Ehealth aug2016 web edition

eHealth Magazine

volume 11 / issue 08 / AUGUST 2016

` 75 / US $10 / ISSN 0973-8959

SPECIAL ARTICLES

HSCC (India) Ltd: Enhancing Healthcare Space via Innovative Patient Management Technology BECIL: Creating Synergy between Healthcare & Technology to Offer Healthcare at Doorsteps

SPECIAL INTERVIEWS

SPECIAL FEATURE

ONLINE PHARMACY BUSINESS Standing at Crossroads

Alok Kumar

Assaf Barnea

Mission Director (NHM) Department of Health & Family Welfare, Government of Uttar Pradesh

Chief Executive Officer Sanara Ventures

Herman Pihltrad Chief Operating Officer Blueair

Joseph Alexander Chief Executive Officer dWise Healthcare IT Solutions Pvt Ltd

Asia’s first Monthly Magazine on the enterprise of healthcare Volume 11

Issue 08

August 2016

EDITOR-IN-CHIEF: Dr Ravi Gupta EDITORIAL TEAM - DELHI/NCR Senior Assistant Editor: Nirmal Anshu Ranjan Assistant Editor: Souvik Goswami, Gautam Debroy, Kusum Kumari, Manishika Miglani Senior Correspondent: Manish Arora BANGALORE BUREAU T Radha Krishna - Associate Editor MUMBAI BUREAU Kartik Sharma - Senior Assistant Editor Poulami Chakraborty - Correspondent JAIPUR BUREAU Kartik Sharma - Senior Assistant Editor CHANDIGARH BUREAU Priya Yadav - Assistant Editor BHUBANESWAR BUREAU Namita Panda - Assistant Editor HYDERABAD BUREAU Sudheer Goutham B - Senior Correspondent LUCKNOW BUREAU Arpit Gupta - Senior Correspondent SALES & MARKETING TEAM: eHealth Product Head: Fahim Haq, Mobile: +91-8860651632 Senior Executive: Priyanka Singh, Mobile: +91-8860651631 SUBSCRIPTION & CIRCULATION TEAM Manager Subscriptions: +91-8860635832, subscription@elets.in DESIGN TEAM Creative Head: Pramod Gupta, Anjan Dey Deputy Art Director: Om Prakash Thakur, Gopal Thakur, Shyam Kishore EveNt Team Manager: Gagandeep Kapani ADMINISTRATION Head Administration: Archana Jaiswal EDITORIAL & MARKETING CORRESPONDENCE

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Contents

august 2016 | VOLUME - 11 | ISSUE - 08

10 Smart Healthcare – Cover Story

Spellbinding Realm Making Impossible Possible Healthcare stakeholders are all set to magnify efficiency & empower patients by integrating magical effects of high-end technology

20 16 Government Voice

Uttar Pradesh: Empowering People & Healthcare Workers via Integration of Technology & Progressive Health Projects Alok Kumar Mission Director, National Health Mission (NHM) & Executive Director, State Innovations in Family Planning Services Agency (SIFPSA), Government of Uttar Pradesh

52 Online Pharmacy – Special Feature

Online Pharmacy Business – Standing at Crossroads

Online Pharmacy Business Models Await a New Lease of Life from Progressive Policymakers & Regulators to Deliver Real Benefits

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In Spotlight Lifetrenz EHR System: Enhancing Informed Clinical Decision-Making via Fully StandardCompliant Platforms

26 Customer Perspective Understanding Holistic Advantages of Cloud over Stand-Alone Systems

Financial Management System (FMs) Purchase & Inventory Management System (PIMs)

Integrated erP system Ideally suited for hospitals

Now oN Cloud also

Fixed Asset Management System (FaM) Over the Counter Pharmacy Management System (oTC) Human Resource & Payroll Management System (HRMs) Doctors’ Fee Management System

Purchase ManageMent • Quotation & Tender • Rate contract • Purchase • Consignment • Cost Sheet Inventory ManageMent • Indent • Inventory & stock • Bar code • Inventory Planning over the counter PharMacy • Pharmacy Billing • Discount & Schemes • Return & Refunds • Cashier Scroll FInance • Budgeting • GL Accounting • Profit Center & Cost Center • Electronic Bank Reconciliation • Voucher Template • Finance Security • Interface • Consolidation Management • Cheque Printing • Speciality Management

FIxed asset ManageMent • Asset Classification • Pre-Procurement • Purchase • Pre- Sales • Sales Management • Depreciation / Appreciation • Revaluation of Assets • Asset Tracking & Barcode • Asset Movement • Dispose off and write off • Assemble & De-Assemble of Assets accounts receIvable • Payer Management • Pay-in-slip Management • Ageing Analysis • Reminders & follow-ups accounts Payable • Vendor Payment Management • TDS & Deduction • Cheque book Management • Outstandings Analysis doctors’ Fee ManageMent • Share Management • Payment Sharing • Units / Speciality Management • Payment Process • Adjustment Management • Outstandings Analysis

huMan resource & Payroll • Recruitment Process • Organisation Structure • Employee Profiling • Leave Management • Loan & Advance • Shift & Attendance • Perks / Funds • Reimbursement • Overtime • On Duty • Attendance Policy • Appraisal • Training Management • Employee Dependents • Salary and Arrears • PF / ESI/ SSO Management • Increment / Transfer / Promotion • Full & Final Settlement • Duty Roaster InterFace caPabIlItIes • HIS / LIS • Bar codes & RFID • Biometrics • SMS / Email Gateway • Credit/Debit Card • Payment Gateways • Third Party Solutions • Asset Tracking

Global Foyer (6th Floor), DLF Golf Course Road, Sector 43, Gurgaon 122 009 (Haryana) India +91-124-4738400

+91-9971714154

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prodigious@mtechsoft.com

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Special Articles

other special interviews

HSCC (India) Ltd: Enhancing Healthcare Space via Innovative Patient Management Technology Gyanesh Pandey Chairman & Managing Director HSCC (India) Ltd

46 Dr Ajit Gupta

Philanthropist, Founder & Chairman Park Group of Hospitals

48 Medical Device Regulatory Reforms –

Ready to Boost Business & Quality Care via Improved Quality

Understanding Online Pharmacy

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1MG: Offering Integrated Platform Under Right Leadership

BECIL: Creating Synergy between Healthcare & Technology to Offer Healthcare at Doorsteps

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Prashant Tandon Founder & CEO 1MG and President, IIPA

George Kuruvilla CMD, BECIL

Corporate

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PharmEasy: Proactively Engaging with Both Patients & Local Retailers

56

Dharmil Seth Founder, PharmEasy

Overview of Medical Assessment Tools Pearson VUE: Ambassadors of Best Practices & Platform for World-Class Assessment Tools Assaf Barnea CEO Sanara Ventures

Phanesh Atmuri National Sales Manager – DR & X-Ray, Fujifilm

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The need of the hour is to expose the policymakers to new high-end assessment tools and their benefits to address the growing challenges in the medical education Divyalok Sharma Senior Director Client Development Pearson VUE

Rajiv Bhalla Managing Director Barco Electronic Systems (P) Ltd

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Herman Pihltrad COO Blueair

Current Debate

64

Inclusion of Stents in NLEM – Good or Bad?

editorial

Reject Old to Build New or Build New Over Old? With the increased focus on intelligent mediums capable of increasing performance & decreasing cost, new trends & business models are emerging worldwide. These disruptions are forcing Indian healthcare stakeholders to rethink the visions of the past to build new visions of the future. To achieve new milestones, such as convenience, cost-effective services, etc., in the healthcare, we need to become part of the evolutionary journey of innovation. eHEALTH Magazine as a firm believer in the saying that ‘Science is no illusion’ believes that only ‘curiosity’ can catalyse the spirit of ‘innovation & invention’. In the absence of innovations, we will become chained to a system that continues to be inadequate and inefficient. As a result, Indian healthcare stakeholders can in no case afford to sit over the fence, rather need to be the real innovators by playing in the field to know the rule of the games. With the progressive leadership around, Indian policymakers have exhibited positive mindset towards experimental models & platforms and are more than willing to persevere to introduce regulatory reforms, as well as encourage new collaborations & partnerships, to address invisible & visible roadblocks to allow innovators to enter the real playground.

The August issue to be launched at the first-of-its-kind Smart Healthcare Conclave, 2016 offers an opportunity to catch a glimpse of high-end technologies that target the contemporary challenges of any emerging markets, such as increased air pollution, lack of scientifically designed assessment tools to narrow down the right candidates in the medical field, high-end technologies with world-class design elements to streamline workflow, etc. Undoubtedly, these technologies can propel the entire vision of ‘smart healthcare’ in the positive direction.

In order to assist the healthcare stakeholders in becoming part of this entire journey, eHEALTH Magazine as the voice of the healthcare sector has put in serious efforts to comprehend the ins and outs of other relevant debates around medical devices and inclusion of stents in the National List of Essential Medicines (NLEM) to encourage lively debates and improve arguments to undertake sound decisions.

We close the reflection on the note that innovations and moral responsibility towards larger goals will define ‘Smart Healthcare’. We look forward to participation of decision-makers and other stakeholders at Smart Healthcare Conclave scheduled on August 12 to further comprehend the concept.

“The mind is not a vessel to be filled, but a fire to be kindled.”

- Plutarch

Dr Ravi Gupta ravi.gupta@elets.in

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Cover Story

Smart Healthcare

Smart Healthcare:

Spellbinding Realm Making Impossible Possible

Healthcare stakeholders are all set to magnify efficiency & empower patients by integrating magical effects of high-end technology, shares Kusum Kumari of Elets News Network (ENN)

U

ndeniably, it is very, very difficult to conceive a world in which there is no innovation. The poverty of ideas, imagination and invention pushes a country to dark ages where accessing basic necessities involved a long tedious journey. The need of the hour is to wear the thinking cap and comprehend the real benefits of technological interventions, as well as bridge the gap between magic and reality to fathom the magnitude of changes due to futuristic technologies. ‘Smart healthcare’, as a concept, involves the right assimilation of high-end technologies and infrastructure to provide affordable quality care to the common masses with ease. The concept may sound like an alternate history, especially in the light of our adaptability to the traditional settings, but it is all set to dazzle both the medical fraternity & patients.

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Smart Healthcare

With the growing focus on patients, technological interventions and regulatory amendments will ensure that the key elements of ‘Smart Healthcare’, such as convenience, care, patient safety, delivery of services on time, etc., reach them. Interestingly, in order to realise the above goal, we have seen the foray of numerous products of imagination and technologies that are ready to make strongest impacts.

Moreover, the healthcare stakeholders have been collaborating & partnering in an innovative way to accelerate our movement towards the goal.

Procedures conducted through futuristic technologies, such as robot-assisted surgeries, artificial intelligence, etc., are steadily trickling down to tier-II and tier-III cities. With the growing geographical reach of futuristic technologies due to adoption by the government hospitals, cost-

effective quality care is increasingly within the reach of the people.

With the growing technology licensing agreements and partnerships between different platforms, the Indian healthcare sector seems to be all geared up to meet the inventory challenges that stakeholders witness in the entire supply chain of essential services, which will define smart healthcare. The latest series of cost-effective medical refrigerators launched by Godrej Appliances in partnership with the United Kingdom (UK)-based the Sure Chill Company can undoubtedly solve the ongoing problem of appropriate storage of vaccines and blood, which is essential for the entire healthcare ecosystem.

One of the key ingredients of ‘Smart Healthcare’ is ‘home care’ or ‘offering healthcare within the comforts of home’. With the realisation of this

Cover Story

fact, healthcare service providers are collaborating to redefine healthcare.

The recent collaboration between KIMS Group of Hospitals, the largest corporate healthcare group in Telangana and Andhra Pradesh, and Portea Medical, India’s leading home healthcare company, has opened new windows of partnerships.

In order to understand the concept of ‘Smart Healthcare’, we asked some of the key players to share their views on the following questions: • In this entire conceptualisation of ‘Smart City’, what key measures need to be undertaken to realise the larger goal of ‘smart healthcare’?

• Please suggest key technological advancements in the healthcare landscape that can be truly defined as smart.

Here are the excerpts:

Bejon Misra

Founder & Director, PSM India Initiative In my perception, the smart city concept should provide the following with respect to healthcare: • Emergency service like ambulances should reach all patients within maximum 5 minutes after making a call on a three digit toll-free helpline like 108 or SMS service with a call back facility. The ambulance must arrive with a doctor and provide care at the called location, then neither further process time nor burdening of the care centres or hospitals is required.

In case further action is required, then the patient should be shifted to an appropriate hospital for emergency care provided free of cost or based on an insurance cover. All such expenses need to be FREE for the poor and senior citizens.

Smart city must have a dedicated lane for prompt passage of ambulance, fire brigade and emergency healthcare related casesandanypersonnotadoptinglanedrivingshouldbe heavilypenalisedorlegal prosecutioninitiatedonafasttrackmode.

Healthcare treatment should be subsidised for the poor and not a single citizen should be made to create a debt or sell assets to access quality healthcare. We must increase the healthcare budget of our Government from 1 per cent to at least 5 per cent of the gross domestic product (GDP) from 2017.

• We must have health records of all the citizens since birth on one single portal similar to Aadhar. We must also have a robust tracing and tracking system for all medicines sold in India to ensure the rational use of medicines, especially antibiotics and prescription drug abuse, which are addictive in nature. We must train all medical practitioners to start using e-prescription and all the records of healthcare should be properly monitored by the Government to ensure safety and quality to the patients. E-pharmacies with proper regulations must be implemented immediately and healthcare should reach the doorsteps of the patients, especially senior citizens.

