percent per annum in the last 5 years. In addition, changing demographics, disease profiles and the shift from chronic to life-

style diseases in the country has led to increased spending in healthcare delivery.

Substantial growth rate (more than 16 percent) of global healthcare IT spending is expected to push EMR development all over the globe. It is estimated that healthcare IT (HCIT) market will exceed USD 23 billion in 2015, where EMR is the major segment that is driving its growth. Government initiatives, hospitals approach towards increasing efficiency, reducing cost, improving quality and fast access to patient data are some of the major drivers of EMR growth. EMR/EHR implementation and its usage are not mandated, its adoptability in public sector hospitals is very slow. The good news is that the Ministry of Health is turning its attention towards the issue and hopefully, publicly owned health sector will soon mandate for a quick widespread adop-

tion of IT. Adaptation rate of EMR/EHR in privately owned hospitals is much higher. Private hospitals maintain much more patient records in the systems so that it can be readily available as soon as a universal interoperable EHR initiative is mandated by government.

With the increasing use of information technology in healthcare and the outsourcing of business processes to India, we need to reconsider the right to medical privacy and the protection of this right in terms of who can or cannot access sensitive health information.

Some of the key focus areas will be, a nation-wide system of electronic medical records system, cloud computing solutions in the EMR/EHR space, supporting Health Information Exchange (HIE) and Accountable Care Organisation (ACO).

april / 2012 www.ehealthonline.org

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product PROFILE

ChARM

MedicalMine Inc

Tracker

Name of Company: MedicalMine Inc Address: MedicalMine Inc. 5611, Highland Road, Pleasanton, CA 94588 Products: ChARM EHR and ChARM PHR Email: info@charmehr.com CEO: Dr. Pramila Srinivasan Phone: +1- 855- 571- 5557

Pramila Srinivasan, PhD, is CEO and founder of MedicalMine Inc. Her specialty includes algorithms for multimedia data analysis and classification. In 2007, she founded MedicalMine Inc. to apply cutting edge technological advances to facilitate data analysis and efficient management of medical treatment. ChARMtracker. com hosts ChARM EHR and ChARM PHR, the products of MedicalMine Inc. Research into treatments for multi-factorial chronic conditions is still a work in progress, and her goal is to present state-of-the-art tools and visualisation to help generate hypothesis and support research, simultaneously supporting the clinical needs of physicians and patients who need multi-modal treatment tracking, monitoring and interaction with caregivers.

Products/Solutions The company offers various products including store and manage patient health records online, schedule appointments and share pre-appointment questionnaires, charting of SOAP notes with customisable templates, secure messaging with patients, fellow practitioners and staff, kiosk - automated patient check-in workflow, integrate with labs using HL7 - plot graphs and analyze results, feature rich personal health record portal integrated
 with EHR for patients
and electronic prescription handling. We generate automated bills / invoice for patient visits, manage your practice inventory, multi-facility support.

The price starts at INR 1500 per month, per Medical practitioner as a Monthly Subscription for ChARM EHR. MedicalMine Inc provides a number of online video based self-help tutorials which, are updated from time-to-time. In addition, MedicalMine offers free 14-day EHR set-up programme where it is possible to upload their templates and other information and we will create and configure your account from our end. If required, MedicalMine can offer training to the staff through web conferencing or onsite.

Onsite training, if any, will be separately charged.

MedicalMine is actively working with few prospects from government agencies around the world to provide Online EHR solution in a cost effective way to a large number of rural clinics.

EHR Market Our primary market is North America and Australia, and we are seeing significant traction in moving to EHR. Cloud-based Electronic Health Records is a relatively new technology and it is still in its inception stage in India. We see that over next 5 years a significant number of practices will be switching to Electronic Health Records. Being cloud-based, our solutions do not require any IT infrastructure to go electronic which is a huge relief.

The cloud-based ChARM Product suite is mobile ready and all our solutions are evolving in tune with the latest trends in the market. Our customers get latest upgrades free of cost. Our updates and new innovations take into account the popularity of touch based devices. MedicalMine is investing big on Mobile multi-device technologies which will be common place in future.

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Connect to your patients through ChARM! ChARM EHR

ChARM Tracker

HIPAA compliant, collaboration driven, Online Electronic Health Record (EHR) and Practice Management solution that dramatically improves the quality of care for Patients.

Features

Benefits for Practice

Store & Manage Patient Health Records Online

Improved Quality of Patient care

Schedule appointments and share pre-appointment

Reduced medical errors and better decision making

questionnaires

Enhanced staff productivity

Charting of SOAP notes with customizable templates

Convenient and portable entry of SOAP notes using

Secure Messaging with patients, fellow practitioners and staff

Tablets (iPad, Galaxy Tab)

Kiosk - Automated patient check-in workflow

Streamlined workflow and improved communication

Integrate with Labs using HL7 - Plot graphs and Analyze results Feature rich Personal Health Record portal integrated with EHR for patients Electronic Prescription handling Generate Bills / Invoice for patient visits Manage your practice Inventory Multi-Facility support

with patients Reduced IT infrastructure cost Share relevant patient education materials

Benefits for Patients Secure and direct messaging with Care Team Requesting / Scheduling an appointment with Care Team Completing new patient intake forms (medical history / insurance / demographics)

NO Hardware / Software to be installed.

Just use your browser.

Periodic tracking of observations, intake prescriptions Checking lab results Be informed of medical conditions and latest research

charmehr.com Phone: +91-44-22707070 Email: info@charmehr.com ZOHO Corporation Pvt Ltd. DLF IT Park, Block 7, Ground Floor, No. 1/124, Mount PH Road, Ramapuram, Chennai 600 089, India.

Discover what ChARM EHR can do for your practice.

Visit charmehr.com and request a FREE TRIAL today

Health Insurance

Making the Right Moves in Healthcare The amount of public financing and the strategies followed will affect the overall performance of the health systems, and will also affect the extent of health insurance cover for Indians

By Dhirendra Pratap Singh, Elets News Network (ENN)

A

s part of liberalisation of the economy since the early 1990s, the government opened up the insurance sector, including health insurance, to private sector participation in the year 1999. This development had thrown open the possibility for higher income groups to access quality care from private tertiary care facilities. This was expected to provide financial risk protection to a relatively small segment of the society.

India’s landscape of health insurance has undergone tremendous changes in the last three years with the launch of several more health insurance schemes in the country, largely initiated by central and state governments. It is fascinating to observe the rapid and significant change in the geometry of health insurance coverage in the country. The country that has been witness to three health insurance programs until 2007 (Employees State Insurance Scheme-ESIS, Central Govern-

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Health Insurance in India • Total expenditure on health in India is nearly 6 percent of the entire GDP • Government spending is less than 25 percent against the average spending of 30-40 percent in other developing countries • Indian health insurance industry stands at `5,125 crores with only a small section of the total population (around 2 percent) being covered so far • CAGR of around 35 percent (FY2002-08)

• Health Insurance industry in India is one of the fastest growing segments • Health Insurance has the potential to become a `25000 crores industry by 2012 • Number of elderly people in the developing world will triple in 25 years • In India, the number of people above 60 years is about 8 percent today, with that number expected to hit 21 percent by 2025 Sources: IRDA and WHO

ment Health Scheme - CGHS and Private Health Insurance - PHI), is now swamped by a plethora of insurance programs, in less than three years time. The breadth, depth and height of health insurance coverage has witnessed enormous leap during this period.

In today’s world wherein customer is quite aware and educated about health insurance, organisations are moving towards standardisation of products. The move is also

Health Insurance

being driven by government regulations and by the customer feedback. Gone are the days when Information Technology was considered as a “back-end” system for user based industry. It is now the “backbone” for an organisation.

Says Anjana Agrawal, Head of Customer Services and Operations, Max Bupa, “It’s impossible for any health insurance organisation to define a service model without considering these basic service re-quirements. Unique about India is its demographic challenges and we have been smart enough to work through the same using mobile technology which has advanced much faster than internet. Today we all are connected and it is of paramount importance that this connection is utilised effec-tively specifically in the health insurance sector to disseminate the information at the right time to the consumers to be considered as a health partner.”

K Murali

Chief Underwriting Officer, L & T General Insurance

“The health insurance industry needs to follow the example of the banking industry to make the transition to enabling the customers do their transactions on their own”

Anjana Agrawal

dia to eradicate the healthcare problems of the population living below poverty line in rural and urban India.

Head of Customer Services & Operations, Max Bupa

Health Financing Challenges IT in Health Insurance Throwing light on the importance of IT in health insurance K. Murali, Chief Underwriting Officer, L&T General Insurance says, “Health insurance industry, being transaction intensive, has benefitted immensely with the use of IT. Apart from improving existing processes, it must also develop new processes and capabilities to meet new customer demands.

The health insurance industry needs to follow the example of the banking industry to make the transition to enabling the customers do their trans-actions on their own.”

The Planning Commission brought together an expert group to develop a blueprint and resource requirements to help achieve ‘Health for All’ by 2020, under the leadership of Dr Srinath Reddy of the Public Health Foundation of India.

Health insurance coverage has sometimes been provided by organisations that people are members of. One such scheme, with more than one million members, is the Yeshasvini Cooperative Farmers Health scheme in Karnataka that covers members against the risk of expensive surgeries. Both the Yeshasvini and SEWA schemes have also benefited from subsidies, whether from the government, or from international funding agen-

“Today we all are connected and it is of paramount importance that this connection is utilised effec-tively specifically in the health insurance sector” cies. Rashtriya Swasthaya Bima Yojana (RSBY) is an innovative public-private partnership model of micro health insurance launched by the Government of In-

There is an increase in healthcare costs and increasing burden of new diseases and health risks, which create high financial burden on the poor. There is an urgent need for long term and nursing care for senior citizens in our country.

Also, due to underfunding, preventive and primary care and public health functions are yet to meet their objectives.

In India, private health insurance has been observed to result in cost escalation, inequity in health financing pattern while cost-effectiveness of healthcare provided by the private sector can also be questioned. This is likely to be the case in a country that depends heavily on fee-forservice and a large and an unregulated private sector healthcare. If stringent regulatory structures and an effective implementation mechanism are put in place, the deleterious effect of voluntary private health insurance could be ameliorated to some extent.

Universal financial protection is necessary to guarantee health as a right of all citizens. The country’s national health goals cannot be achieved without expanding public financing in the healthcare sector. In view of the very low level of public financing, greater public investments are thought to be necessary if India is to achieve its long term health goals. april / 2012 www.ehealthonline.org

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expert corner

Insuring Your Future As health insurance industry is on a high growth path in India, insurers need to adopt web technologies and cloud based systems large population base, which would have been very difficult to implement on a paper based transaction processes. Penetration of internet, emerging web technologies has accelerated the adoption in our country. Large and medium sized health care providers have invested in quality human resources to enhance customer experience with dedicated Insurance desks.

P Rammohan Managing Director & Co Founder, Healthsprint Networks Pvt.Ltd

Give us a brief overview of Healthsprint and its footprint in the health insurance space in India.

HealthSprint Networks, a healthcare IT services company providing services to payers and providers, started in year 2006. Today we are India’s first and largest health insurance exchange services. HealthSprint has been able to successfully metamorphose paper based workflow into internet enabled transactions.

What are HealthSprint’s offerings in the health insurance domain?

We have two lines of business for serving our customers. First is Managed Services, in which we handle health insurance transaction processes for healthcare providers over the customer billing cycle by using state of art of Information Technology platform which automates all the processes. Another is Payer Automation, which is an IT Platform for managing policies, member enrolment, claims management, fraud and abuse management and payments electronically.

How do you see the advancement in the field of health insurance in India over last decade?

There have been early adopters of IT solutions for health insurance processes over the last few years. New business models have evolved on cloud computing services focussed on bringing down transactional costs and customer satisfaction for payers and providers. Some of the central and state sponsored programmes have adopted information technology for covering

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What is your perspective on the role of IT in health insurance?

Health insurance in India requires process and technology transformation. As a transaction-intensive industry, health insurance has benefitted, and will continue to benefit, from the efficiencies that technology brings to traditional paper-driven processes. But the industry is at a crossroads, it not only must improve existing processes, it must also develop new processes and capabilities to meet new customer demands.

As the health insurance industry is on a high growth path in India, insurers will also need to adopt web technologies and cloud based services that can provide reliable, accurate information on an up-to-date real-time basis of pre-approvals and claim settlement. Customer expectation in this regard will be set only by their experiences with other industries. For example, once payers introduce outpatient health coverage in India, a customer will expect real time transactional delivery models.

What is your marketing and business strategy in India?

We were one of the first information technology companies in the health insurance space to adopt SaaS business model for Payers and Providers. We started out as a payer provider transactional network and matured to add Payer solution services business lines. We have been highly successful in the state sponsored health insurance programmes and have achieved coverage of close to 85 million members who are registered in our platformmes deployed and whose claims are managed in a paperless transactional scenario.

What are your future plans?

To grow our shared managed service business line with a vision to network 2000 healthcare providers and majority of healthcare payers by the end of 2015. We continue to have a leadership position in this space and we aim to cover 50 percent of India’s population.

expert corner

On Road to Success

The advent of various social health insurance schemes has opened a significant new market segment and treatment protocols. Our IT team focuses on data warehousing, analytics and in integrating our guidelines into third party IT platforms. We occasionally create multi-disciplinary teams to undertake operational reviews of specific functions at insurers or to do comprehensive reviews across all departments. We also help in health insurance reforms; currently we are working on govern-ment run health insurance programme in an African country to help them revise their mechanism for provider reimbursement.