Telemedicine in India has been a flop show, which is only due to poor connectivity of broadband facilities and lack of trained manpower. India is the world’s software centre, but we Indians are denied the benefits of such discoveries in our own country. Healthcare services in India have to be patient centric and technology enabled to ensure userfriendly systems are made accessible and there is universal health coverage without compromising on the safety and quality of the healthcare delivery system.

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Cover Story

Smart Healthcare

Dr Rajendra Patankar

Chief Operating Officer, Nanavati Super Speciality Hospital, Mumbai • The Indian healthcare industry is projected to grow to a staggering USD 280 billion by 2020. An ageing population with increasing lifespans, growth in income standards owing to better paying jobs, advancing economic prospects and a shift in disease pattern veering towards lifestyle diseases has made it imperative for policy-makers and stakeholders in the domestic health market to conceptualise new age disease monitoring standards and modern treatment protocols. With a shift from a predominantly provider market to a user (patient) dominated market, the dynamics of the healthcare business has changed. Earlier, patients were largely dependent on doctors and healthcare professionals for prognosis of their medical conditions. With the advent of information tools like Google, patients have starting going online to seek health information from online portals. Medical blogs and patient communities have also proliferated on the net, which offer real-time medical advice and have made people aware of diverse treatment methodologies.

With technological innovations and digital connectivity bringing paradigm changes in the patient-doctor interface, it is estimated that on a global level, around 70 per cent of healthcare entities will expend substantial investments in health mobile applications, remote health monitoring devices and virtual diagnostic platforms in the next 2 years. A huge demand is foreseen for data-driven digital health start-ups with an emphasis on big data and analytics. A large number of corporate employees are being incentivised by organisations to maintain accurate checks on their health through the increased use of latest technological inputs like medical wearables and apps, which can be freely downloaded on mobile phones.

Wider accessibility and easy adaptability are the buzzwords in the new technological revolution in the medical space.

Telehealth and mobile health initiatives are proving to be the key triggers for pharma players and device manufacturers to invest in data tracking devices. With the provision of reimbursement by insurers and cost reduction, these devices are acquiring a huge clinical utility in monitoring the patient’s health and treatment progress. Health players in the private and public space are increasingly using health data of patients for tracking their progress in the postdischarge stage and reducing the chances of disease relapse. Clinical research organisations (CROs) and pharma companies will bring innovations in research and accuracy in clinical trials through effective monitoring of data.

Data is also increasingly utilised by companies to create incentive structures revolving around increased physical activity and healthy living.

• By 2025, around 58 per cent of the global population will be living in urban areas. A blueprint for the development of 100 smart cities has been prepared by the central government. Smart healthcare systems largely determined by the convergence of technologies, innovative clinical practices, state-of-the-art facilities and advanced health standards will be a defining element of the modern ‘Smart City’ programme envisioned by the government. With the smart cities concept gaining ground, cross device connectivity is slated to achieve the next level progress, with an emphasis on remote patient monitoring. Internet of things (IoT) is also rapidly bringing healthcare within its gamut and rapidly advancing communication technologies are resulting in healthcare services becoming more accessible and innovative.

The success of the smart city programme will also largely depend on the ability of doctors to leverage the effectiveness of health monitoring devices for initiating diagnostic care, undertaking preventive measures and tracking the results of treatments administered. The smart city model would also enable residents to receive periodical alerts for health check-ups and taking medicines through advanced technological inputs. Electronic medical health record (EMHR) is an effective mechanism that can be used for setting up notifications at periodic intervals concerning medications of patients or medical test schedules and appointments. For the smart city initiative to become a resounding success, there should be large-scale emphasis on the deployment of processes, such as cloud computing and advanced data analytics. Synergistic collaboration between diverse platforms, such as Cloud and IoT, will form the essential base of a successful smart city ecosystem. Optimum utilisation of modern technological models, when viewed in a smart city context, will prove largely effective in scaling down operational costs and bringing in much-needed automation in disbursal of services. With enhanced quality and improved delivery services in the healthcare sector, ‘smart care’ has the potential to become a key trigger in driving the success of the ‘smart city’ programme.

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Cover Story

Smart Healthcare

Aditya Gupta

Director, Neurosurgery, Artemis Hospital, Gurgaon As a healthcare stakeholder, I recommend the following key measures: • Planned access roads into the city and also within it to allow fast access to healthcare facilities, given the state of traffic today.

• World-class energy & civil infrastructure for healthcare facilities to enable them to be operational 24x7 and being green facilities at the same time.

• Separation of primary, secondary and tertiary care facilities to enable unnecessary clogging up.

• A well-planned network and emergency response system for citizens, including medical evacuation.

• A public-private partnership structure to use the advantages of both the systems and for the spill over to be taken care of by the either stream.

• Integration of preventive healthcare aspects into education and retail for wider penetration and propagation.

The key advancements happening are: • Smart sensors linked to widespread devices, such as mobile phones and other devices, for early warning for critical ailments.

• Appointment scheduling and medical data transfer using smartphones.

• Electronic second opinions and opinions from super super specialists.

• Expert systems for prediction of risks of having a particular disease, its severity and outcome.

• Genetic tests being used for determining outcome and prognosis • Quicker & faster imaging modalities with easier data portability.

• Expanding repertoire of ability to image function of various organs.

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Government Voice

Uttar Pradesh: Empowering People & Healthcare Workers via Integration of Technology & Progressive Health Projects Significant emphasis needs to be given on training, behavioural change and handholding of frontline health workers (ASHAs and ANMs) to realise total potential of all health programmes, says Alok Kumar, Mission Director, National Health Mission (NHM) & Executive Director, State Innovations in Family Planning Services Agency (SIFPSA), Government of Uttar Pradesh, in an interview with Arpit Gupta of Elets News Network (ENN) How mSehat Scheme has improved the performance of frontline health workers’ (accredited social health activists (ASHAs) and auxiliary nurse midwives (ANMs)) day-today work?

The ‘mSehat’ scheme has been developed to empower the frontline health workers (ASHAs and ANMs) by providing smartphones/tablets with customised apps that will capture the complete Reproductive, Maternal, Newborn Child and Adolescent Health (RMNCH+A) continuum of care services.

The software is designed in way that it auto-generates the work plans and gives alerts to the service provider, as well as the registered beneficiary. The frontline health workers are provided on-demand training and regular skill updates. There is a provision of mobile phone based multimedia job aid for beneficiary counselling, registration, tracking, reporting, screening and referral. In due course of time, mSehat aspires to interact with the Mother & Child Tracking System (MCTS) and reproductive child health (RCH) e-governance schemes of the Government of India which will help in real-time data update.

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The scheme covers a total population of 15.5 million in five priority districts viz. Sitapur, Bareilly, Mirzapur, Kannauj and Faizabad of Uttar Pradesh.

The mSehat app mainly covers Family Registration, Beneficiary

Registration, Village Health and Index Register (VHIR), Village Health Nutrition Day (VHND), ASHA Incentives Alert, Training and Counselling, ASHA Kit, Work Plan, Grievance Redressal, Referral, Stock Management for VHND, ASHA Sangini Module, Dashboards for ANM, Ministry of Information and Communications (MOIC) and State, Reminders and Alerts to the beneficiary.

Manjhwan Block of Mirzapur district was the first block in the country to have achieved 100 per cent digitisation of the VHIR and further Mirzapur become the first district to complete 100 per cent feeding of the VHIR followed by Bareilly, Faizabad, Kannauj and Sitapur district. mSehat intends to achieve 100 per cent coverage for timely and appropriate care for pregnant and lactating mothers, immunisation of pregnant women and infants, nutrition

mSehat – Key Objectives • 100% coverage for timely & appropriate care for pregnant & lactating mothers • Immunisation of pregnant women & infants • Nutrition for children below 6 years & adolescent girls • Streamlining the process of data collection

Government Voice

for children below 6 years and adolescent girls, and streamlining the process of data collection.

What is the roadmap to achieve targets of Hausala Sajheedari programme, another big initiative undertaken by the Government of Uttar Pradesh?

Under the Hausala Sajheedari programme, the Government of Uttar Pradesh invites private health facilities and family planning surgeons in the State to join hands

mSehat – Key Takeaways • Developed to empower the frontline health workers by providing smartphones/tablets with customised apps • Auto-generates the work plans & gives alerts to the service provider • Provides on-demand training & regular skill updates • Provision of mobile phone based multimedia job aid with the Government and contribute to the State’s commitment to Family Planning 2020, thereby achieving the larger vision of stabilising the population growth. The entire process of accreditation and reimbursement of private sector health facilities has been simplified through a dedicated online web portal called ‘Hausala Sajheedari’, which provides end-to-end solution designed and launched under the overall leadership and supervision of a state-level apex body called State Task Force (STF) under the patronage of Principal Secretary - Health and Family Welfare, Government of Uttar Pradesh. Hausala Sajheedari web portal provides one-stop solutions for private healthcare facilities and private sector surgeons in the state for online accreditation, empanelment, progress reporting, submission of claims and online reimbursement through bank transfers.

The STF is led by the Executive Director SIFPSA and has representation from Directorate of Health & Family Welfare, SIFPSA, Technical Support Unit of Bill & Melinda Gates Foundation (BMGF), other development partners, representatives of private sector viz Federation of Obstetrics & Gynaecological Societies of India (FOGSI) and Indian Medical Association (IMA) and representative of CMOs from the field. A four-member secretariat called the Private Sector Partnership Cell (PSP Cell) has been established at SIFPSA to support

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Government Voice

STF in its day-to-day functioning and maintenance, oversight and problem solving of Hausala Sajheedari web portal at the state level.

The potential for the programme could be well assessed by the fact that in last 6 months nearly 1,200 private hospitals, including clinical outreach teams (COTs), have applied online for accreditation, out of which, 468 (including 13 COTs) have been empanelled till now. Similarly, over 900 private sector surgeons have applied online to be empanelled with the state to provide sterilisation services (various techniques like MiniLap, laparoscopic sterilisation, no-scalpel vasectomy, etc.), out of which 481 have been empanelled so far. The overwhelming response from the private sector has encouraged the Government of Uttar Pradesh to have a vision to accredit at least 1,500 private hospitals and an equal number of surgeons for surgical family planning services in the private sector.

What are the major challenges in implementing e-governance projects in the State?

Whenever any new technology is introduced in the system, a formal training session is required to make it user-friendly. In the Health Department, I feel significant emphasis needs to be given on training, behavioural change and handholding of frontline health workers (ASHAs and ANMs).

Major Challenges • A formal training session is required to make the technology user-friendly • Significant emphasis needs to be given on training, behavioural change & handholding of frontline health workers

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Hausala Sajheedari Programme • Till now nearly 1,200 private hospitals, including COTs, have applied online for accreditation, of which 468 (including 13 COTs) have been empanelled till now • Over 900 private sector surgeons have applied online to be empanelled with the state to provide sterilisation services, of which 481 have been empanelled so far Besides, 2G/3G connectivity in remote villages is another major challenge, as our software and application run on Internet.

Brief us about other projects of Department of Health & Family Welfare.

Sampoorna The project ‘Sampoorna’ has been launched under the umbrella of National Programme for Prevention and Control of Diabetes, Cardiovascular Disease and Stroke (NPCDCS) Programme by Department of Health & Family Welfare, Uttar Pradesh, which is unique, as it brings forth the preventive approach towards the noncommunicable diseases (NCDs) in women. NCDs cause high morbidity and mortality, which in turn have high impact on human productivity and healthcare expenditure. Therefore, Sampoorna Project has been launched with the goal to reduce mortality and morbidity due to non-communicable diseases in women. The project not only aims to screen for diseases, but also makes women aware about lifestyle modification and screening approaches which is important for prevention of non-communicable diseases, including cervical and breast cancers. Women are pivots of the families; hence, educating them and taking care of their health will definitely improve the family’s health and will shift community’s perspective from curative healthcare to preventive healthcare.

Matritva Saptah As a part of innovation, we had organised Matritva Saptah to create awareness among poor rural people regarding quality antenatal care (ANC) identification of health reimbursement plans (HRPs) backed with service provision. This campaign brought out a welcome social change and awareness among rural poor about components of quality ANC, which is the right of every pregnant woman. This also led to preference to institutional delivery.

Awareness regarding anemia and blood pressure (BP) got enhanced overnight in the community. This would definitely help in bringing down the MMR in the state and thereby in the country.

Our Chief Minister Akhilesh Yadav issued a personal letter/appeal to Gram Pradhans for supporting this initiative and mobilising the maximum number of pregnant women and their families.

Matritva Saptah- Quick Gains • 1,765,105 pregnant women identified

by ASHAs and anganwadi workers (AWWs) in rural areas • 1,584,086 (86.20 per cent) pregnant women attended Matritva Saptah sessions • All components of quality ANC made available, (HB, BP, weight, urine for sugar albumin, TT, abdominal exam) • 113,911 (7.20 per cent) pregnant women found to be at high risk and referred for medical attention • General awareness enhanced immediately regarding quality ANC and high-risk factors

Comprehensive Cancer Center Criical Care Medicine Gastroenterology and Hepatology Heart Insitute & Electro Physiology Intervenional Radiology Nephrology / Urology Neurosciences with DBS Neu Nuclear Medicine & PET CT Liver Insitute Orthopaedics and Joint Replacement

Kovai Medical Center and Hospital Excellence in Healthcare

Avanashi Road, Coimbatore - 641 014 Phone : +91 422 4383800, 3083800 | Web : www.kmchhospitals.com | E-Mail : getwell@kmchhospitals.com

In Spotlight

dWise Healthcare IT Solutions Pvt Ltd

Lifetrenz EHR System: Enhancing Informed Clinical Decision-Making via Fully Standard-Compliant Platforms

dWise Healthcare has taken the forefront role in upgrading the overall clinical efficiency of the hospitals by addressing each and every gaps within the system by integrating innovative features in the offerings to provide a holistic solution, shares Joseph Alexander, CEO, dWise Healthcare IT Solutions Pvt Ltd exclusively with Elets News Network (ENN) What are the challenges of adoption of electronic health record (EHR) systems in India?

EHR is about ‘standards & code sets’, and how health records and all clinical data of patients are electronically captured, stored & secured in health IT systems.

It is also about ensuring interoperability, portability and availability of data to patients. Therefore, the onus is on the Government of India to define and publish these standards and also to ensure that the approved standards are in sync with international standards to ensure interoperability and portability of health records as patients move across nations.

The Government also has to mandate and regulate the use of these standards and further create bodies to validate and certify products from vendors on the compliance of standards. Fortunately, India has taken some important steps in this direction. In August 2013, the Ministry of Health and Family Welfare, Government of India published the ‘Healthcare IT & EHR’ standards. The second version, the draft of which is already available in the public domain for feedback from various stakeholders, is expected soon.

In comparison to other advanced countries, especially the United States (US), the standards approved are minimalistic. However, it is a good beginning, considering the lack of advanced EHR systems in the country.

Currently, only few solutions, like

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Lifetrenz EHR System, fully comply with the international and Indian standards.

In March 2015, Government announced the formation of a regulatory body called the ‘National eHealth Authority (NeHA)’, which is likely to be similar to Telecom Regulatory Authority of India (TRAI) for Telecom or Insurance Regulatory and Development Authority of India (IRDA), through an Act of Parliament, with the mandate to regulate and enforce adoption of the approved standards in the country.

Once NeHA is formed, the next big challenge would be to create a qualified and impartial certifying body to certify EHR products from vendors on the compliance of standards. Recently, KB Aggarwal, Additional Secretary, Ministry of Health and Family Welfare, Government of India emphatically stated that NeHA would be a reality soon and the Central Government is

serious about ensuring adoption of the Government-approved EHR standards by healthcare providers.

As such, only a few large hospitals extend their investments to EHR systems due to lack of clinical domain expertise, awareness of standards around EHR and lack of availability of good EHR systems with high usability.

However, healthcare IT investment on clinical systems is gaining traction due to the Government regulations on Central Government Health Scheme (CGHS) & Ex-Servicemen Contributory Health Scheme (ECHS) empanelment, wherein the agreement signed with the providers mandates that the hospital has to use a system that complies with the approved ‘HIT & EHR’ standards within 1 year of the signing of the agreement.

This has been in force for agreements signed since 2014-15. Secondly, the need to have the National Accreditation Board for Hospitals & Healthcare Providers (NABH) accreditation to enrol as providers for various government insurance schemes and now also for a few private schemes has assisted in gaining traction.

The hospitals have realised that the only way to go forward is to improve operational efficiency across departments and build smarter systems and processes, and for this hospitals have to invest in IT in their clinical workflows and also in processes.

However there are progressive hospitals in the country who have adopted EHR

dWise Healthcare IT Solutions Pvt Ltd

systems that comply with international standards, way before the Government of India published EHR standards, such as the Cloudnine Hospital Chain, the leading player in the country specialising in mother & child care. Cloudnine Hospital Chain, which was our first EHR customer in India, has grown to over 16 sites across the country. It follows the smart hospital format, which many of their competitors today are trying to replicate.

Adoption by clinicians is the key to success of EHR systems. Overall, our research suggests that the main reasons for low adoption are ‘Usability’ and ‘Accountability’. In order to overcome these challenges, we built a highly usable system with features like ‘machine learning’ and many more, which helped physicians to practice on the system at a faster rate and consult more patients. In the US, we witnessed close to 100 per cent adoption by doctors in the 20 odd hospitals that used our EHR platform by ensuring that all clinicians, such as nurse, pharmacist and over 35 such roles, were equally accountable as the doctors for delivery of care. Even in India we see similar high adoption levels by doctors at over 30 sites.

How can patient awareness improve EHR adoption?

Markets always respond to customers’ demands and expectations. Every industry would initially resist change even if the benefits are obvious or huge.

Regulations and customers’ demands are facilitators that can help overcome this resistance.

Awareness will ensure patients demand their EHR from care providers.

Patients need to be aware that their health records updated and made available to them is as much part of their ‘paid for’ service as the doctors’ treatment plan and advice.

Why in your opinion is clinical decision support system (CDSS) imperative for all healthcare providers?

A good EHR system can strongly impact the healthcare sector by reducing the number of clinical errors that occur due to lack of ‘informed clinical decision-making’ or ‘evidence-based clinical protocols’ or non-adoption of ‘clinical quality measures’ or processes, among other issues. The EHR system provides the clinicians access to the patients’ longitudinal health records to take informed clinical decisions.

With the patients’ EHRs in place, the CDSS can alert the clinician, while ordering medications, of any Drug to Diseases, Drug to Drug, Drug to Allergy, Pregnancy, Lactation Interactions or Contraindication that his medication order could have with patient’s active conditions or medications. Furthermore, it can help and alert clinicians with dosage adjustments they need to make for paediatric patients, or patients with a hepatic or renal condition.

Lifetrenz EHR System – Key Takeaways • Fully complies with the international & Indian standards • Improves operational efficiency across departments & builds smarter systems • Has built a system addressing ‘Usability’ & ‘Accountability’ factors • Has witnessed 100% adoption by doctors in 20 odd hospitals in the US • Has been witnessing similar high adoption levels over 30 sites in India • Provides access to patients’ longitudinal health records • Integrates features to reduce the number of clinical errors

In Spotlight

‘Clinical Treatment Protocols’ and ‘Clinical Care Pathways’ in the EHR systems can help healthcare providers define these based on evidences and ensure quality of healthcare delivery and ensure that the lack of experience or knowledge of the younger or lessexperienced clinicians do not lead to clinical errors.

Defining ‘Clinical Quality Measures (CQM)’ and processes in the EHR system, can help with the actual measurement of adoption of CQMs. A good EHR system can help in ensuring adoption at the time of care delivery through alerts/reminder triggers, which is better than just measuring adoption post the event.

EHR systems with ‘Physician Monographs’, ‘Drug Information’, ‘Hepatic and Renal Monographs’ and several other such references, all within reach and context-based while consulting, ordering medication or building the patients ‘Care Plan’, will immensely assist the physician to take informed clinical decisions.

What’s the future of healthcare IT in India?

The future of healthcare IT innovations in this country depend on how fast can we cross the barriers and lay the foundation required for EHR adoption.

Once this is achieved, we as a nation can even move ahead of developed nations on healthcare IT innovations.

At dWise Healthcare, we have taken a decisive step by providing an EHR system free of cost for lifetime to the primary care market in the country. As such, 80 per cent cases of healthcare incidence of patients are addressed by the primary care segment, and longitudinal health record or EHR of patients can become a reality, only when this segment also uses EHR systems.

For our innovative approach to healthcare IT, dWise Healthcare was recently rated by a media house as the ‘Most promising Healthcare Solution Provider’ in the country for 2016.

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Special Article

HSCC

HSCC (India) Ltd: Enhancing Healthcare Space via Innovative Patient Management Technology Accelerating the ‘Digital India’ campaign, HSCC has been in a true sense enabling medical facilities in delivering ‘smart healthcare’ by facilitating advanced technologies & integrating ICT systems recognised globally for transforming healthcare space

O

ne of the vital elements of ‘Smart Healthcare’ is integration of Internet technologies and other advanced smart systems in the infrastructure of medical facilities to enable access to quality care to the end users. Through the appropriate use of information and communication technology (ICT), not only many lives can be saved but the level of patient care can be to a large extent improved and cost reduced. The current driving principle for all policymakers is delivering optimum health & social care in a safe, cost-effective and efficient manner.

With the implementation of a series of progressive reforms in the Indian healthcare ecosystem by the Government of India in the light of ‘Digital India’ and ‘Make in India’ campaigns, HSCC, a profit-making public sector unit (PSU) and the world’s one of the leading consultancy organisations under the Ministry of Health & Family Welfare, Government of India, has been assisting the Government in concretising these goals by rendering a comprehensive range of professional services in healthcare and other sectors.

Overview Established in 1983, HSCC has come a long way. It has established a brand image through consistent diligence and emphasis on quality over quantity.

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“IT has emerged as game changer and strengthening of IT infrastructure has become a strategic imperative. In fact, it will be the key to how we innovate and expand our business along with retaining our competitive edge” Gyanesh Pandey Chairman & Managing Director HSCC (India) Ltd On the basis of the DPE’s MOU targets for the past 7 years, it has been consistently ranked ‘EXCELLENT’. As of today, HSCC boasts of 90 odd projects which are diverse and of varied capacity across the length and breadth of India.

HSCC

More importantly, it will be interesting to note how HSCC is spearheading the goal of both digitisation of healthcare services and capacity building. Interestingly, HSCC is those rarest PSUs that has learnt the lesson to keep pace with technological advancements and has emerged as the fastest growing PSUs in the last 3 years by continuing to be relevant.

Key Achievements Bhopal Memorial Trust Hospital & Research Centre (BMHRC), Bhopal: In 1999, HSCC became an IT enabler by adopting ICT in BMHRC, Bhopal in 1999. Post the apex court order, the 350-bed multi-speciality tertiary care centre BMHRC was established for the Bhopal Gas Tragedy (1984) victims and the public at large. Setting an example for others, BMHRC comprises various first-of-its-kind ICT facilities, including Hospital Management Information System (HMIS) and SAP. By introducing smart cards for the victims, BMHRC emerged as the first hospital to implement such an innovative measure that will facilitate easy record management. These IT infrastructure and innovations have been replicated across different hospitals designed and engineered by HSCC according to the client needs.

OPD Automation: The medical facilities as large as the All India

Understanding QMS

Special Article

Major System Components in Queue Management System (QMS) • Token Dispenser Unit It is used for printing tokens. Various services can be displayed on the panel (in touch screen dispenser).

QMS may have a single or multiple token dispenser units as per the requirement • Master Token Display The display unit is generally installed in the waiting area to enable the patients awaiting their turn to check the token number at the registration counter. It is available as LED/LCD TV • System Outputs Token: The system issues tokens which have serial number from 0001 to 9999. The token indicates the date, time & type of the registration etc Reports: The system can also generate various reports, facilitating manager/administrator optimise the resource allocation to improve patient care services; thus, providing real-time overview of all the ongoing activities Institute of Medical Sciences (AIIMS) with large patient flow are constantly in search of innovative technologies that can make the entire process patient-friendly, less chaotic and manual, and less time-consuming to increase throughput. Keeping these key takeaways in mind, HSCC which was entrusted with the responsibility of OPD automation of

Key Challenges • Implemented in a phase manner • Users’ resentment to accept the new system; adoption of new system made possible only after intervention by the higher authorities • Interfacing of QMS with HMIS of the AIIMS Rajkumari Amrita Kaur (RAK) OPD at AIIMS implemented a series of automation features, including queue management system (QMS), and established network infrastructure and hardware & system software, including desktops, printers, etc. As such, QMS has altogether changed the OPD practices ranging from registration to consultation with doctors of various departments.

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Special Article

HSCC

Therefore, those serpentine queues and hassles in getting consultations have become things of past.

Under the QMS, a number of devices, such as token dispensers and LED displays, have been installed along with the basic facilities like air conditioners and hygienic environment to ensure true customer care experience.

Though QMS has been operational in AIIMS since February 2011, AIIMS has moved ahead with the online appointment system to lower the load on the registration counters of the OPD.

Understanding Queue Management System (QMS) QMS essentially comprises a token dispenser unit with a touch screen, master display (LED TVs), computer desktops (each with a different client operator software) installed at the registration counter connected through LAN, counter display and a server with Manager Console server software.

Various types of token dispensers are coming up in the market

Despite many benefits, its adoption among both medical staff and patients needs to be accelerated at a rapid speed to realise the larger benefits. In order to ensure behavioural change and paradigm shift in the healthcare, regular workshops need to be conducted.

The diffusion of new systems and technologies is the true parameter

QMS - Salient Features • Supports multiple master LCD displays & multiple token dispensers • Can be operated as a standalone system • Flexibility in prioritising patients • Audio announcement of tokens • Services can be scheduled to stop issuing/ printing token after specified time in the day • Load distribution in each counter • Operator can defer a token & the patient can be recalled later Serpentine queues can become thing of past with QMS

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to determine economic growth, as it ensures increased productivity.

HSCC by introducing innovative technologies has been playing a crucial role in the economic growth.

Though such technologies initially bring discomfort, they ensure larger benefits to both hospitals and patients in the long run. Such innovative technologies can be implemented in other departments where heavy patient load is often witnessed.

HSCC can play a crucial role in increasing transparency and visibility by facilitating smarter technologies like smart cards and QMS discussed above in the medical facilities in its fold. It can also assist other healthcare stakeholders, such as health insurance companies and the Government of India, in uncomplicating the complicated procedures of application for any compensation, appeals and grievances by automating the entire process.

Automation of procedures will prove beneficial to both insurance and government bodies as their services largely involve data gathering from multiple sources and enable keeping a check on the deadlines and other requirements. QMS and smart cards can become the standard practice in the industry as they accomplish the entire objective of delivering productivity, quality care, less hassles and cost reduction.