How have you seen the advancement in the field of health insurance in India over last decade?

Alam Singh, Assistant Managing Director, Milliman India

What is Milliman’s footprint in Indian health insurance space?

Milliman has been in India since 2005. We employ more than 90 people in India. Our Gurgaon office focuses on health insurance. Our client base includes insurers, government institutions, TPAs, healthcare providers, large employers, multilateral agencies, disease management and wellness companies, IT services companies, etc. We not only service clients in India, our staff frequently works onsite in US, UK, Europe, Africa, Middle East and South East Asia. Our Indian employees have global exposure and knowledge of very diverse practises of health insurers and providers worldwide.

Give a brief overview of Milliman’s offerings in the health insurance domain.

Milliman offers a wide range of actuarial and clinical services and products to general and health insur-ance companies in India. Our actuarial services include portfolio analysis, product design and pricing, IBNR review, market entry and strategy consulting. The clinical team produces various tools such as claim processing guidelines, underwriting guidelines and an underwriting management system, health risk assessment tool

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The growth in terms of lives covered and premiums is significant. The growth trend is likely to continue for the next few years. The advent of various social health insurance schemes in the past 3-4 years has opened up a significant new market segment. The big story recently from the insurer’s perspective is the reduction of group benefits, especially for parental coverage or hardening of group rates if benefits are generous and there is growth in the retail segment. Unfortunately product innovation is still limited but as consumers become more familiar with health insurance, they will demand differentiation in products to suit their specific needs and that will fuel the next wave of growth.

What is your perspective on the role of IT in health insurance?

In-patient health insurance is not transaction heavy and insurers and TPAs have managed with rudimentary systems. Expansion of benefits, especially the advent of new benefits such as OPD coverage will significantly increase transaction volumes and the insurers and TPAs will need better technology to both service these volumes and reduce transaction costs.

In addition, insurers will start to build in more intelligence into systems to streamline and standardise core operations such as underwriting and claim processing. The other major growth area will be data warehousing as health insurance will generate large volumes of data. Distribution analysis and planning as well as product design and pricing are dependent on easy access to data.

Radiology Information Systems

Imaging Demands Digitisation

By Shally Makin, Elets News Network (ENN)

T

he industry is looking forward to a much advanced world of sharing, communicating and analysing medical reports, Xrays and digital impressions. Analysing the need of healthcare organisations the engineers have crafted a mechanism to increase operational efficiency. Despite insignificant of Government initiatives towards shifting to a digital infrastructure, the technocrats create space to design such interfaces. PACS is a medical imaging device to capture the digital format of the image to store, manipulate and transmit over a computer network. The market is rapidly growing at a rate of 10 percent CAGR through 2014 globally as reported by various reports. The soaring adoption of RIS/PACS system has signifi-

cantly reduced the implementation costs in the hospitals. As we observe shortage of medical staff and increasing number of patients, hospitals are encouraged to automate their systems to enable seamless exchange of information especially the radiology industry. With RIS, the information captured can be authorised, protected and interpreted in collaboration with the existing hospital information systems. Such sophisticated systems demand trained workforce and huge investments to completely produce effective results.

The experts give their profound thoughts on the health IT industry and its scope to develop the RIS and PACS applications in the desired space. april / 2012 www.ehealthonline.org

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Radiology Information Systems

“Health IT market to grow at a CAGR of 20 percent�

How do you perceive the growth of Health IT market?

There are some reports which mention that India has the fastest growing healthcare IT market in Asia. It has been growing at a healthy double-digit growth rate of around 20 percent. The demand for public healthcare is on the rise in India, but some immediate hurdles need to be overcome for achieving a higher growth rate. Advent of IT has not only ushered in an era of high productivity and service care accountability, it has also created a platform for introduction of advanced healthcare technology, and the ability to respond faster in case of medical emergencies.

Please brief us about the various technologies in this sector.

The role of technology is being felt across different areas and we believe that the spurt will come predominantly in the areas of EMR, Image Archiving and Medicine. Picture archiving and communications systems (PACS) can be integrated with health information system for quick and easy sharing and archiving resulting in benefits such as faster and more accurate diagnosis, near filmless process, flexibility across digital, systems, elimination of image loss, and, integration with EMR for a total solution, mobile based diagnostic and monitoring and HIMS. What are the challenges being faced by the healthcare companies in India today?

For a large section of the population, especially that in rural areas, access to basic healthcare continues to be a problem. This is accentuated by the inadequate infrastructure of healthcare service delivery. Healthcare affordability in India remains very low. More than 82 percent of payments are made out of pocket as Insurance covers only a small percentage of the payments. To lower

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sarily carried out in labs can now be done in the home of the patient. The opportunities of telemedicine and remote patient monitoring are yet to be fully utilised due to variety of reasons. The possibilities are endless and a country like India will require enabling technologies more than any other country.

Anjan Sen, Director, Strategy & Operations, Deloitte in India affordability barriers, healthcare ecosystem players are driven to innovate and create affordable solutions, and/or drive volume to generate economies of scale.

A large segment of the population lives without access to basic education and lack health/disease awareness. There are currently only 0.7 beds per 1000 of the population. In addition, there is shortage of doctors, nurses and paramedical staff which further aggravates this gap in demand and supply.

How do you think IT in healthcare has transformed treatment procedures ?

The role of IT in healthcare is capable of transforming the record keeping, diagnostic, monitoring and treatment procedures prevalent now. Overall penetration of healthcare IT is fairly limited at present compared to other developed and even some developing countries. Diagnostic or monitoring tests, which were neces-

What is your prediction for this market in the next decade in India?

What are the growth contributors in the industry?

Health IT technology and electronics market is expected to grow considerably over the next few years. We expect that the health IT and related technology market to grow to USD 2+ Billion by 2015 growing at a CAGR of ~20 percent. We believe that the growth will be fuelled by uptake of healthcare management information systems (HIMS), EMRs, PACS, and medical electronics market. In summary, the key growth contributors are demand supply gap. Favourable shift in consumer’s socio-economic conditions, increased spend by the private sector and increased government spending and regulatory incentives.

What are the standards laid down for the healthcare industry? Do we have enough policies defined for regulating the market?

In USA, the Health Insurance Portability and Accountability Act of 1996 (HIPAA), Health Information Technology for Economic and Clinical Health Act (HITECH Act), etc. are examples of some laws that have been instituted to cater to clinical and technological legal statues governing e-Health and telemedicine.

Essential attributes such as clinical data privacy control, data protection, data security, cyber security, patient safety, confidentiality maintenance, etc. need to be governed by law. India currently lacks adequate dedicated e-health and telemedicine laws.

???? expert corner

“Philips Focuses on Clinical

Expertise”

Rajeev Agarwal, Business Head, Healthcare Informatics, Philips, believes that supply of good quality healthcare specialists is a constraint to healthcare expansion/growth and thus there is a need to invest in informatics systems and solutions to allow the existing specialists to scale and provide quality care to more patients Health IT market is growing…

Market has reached an inflexion point and the whole healthcare industry has moved beyond the experimentation stage. They realise that it is a critical part of their operations; as evidenced by any new hospital that is being set up starts with IT. Right now it is not very sophisticated, but the inflexion point has been reached. The government has also started investing. We actually see tenders coming out regarding HIMS, RIS, PACS, etc. They normally are followers, but the fact is that they are investing. It is a clear indication that this is the right time and the market is growing. There are multiple ways of estimating, slicing and dicing, but our estimate is that currently it is around Rs 700 crore of a market and is growing at around 26 percent. If you look at various cuts in some areas, it is growing slower, like HIS is growing slower, but the CIS, PACS are growing faster.

Further, the clinicians, radiologists, oncologists, or cardiologists are a scarce resource. For healthcare, as a system to work, demand is not the constraint.

India is becoming the disease capital of cardiac diseases, oncology patients and looking at this scenario both the government as well as insurance providers are now investing. What we think is that the constraint in the healthcare system is not of demand but that of supply. Supply of good quality specialized healthcare professionals is a constraint.

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Rajiv Agarwal General Manager, Healthcare Infomatics, Philips Government is setting up medical colleges, but it will take the next 10 to 15 years to have an impact, till then we are already facing a shortage even in the tier 1 centres, forget the tier 3 tier 4 centres. We have our own R&D centres over here and are also doing a lot of partnership and alliances for the same, with special attention to every sector and product segment and we are very positive about the healthcare IT.

expert corner ????

Philips offers…

Emerging informatics will reduce expenses as well as increase expenses. An investment in the space of emerging informatics needs an initial capital outlay, which can be put up by the facility or companies like us who do those kinds of deals which are not just a capex model but also opex model.

All our solutions are bringing in the face that imaging or critical care, the physician is at the centre. So our focus is on their empowerment and making things virtually available. The core idea is to provide productivity and enhance the revenue

Philips has taken a clinical approach to the market with systems related imaging informatics (cardiology, oncology, or radiology imaging) and critical care informatics, which can be within hospital or outside hospital; oncology informatics and cardiology informatics which cut across a small hospital centre. There are many players in the imaging informatics market that are new and there are only a couple of players who are competing in this space.

IT is affordable…..

Informatics will reduce expenses in the medium to long run as well as increase expenses. An investment in the space of informatics needs an initial capital outlay, which can be put up by the facility or companies like us who do opex deals as well. Currently the carrier of all the information is the patient himself and the knowledge of the output is retained with the radiologist. So if they go from one radiologist to another, or to a referring doctor, the patient is the one who is carrying it and he owns the data. However, they are yet at the mercy of the referring doctor as he might just not agree with the reports that will make the patient go in for another test. So they will end up paying more. But if the radiologist or the hospital retains the image, the benefit to the hospital is that they can retain their customers. When you look at diseases like cardiology and oncology the patient is pretty much comes back for the next 7 to 8 years. So it makes business sense for them to retain the image. It also makes sense for the patient because they don’t have to do a repeat test again and again. Also, in case of a referral, they can automatically have them sent electronically. So that’s how the economics will work out. Initially there will be an outlay, but that is less than the benefits that are there in future. It is easier to pay some money, rather than repeating the test.

How is Philips different...

It is not just offering productivity but also helping clients scale their businesses, gain more revenue and see more pa-

tients with the same setup. It is basically a force multiplication of their current capabilities. Globally Philips is ranked #3 Overall Software Vendor rated by the independent agency KLAS, so we are bringing in our clinical expertise and credible track records and build our reputation. Most of our solutions are targeted towards productivity. Along with this, we are also iving them a solution that will convert them into a force multiplier.

Phillips is entering this segment in India, because we are a worldwide leader in this space also. However, differentiation is the key here. Our focus is providing clinical expertise because we understand things better than other local vendors or MNCs. Late entrants face challenges but they also have some advantages. You see all the mistakes that others have made, learn from them and position yourself accordingly. We have come in with the approach that there has to be a tele-model. Our focus is on physician empowerment and making things virtually available. The core idea is to provide productivity and enhance the revenue.

Telemedicine…

The first generation of tele-imaging is all about getting the image back. What we are combining with is what we call clinical decision support. In the original model 10 patients will be seen in an hour. But with the help of CDS, they can attend up to 15 patients an hour.

They can see more patients, and if they choose they can actually charge less.

Challenges...

You are a global player but you have to customise according to local needs so we have a large R&D setup in india to allow us to be fast and flexible locally.

Another challenge is that healthcare IT needs to prove its value. We bring credibility from what we have learnt globally. If you want to play well from a tele side, you need a very good and robust telecom partner. Telecommunication in india has grown well so it will provide the reach, but when you come to healthcare like applications we need reliability and that is still not up to the mark. april / 2012 www.ehealthonline.org

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Clinical Solutions’

IntefleCS Contact Centre Designed specifically for the healthcare call center environment, IntefleCS Contact Centre can be deployed using our advanced modules to meet your organization’s business requirements.

Call us today on +91 (0) 99205-92475 or visit www.clinicalsolutions.com

Clinical Solutions’

IntefleCS Contact Centre TeleGuide 104 Triage Module Directory Information Module SMS Integration Module Long Term Conditions Module Treatment Centre Module Home Clinic Module Symptom Enquirer Module Emergency Responder Module

Clinical Solutions is a company focused on healthcare, with a unique combination of proven clinical content, scalable multichannel software applications and IT infrastructure.

See how IntefleCS Contact Centre could work for your organisation

IntefleCS Contact Center Ready to deliver real benefits for your organisation and its patients, today.

Designed for State Government, 104 – Non Emergency Health Helpline to deliver high quality health advice and direct patients to the right local health service as fast as possible.

With the most robust, scalable software combined with TeleGuide content, that has been proven in over 70 million clinicial encounters, worldwide.

Call us: +91 (0) 99205-92475 Email us: enquiries@clinicalsolutions.com

Visit us: www.clinicalsolutions.com Follow us: www.twitter.com/CS_news

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expert corner

“We Intend to be the Largest Supplier of 104-Health Helpline Call Centre Solutions” Our solution for India powers two of the five leading telecom operators and a prominent insurance player, says Nehal Shah Which industry does Clinical Solutions India cater to?

Clinical Solutions caters to the healthcare call centre market and specialises in the non-emergency segment. Its high technology solutions are most suitable for catering to the state funded programmes like 104 – health helpline, dial-a-doctor helpline. It also provides value-added services to the insurance industry. Globally, we are the largest supplier of non-emergency health helpline call centre solutions.

How do schemes like 104 helpline help the citizens?