Customer Perspective

LiveHealth

Understanding Holistic Advantages of Cloud over Stand-Alone Systems Like other healthcare segments, diagnostic services are also witnessing major disruptions due to the intervention of Internet & other digital tools. The adoption of a cloud-based LIMS like LiveHealth has enabled Lab World Plus to not only offer services seamlessly, but also provide data to track grey & business opportunity areas, shares Dr Sandeep Porwal, MBBS, MD (Pathology), Managing Director, Lab World Plus Health Diagnostic Services Pvt Ltd with Elets News Network (ENN) Tell us about Lab World Plus.

How do you see your growth and how does information technology (IT) contribute to it?

Lab World Plus is unique and state-ofthe-art referral pathology laboratory conceptualised, owned and managed by a group of qualified pathologists and microbiologists. We are focused towards minimising lifestyle diseases with advanced diagnostic services and empowering doctors with fast and accurate diagnostics, helping speedy recovery of the patients. IT plays a very vital role in such kind of laboratory where it helps to reduce errors and turnaround time by unique barcoding and bidirectional interfacing.

Remote centre connectivity and mobileb a s e d ap p l ic at io n are a value addition.

As a healthcare provider, what are the key challenges you are facing

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in the healthcare delivery and patient care?

Laboratory tests play an important role in the patient-centric healthcare delivery. Physicians rely on accurate and timely laboratory test results for the diagnosis of diseases and guiding the treatment. Maintaining consistent accuracy and minimising the turnaround time are always the key challenges. Most of the times, preanalytical errors result in unnecessary testing; thus, leading to additional financial burdens on the patient and/or the healthcare provider. Preanalytical errors are inevitable, but minimising them is a key challenge. As a business, it becomes vital to record every transaction and communication to deliver the best experience to your customers. Besides monitoring of business resources, operations, referral relations, marketing, finance, inventory, etc. is required to ensure efficiency at the operational level.

With so much data and information being generated daily, managing, monitoring and effectively controlling the management information is a challenge.

What’s the role of IT in meeting these challenges?

IT as a tool has enabled solutions to meet most of the above challenges. The laboratory information management system (LIMS) software helps you to effectively manage the operations of

LiveHealth

your labs. Using the LIMS software you can automate workflows, integrate the instruments, and manage samples and associated information. Besides reducing manual errors through automation and interfacing, some good softwares help you minimise the turnaround time. Most of these softwares are stand-alone systems and track almost every transaction and event in the testing process and serve as a good management information system (MIS). Moving further, you can now reap the benefits of advanced technologies like cloud and mobile. The total testing process right from the registration of patient, to sample collection, sample accession, processing, verification, approval to the delivery of reports can be managed from multiple locations on a remote cloud server, in a seamless way. Test reports can be instantly delivered to the patients and their referral physicians via mobile app.

What were your concerns with respect to purchasing a comprehensive IT solution for your diagnostic centre?

As we are healthcare providers, we always wanted to stay focused on healthcare delivery rather than develop and manage an IT solution for ourselves. While we were convinced to outsource IT overhead to an agency, we made sure that we hire an expert team in the domain who will work closely with us, understands our workflow and provides a solution exactly meeting our requirements.

We ensured that once the solution is deployed, our solution provider promptly responds to our queries and provides timely support.

What are the outcomes you expect in terms of optimising your operations and increasing the revenue? How do you see technology making a difference to achieve these outcomes?

We have deployed LiveHealth - a

Customer Perspective

IT & Other Advanced Technologies - Key Takeaways • Reduce errors & turnaround time by unique barcoding and bidirectional interfacing in a lab • Reduce manual errors through automation & interfacing • Enable tracking of every transaction & event in the testing process • Allow management of multiple tasks from multiple locations • Enable instant delivery of test reports to patients & their referral doctors • Better tools to connect with people cloud-based, mobile-ready solution for laboratory management. Our software solution serves as the central hub for all our stakeholders and operational activities.

Everyone - right from patients, staff, technicians, collection centres, and consulting and referral doctors - have to go through this solution for every activity associated with our operations. This helps us track every activity of all our stakeholders and optimise our operations. We get data and insights from this solution that enables us to track our potential sources of revenue and we can capitalise on that. This surely wouldn’t have been possible with a stand-alone software system, cloud is definitely an enabler.

Do you think you were able to reduce the number of human errors by interfacing your medical devices with your LIMS? We were definitely able to reduce the number of human errors. As managing skilled human resources and training them to maintain

Remote centre connectivity & mobile-based application are a value addition.

accuracy in testing has always been a challenge for laboratories, we wanted to address this challenge through an effective solution like interfacing.

After implementing unique barcoding and bidirectional interfacing, we have observed a remarkable outcome in the accuracy of our testing.

Have you witnessed any difference in the turnaround time by using cloud service provider? How does it benefit from a stand-alone system?

As mentioned earlier, a cloud-based solution surely has advantages over a stand-alone system. We would not

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Customer Perspective

LiveHealth

have been able to integrate all our stakeholders and our operations at different locations using a standalone system. LiveHealth being a cloud-based solution has considerably minimised the turnaround time by enabling patient registration right at the point of sample collection, approval by consulting doctors via mobile app and automated delivery of reports to patients on mobile as soon as they are verified and approved.

Do you think technology can help you better understand your patient needs (e.g. a mobile app or other things)? Has it enabled you to achieve highquality patient care?

We always believe that healthcare should be patient-centric. The active involvement of patients in managing their healthcare has delivered better outcomes. Mobile app has emerged as an effective tool to connect and engage with your patients. We deliver the medical reports to the patients on a mobile app configured to our lab management solution, thus enabling them to manage their health records and track their health, anywhere, anytime. Their test reports are linked to information repository in the app where they can know and educate

Advantages of CloudBased Laboratory Management Solutions • Serves as the central hub for all our stakeholders & operational activities • All stakeholders need to go through this solution for every operation-related activity • Offers data & insights to track potential sources of revenue

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Laboratory Information Management System (LIMS) – Key Takeaways • Effective management of lab operations • Automation of workflows • Integration of instruments • Management of samples & associated information Laboratory Tests – Key Challenges • Maintaining consistent accuracy • Minimising turnaround time • Reducing pre-analytical errors to avoid unnecessary testing themselves about the tests performed.

Informed patients always lead to better patient outcomes.

Do you think technology will be a key differentiator for diagnostic centres in the future?

Like many other areas of healthcare delivery, diagnostic services are experiencing an IT revolution.

Diagnostic centres keeping pace with emerging IT have found new, more efficient ways to communicate and provide services; educate themselves, their staff and their clients; market their products; and manage data and information. With Internet becoming the primary means of communication, test requests and test results will

be communicated electronically.

IT has created new marketplace and advertising opportunities for the diagnostics. Increased patient education and empowerment, new testing techniques that are simple enough for home sample collection and IT have combined to create a new direct-to-consumer marketplace for diagnostic testing. Collecting and analysing patient outcome data may become more essential in the marketing of diagnostic services and IT will be the key enabler for storage and processing of data. Besides, automation has been, and promises to continue to be, an important force in the changing laboratory marketplace.

Special Article

BECIL

BECIL: Creating Synergy between Healthcare & Technology to Offer Healthcare at Doorsteps BECIL aims to provide the technical framework to use ICT to enhance the reach & impact the way in which healthcare is delivered at the grass-root level.

A

ccessing specialised medical care at affordable cost might sound like a dream to a layman, particularly in the context of remote and rural areas; however, as rightly mentioned by many today’s dreams can answer tomorrow’s answers. Although healthcare has grown by leaps and bounds over the years, our citizens living in faraway areas are not able to avail the benefits of these medical advances. Well, situations are bound for a change, as Broadcast Engineering Consultants India Limited (BECIL) has created the technical framework using which specialised healthcare can be delivered at the last mile at an affordable cost.

Understanding BECIL’s Goals Overall, BECIL is in the process of creating the perfect synergy between healthcare and technology using which specialised healthcare services can be delivered at the door steps of common man at an affordable cost even in the remotest part of the country.

Additionally, BECIL has partnered with one of the best technical solution providers in the field of healthcare to provide affordable healthcare solutions. The proposed solution ensures enhanced efficiency and seamless delivery of healthcare schemes by uniquely identifying the correct beneficiary by Aadhaar using ICT at every possible level.

These features of the BECIL solution also form the five pillars over which its entire healthcare solution stands, which

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“At BECIL, we are in the process of creating the perfect synergy between healthcare and technology using which specialised healthcare services can be delivered at the door steps of common man at an affordable cost even in the remotest part of the country.”

George Kuruvilla CMD, BECIL

BECIL

Special Article

“Sukhia, what happened? You haven’t come to work for last 4 days…”

“Oh Jairam, I am not well. My fever is not going down. I cannot afford to visit the city for doctor as I am the sole bread earner. Also, the medical treatment is going to finish my savings. I don’t know what to do…”

“Bas…itni choti baat!” Jairam’s face lightened up when he said, “Don’t worry. Now specialised medical treatment at an affordable cost is within our reach. The village primary health centre (PHC) is now providing medical counselling from expert doctors who are from big hospitals in the city.”

“Doctors from city are coming here in the village?” Sukhia said in astonishment.

“Yes, doctors are coming to the village, but via computer. Moreover, the swasthmitras are going around the village doing door-to-door free diagnostic check-ups. They only ask for your Aadhaar Card and that’s it. Also, if you are eligible for any medical benefit scheme, then you avail the same at the PHC directly. No running around offices for reimbursement of benefits of medical schemes.” approach, which enables it to be highly flexible to accommodate any functionality or feature present or coming up, highly scalable which empowers the solution to cater to a very large population and highly dynamic in nature to integrate with any government department & health scheme.

Categories of BECIL Solution

The five pillars of BECIL healthcare solution

Key Goals • Provide the technical framework to use ICT to enhance the reach & impact the way in which healthcare is delivered at the grass-root level • Aims to deliver medical care to the last person with enhanced efficiency & seamless delivery of schemes using Aadhar & ICT at every possible level not only has the potential to revolutionise healthcare in India, but also open up avenues for employment generation.

BECIL Healthcare Solution The proposed BECIL healthcare solution undertakes a modular

The BECIL solution can be categorised into three major sections which are: • Grass-Root Level: This level will employ the use of handheld battery-operated devices that bring diagnostic testing right to the patient having real-time lab-quality results in minutes with proven quality at an affordable cost. These devices would be carried by the medically trained personnel called swasthmitra who can undertake medical diagnosis by mapping the results with the Aadhaar number of the citizen.

The proposed BECIL solution will have sufficient flexibility using which door-to-door diagnostic tests mapped with Aaddhaar number can also be undertaken by the swasthmitras.

• Central Level: This level will

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Special Article

BECIL

Phases of BECIL’s service delivery

have a centralised data repository which will create, store and manage the individual health profile of the citizens mapped with the Aadhaar number. All the health centres connected to this centralised repository would be able to access & update the health profile of individual citizens. This highly secure centralised data

repository can be accessed only by authenticated users across the geography.

• Health Centre Level: This level will use a workflow-based hospital information management system, which will be tightly coupled with the centralised data repository, thereby facilitating the delivery of the intended services by trained

BECIL Healthcare Solutions - Key Takeaways • Believes that it is their social responsibility to serve the society • Is in the process of creating the perfect synergy between healthcare & technology to offer affordable specialised healthcare at the doorsteps of common man, even in the remotest part of the country • Partnered with one of the best technical solution providers in the field of healthcare • In the process of building a state-of-the-art data centre using which the intended services can be delivered securely • Provides end-to-end health services thereby delivering the entire lifecycle of these healthcare solutions

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operators. This level will also have dedicated telemedicine equipment using which specialised medical consultation will be provided by the panel of expert doctors.

Moreover, with the integration with Aadhaar, medical scheme benefits will be directly provided to the authenticated beneficiary.

BECIL aims to provide the technical framework to use information and communications technology (ICT) to enhance the reach & impact the way in which healthcare is delivered at the grass-root level.

The ecosystem created by BECIL with proven healthcare solution providers and assured quality of services would enable various ministries & departments to provide these envisaged services. BECIL is also in the process of building a state-of-the-art data centre using which these intended services can be delivered securely.

BECIL provides end-to-end health services thereby delivering the entire lifecycle of these healthcare solutions which includes requirement gathering, system designing, implementation, and operations & maintenance.

Sanara Ventures

Corporate Interview

Sanara Ventures: Building Mechanisms to Ensure Adequate Capital & Right Mentoring to Early-Stage Start-Ups We need to be very cautious in choosing the right technology that can truly bring clinical value and really make it to the marketplace in terms of integration in the later stage in the existing technology or IT of the medical facilities, shares Assaf Barnea, CEO, Sanara Ventures exclusively with Kusum Kumari of Elets News Network (ENN) Sir, Sanara Ventures is a unique combination of a pharmaceutical major and a medical device major.

Please throw light on how Sanara Ventures came up and what were the objectives behind its creation?

Sanara Ventures, which is a joint venture between Teva Pharmaceuticals and Philips Healthcare, is based in Israel. Overall, the idea was to establish an early-stage investment platform that comprises two aspects, including investing around a million dollar in start-ups primarily through the

incubator platform. Of the entire budget available, we allocate the start-up companies the very first millions of dollars. We invest in a broad spectrum of medical devices and digital health technologies.

However, we do not invest in pharmaceuticals and biotechnology.

Most of our investments are mostly on technologies that are complementary to Teva Pharmaceuticals and Philips Healthcare. However, if we come across interesting technologies that might not be synergistic to these companies, we will still invest in them in an opportunistic way.

In total, we have about 20 incubators in Israel under the Office of the Chief Scientist (Israel), Ministry of Economy, Israeli Government. The early-stage investment through the incubator platform is of around 1 to 1.5 million dollars, which would be through the incubator platforms that are part of Sanara Ventures. These applications are processed by the Office of the Chief Scientist, Ministry of Economy, Israel. Our incubator programme is a very well-known and prestigious programme worldwide.

During the later stages, we invest somewhere between 3 and 5 million dollars in technologies that are complementary

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Corporate Interview

Sanara Ventures

to Teva Pharmaceuticals Philips Healthcare.

and

In a recent announcement, you mentioned to fund 10 companies by the end of 2016 by particularly focusing on medical device manufacturers, which is a great news for our young medical device manufacturers. In the light of the above, have you succeeded in identifying start-ups with high potential in the traditional sectors of healthcare?

We have dealt with over 500 technologies, which are mostly from Israel and some from other countries.

As such, there is an increased flow of innovative technologies from hospitals, research institutions, private entrepreneurs, physicians, etc. In total, we currently have four companies in our portfolio. We are also right now working on two to three deals. Hopefully, we will have between eight and ten companies towards the end of 2016. These companies are currently undergoing the process of approval. The vision of Sanara Ventures is to be involved in about 50 start-up companies in the early stage in the next 10 years.

In most cases, when corporates meet early-stage start-up companies offering technologies or solutions of interest to them, they instruct them to clinically try the solutions on about 30 to 50 patients to make it resultoriented before they can be integrated in their system. As a result, corporates and start-up companies within a year and half lose communication and potential partnerships in the majority of the cases. Regardless of Philips Healthcare and Teva Pharmaceuticals, this has been typically observed across all corporates that are trying to do business with early-stage companies.

The principle objective of Sanara Ventures as an innovation-investment

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Sanara Ventures – Key Takeaways • Has a very well-known & prestigious programme worldwide • Brings true strategic value to start-up companies by delivering true knowhow & expertise exchange.

• Aims to be involved in about 50 start-ups in the early stage in next 10 years • Applies generic venture capital criteria while selecting start-ups, such as interesting technology, potential to target a big market, good entrepreneurs, etc.

• Looks for technologies that are also synergistic to Philips Healthcare & Teva Pharmaceuticals platform is to actually identify such early-stage companies and build a mechanism ensuring adequate capital injection to ensure right mentorship, offer assistance in commecialising their technology and find the right application within a certain cost. For this, we have an impressive advisory board comprising 60 people, 20 from Teva, 20 from Philips and 20 external advisory board members from both Israel and abroad.

Through the advisory board and other members, Sanara Ventures aims to support the selected companies in shaping their technologies, as well as guide them the way to select the right applications and market their solutions. Once start-up companies are selected, we conduct conference calls with the corporates to ensure matchmaking between them. Therefore, as a platform, we bring true strategic value to startup companies by delivering true knowhow on market, regulation caps, information technology (IT), etc. and expertise exchange. On the top of the capital, we keep on adding values that we can be identified with the process to make a significant impact.

In Israel, the budget allocated for investing in the incubators by the Office of the Chief Scientist is very

structured, which is 700,000 dollars.

Sanara Ventures allocates capital on top of the above budget to ensure the total budget runs around 1 or 1.5 million dollars to ensure startup companies get into a fundable state and not fall into the state of debt after 2 years. Hence, our major contributions include additional capital and development of a system that integrates knowhow and expertise. Interestingly, we work with start-ups with no strings attached and comparatively less-controlled capital. The selected companies are not obliged to work only with us or only with Teva Pharmaceuticals and Philips Healthcare. They are free to develop their own standalone products, as well as incorporate new changes and shape their products.

They can sell their products and become an independent company.

Overall, we offer a very open platform model with no exclusive rules and obligations.

With the introduction of economic reforms by the current Government of India to enable ease of access and remove other roadblocks witnessed while establishing business, how is Sanara

Sanara Ventures

Ventures planning to tap this opportunity?

At Sanara Ventures, we are looking forward to investing in technology in Israel and abroad to bring disruptive solutions to various corporates, including Teva Pharmaceuticals and Philips Healthcare. Currently, we are not sure whether we can inject capital in the Indian companies as this is not our focus area; we might look into this at a later stage. We can definitely build up collaborations that are relevant. We can assist corporates in identifying the potential start-ups and can also bring such companies into the fold of Teva Pharmaceuticals and Philips Healthcare if they meet their requirements. As such, we are constantly in search mode by talking with Teva Pharmaceuticals and Philips Healthcare to enable investment on their behalf. In case any need arises, we are ready to open up and invest or exclusively license technology from Indian research institutions, hospitals, universities, etc. and fund start-ups.

What are Sanara Ventures’ policies and criteria for selecting start-ups? Please

Corporate Interview

Sanara Ventures - Key Features • Invests in a broad spectrum of medical devices & digital health technologies • No investment in pharmaceuticals & biotechnology • Has about 20 incubators in Israel under the Office of Chief Scientist, Ministry of Economy, Israel • Has an impressive advisory board comprising 60 people - 20 from Teva Pharmaceuticals, 20 from Philips Healthcare and 20 external advisory board members from both Israel and abroad provide the details of parameters on which they are selected.

First of all, we proactively search potential companies by meeting technology transfer organisations (TTOs), start-ups, projects of private entrepreneurs, etc. looking for capital for investment. Post identification of such companies, we conduct one-to-one meetings with them. During the entire process, we apply generic venture capital criteria. These companies must offer interesting technologies and have the potential to target a big market, among other factors. Additionally,

the entrepreneurs need to establish their leadership skills. We also look for technologies that are synergistic to Philips Healthcare and Teva Pharmaceuticals.

Due to the increased focus of Philips Healthcare on prehospitalisation technologies focusing on prevention and awareness, if we stumble upon such a technology that is relevant to the home care division of Philips Healthcare and makes sense to us, we will probably conduct a conference call with the relevant people of Philips Healthcare.

We are looking for technologies that understand more about patients.

We have very close relationship with various divisions of both Teva Pharmaceuticals and Philips Healthcare. Hence, if a technology makes a sense as complementary solutions to these companies, then we run a gating process with the relevant division. Post checks, we try to structure a deal with these companies.

In this gating process, post selection we submit an application to the investment committee of the Office of Chief Scientist and finalise the cost. In case of non-submission of application to the Office of Chief Scientist, the entire capital will be invested by the investment committee of Sanara Ventures. We are using various vehicles to make Sanara Ventures an open and flexible

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Corporate Interview

Sanara Ventures

platform. We may also not necessarily go through the Office of Chief Scientist stage during this entire procedure for a later-stage deal.

Please enumerate the current key challenges in the healthcare ecosystem?

Within the digital health segment, we as investors have to take decisions on a lot of technology from the patent point of view as applicable to medical devices. Internally, it’s a challenge for us to be open-minded about not necessarily check or look for such patents in digital health as they are not relevant for such applications. Externally, we come across companies that promise the sky in terms of patient care, predictions and analytics, which are truly beyond someone’s reach. Such companies need to ensure that their offerings undergo a long validation & regulation process to prove the level of feasibility and acceptance of their offerings as a global solution.

We as investors need to truly look into such solutions to develop a deep understanding of the product in terms of offerings. We need to be clear whether the product offered is a support system, disease management tool, a solution for chronic diseases, etc. More importantly, we need to decipher the clinical efficiency or value that these companies are claiming to bring. These companies should really be able to get close to what they claim or promise.

India as a Market • In case any need arises, we are ready to open up and invest or exclusively license technology from Indian research institutions, hospitals, universities, etc. and fund start-ups.

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In the digital health space, we have seen more than hundreds of technologies from world over, with many companies having long procedures and solutions that are not necessarily feasible.

These companies need to shape their technologies by following all standards. We need to be very cautious in choosing the right technology that can truly bring clinical value and really make it to the marketplace in terms of integration in the later stage in the existing technology or the IT of the medical facilities. Additionally, it should not affect the workflow of the physicians and truly reduce both time and cost.

At the later stage, what matters are integration and appreciation within day-to-day workflow.

What are your recommendations to the startups before they venture into the marketplace?

I would say if the entrepreneurs have good ideas, addressing the initial requirements of the physician is just one aspect. One of the very important requirements is that the start-ups must ensure accurate & true clinical value of their technology.

The performance of those clinical values should be very cautiously fine tuned and not be hyped up on the basis of high-level promises.

Secondly, they really need to look into the methodologies to integrate any new technology into the existing legacy technologies within hospitals and clinics. Lastly, what matters the most is how the market appreciates and accepts such technology, not just from technological integration point of view, but also from the perspective what such a technology can offer to the physicians, nurses, etc.

Which are the key markets for you in the coming years?

Let’s make a distinction between Sanara Ventures’ approach and that of Teva Pharmaceuticals and Philips Healthcare. For Teva Pharmaceuticals and Philips Healthcare, India is part of their strategy. For us, India is part of the global market. As the CEO of Sanara Ventures, we are looking to tap into the markets that we define as the hubs of innovation, such as Israel, the Boston area, Silicon Valley, Paris, etc. which are getting bigger and larger in terms of medical devices. According to the World Bank, the hub of innovation is also rising in India in terms of the startup community and community of innovation. This transition is evolving more and more. We will definitely try to identify opportunities to license new technology and connect startups with Teva Pharmaceuticals and Philips Healthcare.

Fujifilm India Private Limited

Corporate Interview

Fujifilm: Integrating Design Philosophy to Reduce Workflow Bottlenecks Fujifilm consistently strives to refine its digital products based on the key ingredients of the design philosophy to make the work of health professionals more effective and efficient, shares Phanesh Atmuri, National Sales Manager – DR & X-Ray, Fujifilm with Elets News Network (ENN)

F

ujifilm has always been on the forefront of technological innovations that improve the quality of lifestyle and health outcomes. With its pioneering spirit and expertise in imaging technologies, Fujifilm has developed various digital products that not only improves the image quality, but also reduces the workflow bottlenecks.

Understanding Design Philosophy of Fujifilm All our digital products are centred around cost efficiency in long term, enhanced productivity, faster throughput and lesser user intervention. Our products and technologies are proven in clinical applications, and are constantly being refined to make the work of health professionals more effective and efficient. The portfolio includes digital radiography (DR including Mobile DR), full-field digital mammography (FFDM), and picture archiving and communication systems (PACS).

In conventional analogue mammography, the image is not displayed instantly after exposure. Insertion of film cassette and developing the film (in a dark room or through a digitiser) involve a lot of time and cumbersome process. Additionally, at times it necessitates the callback of patients for re-exposure as the analogue systems can’t show images instantly.

Fujifilm Amulet Innovality

Amulet Innovality is a full-fledged digital mammography that is upgradable to digital breast tomosynthesis (DBT) and biopsy with a global footprint of more than 2,500 systems. In India too the system was able to make serious inroads within a short span of time after it was launched last year, owing to its technological capabilities and image resolution. AMULET Innovality is a highly advanced mammography system which offers an extremely fast image interval of just 15 seconds. The low-noise and high-speed switching technology of Innovality allows tomosynthesis exposures with a low X-ray dosage and short acquisition time to be performed.

This system utilises Fujifilm’s unique Amorphous Selenium (a-Se) direct conversion flat panel detector (FPD) with hexagonal close pattern (HCP) type detectors to produce clear images with a low X-ray dose and offers 50 micron resolution images. Compared to indirect technologies, the absorption rate of a-Se is higher in the low-energy range of mammography. And at the same time the detective quantum efficiency (DQE) is higher, which results in high image quality at a low dose. This system makes use of intelligent AEC (i-AEC) combined with a new image analysis technology to automatically optimise the X-ray dosage for each breast type.

Advantages of Intelligent AEC Intelligent AEC has advantages in defining the optimal dose for an exami-

nation compared to conventional AEC systems where the sensor position is fixed. Through the analysis of information obtained from low-dose pre-shot images, Intelligent AEC makes it possible to consider the mammary gland density (breast type) when defining the X-ray energy and level of dose required.

Intelligent AEC can be used even in the presence of implants. It enables more accurate calculation of exposure parameters than is possible with conventional AEC systems. By allowing the use of automatic exposure for the implanted breast, Intelligent AEC can further enhance examination workflow. Fast image display is also possible, realising a smooth mammography workflow from exposure to image display.

Image-based Spectrum Conversion* (ISC) technology aims to ensure that images display adequate contrast even with the use of a high energy, low-dose X-ray beam. This technology allows sites that previously exploited the superior contrast of a Molybdenum target to realise the dose advantages offered by the use of Tungsten without having to compromise image contrast.

Fujifilm has developed and provided new products and services especially DR & Healthcare IT (HCIT), focusing on expanding healthcare business. It is our constant endeavour to innovate and provide high-quality medical solutions that will contribute to better healthcare facilities and services to our customers and society.

August / 2016 ehealth.eletsonline.com

37

Corporate Interview

Barco

Barco: Enabling Smarter Healthcare via Dependable Visualisation Solutions Today’s fast-paced marketplace requires mutually beneficial partnerships to leverage creativity, experience and resources, with right- and left-brain thinkers, which can help you arrive at a solution in less time, shares Rajiv Bhalla, Managing Director, Barco Electronic Systems (P) Ltd exclusively with Elets News Network (ENN) Sir, since our August issue focuses on ‘Smart Healthcare’, we would like to know your perspective on ‘Smart Healthcare’, particularly in the context of the Indian healthcare ecosystem.

Smart care is the outcome of the technological advancement that has taken place in the healthcare sector in the past decade. The reach of technological innovation continues to grow across all sectors. Technology is playing an important role in almost all processes of healthcare – from patient registration to data monitoring.

Advancement in healthcare has contributed to the services in a wider way, being taken out of the confines of hospital walls and integrating them with user-friendly, accessible devices.