The government has now realised that schemes like 104 are excellent as they provide the basic healthcare access to millions in the state, irrespective of the urban-rural divide and divide of time and location. Such schemes end up delivering considerable benefit to the existing healthcare infrastructure. These health lines are going to be made available 24X7 through a toll free system.

The help can come in many ways.

Let’s say a child in remote rural area is suffering from severe abdominal cramp.

The child’s parents can get access to qualified healthcare through proven technology solutions. Even in urban areas people can access healthcare without having to visit a doctor.

Please give more information on Clinical Solutions.

Clinical Solutions is a UK headquartered company with clients across the globe.

We specialise in the non-emergency segment, with products like IntefleCS Call Centre, Home Clinic, Treatment Centre,

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level of care. Clinical Solutions has been powering NHS-Direct, the national health helpline within England to a population of circa 60 million for the past 12 years.

The national health helpline for Scotland, Wales and Portugal are also being delivered using Clinical Solutions technology.

Clinical Solutions has similar customers in Norway, Brazil, US, Australia and India.

How has been your experience in India?

Clinical Solutions set up its operations in India in early 2010. It first went through a complete review and customisation process of the content from the clinical and language perspective. The duration of this project was 9 months. Our solution today powers two of the top five leading Telecom Operators and a prominent insurance player with 400,000 calls triaged till date.

We are now moving our market focus to PPP like 104-Health Helpline as we intend to be the largest supplier of Health Helpline call centre solutions in India as well.

Nehal Shah, Director & General Manager, Clinical Solutions, CS Clinical Solutions India Pvt Ltd Browser based Symptom Enquirer, Long Term Chronic Disease Management and Emergency Responder. Our suite of products is underpinned by worldwide experienced clinical content. This in turn delivers successful platforms from which healthcare professional including nurses, doctors, clinicians can successfully triage a patient and determine the right

What medical conditions are being covered?

We cover everything on the non-emergency side of healthcare. Typically we cover family planning counselling, first aid, first level medical advice and suggestive medication, women and child care information, long term disease management information, service directory, etc.

What is your vision for India?

We are very focused on being an enabler to provide basic healthcare to the billion plus population through telephone which is available 24X7.

expert corner

Cloud Adoption in Indian Healthcare Malav Kapadia, Vice President - Sales, Religare Technologies talks about the emergence of various forums that are driving interoperability and adoption of common standards

T

he Indian healthcare sector, currently valued at USD 65 billion, is expected to reach USD 100 billion by 2015. It is growing at around 20 percent a year, according to rating agency Fitch. The FDI inflow in hospitals and diagnostic centres was USD 1.1 billion during April 2000 and November 2011, according to the latest Department of Industrial Policy & Promotion (DIPP) data.

The rural healthcare sector is also witnessing considerable growth, with the sector adding around 15,000 health subcentres and employing 28,000 nurses and midwives during the last five years, as per the Rural Health Survey Report 2009 of the Ministry of Health. As per the report, the primary health centres in the country have grown to 20,107, growing by 84 percent.

India’s thriving economy is driving urbanisation and creating an expanding middle class, with more disposable income to spend on healthcare. The Government of India has developed an allinclusive policy on healthcare that aims to achieve remarkable growth for the sector.

This has led to a high number of compelling opportunities such as development of new infrastructure and providing of novel medical equipment solutions. The sector holds enormous potential which is waiting to be unleashed to the maximum.

The hospital services industry is expected to be worth USD 81.2 billion by 2015, according to the latest RNCOS research report titled, “Indian Hospital Services Market Outlook,” published in March 2012. Huge private sector investments will significantly contribute to development of hospital industry.

At the macro parameter level, we see significant growth possibilities in all our areas of focus – Hospital Information Systems, Non Emergency Health Helpline (Mediphone), mHealth and Telemedicine.

At the customer interface level, we see significant traction in our dialogues and in the interest in adopting higher levels of technology.

Cloud Computing The healthcare industry is in a period of accelerating change that requires perpetual innovation. All stakeholders expect more value for their money. Patients are beginning to play greater roles in managing their care. Most industries have adopted cloud computing in a significant manner. Cloud encompasses several variations of service models (i e.,

IaaS, PaaS, and SaaS) and deployment models (i.e., private, public, hybrid, and community clouds). Point solutions lend themselves well to the cloud model and few enterprise solutions are gaining traction in this space Healthcare lags most other verticals in the adoption of technology. Besides confidentiality of patient information and compliance issues, India suffers from paper medical records, duplicate tests, film-based radiological images, handwritten notes, fragmented IT systems, and silos of information. Besides this most healthcare providers use outdated legacy systems and have a staff that is not geared for adoption of a comprehensive cloud strategy.

We see the Indian healthcare industry benefiting from technology leapfrogging. Larger hospitals in the cities are moving towards increased technology adoption. There is a healthy dialogue emerging around cloud based services for EMRs, HIS, PACS, PRM and Chronic Disease Management.

Benefits Cloud transforms the economics of IT from capital-intensive to pay-as-you-go.

By using cloud computing, organisations can consolidate their IT infrastructure and reduce IT energy costs while getting access to documents from anywhere. Healthcare organisations of all sizes, across all geographies, can access information technology resources that previously were out of reach. Worldclass applications and computing infrastructure are available to all without considerable up-front investment. april / 2012 www.ehealthonline.org

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expert corner

“Adoption of Quality Management Systems is Accelerating” What is the size of the global Health IT market? What is your market share?

Health IT is aggressively growing in all geographies. A report in May, 2011, predicted that US health IT spend will reach US$40 Billion by end 2012. Dell has a large footprint in global healthcare. It is the number one in EMR software and services in large hospitals and community hospitals and serves nine out of top 10 US healthcare systems. Dell’s systems cater to more than 100 insurance organisations, supporting 45 million policyholders and 71 percent of the Stage 7 HIMSS EMR Adoption Model hospitals.

Dell serves six of the top 10 pharmas and helps over 500,000 physicians connect with their patients.

Tell us about your technologies in the space.

Dell creates end-to-end solutions, bringing together implementation services, process improvement consulting and customised IT technology so that caregivers have better information for better patient care. Dell is one of the few companies that can offer healthcare payers and providers end-to-end solutions including hardware, implementation, hosting, consulting, back office functions (such as enrollment and billing), and services around Electronic Medical Records(EMR), Health Information Exchange (HIE)and Health Insurance Exchange.

What are the challenges being faced by the healthcare providers in India today?

There are several challenges that providers face in India. Patients today are demanding higher quality of care. At the same time there is increasing pressure on providers to cut costs. Healthcare consumers are also demanding

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greater transparency from their providers. Health insurance is growing in India but is still small compared to western economies. This is leading to mounting receivables, some being irrecoverable as bad debts. Other challenges include workforce related issues including rising HR costs, increasing attrition rates, and lack of qualified staff. Lastly, ineffective procurement and inventory management practices are also hampering providers’ growth.

What are the opportunities being served by the industry to the Health IT vendors?

More and more hospitals are becoming serious about having robust Hospital Information Systems in emerging economies like India (including but not limited to EMRs, enterprise solutions for finance, HRD, marketing and sales, etc.).

Telehealth is being explored to drive remote healthcare delivery models. Web enablement to draw customers, retain them, provide value added services, is expected to catch up. Hospitals are also looking for partners to take care of their IT help desk for Hardware and Software trouble shooting. With more emphasis on accreditations, adoption of quality management systems is accelerating.

How do you think IT in healthcare has transformed the way treatment procedures are carried out?

Telehealth implementations are being utilised to improve the accessibility of care. They are being leveraged both for diagnostic and therapeutic purposes.

Robotic surgery has started to help in bridging time and distance barriers and healthcare IT systems have brought in advances in interventional procedures in interventional radiology, interventional cardiology, interventional gastroenterology and other disciplines.

Sid Nair, Vice President and Global Head, Healthcare & Life Sciences, Dell Services, Today hospitals are emphasising more on adopting various IT solutions to remain competitive and improve care quality

What is your prediction for health IT market in the next decade in India?

What are the growth contributors in the industry?

Healthcare IT market is on a high growth path. Reports peg the growth expected in the healthcare IT market to be around 15-20 percent year on year over next 5-10 years. More and more hospitals in urban India are beginning to look at IT as a transformation tool that would help them in improving quality of patient care, efficiency and effectiveness. The government is expected to invest a lot more in IT for healthcare delivery and is expected to bring automation, an opportunity for health IT vendors.

product PROFILE

Aarogya Infotech and Management Systems

AIMS Hospital Information System Name of Company: Aarogya Infotech & Management Systems Pvt Ltd Address: 302/27, Aditya Nagar, A.B. Road, Indore 452001 Email: sales@aarogyahms.com Director: Rakesh Singh Phone: +731-4066043/9826017970

Aarogya Infotech and Management Systems Pvt Ltd (formerly AarogyaSoft) is a leading provider of solutions, systems and services to healthcare providers since 2004.

The company has a successful track record of implementing its Aayush range of software products to the entire spectrum of healthcare providers.

Features The software was first implemented at Choithram Hospital and Research Centre, Indore (a 350 bed tertiary care hospital) in 2004. Today, this proven solution has a large customer base with nation-wide presence. Intuitive user interface, consistency in GUI design, user defined reporting system and online help has made it easily acceptable among end-users. Reliability, lower TCO, compliance with standards, proactive training and consultation by implementation team, configurable design and relevancy due to continuous upgrades for contemporary business practices and latest technologies have made it a hospital management system of choice.

Functionality It is a comprehensive solution for administrative, clinical and financial aspects of hospital management. A set of fully integrated 40 modules, covers all departments and functional requirements of mid-size or large hospitals. Excellent domain knowledge with deep understanding of practical problems faced by hospitals has resulted in a system which leads to a less-paper, automated work environment. Changing with times, the latest release of AIMS range of software have been designed specifically for accreditation and certification requirements like NABH and NABL.

Technology AIMS-HIS is a web enabled, N-Tier application developed on .NET platform. It has been designed for distributed computing environment with SOA. The application can connect to multiple databases simultaneously and can be integrated with other software easily. Tertiary care hospitals generate huge amount of data, which needs to be managed routinely for performance and security. Hence the software is implemented with Oracle 11g as database. Although the client terminals and application server require Windows OS, it can be implemented with Linux as Network OS and Oracle on Linux. Highly scalable, easy to implement and easiest to maintain, the software is a real friend of system administrators.

Business Model The software is available as on-premise SaaS. Instead of buying the software license the hospital pays a monthly subscription charge for concurrent user licenses. Hospital gets the entire set of modules for the same charge. De-linking of software cost from number of modules makes it highly cost-effective. The hospital not only gets the regular updates and upgrades for free, but also eliminates customisation charges.

It is amply clear that to get the most out of IT systems, a holistic approach in needed. If resources and processes are not exactly mapped with IT Systems, it will only create bottlenecks. True to its motto ‘Better Systems for Better Healthcare’, the objective of AIMS-HIS is to provide a well planned, fully integrated and automated workflow approach for implementing management policies and procedures.

Ideal software for any hospital which wants to • Upgrade existing system without investing in license cost again • Go for standardisation and accreditation • Bring automation and efficiency in its processes • Cut costs and control expenditure • Implement rule based administration • Remain flexible and adaptable to change • Move from capital expenditure for software license to operational expenditure in new project

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telemedicine

Telemedicine & the Ability to Consult Remotely

By Anoop Verma, Elets News Network (ENN)

T

elemedicine offers a matchless way of synergising the advances of modern communication technology, and information technology, with biomedical engineering and medical sciences to deliver the healthcare services on an anytime, anywhere basis. In a geographically diverse country like India, where large number of people living in rural areas lack access to quality healthcare facilities, telemedicine is being looked upon as a system that can have seminal impact on healthcare delivery and patient outcomes.

There is no dearth of medical providers and specialities that can deploy telemedicine solutions for enhancing the scope of their healthcare services. For instance, dermatology and radiology are medical specialties that tap into telemedicine solutions. These solutions can also be used by healthcare specialists to remotely monitor patients with chronic conditions, and provide remote consultations for patients in rural areas.

We interacted with a select group of eminent healthcare specialists who are actively engaged in expanding the reach of telemedicine solutions. The series of interviews that follow provide us with a succinct glimpse into the world of telemedicine in India and the promises that this field holds for millions of Indians who are looking for low-cost and quality healthcare.

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telemedicine

Cisco’s Samudaya Project Dr Arjun Kalyanpur MD, DABR, CEO and Chief Radiologist, Teleradiology Solutions

“Having worked in teleradiology arena for 10 years, telemedicine was a natural extension for us as a group. We helped operationalise a telemedicine centre in a low income district in Raichur in North Karnataka, as part of Cisco’s Samudaya project, using Cisco’s technology. Telemedicine consultations have been provided

by Telerad RxDx doctors to the rural villages in Raichur like Gillesgur and Bichalle since 2010. This experience led us to a deeper understanding of the needs and solutions needed for remote parts of India. This year, we became Cisco’s managed service provider in India for the health presence platform.”

Giant strides for Telemedicine in India Telemedicine is being promoted as the great healthcare hope for rural India, a technology that can transform the health statistics of remote India, the innovator that will be the game changer in medical practices in the decades to come The advantages of telemedicine are manifold. Telemedicine is a system for taking a doctor to an area where there is no doctor; it provides medical help to patients where no medical help existed before; it can diagnose a medical condition before it becomes untreatable.

Tele-pathology, teleradiology, tele-ophthalmology-are all ways of accurately diagnosing diseases from a distance.

They have moved beyond the pilot stage to actual implementation in different parts of the world, including India.