It is giving the healthcare industry a much-needed advancement, from medical translation tools to mobile apps that help patients live healthier and better lives.

Technology and patients: In the present day, healthcare has realised that the emphasis is more on the patient and the services need to be more “patient-centric” as people want more attention and adequate communication. This is easily accomplished by using software that supports the core medical processes, hardware that allows easy access to information at the point of care and standards that make the integration

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of different systems easier than ever before are all key features of the new smart healthcare system.

products and innovative services is Barco planning to introduce in the Indian market?

In the light of such an encouraging leadership in India, what kind of new

With a legacy of superior image quality and smart technological innovations, Barco has a solid reputation for delivering dependable

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Corporate Interview

Barco

display systems and visualisation solutions that are central to the provision of quality healthcare. Our comprehensive product offering includes leading-edge displays for radiology, mammography, surgery, dentistry, pathology and modality imaging, along with clinical displays for healthcare specialists, digital OR systems and point-of-care devices.

Collaboration and networking will be the future of the healthcare industry. Nexxis is Barco’s videoover-IP platform for the integrated digital operating room. It’s the best way to share uncompressed, highresolution videos (and audios) in and between operating rooms. This unique technology platform has been specifically designed for integration into the digital OR.

Barco - Key Takeaways • Offers leading-edge displays for radiology, mammography, surgery, dentistry, pathology, and modality imaging, along with clinical displays for healthcare specialists, digital OR systems and point-of-care devices • Offers the video-over-IP platform Nexxis for the integrated digital operating room • Provides the necessary building blocks for a highly reliable control room visualisation system • Believes that collaboration & networking will be the future of healthcare industry We believe it is a win-win way of creating an entire ecosystem that will facilitate industry collaboration for promoting latest manufacturing technologies. Following our corporate philosophy, we continuously strive to excel in customer service, technology & operational excellence domain in whatever we do.

How has been the adoption rate of Barco’s video wall solutions for master control and crisis management rooms?

What are the key challenges and roadblocks in enlarging your geographical footprint?

Today’s business-critical environments increasingly rely on visualisation technology for monitoring and decision-making purposes. Due to the critical nature of the application, the continuous availability and flexibility of these systems are a must. The adoption rate for Barco’s video wall solutions is outstanding. We are present in almost every segment, such as Broadcast, Government, Education, Security and Transportation, Utilities & Process Control, and Oil & Gas. The operational challenge is to have a strong partner ecosystem as the solutions for the different markets are quite complex involving multiple technology stacks and hardware.

Are you looking forward to diversification into new segments to tap the real potential of the Indian market?

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If yes, please provide details.

As mentioned earlier, the future will be collaboration and networking, as well as more products will be introduced that are wirelessly operated. Additionally, Digital India is the next big thing coming in India and smart cities have already made several positive changes in the industry. The changes can be seen and felt in the Indian market. India’s smart city initiative can put India on the global map. As one of the keys to smart systems is information, we will have better solutions with the availability of more data. Barco, as a leading provider of visualisation and networked distribution solutions, will definitely be an enabler of smarter tomorrow. Barco provides the necessary building blocks for a highly reliable control room visualisation system.

This is the era of collaborations.

So, we were wondering what kind of collaborations and partnerships Barco is really keen upon to grow both within and outside India?

We live in a connected world—there are apps today that help solve problems you didn’t even know you had and anticipate needs before you realise them. When you can constantly be connected to the Internet, it opens the door for technology solutions to every challenge.

One way of overcoming the current challenges is through collaboration— in unexpected ways—with other companies.

Today’s fast-paced marketplace requires mutually beneficial partnerships to leverage creativity, experience and resources, with right- and left-brain thinkers, which can help you arrive at a solution in less time.

We do believe in collaboration within and outside India and will share the news with you as and when it is available.

Corporate Interview

Blueair

Blueair: Offers Unbeatable HighPerformance Technology to Tackle Polluted Indoor Air

Looking ahead, Blueair’s all next-generation air purifiers will have IoT connectivity designed to make the invisible contamination ‘visible’ and thereby empower consumers, younger or older, to better understand their surrounding air quality, detect airborne dangers and do something about removing the pollutants, shares Herman Pihltrad, COO, Blueair exclusively with Elets News Network (ENN) Please walk us through the key health benefits of air purifiers manufactured by Blueair. How does your product stand apart from the competitors in the Indian market?

Outdoor and indoor air pollution are two sides of the same coin, but it is easier for us to do something about our indoor air to reduce it being contaminated by dust and chemical particles or germs that are bad for our health and wellbeing. Independent agencies, such as the International Agency for Research on Cancer and the World Health Organization (WHO), have attributed 80 per cent of all cancers to environmental rather than genetic factors, including exposure to the carcinogenic chemicals found in household cleaning products, such as liquid cleaners, as well as air fresheners, paints and varnishes.

WHO says nearly 3 per cent of the global burden of disease is due to breathing polluted air indoors, where we spend up to 90 per cent of our time, which is a scary thought.

There are several factors that help Blueair stand out from our competitors. One of the factors is that since our launch 20 years ago we have remained one of the very few companies to be solely 100 per cent focused on innovating, manufacturing and marketing air purifiers. This gives

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Blueair an unbeatable understanding of the problems and extent of how to best tackle polluted indoor air. We are totally committed to work ceaselessly to bring our air technology knowhow to a wider public. Thanks to our highperformance technology, energy economy and eco-friendly design, millions of people around the world today rely on a Blueair air purifier to work efficiently and silently to remove up to 99.97 per cent of allergens, asthma triggers, viruses, bacteria and other airborne pollutants.

Do you think there is now increased awareness about air purifiers as such, as their key benefits have been popularly disputed by many sceptics in the healthcare ecosystem?

There will always people who are skeptical of new developments.

For that reason, at B l u e a i r we believe in giving p e o p l e accurate information

be

about the overall issue of bad indoor air quality and the performance of our air purifiers that can allow them to make a considered choice about the efficiency of our technology and how it can help them combat the negative health effects of polluted indoor air.

Today millions of people a r o u n d the world rely on Blueair’s a i r purifiers to remove potentially h a r m f u l

Blueair

contaminants from their indoor air.

Blueair’s air purifiers have won top results for their efficiency in purifying indoor from several independent and national testing organisations, such as the Association of Home Appliance Manufacturers (AHAM) in the Unites States (US) and China’s Consumer Protection Agency, which have awarded Blueair’s air purifiers top marks for delivering the clean air we claim they do.

The air purifier market in India has grown from almost nothing to over Rs 150 crore ($23.45 million) in the last few years and has been predicted to be as big as the water purification industry. Please share your opinion.

Water and air are essential to life on our planet. Looking around us, it is pretty obvious that we humans have not been very good at protecting these vital resources from the ravages of pollution. And, there is now substantial scientific evidence that shows the potential long-term damage caused by breathing polluted air. As people become more aware of the problems

Key Impacts of Poor Air Quality • 80% of all cancers are due to environmental rather than genetic factors, including exposure to the carcinogenic chemicals found in household cleaning products • 3% of the global burden of disease is due to breathing polluted air indoors residents are now in search of alternative solutions, particularly air purifiers. In the light of this statement, are you focusing merely on mid-level and premium products or plan to diversify into mass products to ensure growth in the emerging markets like India?

Blueair is a premium brand in all its 64 markets around the world.

From the start 20 years ago, our

Blueair Friend App

related to poor air quality, it is only natural they will increasingly seek to protect themselves. So, yes, it is very likely that the air purifier market in India will grow substantially in the coming years.

With the growing threat of respiratory diseases due to increased pollution in India, most of the middle-class

Corporate Interview

focus has been 100 per cent on innovating, designing, manufacturing and marketing simply the best air purifiers in the marketplace. Due to our commitment to ‘no substitute for excellence’, we generally are at the top end of each price category in which we compete.

The market is constantly evolving of course. Today, Indian consumers can choose between 100 different air purifier brands, but not all are created equal in terms of secure performance. Blueair stands out of

Blueair Aware air quality monitor monitors indoor air quality and senses particles and VOCs

the crowd because of our sole focus on indoor air purification and 20-year history of innovation, which means we are a tried and tested brand today with a proven track record in delivering people clean air at home and work.

What are the key deterrents and challenges in operating a market as challenging as India? Do you think with the growing focus of the Government of India on improving India’s position in the

August / 2016 ehealth.eletsonline.com

43

Corporate Interview

Blueair

global ease of doing business list, you will be able to trickle down your solutions to smaller cities and facilities?

India is a fast-growing market for the air purifying industry. At Blueair, we are working to double our market size every year. We established Blueair’s own organisation in India almost 2 years ago and our key focus to date has been on developing our position in key metropolitan markets, such as Delhi and Mumbai. However, we are expanding into tier-II cities, such as Pune, Chandigarh and Ahmedabad; our aim is to continue that expansion going forward. In addition, Blueair is also available on online portals, such as Amazon, Snapdeal and eBay.

Blueair has been consistently underlining the need to enshrine clean air as an internationally recognised human right in the Declaration of Human Rights of the United Nations (UN). What measures have been enunciated by Blueair to realise this goal?

We believe passionately that clean air is a basic human right. At our launch in 1996 and during the first few years, we saw our mission as one of making the best machines in the world to purify the indoor air of all the nasty particles, dust, chemicals, allergens and germs that could threaten people’s health. But as time passed, we soon came to realise that there was a bigger story to our mission.

We realised our job was not just to make a better piece of machinery, but to also deliver enhanced health and well-being to our customers. That is why we invest constantly in research and development (R&D), as well as in promoting information about the state of the air we all breath with the aim of giving consumers the knowledge that will help them make the right choices to protect their health and that of people they care about.

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Blueair – Key Takeaways • Believes passionately that clean air is a basic human right • Committed to work ceaselessly to bring their air technology knowhow to a wider public • Offers high-performance technology, energy economy and eco-friendly design • Invests constantly in R&D • Removes up to 99.97% of allergens, asthma triggers, viruses, bacteria & other airborne pollutants • Has won accolades for efficiency in purifying indoor from several independent & national testing organisations • Established Blueair’s own organisation in India almost 2 years ago with the focus to penetrate into the key metropolitan markets, such as Delhi & Mumbai • Also available on online portals, such as Amazon, Snapdeal and eBay Do you think the air purification industry will be one of the key elements of the entire ‘Smart Healthcare’, which is the goal of healthcare stakeholders?

Smart technology is a key to optimising the way society addresses healthcare in the near future.

Blueair was one of the very first air purifier companies several years ago to launch a fully integrated Wi-Fi-connected air purification system for home and office capable of detecting and combatting airborne germ, chemical and particle attacks. For example, the Blueair Sense+ air purifier uses wireless technology to access the information being harvested by the remote Blueair Aware air quality monitor, which monitors indoor air quality and senses particles and volatile organic compounds (VOCs) while sending updates in real time to a smartphone using the Blueair Friend App. Blueair’s Friend App can either automatically adjust the

Sense+ airflow speed or permit manual control.

Looking ahead, Blueair’s all next -generation air purifiers will have ‘Internet of Things’ (IoT) connectivity designed to make the invisible contamination ‘visible’ and thereby empower consumers, younger or older, to better understand their surrounding air quality, detect airborne dangers and do something about removing the pollutants, Finally, I believe that air purifiers are fast becoming as natural a part of the home or office environment as vacuum cleaners are today due to the growing awareness about the hazards posed to human health and well-being by contaminated indoor air. There is little we can do in the short term about polluted air on the street, but we can do something positive to make sure we are breathing air as pure as nature intended indoors, at home, work and play by simply investing in a premium air purifier such as those made by Blueair.

Technology & Medical Infrastructure Park Group of Hospitals

Park Group of Hospitals: Committed to Cost-Effective Healthcare Services without Compromising Quality Our main strength is the rates at which we offer affordable healthcare to the patients, which doesn’t mean that we compromise with the quality of the treatment. I believe that every individual deserves expert & affordable health treatment, irrespective of their financial status, shares Dr Ajit Gupta, Philanthropist, Founder & Chairman of Park Group of Hospitals with Elets News Network (ENN) Please walk us through the key information and communications technology (ICT) measures being undertaken to ensure smart healthcare across all facilities in the chain of Park Group of Hospitals?

The ICT is becoming most important information gathering system in the healthcare industry. The demand of the technology has changed healthcare system and given solutions for several activities. The main aim is to provide smart healthcare

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facilities to the patients. Right from booking the appointment, to their release, the patients will see the prominence of ICT everywhere.

Existing in house of Park Group of Hospitals, the patients can book their appointment from our website/ application in no time. They can also book an ambulance from our website and application.

Moreover, the patients can also book an appointment from our toll free number. We have an in-house set-up of centralised call centre (Pan Park) wherein through software we send patient email regarding the scheduled appointment and other related queries. In today’s healthcare sector, hospitals demand technologies like app development, which make the work convenient for both patients and healthcare professionals.

Nowadays, there are clinical apps for clinicians where they can share their views or can discuss patient reports in no time.

Park Group of

Hospitals is in the process of tying up for such advancements in which our in-house application will be linked for clinical practitioners at work.

Apart from technological advancements, what all key measures have been enunciated to deliver better experience to patients right from the time of registration to the time of discharge?

We make sure that the patients get the best experience when they visit Park Group of Hospitals. As the appointments are booked quickly through the website and application, the patients no more have to wait in long lines and wait for their turn.

The tests are done then and there, and the reports are delivered on their doorsteps. Additionally, we try to follow turnaround time for various preventive health checks. The entire chain of Park Group of Hospitals has a hospital information system (HIS) wherein outpatient department (OPD) and inpatient department (IPD) database for patients is maintained for records. As a result, the patients can ask for their reports whenever they want.