High level of satisfaction in patients Telemedicine consultations where a doctor remotely talks to a patient and advises, is typically done via a video conference link up. The system, according to us is working very well, but it is not without its share of controversies. If you can’t touch a patient, how can you accurately diagnose his condition? Can a patient and doctor who see each other on a TV screen actually bond? Does the patient ‘feel’ he got a real consultation from his doctor? Is the doctor at the other end legally liable for the patient seen on a telemedicine link?

Several studies have been done to assess these issues. A recent study in the United States had patients answer a questionnaire at the end of the telemedicine consultation. Eighty five percent of patients felt satisfied with the consulta-

itors, are serving the purpose of making telemedicine consultation more scientific and data based.

Initiatives from companies like Cisco

Dr Sunita Maheshwari

ABP, ABPC (USA), Senior Consultant Paediatric Cardiologist and Chief Dreamer, RXDX and Teleradiology Solutions

tion. A survey conducted by SGPGIMS (UP) tele-follow up programme for the patients in Orissa revealed that 99 percent patients were satisfied with using telemedicine technology. So clearly a telemedicine consultation can achieve a high satisfaction level with patients if done well.

The use of newer technologies like telemedicine boxes and software, rather than just a video conferencing link, can lead to increase in the scientific value of the telemedicine consultation. Modern tools like digital stethoscope (to listen to the heart and lungs), digital otoscopes (to see the inside of the ear), oxygen saturation probes (to assess the oxygen level in the patient), blood pressure mon-

Teleradiology Solutions initially helped operationalise a telemedicine centre in a low income district in Raichur, North Karnataka, using Cisco’s technology.

Telemedicine consultations have been provided by Telerad RxDx doctors to the rural villages in Raichur since 2010. As we are now the managed service provider for Cisco’s telemedicine in India, several such projects are in the pipeline.

The Cisco’s HealthPresence solution is especially promising.

In a vast country such as ours where large tracts of the country have patients, but no doctors, telemedicine has the potential of changing the lives of patients. In order to expand the reach of telemedicine in India, a solution has to be found to the Infrastructural issues such as poor bandwidth in some areas, expensive bandwidth in others.

Although ISRO does provide free V-sat link to those centres that offer to do free telemedicine consultation, how they pick those centres and not others is not clear to everyone. Thus, this free V-sat link is not available to all of the centres in India and so it has not been exploited to the maximum. april / 2012 www.ehealthonline.org

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telemedicine

Telemedicine for Better Health Vishal Gupta, VP/GM, Global Healthcare Solutions, Cisco, offers a perspective on the role that Cisco is playing in the field of telemedicine billion a year. We believe Telemedicine is one of the 5-6 key ICT areas. We expect a growth rate of 25 percent a year for the next 3-5 years.

What is the most important area of healthcare that telemedicine must focus on?

Telemedicine should create a level playing field where access to quality and affordable healthcare can become a right for every Indian just like right to Education. The most important thing is to enable healthcare for the over 600 million Indians who live in villages. The primary Health Centres (Over 60,000 in India) that support villages are not able to attract doctors and the problem is especially acute for specialists. Telehealth is proven to solve this problem which cannot be solved by any other means.

What kind of response do your telemedicine solutions see from rural areas?

We are seeing excellent response from rural areas in India, China, Jordan, US and a number of countries in Africa and Europe. In India, in one of the districts where we have deployed HealthPresence, our efforts combined with those of the government are seeing children and mother’s mortality rates fall significantly. This is very encouraging development for us. Also the survey shows over 95 percent satisfaction rates from patients and doctors using this technology.

Tell us about your HealthPresence solution.

TeleRadiology Solutions has become both a customer and a partner for Cisco’s HealthPresence solutions in India. They first leveraged HealthPresence as a customer and have done over 1500 consultations for PHCs (Primary Health Centres) in Karnataka with their doctors from RxDx. They are now one of the key managed services partner for HealthPresence. TeleRadiology Solutions can market HealthPresence as an end to end solution, which enables hospitals, NGOs and corporate clinics to adopt the exciting HealthPresence technology without capital expenditure or IT resources.

What is the overall market size of your telemedicine business in India? What is the growth rate that you are expecting?

Telemedicine business in India is still in early stages, but it is expected to grow at a high rate of growth. The overall market for healthcare in India is about $50 billion and if 2 percent of the money is spent on ICT, the ICT spend will be roughly $1

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As of now how many hospitals in urban and rural areas are using your telemedicine solutions? Are you systems gaining popularity with the population?

We have deployments in both private sector hospitals like RxDx, as well as in numerous districts in Karnataka and MP, where primary health centres connect to district hospital doctors using HealthPresence. Over million people have access to healthcare in India using our technology in the districts of Karnataka and Madhya Pradesh alone.

What can the government do to facilitate telemedicine in the country?

We believe the government has to take two actions to enable a breakthrough for Healthcare in India. One, the government will need to accelerate the rollout of Broadband in Villages so that critical applications in telemedicine, education, e-Governance can run on broadband infrastructure. Two, the government needs to enable public and private partnerships to enable sustainable rollout of care at a distance technology in rural and semi urban areas.

telemedicine

Telemedicine Improves Patient Care “If private providers are allowed to utilize National Knowledge Network, State Wide Area Network, end-users will benefit as high quality of healthcare will become available at an affordable cost,� says Dr Suryanath Gudidevuni, AVP & Head Healthcare Services, Apollo Tele Health Services (ATHS), in an exclusive interview...

Please tell us about your plans for development of telemedicine in Indian market. What is the next milestone for you as far as the telemedicine operations are concerned?

Apollo Telemedicine is has been operational from more than a decade. It has provided about 70 thousand telemedicine consultations so far. Our next milestone is to have 1000 telemedicine centres within next couple of years. We are aggressively working in the fields of Wearable Health Monitoring Systems, Tele ICUs, Robots, Virtual visits etc.We are looking forward to utilising telemedicine technology to bring about a closer interaction between the doctors and patients even when they are geographically separated. The care in telemedicine can be provided without compromising on quality of care and without an increase in cost for the patient.

Give us a brief overview of how telemedicine industry is evolving in India?

Challenges in regards to geographical accessibility and a healthcare provider’s preferences for cities are the main drivers of telemedicine development in India. Other contributing factors are timely healthcare, cost containment, enhanced connectivity, and much else.Initially, telemedicine services were being provided through ISDN and satellite connectivity and were mainly limited to video conferencing. Government, through ISRO, has played a major

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role in promoting these services. Pan-African e-Network is another good example.

Awareness and availability of EMR, ability to send large files online have also the scenario for better.Initiatives from NRHM, State Governments etc. are further helping the situation.

In your view what is the most important area of healthcare that telemedicine must focus on?

Outcomes from primary care, preventive care and wellness management will be most beneficial. Focus on health education, both for people and healthcare providers will also help in enhancing health status of population.

Rural areas in India are especially lacking in quality healthcare facilities. What kind of response do your telemedicine solutions see from rural areas?

In general we have a good response to our telemedicine solution. Probably, we have provided highest number of teleconsultations in the country from a single organisation. We are one of the teleconsultation providers for Pan-African e-Network initiatives. We are the only organisation in the world that has provided 550 specialty consultations within duration of 14 hours, during recent camp in Ajmer (February 2012).

As of now how many hospitals in urban and rural areas are using your telemedicine solutions? Are you systems gaining popularity with the population?

About 63 non-Apollo hospitals are utilizing our telemedicine solution. Yes we are gaining popularity.

Many analysts have expressed the opinion that one of the most exciting areas where telemedicine might have a potential role to play is disaster responses. Please tell about your views on this. Have you developed solutions that can facilitate relief work during disasters?

It is true that telemedicine has very high potential in disaster management. It can provide quality healthcare, on time and on site, thereby minimising avoidable travel, overcrowding of healthcare facilities and hardships thereof. Early medical intervention can be life saving in many such cases.

In general, that is all what majority of victims would need. Apollo has solutions and systems to meet disasters at a very short notice. We have telemedicine vehicles of different magnitude and laptop based solutions, which can be quickly deployed at site, in addition to having helipad on our tertiary care hospital to receive victims.

What can the government do to facilitate growth of telemedicine in the country?

One of the challenges is to retain healthcare professionals in remote healthcare centres like PHCs. One thing Government can do is to outsource consultation for patients from those centres. This will not only provide healthcare when and where needed, but the software (EMR) used will provide Government with accurate and online statistics of healthcare services that are being provided. Government should also promote public and private partnerships. Telemedicine needs different breed of healthcare professionals. New type courses, recognition and employment opportunities will encourage growth in number of such professionals.

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Telemedicine Through Skype Baljit Singh Bedi, Advisor, Health Informatics, Centre for Development for Advanced Computing (CDAC), President, Telemedicine Society of India (TSI) in an exclusive interview with eHEALTH

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Tell us about the role that the government can play in furthering the growth of telemedicine in the country.

Telemedicine is an idea whose time has come. It can be of great help in our rural population. The government is taking many new initiatives to further the growth of telemedicine in the country. There is plan for connecting all the medical colleges and major hospitals through the National Knowledge Network (NKN).

There is also plan to link all district hospitals with leading tertiary medical centres. The same infrastructure can also be used for providing medical consultation to people in different parts of the country. People living in one part of the country will be able to In your view interact with doctors residing in some other what is the most part by use of telemedicine. important area of healthcare that What are your expectations in telemedicine must focus the telemedicine sector from on? the Twelfth Five Year plan?

Most important area is providing To improve healthcare seraffordable healthcare at affordable vices in the remote parts price on 24/7 basis. of the country, the Planning CommisWhat benefits do telemedicine sion plans a massolutions offer in rural areas? sive exercise of It is true the doctors educated from urban mediadopting telemedicine by use of software applications cal colleges are accustomed to urban way of life such as Skype. If I may quote the report on health for and would not like to go to rural areas. With innovathe 12th Five-Year plan directly, it says, “Computer tive IT solutions, it can be possible for those in ruwith Internet connectivity should be ensured in ral areas to utilize the expertise of eminent doctors Tell every primary health centre within this Plan based in city hospitals. us period; sub-centres will have extended conabout nectivity through cellphones, depending As of now how many hospitals in urban GTI Infotel and rural areas are using your telemedicine on their state of readiness and skill set plans for of their functionaries. The availability solutions? Are you systems gaining popularity development of Skype and other similar appliwith the population? of telemedicine cations for audio-visual interacPresently our Remote Call Centre Solution is being in Indian market. tion makes telemedicine a used by the JPNATC and AIIMS. Our Tele-MediGTI Infotel has ambi- cine solution is being used by Lavanya Ayurveda near-universal possibility tious plan to introduce in its Urban & Rural centres for Ayurvedic treatment and could be used to telemedicine in various and S. Lal Hospital, New Delhi, for Allopathic treatameliorate the prostate governments. We have ment. The response is excellent. fessional isolation already submitted our tender for of health pertelemedicine to the government How fast do you expect the telemedicine sonnel posted of Bihar. GTI Infotel is also planning vertical to grow? in remote to set up our own telemedicine cen- Now that the centre and the various state governand rural tre at Noida. The Noida centre will have ments have started promoting telemedicine in rural areas.� the unique system of providing affordable areas, the sector is likely to grow very fast. The fast healthcare by combination of Allopathic, Ayur- growth in the telecom industry is also contributing veda and Homeopathic. to the popularity of telemedicine.

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Tax Subsidies for Use of ICT in Telemedicine and Tele-Health are Crucial K. Ganapathy, M.Ch.(Neurosurgery), FACS, FICS, FAMS Ph.D, a former Secretary and Past President of the Neurological Society of India and a former Secretary of the Asian Australasian Society of Neurological Surgery, is currently President of the Indian Society of Stereotactic & Functional Neurosurgery. He is also the President of the Apollo Telemedicine Networking Foundation, the largest and oldest multi specialty Telemedicine network in South Asia. In an exclusive interview with eHEALTH, K Ganapathy talks about different issues in telemedicine.

Ministry of External Affairs, Government of India. More tele-consultations have been given from Apollo Hospitals, Chennai to the African countries than all the other 10 super speciality hospitals in this network, put together. ATNF has also provided more than 71,000 tele-consultations in 25 different specialities besides having conducted about 500 inter Apollo grand rounds through multi point video conferencing.

What according to you is the next milestone, as far as telemedicine is concerned?

Apollo Telemedicine Networking Foundation was conceptualised in 1999. On March 24, 2000, Bill Clinton, the then President of the USA, formally commissioned the world’s first VSAT enabled village hospital in Aragonda, (in Nellore district, Andhra Pradesh (the birth place of Dr. Prathap C. Reddy, founder Chairman of the Apollo Group)). Apollo has also contributed by creating the ATNF, a not for profit foundation, whose major objectives are to evangelise tele-health. With the formation of ATHS (Apollo Tele-health Services Ltd - the commercial arm of the Telemedicine Division of the Apollo group), Apollo has embarked on a major project to set up 1000 telemedicine centres in the next few years. Today Apollo has 95 centres in India and 9 overseas. This is in addition to the 42 countries of the African Union which are connected to the Telemedicine Department at Apollo Hospitals, Chennai through the Pan African eNetwork initiative of the

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Give us a brief overview of how telemedicine industry is evolving in India?