The patients admitted are given expert and homely care, as well as all measures are undertaken to ensure they recover faster. Everyone in the hospital, from doctors and

Park Group of Hospitals

nurses to paramedics, is dedicated to provide the best experience to patients. Additionally, the rooms are not like the mainstream hospital rooms that look monotonous and quite upsetting for patients.

For patients’ entertainment, we also have a TV. As the minute-tominute reports of the patients are updated, they can know the status of everything. Patients have to not wait in the long queue during billing and are also discharged from the hospital smoothly as the billing system is centralised.

How do you plan to increase your geographical footprint across India, particularly in the light of the emergence of numerous corporate medical facilities?

Our main aim is to provide expert and affordable healthcare at places where it is needed the most. Recently, we have launched our eighth hospital in Panipat. It is the first super speciality corporate hospital that has the largest number of intensive care unit (ICU) beds in Panipat. No more the residents of Panipat and nearby areas have to go to Delhi for medical and emergency treatment in the absence of a super speciality hospital. As the number of accidents on the highway has increased over the years, the Panipat hospital is a relief to the people as they can reach the hospital at the time of emergency.

Therefore, we launch our hospital as a true trauma centre, where we have a 24X7 anesthesiologist, intensivist, neurosurgeon, orthopaedics, and plastic and general surgeon in the day and also in the night for the emergency patients. Just like Panipat, I wish to launch Park Hospital where it is needed the most.

Sir, according to you, what are the key areas of strength and improvement for Park Group of Hospitals? Please provide details.

Technology & Medical Infrastructure

Park Group of Hospitals - Key Takeaways • Book appointments from website/application in no time • Can also book an appointment from toll free number • Has an in-house set-up of centralised call centre • Has launched eighth hospital in Panipat as a true trauma centre • Offers affordable quality healthcare to the patients • Runs camps, CSR activities & campaigns • Accepts new technologies & also trains the staff on them • Participates in various conferences worldwide for the launch of machines Our main strength is the rates at which we offer affordable healthcare to the patients. Most of our treatments are at government rates, and that doesn’t mean we compromise with the quality of the treatment.

I believe that every individual deserves expert health treatment, irrespective of their financial status.

In fact, we also run camps, corporate social responsibility (CSR) activities and campaigns from time to time, in which we provide free check-ups, consultations, etc. to the people. We also have the best and state-of-theart technologies, which make sure that the patients recover faster.

I understand nothing can be perfect, and there is always a scope for improvement. I think Park Group of Hospitals keeps on improving on quality. We have a team that conducts quality analysis to understand the various areas where we can improve, such as operations, patient satisfaction, employee satisfaction, etc. Even in the research area, we accept new technologies and also train the staff so that they can use these technologies in the best way possible. Whenever a new technology comes, we also need to train the staff members, so that they can use these technologies in the best way possible.

How keenly have you been observing the rise of the nextgeneration technologies? Do you think such technologies can ensure cost-effective quality care?

The next-generation technologies are always our main focus.

We have a research, corporate communication and development team that keeps looking for new technologies that have come up as advancement in the healthcare sector. The team participates in various conferences going on around the world for the launch of machines and technologies related to healthcare. We also ensure that the staff members get trained on the use of these technologies.

These new age technologies are cost effective and even if the treatment seems a little expensive as compared to the other treatments, the advantages are seen in the long run. These machines help in detecting the disease earlier and cure it at the earliest. Other technologies like futuristic ICT applications for hospitals will be not only cost effective but also relevant for the healthcare professionals.

Such technologies will change the scenario of healthcare.

August / 2016 ehealth.eletsonline.com

47

Medical Device Policy

AIMED

Medical Device Regulatory Reforms – Ready to Boost Business & Quality Care via Improved Quality

With a focus on implementing best international practices & quality care as envisaged under the ‘Make in India’ campaign, the Government of India announced to create a separate rule book for medical devices post addressing the challenges & integrating the best practices. The medical device industry has welcomed the announcement and shared recommendations to accelerate the efforts in the progressive direction.

A

t a high-level meeting at the Prime Minister’s Office (PMO), industry representatives from AIMED - Association of Medical Device Industry, Confederation of Indian Industry (CII) and the Federation of Indian Chambers of Commerce and Industry (FICCI) shared their common visions and thoughts on ‘Medical Devices Regulatory Framework’ along with the officials from Ministry of

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Health & Family Welfare (MOH&FW) to the PMO Secretariat, based on the following key principles: • Best international practice - Confidence in medical devices available in India whether manufactured in India or imported.

• Ease of doing business • Patient safety

What will change for medical device manufacturers?

A separate ‘Medical Devices Regulatory Framework’ will usher in change, which will hopefully be for the better. As such, there has been a long outstanding demand from AIMED for a separate rule book and separate law to regulate medical devices. The changes are being done in three to four phases.

• Step 1 - Schedule MIII under the Drugs and Cosmetics (D&C) Act that provided regulations for

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Medical Device Policy

AIMED

infrastructure and equipment requirements for three types of medical devices was inadequate to regulate the 15 medical devices notified as drugs. As the above Schedule did not have the provision of quality management system (QMS) or good manufacturing practices (GMP), the regulators used to arbitrarily apply Schedule MIII from pharmaceuticals to medical devices, which was inappropriate, incomplete and incorrect, leading to harassment. Now on the request of AIMED, Schedule MIII has been amended and notified on June 29 with the provision of QMS requirements and these are aligned to ISO / IS 13485 Standard.

• Step 2 - In addition to the Schedule MIII revision, the balance rules are being drafted to meet specific needs of the medical devices (and in vitro diagnostic device (IVD)) sector but under the current D&C Act, as the Government decided not to amend the existing Act as was being proposed by the MOH&FW by adding a chapter specific to medical devices. Hopefully, this will meet our requests of delegation of QMS inspections to third-party certification bodies.

Additional medical devices may be regulated on getting the specific notification. These draft rules have been discussed with the key stakeholders, and these have now been posted on the MOH&FW website in a week’s time to gather public comments.

• Step 3 - A separate Medical Devices Bill 2016 is under drafting too by the MOH&FW and will be on the lines of earlier proposed amendment to D&C Act, but hopefully would be better drafted with wider consultation. This is targeted to be issued for public comments

by September and tabled to the Parliament by the winter session.

• Step 4 - The current rules are being drafted keeping in mind

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Medical Device Reforms in Regulations - Key Takeaways • Schedule MIII amended & notified on June 29 to include the provision of QMS requirements & aligned to ISO / IS 13485 Standard • Drafting of balance rules is under process to meet specific needs of medical devices.

• Drafting of a separate Medical Devices Bill 2016 is under process • Has recommended delegation of QMS inspections to third-party certification bodies.

• Has recommended manufacturers to be voluntarily self-compliant to ICMED or CE certifications • Need to tweaked to meet the challenges of patient safety and ease of doing business to enable Make in India

A separate ‘Medical Devices Regulatory Framework’ will enable regulation of all devices in one go

the regulatory framework being proposed in the new revised Bill, so that they would need minimal tweaking or change once the Act is done. The main impact of the Bill when enacted would be that all devices would get regulated at one go within a definite transition period instead of item by item notifications that lead to confusion of terminology and applicability.

What should manufacturers plan to do differently?

Manufacturers should aim to be voluntarily self-compliant to the Indian Certification for Medical Devices (ICMED) voluntary certification or CE certification. This will ensure they have to do minimal changes to documentation and processes to be compliant to these rules.

What are the proposed legislations? Any comments?

The forthcoming Bill will cover the legislation part of regulations for which the Government needs

AIMED

backing of Parliament. In case of rules, the Government of India can amend rules without pre-approval from Parliament. The major strategic elements are common in rules under drafting, e.g. it permitted Government of India to have powers to define rules to regulate through third-party certification bodies and consider a four-tiered risk-based proportionate regulatory control.

In essence, we welcome this separate set of rules as this has been a long outstanding request. However, there are some challenges, as these rules need to be tweaked to enable the dual needs of patient safety and ease of doing business to enable Make in India.

In terms of key elements, they are getting aligned to regulations of some or all the major economies.

In terms of who will regulate, we had proposed the Government of India through third-party certification bodies as done in the European Union (EU). However, we found that the Government of India is willing to consider this only for Class A & Class B Devices. The Government still wishes to use medical officers for inspection of Class C and D Devices and possibly B too. We need to negotiate with the Government of India to consider voluntary thirdparty certification for QMS-compliant high-risk devices as well.

Will there be risk proportionate regulations and controls?

Yes, a four-tiered proposed.

structure

Healthcare stakeholders are happy that medical device is now the national agenda

Third-Party Certification Bodies for Regulation • The GOI is willing to consider this only for Class A devices • The GOI still wishes to use medical officers for inspection of Class C & D Devices, and possibly B too • The Industry wants to negotiate with the GOI to consider voluntary third-party certification for highrisk devices as well

is

Who will regulate the Indian national medical devices regulator?

We have recommended that the currently proposed rules propose a Central Regulatory Authority to regulate the manufacturers and importers, as well as delegates the Regulation of Trading Company to the State Licensing Authority. This

Medical Device Policy

has to be seen in terms of challenges provided in the current law whereby the state is the licensing authority, but does not have the skill set, manpower and competency to regulate this case and complex field without handholding

by Government of India. The National Regulatory Authority and the National Accreditation Board of Certifying Bodies (NABCB) will jointly supervise the certifying bodies and their auditors.

What else was discussed at the meeting?

AIMED, CII and FICCI made a joint pitch for making India one of the top 5 manufacturing hubs in the world by implementing the following actions: • Department for Medical Devices or renaming the Department of Pharmaceutical as Department of Pharmaceutical and Medical Devices • Creation of a special purpose vehicle (SPV) for a coordinated approach for facilitating Make in India of medical devices • Incentives to attract overseas and domestic investors to build factories for not only importing substitution but for also targeting the global market and what it would take to compete with Ireland, China, Malaysia and Costa Rica as manufacturing destination and hub.

Overall, we were enthused by the importance being given to medical devices sector and the fact that it’s a national agenda now. We hope that the Government of India releases a comprehensive medical devices policy to realise not only the potential of import substitution of 23,000 crores, but also to unleash the huge export potential in the global market.

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Special Feature

Online Pharmacy

Online Pharmacy Business

Standing at Crossroads

Online pharmacy business models await a new lease of life from progressive policymakers & regulators to deliver real benefits

A

re we dissuading new business models from growing & spreading their roots in the Indian healthcare sector due to the entire balancing act of the government bodies and other structures? More than ever, we are now quite aware of new platforms & models that are putting all genuine efforts to play the role of a game-changer in the entire healthcare ecosystem. Of all the emergent models in the Indian market, online pharmacy has become the moot point of debate among all the key healthcare stakeholders. Instead of turning the entire debate into a shouting match, the need of the hour is to brainstorm by running different perspectives into one another to create a nexus of ideas and derive a dynamic conclusion, both relevant and contemporary. Usually brainstorms do cause disturbances in our immediate environment, but they enable to come up with lightening ideas.

Lately, we have been witnessing a series of progressive changes in the country, especially when it comes to regulations. There has been increased

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emphasis on amending the umbrella Act Drugs and Cosmetics Act, 1940, which provides a regulatory framework for ensuring quality, safety and efficacy of medical products. The charges leveled against the Act are that it is quite outdated and is in urgent need of amendments due to the inclusion of new medical areas and business models. Â In the light of the above, even online pharmacy business models have been witnessing numerous roadblocks.

Post numerous debates, the need of the hour is to define the document, quality to customers, balance between cost & patient safety and enforcement of the revised regulation in a stringent manner. The skeptics believe that online pharmacies pose a serious challenge to patient safety and medicine quality due to high risk of supply of spurious medicines and bulk purchase of medicines. However, online pharmacy entrepreneurs have

categorically denied such chances as their business models comply with rules and medicines are dispensed based on only prescriptions.

With consistent efforts of both online pharmacy entrepreneurs and the progressive leadership of India, there have been renewed efforts to comprehend the contemporary challenges and changes, as well as redefine the regulations.

Entrepreneurs suggest that the Government has been in the process of drafting new regulations and should not take more than few months to ensure relevant changes are included, so that the contemporary challenges are addressed. People need to understand the business models based on which online pharmacies operate, which can play a larger role than what is being allowed now through its holistic business models and also prove beneficial to the needy patients.

1MG

Understanding Online Pharmacy

1MG: Offering Integrated Platform Under Right Leadership Our vision is to be the health partner for consumers whether be it product services, information and insights. We want to make healthcare affordable, accessible and comprehensible for consumers, shares Prashant Tandon, Founder & CEO, 1MG and President, Indian Internet Pharmacy Association (IIPA) exclusively with Kusum Kumari of Elets News Network (ENN) How did the entire novel idea of Indian Internet Pharmacy Association (IIPA) came up?

When we started business, there was a lot of misinformation being spread about the online pharmacies.

As of now, there are around 40 to 50 other e-pharmacies. For our kind of business models, we felt the need for a collective voice, which should be done by coming on a common platform to unanimously agree on the ways we are going to operate in complete compliance with the law and come up with a unified voice while talking to regulators, offline pharmacies and other stakeholders. We started off with 11 members and set tough criteria f o r

membership, such as members of IIPA have to comply with laws stringently and they need to have a certain set of processes and guidelines on the basis of which they need to operate. In recent times, we have added just Frank Ross from Emami Group as a new member.

In the name of e-pharmacy collective, we do not want people not operating in the correct and legitimate ways t o

get represented. Therefore, our members are very carefully selected.