We now have almost one conference a month at the regional or nation level somewhere in India dealing with some aspect of telehealth. Awareness of telehealth among the stakeholders is slowly but steadily increasing. Invitations to Indians to participate in global telehealth meetings is now becoming routine. In 2011, the American Telemedicine Association signed a formal MOU with the Telemedicine Society of India. At the 10th National Conference of the TSI held in Mumbai in 2011, there were almost 650 participants. With the exponential increase in utilization of mobile phones and a rural penetration nearing 40 percent, we strongly feel that healthcare of the future will be based on mobile solutions. Mobile technology will help bridge the urban-rural health divide. Mobile value added services like mBanking, mEntertainment and mCommerce are already being deployed in urban and suburban India – why not mHealth!

What kinds of telemedicine solutions are best suited for rural areas?

Telemedicine for rural India should primarily consist of mHealth solutions.

This is because broadband internet penetration in rural India is very low.

The availability of personal computers, laptops, tablets is also very low.

Over the next few years wireless access to the internet in rural areas will primarily be through mobile phones. The challenge is to customise mHealth solutions for low level entry phones. The cost of smartphones is progressively reducing.

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What is the most important area of healthcare that telemedicine must focus on?

All areas of healthcare are equally important. Ideally the mobile phone should become a “doctor in your pocket” if not “a hospital in your pocket.” Eventually there we will get access to all knds of sensors, miniaturised hardware and sophisticated cloud based software that can fit into our smartphone.

A solution is not a solution unless it is universally available.

Fancy video conferencing cameras, robotic tele-pathology or tele-mentoring or robotic tele-surgery make interesting news, but do not necessarily change health outcomes for the masses. Providing authenticated reliable health information at the right place, right time, at an affordable cost can do wonders. Knowledge empowerment in the local language will result in earlier referrals and avoidance of complications.

Indian Telemedicine Industry is at The Cusp of Its Evolution Marc Alexis Remond, Global Director, Government Solution and Market – Polycom, provides his insights on telemedicine sector in India

One of the most exciting areas where telemedicine might have a potential role to play is disaster responses. Your views on this.

The sine qua non in disaster management is immediate access to communication and availability of authenticated reliable health information and advice on what is to be done and not to be done. The telemedicine network therefore will be most useful as the first step in a disaster response. This was very well demonstrated during the Tsunami outbreak at Port Blair, Cuddalore and particularly during the massive earthquake in Pakistan and Haiti.

How fast do you expect the telemedicine vertical to grow?

80 percent of India’s population lacks direct access to specialist healthcare. By most conservative estimates, the telemedicine market is for 800 million Indians. Even if half of these 800 million need to consult a specialist once a year, that still amounts to 400 million specialist consultations per year. Even if 10 percent of these are enabled through telemedicine, we are talking about 40 million consultations per year from rural India alone. The market potential for telemedicine is obviously enormous.

What kind of funding will telemedicine sector require over a period of next few years?

We have to look at setting up at least 10,000 new telemedicine units (for a population of 1300 million). In addition to the software, hardware, peripheral medical devices, real estate, we also need to include operational expenses, connectivity charges, salaries for personnel, obsolescence upgradation, EMR etc. An amount of at least Rs 500 crores will be required, assuming that the entire network will be self sustaining and revenue generating. Even if 10% of India’s rural mobile phones are used for mHealth, 30 million phones will get logged in. At Rs1000 per year an additional 300 crores will be required annually. A capital outlay of 2000 crores over the next 5 years can bring radical transformation in telehealth.

Marc Alexis Remond Global Director, Government Solution and Market – Polycom

Tell us about Polycom’s initiatives in India’s telemedicine space.

Polycom’s telemedicine solutions are designed to accelerate the quality and delivery of patient care and are vital for healthcare systems. We enable the use of communication technologies in the practice of medicine. We have been working with the likes of Escorts, Narayana Hryudayalaya, Apollo and TeleVital to deliver telemedicine solutions that break down the barriers of distance and facilitate communication between patients, practitioners, specialists, and healthcare administrators.

Give us an example of a situation where your telemedicine solution has been used?

Recently doctors became part of an operation conducted by the Live International Otolaryngology Network (LION) on a patient with a mid-ear ailment. While the operation was conducted in the Netherlands, Polycom India office in Gurgaon enabled a april / 2012 www.ehealthonline.org

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live Telepresence interaction that allowed doctors from 19 countries to access the surgery and interact with the surgeons as they performed the operation. Approximately 20 Indian doctors attended the session. Going forward, our mission is to recreate similar live sessions that contribute significantly to training and the exchange of medical knowledge to and from India. This solution can also be used to train existing healthcare professionals in remote locations on a large scale allowing specialists to regularly consult with each other and exchange notes on best practices.

Give us a brief overview of how telemedicine is evolving in India?

The use of communication technologies in the practice of medicine is changing the face of healthcare in India, as it is constantly improving access to quality and affordable medical services, regardless of location or time. With rural India accounting for over 70 percent of the Indian population the opportunity for telemedicine solutions to grow is enormous. Add to that the government’s recent proposal for all students pursuing MBBS, nursing and paramedical services, in both government and private colleges, to extend their services in rural areas will add to the

positive momentum.

What is the most important area of healthcare that telemedicine must focus on?

We feel that the most important area for innovation is the need for collaboration, amongst public and private entities to deliver solutions over the last mile. This will also include the need for interoperability of solutions that allow multiple vendors to work together to create a seamless solution. Polycom has been taking a lead in this direction by creating solutions that are based on open standards allowing healthcare institutions using other vendor products to communicate and collaborate. The company has made R&D investments to interoperate with other platforms such as Microsoft OCS/Lync, IBM Sametime and Cisco Telepresence Systems.

One of the most exciting areas for telemedicine is disaster responses.

Are you developing solutions that facilitate relief work during disasters?

Absolutely, with Polycom® RealPresence™ Mobile, government agencies can provide secure, instant, face-to-face access to people, information, and locations from anywhere to anywhere. Designed for easy transport, set-up, and use, Re-

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alPresence Mobile is the ideal application for extreme situations such as national disasters, terrorist threats, and healthcare emergencies. In fact, such solutions are already being implemented by the Beijing Ditan Hospital, using Polycom’s comprehensive video collaboration solutions for healthcare. The hospital has built a telemedicine network to contain and prevent the spread of infectious diseases throughout China, saving precious time in the event of a health emergency, and ensuring the most productive use of resources.

What can the government do to facilitate telemedicine?

Managing and providing quality medical service to citizens is a key responsibility of government. To help government organisations achieve this objective, Polycom works closely with partners and customers such as government departments, Public and Private Healthcare providers and the Telemedicine Society of India.

Through its solutions, Polycom enables and encourages the use of communication technologies in the practice of medicine and offers the best way for healthcare providers to increase their level of patient care, control costs, address staffing shortages and serve rural patients.

Latest news, articles, Interviews and case studies at

@ www.ehealthonline.org

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Telemedicine for Better Health In a Tête-à-Tête Pankaj Vaish, President, HealthFore (Healthcare IT Division of Religare Technologies), offers his views on telemedicine in the country

What is the next milestone for HealthFore as far as the telemedicine operations are concerned?

Telemedicine is integral part of HealthFore’s overall mHealth offerings alongside TeleTriage (also commonly referred to as Health Helpline or doctor on phone or 104 service). We see it as a key enabler to bridge the healthcare access divide that exists in India. HealthFore is working closely with its partners to ensure that we are among the leading telemedicine solution and services provider in India and in Africa. We are offering both, low cost solutions that can be of use in the semi-urban and rural areas, and also more sophisticated solutions that cater to the urban market. Our focus is to offer solutions that have tight coupling with the backend healthcare provider systems for real-time doctor consult, EMR, scheduling, expert consultation, so on and so forth.

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Tell us about your solutions for patients requiring chronic care.

India has a large aging population with millions suffering from chronic conditions like diabetes, hypertension and cardio.

With ever escalating rates of detection of lifestyle ailments, and increasing awareness of treatment options, management of chronic ailments is assuming centre stage in the quest for a better quality of life. Through its “MediLife” offerings, HealthFore have created a bouquet of services to enable patients better manage their lifestyles through a combination of standardised monitoring, counselling and reminder services. Starting with Diabetes, Cardio and Hypertension, we intend to expand to other areas like Asthma, Obesity and Renal ailments.

Give us a brief overview of how telemedicine industry is evolving in India?

Telemedicine in India has been around for over a decade now. However, now the in-

dustry has started moving from an infancy stage to a more mature phase. The primary reason for this is the huge improvements one has witnessed in connectivity (from dial up modem to ubiquitous 3G and broadband connectivity), availability of audio video equipment and clinically certified devices like digital stethoscope, microscope, 12 leads ECG, blood pressure, glucometer etc. and overall affordability, adoptability and acceptance of a telemedicine solution. We are anticipating an infinitely more advanced version of telemedicine in the coming years.

In your view what is the most important area of healthcare that telemedicine must focus on?

Primary care remains the most important area for application of telemedicine.

There are still scores of PHCs running without medical professionals. Absenteeism is rampant. By and large, physicians do not want to work in rural and/ or remote areas; there are millions of people living in these areas with no access to healthcare and usually end up going to unqualified practitioners, or just ignoring their medical needs till too late.

Telemedicine can help connect PHCs to other PHCs or CHCs, and offer medical advice to citizens. Both general and limited specialist consultations can be offered, with only few cases being referred for physical examination at the nearest hospital.

In what ways can telemedicine play a role in rural areas?

Doctor to patient ratio in India is 1:2000.

625 million Indians living in rural areas have access to less than 20 percent of the available doctors. This is an alarming problem. Telemedicine has the potential to fulfil this huge unmet healthcare need in the rural areas. The real advantage of telemedicine is to connect the rural and tribal areas with primary care in a cost effective manner. The time-lag between the occurrence of medical need and delivery of the medical services, makes the requirement of telemedicine facilities even more imperative. The response to our solutions in rural areas is very favourable from the pilots that we have done so far.

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Apps   on the Go

Many Indians still lack access to the internet, even if they have a phone. i2i and Maestros Mediline are trying to bridge that gap, the companies have ambitious plans to bridge the gaps in healthcare sector through health apps. Dhirendra Pratap Singh interacted with i2i and Maestros Mediline to learn about their corporate vision and the new initiatives in mHealth

Sham Banerji, Chairman and CEO, i2i TeleSolutions & TeleMedicine Pvt. Ltd. i2i TeleSolutions is a provider of innovative software solutions and services for Telemedicine. BlackBerry has strengthened its innovative software solutions in India to enable telemedicine, computer telecommunications, medical electronics and imaging technologies through i2i Telesolutions.

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What are the services that you are currently offer in India?

Our focus is to provide remote screening and diagnosis applications on PC and Tablet platforms, primarily in three areas: Infant and adult blindness, Remote Cardiac Monitoring and early detection of fetal defects. We partner with healthcare service providers, specialising in these areas to provide an end to end solution to the patients in remote and or rural areas.

What are your future plans?

All our plans are focussed on providing users with easy access to quality healthcare facilities.

Give us a list of the clients to whom you are providing your services. What model do you follow?

Our model for the base of the pyramid client is PPP, i.e. Public Private Partnership. The National Rural Health Mission (NRHM, a GoI program) is one of our major clients. For clients in other

segments we provide a license fee or a hosted pay per use model. These are typically large private hospitals.

What is your market share in India?

Only about 5 percent of the total IT and Mobile enabled healthcare access and services market (total estimated at `800cr.) is served by existing players . Market share numbers are difficult to obtain. We are the leading supplier in the areas of TeleOphthalmology, TeleSonography and Remote Cardiac monitoring which are all emerging segments but growing at >80 percent versus the rest of the market at 22 percent per annum.

What are the innovations you are bringing into the market?

The innovations are mainly in the workflows relating to access and delivery of healthcare on Tablet platforms. This coupled with unique decision support systems available to doctors on mobile platforms is setting new levels of productivity, collaboration and flexibility for existing practitioners.

Chandra Mohan, Vice President, Maestros Mediline Systems Ltd. One of the key innovations in telemedicine is mobile-ECG, in which a patient can immediately send his ECG report from his mobile phone to his doctor’s mobile phone. Maestros Mediline Systems has tied-up with Research in Motion (makers of Blackberry) for this service. april / 2012 www.ehealthonline.org

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Please tell us about the services that you company is offering in India?

Maestros Mediline Systems Limited (Maestros) is a market leader in providing Information Technology (IT) products, solutions and services focused on discovering new ways for using technology to bring benefits to different businesses.

We provide services in infrastructure management, applications development, healthcare solutions, software embedded systems, medical equipment, integration and interfacing services, project management and consulting.

Maestros has successfully delivered innovative value-added services to its customers across industry verticals including retail, FMCG, government, BFSI, manufacturing, IT, telecom, BPO and healthcare. Maestros have a long term alliance with Microsoft. Also, Maestros has accrued accreditations and certifications like ISO 13485, CE certified HL7, etc. The company continually endeavours to achieve high standards.

We have competencies in advanced infrastructure solutions, business process and integration solutions, custom development solutions, data management solutions, information worker solutions, networking infrastructure solutions, security solutions, SOA and business process solutions.

What are you initiatives in Telemedicine?

The large gap between the number of doctors and patients in India has infused a deep desire into Maestros think-tank to develop sustainable long-term solutions for bridging these healthcare needs. Thus began the quest for Telemedicine solutions.

For more than one decade Maestros R&D has been striving into uncharted waters and has been able to deliver some extremely useful path changing devices & solutions .

The mobile health solutions can be very useful in tackling in healthcare issues. What are you solutions in this segment?

It is an established fact that coronary heart disease is one of the leading causes of death. Every second in some part of the world a person suffers from chest pain or has a heart attack. It is commonly observed that these victims waste substantial time before seeking medical help. This could be due to sheer ignorance, lack of knowledge or the absence of an efficient support system.

Our solution eUNO R-10 is a remote ECG reporting solution. The eUNO is a simple handheld ECG device with a built in GSM modem. The system is supported by a secured web based platform the Rhythms24X7.

The patient and physician are at different locations. At the patient end is the eUNO, a standalone 12 lead ECG acquisition peripheral device. This device can capture demographic data of patient along with symptoms to facilitate diagnosis.

The eUNO can store 20 ECGs. And can be configured to send ECG individually to 20 consultants.

The ECG sent to Rhythms24x7 is safely stored on this server.

This server is available to valid users around the clock round the year.

The ECG, once it comes to the server, is automatically for-

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warded to the mobile phone of the consultant for reporting. The consultant can receive this as an email, MMS or a PDF. The expert has a simple and efficient user interface which helps him/her select the ECG, diagnose, write the comments and send it back. Every hospital is provided with their own monitoring console. At the hospital end users can login to this server with their preferred browser, using their username and providing valid password.

Potential Clinical Applications Case 1: A patient calls in with chest pain. The paramedic or the family physician makes a home visit and takes an ECG using the eUNO 12 lead ECG machine. He enters the patient details and selects the physician to whom the ECG has to reach. He then presses the transmit button on the device. eUNO will automatically dial to the server and the server ensures that the digital ECG reaches the consultant within five minutes of being sent. The status of transmission is indicated to the sender.

Case 2: EUNO R10 can be used in ambulances for taking the 12 lead ECG and sending it to the hospital or consultant at time they are picked up and during transport. This helps the hospital to prepare for the patient and the treatment can start early thereby reducing damage to heart and improving chances of survival in case of heart attack.

Case 3: A patient with chest pain reaches the hospital casualty.

The opinion of a cardiologist who is not immediately available on the premises is required. ECG using the eUNO 12 lead ECG machine can be taken and transmitted to the consultant. Treatment can be advised and started even while the consultant is in transit to the hospital to be with his patient.

Tell us about the new innovations that you are planning?

Maestros has successfully delivered innovative value-added services to its customers across industry verticals including retail, FMCG, government, BFSI, manufacturing, IT, telecom, BPO and healthcare. Maestros was awarded Technology Innovation, Mobile Healthcare Asia-Pacific, 2011 by Frost & Sullivan’s Global Research. Over 50 dedicated scientists are working round the clock to produce end to end solution, which caters to specific needs of healthcare delivery system through the use of software based framework, internet services and mobile telephony. The system will bridge the distance between patient and health services in the most cost effective manner.

What are your future plans?

We started our journey with medical devices and now we have developed capabilities for delivering cutting edge devices linked to tele solutions. Our first platform was Rhythms 24 X7 for delivering timely ECG interpretation and data transfer facility. This was followed by consensus (remote teleconferencing platform) and now we are on the course to deliver best home health solutions.

We intend to integrate all diagnostic results in the web space to enable best treatment for one and all.

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“There is a huge potential for mHealth in India” Give us a brief overview of IL& FS and its footprint in mHealth space in India.

IL&FS Education Technology Services (ETS) is the social infrastructure initiative of IL&FS India. Established in 1997, IL&FS ETS Ltd specialises in the fields of education, health initiatives, e-governance, financial inclusion, skill development, and industrial cluster development. By integrating the benefits of information and communication technologies and medicine, we offer innovative methods and technology to deliver healthcare services to the people in remotest regions of the country.

We are the first private corporate to be nominated as principal recipient of the global fund to fight against HIV/AIDS, Tuberculosis and Malaria (GFATM) and to manage the Prevention of Parent to Child Transmission of HIV/AIDS (PPTCT) programme in the country.

What services are you offerings in the mHealth domain?

The Prevention of Parent to Child Transmission of HIV/AIDS (PPTCT) programme’s objective is to counsel, test and treat pregnant women who are HIV positive so that the transmission of virus to the child can be prevented.

The process involved is generally manual where the field workers use paper forms, booklets and registers to record details of the service and treatment provided. The data is aggregated manually in most of the cases and ‘uploaded’ to the computer software systems for the purposes of reporting and analysis.

Since the system is largely manual at the field level, the field workers find it very difficult to maintain proper records.

Tracking and monitoring of the HIV positive women for the purposes of providing Antiretroviral Therapy (ART) or other treatment on time becomes difficult, thereby raising the risk of transmission.

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Dr Arun Varma Vice President & Head Health Initiatives, IL&FS Education Technology Service One of the key factors for achieving a high success rate in this endeavour is to use an appropriate ICT enabled technology solution for tracking and monitoring HIV positive pregnant women for the purpose of counselling, testing and treatment as well as monitoring the new born babies for a period of up to 18 months post birth. In this context, we have introduced a mobile based monitoring system that addresses the monitoring and management system requirements of this programme.

Enlist the clients to whom you are providing your services. What model do you follow?

At present the mobile phones with the PHMMS application are used by the field workers called outreach workers (ORWs) to track our primary clientele, pregnant women, mainly from poor socio economic background. In near future, we are planning to bring in more clients like healthcare workers in the communities such as Accredited Social Health Activists (ASHA) workers who can use a similar mobile based tracking system for various programmes.

The outreach workers are provided with a mobile phone installed with easy to use software to record their visit details to a HIV affected pregnant women or a HIV infected woman with a baby within 18 months.

The data collected during the visit is securely transmitted to a central server. The mobile phone application prompts and reminds the outreach worker about the various HIV positive pregnant women in her care, for whom the next course of action like next Anteretroviral Therapy visit, CD4Test, due for delivery, baby follow up is due and such other important information. The outreach worker can easily track the beneficiary and provide the access to the required treatment or health service.

The solution has a web application that can be accessed from any internet connected computer. The web application provides the reports, analysis and management control of the programme for various stakeholders, agencies and the government.

How have you seen the advancement in the field of mHealth in India over last decade? mHealth is in very nascent stage in India.

With the exponential increase in number of mobile phone users and the huge demand for healthcare services in our country, there is certainly a huge market potential for mHealth for tangibly mitigating some of the inherent problems in the healthcare service delivery in the country both in the public and private sector.

What are the innovations you are bringing into the market?

The programme is unique. It can be scaled globally to enable the tracking of HIV positive women through mobile phones. The model empowers outreach workers in using a software application for providing the grass root level data using the mobile phone as a medium. (In conversation with Dhirendra Pratap Singh)

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Connecting Healthcare Nokia is looking at better ways of connecting people to what matters to them when it comes to healthcare What is Nokia’s footprint in mHealth space in India?

Nokia Life, the world’s largest livelihood and life improvement services suite for connecting and engaging the next billion is live in India since mid-2009. Health services are one of the main service offering along with education, agriculture and entertainment under Nokia Life. Nokia Life is pre-embedded in most of the Series 30 and 40 Nokia devices being shipped in the market, hence the user need not download a separate application to access health information.

What are the services you are offerings in the mHealth domain?

Nokia Life has a range of information services that are potentially useful to user’s right from conception until old age. Health services in Nokia Life range from mother and child that cater to information around pregnancy and childcare, health and fitness which is information for men and women who want to stay healthy and health topics that include information around

Dr Arun Gowda, Product Manager (Global) – Health and Wellness Services at Nokia

respiratory health, heart and diabetes. These services are available on a subscription basis for a monthly charge of `30.

Information provided under the Nokia Life Health services is relevant, hyper-local and personalised for the user.

How have you seen the advancement in the field of mHealth in India over last decade? mHealth in India has received lot of attention in the last decade and a lot of pilot projects have been conducted. Time is right for both the public and private sector to step up and convert the pilots into large scale projects that will help the general public and the health community. Another good thing to note is that the health community doesn’t see mHealth and technology as a threat but as an enabler to improve community knowledge about disease.

Enlist the clients to whom you are providing services.

What model do you follow?

Nokia Life is a suite of information services that is for the general population to use. Users who want to try Nokia Life Health services have the option of a free trial period and subscription to the service for which they need information for. There are instances where a developmental organisation would like to reach out to an audience with health information. For e.g., Nokia Life along with Arogya World and other partners is currently offering mDiabetes service in India, free of cost to the user.

What innovations are you bringing to the market?

Nokia Life which was until now a one-way information dissemination service will see the addition of social elements like Ask an Expert, Polls and Share that allows the user to communicate with us and their immediate social network through Nokia Life.

We are also adding new services as well as expanding the service offering to make it useful for a larger group of audience.

The childcare advice offering is evolving to a parenting advice service that will now expand from offering information from the earlier 0 to 5 years to 0 to 17 years of child’s age.

What is your marketing and business strategy in India?

By pre-embedding Nokia Life in the Series 30 and 40 devices we have made it possible for people to readily access information and not go through the hassles of downloading an application. At the point of sale, retailers are trained to talk about and help users activate Nokia Life services. Literature available both inbox and out-of-box have information about the availability of Nokia Life services. april / 2012 www.ehealthonline.org

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mhealth

Keys to the Future Many more innovative things are yet to arrive in the mHealth space

Kunal Sinha, CEO, HealthcareMagic

We are an online-wellness company and we recently signed our 50th corporate client. We take pride in providing wellness

services to clients like SAP, Dell, McAfee, Lenovo, and HSBC. We provide services like “E-Opinion from specialists”, “Doctor Live Chat”, “EAP (Employee Assistance Program – Counselling)”, “Personalised Diet Chart” and “Health Risk Assessment – HRA”. Our services have helped our clients realise quantifiable gains resulting in higher productivity.

There have been lots of advancements by many innovative companies during the last 10 years. Now, we have SMS based medication reminder and tip services; we have newer initiatives of connecting doctor and patients through mobile phones.

Medical devices can now transmit the readings to doctors sitting in a larger hospital. Telemedicine and its portability to mobile devices is happening. So there’s a lot happening and I believe that it is just the beginning as many more innovative things are yet to come to the market.

Our major contribution is in connecting experts to the common man. For example, if a person in Indore needs to get opinion from a top Cardiologist or Oncologist in India or abroad, he can send his report online and get the recommendation of top cardiologists through Healthcaremagic platform. We have over 3500 top doctors answering questions from our users.

The doctors get paid for each answer that they provide through HealthcareMagic platform.

Dialling a Healthy Tune Mobile Apps have leveraged best features of social networking for aggregating health related activities WINIT is India’s leading mobile app strategy and development company. Currently we are working with global organisations across verticals.

Mobility is a rapidly evolving field with technology trends changing at an extremely fast pace. For healthcare service providers who are interested in starting mobility initiative, we develop the key success-factor i.e. to devise an effective mobile application strategy. The strategy outlines the rationale as to what mobile platforms and technology is to be targeted and at what phase of the project.

Leveraging strong expertise in the mobility domain, WINIT provides the mobile app strategy, which outlines timelines and

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feature-sets for all the mobile platforms currently available. Any good mobile app should provide sound end user experience and hence the mobile application design methodology has to be based on concepts like User-Centred-Design, Information and Interaction-design etc. WINIT helps health service providers create innovative and unique applications that offer good user-experience for the end-users.

The advent of Smartphones with high resolution display technology like Retina Display provides the patients the opportunity to store their electronic medical records in their mobile devices and enjoy anytime anywhere access. WINIT creates mobile strategies for clients and works

Prakash Sreewastav CEO, WINIT

long term leading to better ROI, efficiency and consumer engagement. WINIT engages with clients and takes the onus of driving innovation for them.

mhealth

The Right Connection mHealth is a powerful tool for transferring critical information and monitoring essential functions

Sanjay Aggarwal CEO, UNICEL Technologies

UNICEL is an enterprise mobility specialist. It is a leading provider of wireless mobility solutions that help organisations create clear, quantifiable value for customers. Capable of mobile-enabling virtually any application in the enterprise space, the company uses the versatile platform of mobile telephony

to offer innovative, customised solutions to organisations across function areas. The company’s core strength is in the ability to identify and plug operational gaps in an organisation and allow it to achieve higher levels of performance and profits.

For critical solutions like EHR/EMR, UNICEL can send updated reports over email with an SMS trigger to a virtual number. Consumers can also access hospital information, doctor profile and more through SMS triggers or intelligent toll-free IVR systems with call-patching and call back. On an organisational level, UNICEL also has powerful Inventory Management and Emergency Care solutions over SMS and Voice. The health insurance sector has also greatly benefitted from automated alerts, premium reminders, and insurance details directed to the customer’s mobile phone with an enquiry SMS trigger.

With the sheer penetration of mobile phones across India, mobility solutions have steadily become a favoured

mode of communication between the healthcare enterprise, the provider and the consumer. Previously, SMSes were only being used as a promotional tool, but today it is becoming a powerful tool to transfer critical information and even monitor essential functions in the healthcare sector.

We are providing services to Apollo Group of Hospitals, Fortis Hospitals, Dharmshala Hospitals, TTK Healthcare, Klink Healthcare, Bajaj Allianz, ING Vysya and few others. All our solutions and services are provided on a SaaS model.

Our innovations include, a brand new service - GlobalOne, a UI that makes all enterprise messaging quick, efficient, effortless and economical. We have integrated SMS and Voice to provide a single eco-system that can be customized to the needs of the healthcare provider or insurance provider. We also have a comprehensive reporting module to track every contact and ensure no message goes unattended.

Changing the Face of Healthcare Max Healthcare is pioneering mHealth through use of MphRx’s mobile technology MphRx offers a cloud-based solution for storing, retrieving and sharing complete health records, including radiological images, among patients, care delivery organisations (CDOs) and insurers worldwide. The primary benefit offered by our technological solution is that it enables healthcare facilities to significantly reduce both capital expenditures and operational costs, at the same time it also leads to improvement in patient care.

MphRx-Connect is a sharing and collaboration platform offered by MphRx. By using this system, physicians can

Chetan Uberoy Country Head-India, MphRx

access complete diagnostics of their patients through cloud or any mobile

device. Physicians and patients can search, access and share radiological images, cardiology videos, retina images, lab results and more, through MphRx-Connect on their laptops, smartphones and tablets. We support all RIM devices - Blackberry Curve, Bold and Torch range of smartphones.

Recently MphRx launched the Blackberry playbook application for MphRxConnect.

Max Healthcare and SPS Apollo Hospital in Ludhiana are the two clients that make use of MphRx’s Connect solutions in India. april / 2012 www.ehealthonline.org

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expert corner

“IT will Revolutionise Healthcare Processes” The value of HIS is growing, people are looking into information systems and are developing commercial databases

W

hen it comes solely to the application space, the Healthcare IT market is of around 300 crore. On an international level, the market could be worth US$ 300 million and it is growing at 15 to 20 percent per year. We offer a complete platform ‘PALASH’ to the healthcare industry.

Palash Healthcare Systems (PHS) is specialised Healthcare Information Technology organisation offering various software services and solutions to healthcare providers. PHS offers a complete range of IT solutions viz. HIS, LIS, PACS and Healthcare Dashboards by leveraging healthcare domain expertise and a global delivery model. It provides various frameworks for automating their processes in verticals such as multispecialty, diabetes, ophthalmology, dental, IVF, cardiology and much else.

PALASH provides enterprise wide solutions to clinics, polyclinics, specialty clinics and small and medium hospitals.

The major challenge is to understand the role that IT in the operations and technology can play in the healthcare industry. People are still not able to identify how technology can help them in their field as the market is still in its nascent stage. The information can definitely bring value to care. There has to be a major drive to use technology and awareness, so that it brings value to the patient care.

The value of HIS is growing, people are looking at the information system and developing commercial database to provide streamlined processes not more than 30-35 percent hospitals have shifted to IT based infrastructure. The EMR patient makes a huge difference if it’s dealing with chronic disease. The

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Dinesh Samudra Managing Director and CTO, Palash Healthcare patient needs to keep a lot of records in terms of information sharing and transfer, as it is highly efficient. We have chain of family clinics, which are interconnected and prove convenient.

We do not have enough rules and regulations in terms of keeping potential data and records. Indian government

has to really work on the rules to use IT to manage information. We need to mandate such policies for effective implementation. We are looking forward to creating a centralised EMR of the patient and clinical protocols, which will be followed by NRHM to record and provide information through a common platform.

expert corner

It’s Health First Dr Pradeep Saxena talks about the role of Central Bureau of Health Investigation

T

he Central Bureau of Health Intelligence (CBHI) is the national nodal institution for health Intelligence in the country for maintaining and disseminating national health profile, health sector policy reform options database, and GIS mapping of Government’s health facilities in India. It reviews the progress of health sector millennium development goals in India. We facilitate capacity building and human resource development, and need based operational research for efficient health information system as well as use of family of international classification in India and South East Asia.

CBHI has been regularly bringing out its annual publication “National Health Profile (NHP)” since 2005. NHP involves sustained efforts to collect and collate an enormous national data from the direc-torates of health and family welfare services of all the states, central government organisation, na-tional health programmes and various other concerned national and international agencies in India.

National Health Profile highlights the information under six major health indicators viz. demography, socio-economic, health status, health finances, health infrastructure and human resources for the specified year, and other information required for an efficient public health system in the country.

Health Sector Policy Reforms Options Database Though states and union territories have undertaken reforms in the health sector, a lot of this goes unnoticed and hence not documented. Thus, Ministry of Health and Family Welfare under its Sector Investment Programme funded

by European Commission, entrusted CBHI to develop and maintain health sector policy reforms options database (HS-PROD).

Dr Pradeep Saxena, Director, Central Bureau of Health Intelligence and Director General of Health Services, Ministry of Health and Family Welfare, Govt. of India It is a web-enabled database that documents and creates a platform for sharing of information on good practices and innovations in health services management. It contains entries related to health sector policy reform data base of India and is being updated from time to time.

The HS-PROD website has at present more than 260 reform options from a varied range of fields and stakeholders

like the state governments, development partners, NGOs and categorised them under 16 subject areas.

Creation of electronic database of government health facilities, educational institutions, training centres, and other healthcare establishments in India is an important need. CBHI has prepared a database of the Government health facilities for their mapping through use of Geographical Information System (GIS). april / 2012 www.ehealthonline.org

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expert corner

How to deal with

Malaria Dr Aruna Srivastava is explaining the role of GIS in mapping malaria hotspots

Dr Aruna Srivastava Consultant, National Institute of Malaria Research, Indian Council of Medical Research, Ministry of Health & Family Welfare

I

n India, the number of malaria cases came down from 6.47 million in 1976 to around 2.5 to 3 million cases annually by 1996. After 1996, there was a declining trend in malaria incidence and in 2003 we had about 1.87 million cases. In India, tribal population contributes about 30 percent of total malaria cases. Largest concentration of tribal population, about 15.4 million, is in Madhya Pradesh, which is about 20.3 percent of the state’s total population. Due to the different linguistic, cultural and geographical environment, and its peculiar complications, the tribal world of Madhya Pradesh has been largely cut-off from development and this is a cause for concern for the government.

Presently malaria shows a declining trend, whereas Plasmodium falciparum cases show an uptrend. In central India,

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specifically, Madhya Pradesh, control of malaria is logistically difficult and outbreaks are frequently recorded. Reasons for this being inadequate surveillance, poor reporting, a time lag in reporting to decision makers and a lack of geo referenced information to pinpoint the trouble spots for a timely and preventive action.

Our team from India’s National Institute of Malaria Research have worked extensively with colleagues from the National Vector Borne Disease Control Programme and the State Health Department to use GIS to pinpoint trouble spots for timely preventive action.

An information management system based on GIS using district and block wise malaria data, has been constructed for Madhya Pradesh for quick retrieval of info and dynamic generation of maps to highlight hotspots of malaria for formulating prompt and focused malaria control strategy. Out of total 48 districts consisting of 313 blocks, based on certain criteria, GIS identified 58 blocks falling in 25 districts as hotspots. Malaria flares up from these pockets whenever favourable conditions for transmission occur. It was suggested to National Vector Borne Disease Control Programme (NVBDCP) that focused malaria control in these hot pockets may be taken up on priority during the year 2007; it was implemented by State Health Authorities, M P under the directive of NVBDCP. Implementation of control measures were evaluated by NVBDCP. GIS based malaria surveillance system was implemented in Dindigul municipality on November 19th 1999, ‘The World GIS Day’. Health officers from the district and state head quarters Tamil Nadu were trained for its proper utilisation. GIS mapping would make it easy to update information instantly and to identify the trouble spots at the village level within the district which is the lowest unit equipped with computer facilities and the information can reach instantly to state and the policy makers to formulate focused and cost effective malaria control strategy.

This is the first time when GIS has been used in national control programme for tribal malaria.

expert corner

The Change Agent in Healthcare All healthcare processes rely heavily on technology, says Dr Gayatri Vyas Mahindroo

H

ealth technology is the application of organised knowledge and skills in the form of devices, medicines, vaccines, procedures and systems developed to solve a health problem and improve quality of life. Effective health technology address accessibility, affordability and availability of innovative and core medical devices required to target the health needs. To achieve this there are four phases of medical devices - research and innovation, regulation for device safety, assessment for better decision making, and comprehensive management Clinical Engineers are part of the clinical and management team, and work closely with the medical practioners to achieve optional use of technology in healthcare. Typically, the purpose of a medical device is not achieved by pharmacological, immunological or metabolic means. Medical devices in particular are crucial in the prevention, diagnosis, and treatment of illness and disease, as well as patient rehabilitation.

Medical equipment is used for the specific purposes of diagnosis and treatment of disease or rehabilitation following disease or injury; it can be used either alone or in combination with any accessory, consumable, or other piece of medical equipment. Medical equipment excludes implantable, disposable or single-use medical devices.

Technology not only includes equipment, devices, drugs, biologics and procedures that it enables, but also the organisational and support systems within which it is used. All care processes rely heavily on technology and the patient is the centre of an intricate network of clini-

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Dr Gayatri Vyas Mahindroo, Director, NABH, Quality Council of India cians medical equipment & devices and other elements. The burden of life style and non communicable diseases has raised the demand of medical technologies, which can be used at home for detection and monitoring purposes. Data security and authentication has key role, in the domain of medical electronics.

About four to six percent Indian population is suffering from Diabetes. They need devices such as glucometers, dialysis and insulin pumps. About one to two percent population is visually im-

paired or blind. They need devices such as lenses and ophthalmoscopes There is a direct link between work environment and patient safety (Quality Healthcare Standards). Therefore, if we are not addressing our work environment, we are not addressing patient safety. Creating healthy work environments requires changing long-standing cultures, traditions and hierarchies.

Though everyone must be involved in the creation of healthy work environments, the onus is on the organisational leaders to really make it happen.

Expert Corner

Technology Transforms India’s Health Dr Madhulekha Bhattacharya sheds light on the role of technology in improving Indian healthcare scenario

H

ealth and ill health are affected by a variety of lifestyle and environmental factors, including where people live. Characteristics of these locations, including socio-demographic and environmental exposure, offer a valuable source of epidemiological research studies on health and environment. Health and ill health always have a spatial dimension therefore. The need of the hour is to have a GIS hub at the district level with multi-sectoral data sets for analysing and presenting the data to the district and health administrators for use and support functions.

The existing information scenario in the health sector can be summarised as being huge and unmanageable. The health sector is probably one of the most distributed and widely segregated sectors, as far as vertical and horizontal levels are concerned. Based on the catchment population and administrative boundaries, services are being offered through various health facilities like PHC, SHC, District Hospital and the like. For each of the major programmes, separate database are

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harya Dr Madhulekha Bhattac of Community t.

Dep d, Hea & or Profess ional Institute of Nat , ion trat inis Health Adm lfare We ily Fam Health and

being generated and are often recorded and analysed manually. However, the data is losing its authenticity and accuracy, as it is being compiled and sent to the next administrative level. When it reaches the national level, where the major policy decisions are taken with respect to resources

and new healthcare programmes, it is often outdated.

The Planning Commission approved a Health Ministry proposal to increase the allocation on public health to `4.04 trillion in the 12th Plan from `70,986.76 crore in the preceding five-year period. Given that health is a state subject, the ministry has suggested that two-thirds of the expenditure on public health be borne by the state governments. The Health Ministry will start implementation of the district-wise pilot project of UHC in some states to decide on how much each person will be entitled to and what diseases will be covered under the programme. The exercise of merging all health-related welfare programmes under the NRHM, are aimed at bringing more efficiency and accountability to government healthcare programmes.

The Mission Flexipool, Reproductive and Child Health Pool and the pool set aside for immunisation will initially be merged, while funds under National Disease Control Programme will be brought in later.

Expert Corner

Health IT Takes a Giant Leap Technology has a significant role to play in structuring healthcare data, says Aditya Mani

H

ealthcare information technology is undergoing enormous changes with broad consumer impact. Acuis is a healthcare IT company that focuses on improving clinical and administrative processes. Acuis products enable healthcare administrators with tools that improve their workflow and increase patient satisfaction while reducing costs.

Health IT spending in India and US is expected to continue growing because of rising healthcare costs, aging population and the cost reductions and efficiency gains that health IT is expected to generate. Instead, it will be doctors and large care giving organisations that help drive the adoption of healthcare IT. They, in turn, will be driven by monetary incentives that the government has written into laws.

At Acuis, the knowledge of medical experts converges with IT professionals to develop advanced IT solutions for the healthcare eco-system. Our products enable our clients to conceptualise and realise their healthcare technology initiatives.

Cloud computing in healthcare is converging health ecosystem. Cloud computing has given opportunities for healthcare companies to enter into an agreement with companies offering similar services and share data with the consent of patients to improve service. For large organisations, healthcare service is not the only line of business. A major share of business profit comes from retail or pharmaceutical operations. To ensure that these lines of business are performing well, one of the requirements is that they have a better supply change management and capacity planning.

There is a huge role of technology in structuring data in healthcare. Technol-

Aditya Mani, Director (Systems), Acuis

ogy enables data mining and context searching. With the recent advents of information technology, we are currently able to record and gather this information electronically. We can harvest this data and use it to improve the quality, safety, and competence of healthcare.

Doctors and hospitals can now be proficiently supported by valuable data and analytics to help them treat patients There are many things that you can do

to help yourself. But none of them will do any good until you remember the first rule of holes: When you’re in a hole, stop digging. Don’t make matters worse by making faults. If you want to get out of the hole, your first step is to make sure you’re not digging yourself in deeper. The same principle applies across the healthcare.

The greatest challenge in the new world of integrated healthcare delivery is to provide comprehensive, reliable, relevant, accessible, and timely patient information to each member of the healthcare team, whether in primary or secondary care and whether a doctor, nurse and allied health professional. The electronic health record provides the opportunity for healthcare organisations to improve quality of care and patient safety. april / 2012 www.ehealthonline.org

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Expert Corner

Road-mapping the Future of Healthcare RSBY like model of protecting the poor and unorganised sector is workable and scalable, says Dr Praneet Kumar

Dr Praneet Kumar, CEO, BLK Super Speciality Hospital

I

t is widely recognised that ill-health is one of the most serious challenges that households face. Any catastrophic illnesses in a country like India can wipe out decades of savings of below poverty line people. Illness is the most common reason for falling into poverty in India.

A major part of total health spending in the country takes the form of private, out-of-pocket spending, which is clearly regressive in nature. There is a clear need for developing health insurance mechanism, especially for the low-income people who need it the most. RSBY like model of protecting the poor and unorganised sector is workable and scalable.

Ten years back, government hospitals were grappling to retain their productive resources. However, after the government passed the Sixth Pay Commission, healthcare workers from the government sector enjoyed a hefty increase in salary as well as various other privileges

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which in turn motivates them to stay longer. Most Indian people do not use health insurance to finance their medical expenditure. The financial stress that is engendered due to rising medical expenses is believed to affect the lifestyle of all family members for years.

There has to be risk profiling in health insurance. Besides being more equitable, it is one of the significant drivers of improvement in healthcare, it encourages investment and innovation. It helps improve the quality and efficiency of public healthcare system by continually benchmarking it. In a country like India where public healthcare suffers from poor management, low service quality, weak finances, and lack of responsiveness to patients’ needs and demands, development of health insurance is likely to bring improvement in public healthcare system.

With an increasing number of corporate hospitals, healthcare related issues, research trials and undue attention by me-

dia in India, there is a need to focus on patient’s rights and protection. In India, multiple agencies like regulatory bodies, scientific review committees, ethics committees, NGOs, etc. work toward patient rights and protection. There’s a need to have a separate group of people who provide advocacy to the patient, or simply, a patient advocacy group, which will work explicitly in these areas to increase transparency and credibility of healthcare system in India. This group will provide special attention to patient care and protection of rights from the planning stage rather than at the troubleshooting stage.

There is much less regulatory focus on the consumers for insurance products and the overall goals f health policy in the form of regulation that curbs risk selection, protects consumers, promotes health insurance companies and health products.

Having a universal health insurance to cover all citizens is one of the ideas which can be implemented.

event report

(From L-R)-Dr Ujjwal Rao, Dr Pradeep Mishra, Dr Dinesh Jain, Dr Aruna Srivastava, Dr Pradeep Saxena, Matt Theis and Gunjan Kumar

Healthcare Leaders’ Forum 2012: The Zeitgeist of Healthy Society The Healthcare Leaders’ Forum 2012, organised by eHealth magazine, highlighted myriad strategies that can lead to the development of an efficient healthcare infrastructure in India

By Dhirendra Pratap Singh, Elets News Network (ENN)

e

Health magazine organised the second edition of Healthcare Leaders’ Forum on March 14, 2012, in New Delhi with the aim of bringing together the entire community of healthcare professionals, practitioners, end-users and decision makers to conduct a vigorous discussion on different aspects of healthcare.

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The objective of the Forum was to create a vibrant platform for senior industry leaders and make it possible for them to share business experiences, provide opportunity of mutual learning and showcase existing success stories and best practices in healthcare industry.

The occasion was earmarked by the launch of the eHealth Online Directory.

The online directory provides the most up-to-date information on the various product and service providers. Each segment will take you through a wide array of available products and solutions provided by some of the most eminent players in the industry. There is extensive listing of medical technology and healthcare IT solution providers in the directory.

event report

It is a comprehensive guide for buyers, providing details of key products and vendors in the healthcare technology space.

Launched in November 2006, eHealth has established itself as a leading monthly magazine on healthcare ICTs, medical technologies and applications in India as well as Asia Pacific.

Session One ICT-Enabled Healthcare: e’Transformation of Indian Hospitals The inaugural session of the forum focused on the key growth indicators and government’s initiatives that have paved way for a healthier future. As the Indian healthcare sector is undergoing constant evolution, technology penetration is growing by the day.

Elaborating on the role of ICT in the development of the healthcare sector, Dr Pradeep Mishra, Founder, www.ilaajonline.com, stated that each person in a defined population must be a stakeholder in proper functioning of PHC. He said, “Public- Private Partnership should be encouraged in developing e-health software for PHC. Curative Healthcare for poor has to be affordable. They are most diseased. ” Gunjan Kumar, Head - IT & Automation, Sahara Hospital, said, “Simplicity is the KEY for mass acceptance of technology in Healthcare. Technology in Healthcare increases efficiency, minimises errors and provides consistent data for analysis.”

Dr Dinesh Jain, Senior ManagerMedical Informatics, Max Healthcare Institute Ltd. said, “Digitisation of Patient Records is a major step at Max Healthcare. Clinicians are taking a lead in digitisation of patient records supported by IT. Effective communication and change management was put in place. Due system and process integration was done appropriately so that transition happens smoothly. Effective implementation of EMR systems is improving the quality of health services.”

He added, “Due to meaningful use of ICT in Healthcare, there is an improvement in quality, safety and efficiency, decision support for high priority conditions, access to self management tools

Dr Dinesh Jain Dr Pradeep Mishra

Founder, www. ilaajonline.com

Gunjan Kumar

Head - IT & Automation, Sahara Hospital

and improvement in population health outcomes.”

However, Dr Annie Stanley Thakore, Hospital Administrator, CARE Hospitals was of the view that healthcare is a very information intensive industry. She said, “India’s public healthcare network is six decades old. It is plagued by many problems like absenteeism of doctors, lack of proper facilities and it lacks proper referral services to urban hospitals and specialist centres.”

“Mobile phone usage in India is soaring. Accredited Social Health Activist (ASHA) program needs sup-port and monitoring. 750,000 ASHAs have been deployed by National Rural Health mission (NHRM) since 2005. Training in diverse techniques is needed to dramatically improve maternal and child health”, said Matt Theis, Managing Director, Dimagi Software Innovations.

Dr Ujjwal Rao, Clinical Transformation Specialist & Solution Architect EmerCare- Cloud-Hosted EDIS, OHUM Healthcare Solutions emphasised upon the two million hospitalisations, 7.7 million injuries and an economic loss of `55,000 crores or nearly 3 percent of GDP every year. 30 percent of emergency patients in India die before they reach a hospital.

Senior ManagerMedical Informatics, Max Healthcare Institute Ltd

Dr Annie Stanley Thakore

Hospital Administrator, CARE Hospitals

Dr Ujjwal Rao

Clinical Transformation Specialist & Solution Architect - EmerCareCloud-Hosted EDIS, OHUM Healthcare Solutions

Dr B B Thukral

Vice Chairman, Indian College of Radiology and Imaging

Indrajit Bhattacharya

Professor (Healthcare – IT), IIHMR april / 2012 www.ehealthonline.org

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event report

Dr Balram Bhargava

Sonal Pahwa

Executive Director SIB – India, Professor of Cardiology – AIIMS

Associate DirectorHealthcare, Technopak

Dr Sai Praveen Haranath

Dr RD Lele

Consultant Intensivist and Pulmonologist, Apollo Hospitals, Hyderabad said

Director, Nuclear Medicine Dept, Jaslok Hospital & Research Centre

reach & narrow service portfolio. It is hard to compete with top players on complex tests and turnaround time. 70-80 percent of medical decisions are taken through diagnostics. Out of 6000 diagnostic labs only 200 are NABH accredited.”

Dr RD Lele, Director, Nuclear Medicine Dept, Jaslok Hospital & Research Centre highlighted the need of health insurance being within the mandate of microfinance institution (MFIs). He said, “Depositlinked life and health insurance collaboration between MFIs and health sector.

Income security and health security are two sides of the same coin, especially for the poor who are at the heart of MFIs. My recommendation to government is upgrade RSBY card to my bronze card and provide micro finance to BPL Indians.

The poor do not need charity, they need micro finance support.”

Session Three

Dr Damodar Bachani

Director Professor & Head, Department of Community Medicine, Lady Hardinge Medical College

Dr Nishant Jain

Sr. Technical Specialist (Health Insurance & Health Finance), GIZ

Dr Siddharth Agarwal

Executive Director, Urban Health Resource Centre

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Session Two Defining Trends in Diagnostics and Imaging In the second session, healthcare industry leaders reflected upon the defining trends in diagnostics and imaging.

Sharing digital imaging’s role Dr B B Thukral, Vice Chairman, Indian College of Radiology and Imaging said, “Digital imaging is a broad term. It is defined as any image acquisition process that produces an electronic image that can be viewed and manipulated on a computer. In radiology, images can be sent via computer networks to a variety of locations.”

However, Indrajit Bhattacharya, Professor (Healthcare – IT ), IIHMR was hopeful that Health IT can help in improving organisational effectiveness and in bringing efficiency into clinical, operational and financial performance indicators. He said, “Indian healthcare acutely needs to implement enterprise level Health IT solutions to increase access and reach of healthcare.” Sonal Pahwa, Associate Director-Healthcare, Technopak, expressed her views on fragmentation of Indian Diagnostic Market. She said, “10 percent market is organised. Customer is expected to migrate from low quality poor diagnostic services to higher quality services. Small labs have limited geographic

Indian Medical Technology Industry: Market Challenges & Opportunities As the Indian healthcare sector is undergoing constant evolution, technology penetration is growing by the day. The experts focused on the role of cutting-edge technologies in all sectors of healthcare and the various issues that plague the Indian medical technology sector.

Said Dr Balram Bhargava, Executive Director SIB – India, Professor of Cardiology – AIIMS, Medical Device Innovation BioDesign programme at AIIMS, “In India, 36 percent of deaths are due to communicable diseases, maternal and prenatal disorders and nutritional deficiencies.

State healthcare will create more opportunities for indigenous innovations.”

Dr Sai Praveen Haranath, Consultant Intensivist and Pulmonologist, Apollo Hospitals, Hyderabad said, “The cost of ICU care in a tertiary care centre in India was reported to be `3200 per patient in 1991. Staffing, intravenous fluids, and drugs accounted for 75 percent of the cost of ICU care, whereas 15 percent accounted for laboratory investigations and 6.9 percent for disposables. A mix of the art and science of medicine is an optimal solution.”

Dr Damodar Bachani, Director Professor & Head, Department of Community

event report

Medicine, Lady Har-dinge Medical College highlighted the role of Technology in Medical Education, services and mentoring.

Session Four Health Insurance: Enhancing Equity

by Bringing Healthcare to the Masses Health insurance is one of the fastest growing businesses in general insurance. McKinsey forecasts an `2500030000 crore health insurance market by 2015, at a CAGR of 25-30 percent. This session discussed enhancing equity by bringing healthcare to the masses.

Dr Nishant Jain, Sr. Technical Specialist (Health Insurance & Health Finance), GIZ - Social Protection, Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH highlighted the role of Rashtriya Swasthya Bima Yojana (RSBY).

Dr Siddharth Agarwal, Executive Director, Urban Health Resource Centre said, “Healthy body is the primary productive asset for the poor; facilitating increased earning and minimising risk of falling deeper into poverty. A person from poorest quintile of the population, despite more health problems, is 6 times less likely to access hospitalisation than a person from richest quintile. Urban poor face social exclusion, illegality, many overlooked by official enumeration systems, poor access to public services.”

Dr Upendra Kaul, Executive Director - Academics & Research (Cardiology), Department of Invasive Cardiology, Cardiology, Fortis Escorts Heart Institute said, “World Health Organisation (WHO) estimates that 60 percent of the world’s cardiac patients are Indians. India has the highest number of patients with diabetes. India is the diabetes capital of the world. Deaths due to cardio-vascular diseases are decreasing globally. ”

Session Five The Emerging Trends in Healthcare Sector in India – Medical Education and Private Investments Changing demographics, disease profiles and the shift from chronic to lifestyle diseases in the country has led to increase the role of private investment in healthcare. In order to meet manpower

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Dr Upendra Kaul Executive Director Department of Invasive Cardiology, Fortis Escorts Heart Institute

Dr Sanjeev Sood

Hospital & Health Systems Administrator, SMC, Air Force Station

Rajendra Pratap Gupta

President & Director, Disease Management Association of India shortages and reach world standards India will require investments of up to $20 billion over the next 5 years. The last session highlighted the emerging trends in healthcare sector in India – medical educa-tion and private investments.

Elaborating on the role of private sector in healthcare spending Rajendra Pratap Gupta, President & Director, Disease Management Association of India said, “When the government is set to double its healthcare spending, does the private sector need to invest more in Healthcare.

I believe that the Government is just a catalyst for investments.”

Dr Sanjeev Sood, Hospital & Health Systems Administrator, SMC, Air Force Station said said, “There is no harm in making some money out of healthcare.

It’s difficult to replicate the models of Narayan Hruduyalaya, Arvind Eyecare.

They are in complex operations. Drivers like healthcare insurance are there to support Healthcare Business. Despite manpower and capital challenges, healthcare business is evergreen.

OP Manchanda, CEO, Dr Lal Path labs highlighted the bright part of healthcare industry. He said, “Healthcare is a Sunrise Industry, but needs patience.

We need to have our own innovative technologies/machines suiting our Indian needs.”

OP Manchanda CEO, Dr Lal Path labs

Prof TK Jena Director, School of Health Sciences, IGNOU

Dr Dharminder Nagar CEO, Paras Hospital

Prof TK Jena, Director, School of Health Sciences, IGNOU was of the view that the doctor of future is going to be an engineer. 50 years ago, it was Doctor who mattered. Today it’s the radiologist or other specialists who matter.

Dr Dharminder Nagar, CEO, Paras Hospital said that culturally Healthcare is not seen as a business. It’s more of a charitable operation.

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