Currently, we are evaluating around 10 to 15 applications that are pending with us for membership.

What kind of screening procedures are followed by IIPA to check the authenticity of online pharmacies?

Firstly, we need to understand the operating model of our e-pharmacy.

The operating model needs to have 100 per cent prescription compliance.

All of us have to have fulfil orders only using the scanned copy of the prescription copies. Secondly, the medicines need to be dispensed only from the licensed premises. The final sale has to happen from pharmacies that has a Drugs and Cosmetics license. Thirdly, none of us operate in Schedule X medicines which include narcotics that are sensitive medicines. Overall, these are the mandatory requirements to be part of IIPA. Therefore, when a person applies, we conduct a bunch of preliminary checks on the models and also place orders to understand the systems in place.

Another key requirement is that these e-pharmacies need to be based in India to enable monitoring of medicines,

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Understanding Online Pharmacy

1MG

procedures and premises.

IIPA – Mandatory Screening Procedures

Several international bodies have also expressed issues over online pharmacies and are trying to build guidelines to overcome the challenges, such as fake medicines, spurious fillers, data theft, etc.

Please share your opinion.

• Understanding the operating model • Fulfil orders ONLY via prescription copies • Dispense medicines ONLY from licensed premises • NO sale of sensitive medicines under the category of Schedule X • Based in India to enable adequate monitoring Understanding Online Pharmacies in Indian Market

For this, the online pharmacy models currently operating in India need to be understood. As such, online pharmacies can operate from anywhere in the world. All the requirements mentioned by me earlier are based on the best practices followed across the world.

In the United States (US) and Europe, post reflection what they figured was that in order to catch fake and poor-quality online pharmacies.

The best way to do that is to first identify the right one and give them a special license. In the US and Europe, it was decided to register the domiciled online pharmacies with the regulator. Similarly, we recommended to the Drug Controller General of India (DCGI) in India that even in India we should create a registry of certified online pharmacies, just to follow the best practices. Once that is done, all these online pharmacies need to show all licenses and certifications on their websites prominently. As a result, the consumers in these countries will know whether the particular online pharmacy is certified or not. Therefore, it is possible to track the violators by following this strategy. The menace is with the international trade of medicines without any control. Our model is the legitimate model of local delivery of medicines, which is applicable to all IIPA members. The online pharmacies is often misunderstood as international trade of counterfeit medicines as that too takes place through online platforms. The rules are fairly normalised and structured

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• Follow best practices followed across the world • The online pharmacies is often misunderstood as international trade of counterfeit medicines as that too takes place through online platforms in other countries. Our model is fully compliant with the current laws of India. However, we are recommending the regulator that we need to make it better to enable zero violation. We need to add more rules or values to keep the violators out of the market.

Please throw light on one of your recent articles in which you have supported the entire ‘Digital India’ campaign as a very democratising project that will enable access to knowledge.

In India and most developing countries, the biggest challenge is the lack of information transparency and lack of qualitative and affordable healthcare services. Therefore, we need quality, access, transparency and authenticity. Unfortunately, India as a country had not been able to deliver any of these essential values needed to provide costeffective quality care. A lot of people do not have access to information and basic healthcare. That is where Digital India campaign comes into the picture. All these gaps are possible to be addressed through technology. On 1MG platform, a consumer can see the cheaper alternative for any medicine and also the Jan Aushadhi generic.

For a consumer, we show them how on any medicine he/she can save 70 to 80 per cent. Therefore, even such a fact is not well-known to the customers. Even if the fact is known, people are not aware of the ways to get access to cheaper alternatives.

Consumers do not have information and choice. The system has been purposely kept opaque. With Digital India, the entire scenario is likely to change. If the same customer has access to all the information, quality doctors and right medicines, then that consumer will have choice and then there will be competition to offer better services, as happens in any industry. The digital platforms can enable the realisation of the above. Technology has ensured a major shift in the medical care by making it more patient centric.

We are quite optimistic as the government today at the central level is definitely doing a lot of progressive reforms. We are very hopeful that a lot of investment will take place in healthcare innovation.

Please tell us about innovative concepts and tools introduced in 1MG, such as smart prescription and my health feed, and also the idea of engaging in several public programmes?

1MG

At 1MG, we believe that a lifecycle view of the patient and data approach is critical to provide right solutions to the consumers. We wanted to create a platform to address all needs of the consumers in the most optimum and authentic manner. Therefore, we ensure that all medicines are tracked, traced and validated post testing from certified pharmacists. Currently, one of the biggest problems in the Indian market is that people fail to take medicines on time which leads to significant adverse impact in many serious cases; therefore, we also offer this simple digital tool called ‘medicine reminder’. As a result, we have seen a significant increase in the compliance level amongst the patients. Secondly, we have introduced ‘My Health Feed’, which basically collects all prescriptions in an organised manner in one place, to avoid carrying files of prescriptions during consultation. We are in the process of making it better in terms of digitisation. We are still in the early stage in terms of our long-standing visions. ‘Smart Prescription’ digitises the prescriptions to understand medicines that cannot be taken together as they can cause medical errors. Currently, we are still finalising it. It will enable the customers to know about the medicines that cannot be

Recommendations • Register the domiciled online pharmacies with the regulator • Create a registry of certified online pharmacies • All e-pharmacies should display their certificate/seal on their websites prominently • Creating a methodology to track the violators

taken together, possible side effects, alternatives to enable cost saving, etc. The digital reminder will be set up with the smart prescription to remind patients to have medicines on time. We also offer e-consultation platform to enable patients to interact with a doctor.

What is your vision in terms of Indian healthcare?

Our vision is to be the trusted health partner for consumers whether be it product services, information and insights. We want to make healthcare affordable, accessible and comprehensible for consumers.

This means that whenever a consumer needs anything for his or her healthcare, we want to have the correct supporting tech-enabled solution for that to enable consumer to easily manage their healthcare, whether in terms of access to right information at the right time, right services and consultation, adherence-based and compliancebased tools, etc.

With so many digital health providers in the Indian healthcare sector, it is quite a challenging task to differentiate one from another.

As a digital health provider,

Understanding Online Pharmacy

what is your key USP that differentiates you from others?

The competition is good as it assists us in enhancing our capabilities.

Most of the other platforms focus on one part of the equation or the other, but we as an integrated platform bring everything together along with information and consultation. We believe that consumers will not like to have multiple apps for accessing different healthcare services. In most of the cases, all data is not available at one place for analysis. We invest a lot on data analysis to provide insights and right information, which is our key differentiator. All providers might look similar from outside, but it’s the details used in solutions that differentiate one from the other. We have also witnessed consistent and organic growth with no aggressive marketing. People come to us because we have emerged as the ‘Wikipedia of Medicine’ for India. This happened because of a team of 35 professionals who work on data and qualitative content that is updated according to the changes. I fundamentally believe that healthcare business is about building trust. We are addressing the challenges by constantly improving them. As such, the incidence of damages is very insignificant.

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Understanding Online Pharmacy PharmEasy

PharmEasy: Proactively Engaging with Both Patients & Local Retailers

PharmEasy believes in becoming part of the journey for patients by offering services that do not cost heavy on pockets & addressing store-level challenges, shares Dharmil Seth, Founder, PharmEasy exclusively with Kusum Kumari of Elets News Network (ENN) PharmEasy is quite an innovative platform for dispensing medicines and has been making good news on the entire e-commerce. What were the reasons and experiences that propelled you to establish PharmEasy?

We started PharmEasy with the intention to make healthcare services affordable and accessible to all.

There are no technology p l a t f o r m s

available to connect patients or customers to authentic healthcare services, which is where we saw a huge gap in the healthcare industry.

Though we can today buy things ranging from cosmetics, houses, etc. online, there is no platform to deliver medicines to customers.

L o g i c a l l y, p a t i e n t s would want the services to be made available at their doorsteps.

We can’t expect the patients to

walk down the road to look for medicines or healthcare products.

They are dependent on family members, who are worried and trying to help out the patients. As a result, we thought of becoming part of this journey when a patient is detected with a disease. We want to help the patients in as many ways as possible. Although right now we are just delivering medicines, we plan to suggest patients to undergo different kind of lifestyles and activities to avoid a particular disease. We would be acting like a family member and also proactively take care of the patients. Currently, the relationship between a chemist and a patient is quite transactional; we are trying to make it much more innovative by understanding the requirements of the patients.

We all are aware that there are many players emerging in the online pharmacy segment. In the light of the above, how does PharmEasy stands different from other platforms?

As such, there are many platforms that assist patients in accessing doctors.

However, post-consultation, there are very few companies that help in completing the entire journey. Once you do a comparative analysis, you will come to know that we are better in terms of service delivery to others.

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PharmEasy

In terms of services, medicines are needed right away or on the same day.

As our concept of service delivery is hyper-local model, we connect with partner vendors across the city. For example, we have 50 partner vendors in different locations across Mumbai.

As a result of the proximity to the customers, we are able to ensure the delivery of medicines in a short span or on the same day. Secondly, we ensure affordability by offering a flat 20 per cent discount and even on diagnostics we offer flat 40 per cent discount.

Additionally, we are trying to launch a special category for cancer and AIDs, which are really heavy on the pocket, which will have flat 40 per cent discount. With technology, we are able to aggregate these demands, which give better negotiations to our retail partners as they can avail discounts and can pass it to the customers.

Understanding Online Pharmacy

PharmEasy - Key Takeaways • Follows hyper-local model of service delivery.

• Offers flat 20% discount on medicines • Offers flat 40% discount on diagnostics • Plans to launch a special category for cancer & AIDS • Score 4.3 on 5 on our service level

How has been the overall feedback of customers on the services delivered by PharmEasy? Please share details.

Overall, the feedback has been really good and enthusiastic. People are encouraging us to add more services and categories. As of today, customers have not seen any service that provides discounts and also delivers services at home. Elderly citizens suffering from blood pressure, hypertension, etc. and are dependent on their children feel better with online platforms that can solve their problems easily. Even people staying alone are quite at ease with online platforms. This encourages us to add more services in our basket.

Overall, we score 4.3 on 5 on our service level. People are glad that such a concept is entering the market that enables saving and also offers quality services and convenience.

There have been so many debates on the challenges of the online pharmacies. In the light of the above, please enumerate the key challenges in operating

PharmEasy operates at hyper-local level that enables it to deliver medicines easily

as an online pharmacy in the Indian market and how you are addressing those challenges.

Overall, there are quite a few challenges right now in the supply chain. Firstly, there was no technology used in the entire supply chain till now.

In the pharmaceutical segment, over 80 per cent have not used computer or computerised billing. This poses a key challenge in terms of keeping records of patients to whom medicines were dispensed. This poses problem to keep a track of the movement of the products. If the retailer sells to a patient, they would have no record of this patient. We address this challenge by ensuring that every retailer we work with has a complete digitised store. We assist them in installing inventory management tools, as well as maintaining a record of each and

every patient whom we sell medicines, including digitised invoice, patient name, batch number, manufacturer details, address, etc. Therefore, if tomorrow any drug recall has to be done; this can be done quite easily.

Additionally, we can track from which distributor the drug was bought. This helps us in tracking the manufacturer and the distributor. Secondly, on the regulatory front, people fail to realise that the need of the hour is to introduce such digital models, particularly in the pharmaceutical space, to track the movement of products, ensure record management, create a database, etc.

Today, 30 per cent of the products sold in the pharmaceutical space are fake medicines. Just imagine the leakage that is happening of spurious products in the healthcare market to the customer. It is very important to

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Understanding Online Pharmacy PharmEasy

actually track down things. We need to spread awareness amongst both people and regulators that such models are going to assist the people at large.

The way we operate is that we take down an order on a digital format and take image of the prescription. After this, we send someone from the store to pick up the prescription, who acts like an authorised agent of the customer.

The original prescription is verified and cross-checked at the store and then the medicines are sent along with the prescription to the customer. There is an end-to-end check at every level.

Still, regulators fail to understand that this model is helpful.

We would like to understand whether with time there is an understanding among the policymakers about the difference between business models that sell medicines on Internet and business models that facilitate drug sales?

There is a need to have clarity about the online pharmacy models. The Indian Internet Pharmacy Association (IIPA) has been engaging actively with the regulators even at the Central Government as well.

We made representation to Dr Eswara Reddy, Joint Drugs Controller, Government of India and also the key member in regulating the guidelines for online pharmacy. We are glad about the fact that he understands the dialogues.

Such an understanding is needed even at the local level to comprehend how

PharmEasy offers discounts not only on medicines, but also on diagnostic tests

online pharmacies work. Lately, the central body has expressed keenness and optimism on this entire issue.

The trend suggests that there will be positive changes in the overall approach towards online pharmacies.

You mentioned that PharmEasy operates at the hyper-local level. Please enumerate the key challenges of operating at the hyper-local level.

As we work with extremely small retailers who are losing business to bigger organised groups, the kind of infrastructure available at every store is quite difficult to operate from.

Therefore, we are quite actively engaged in revamping the infrastructure at the

Online Pharmacy – Key Features • Addresses the challenge of unavailability of computerised billing across over 80% of medical stores • Assists in installing inventory management tools and maintaining a record • Helps in tracking both manufacturers & distributors • Maintains end-to-end check at all levels

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store level. Overall, PharmEasy or a similar platform assists such retailers in gaining back their business. For example, one of our local retailers in Vikhroli is now making 80 to 85 lakhs per month. As a platform, we offer quite many changes to retailers in a very legitimate and compliant manner.

We follow a 360-degree approach, as it is quite benefitting to retailers as well.

What will be the key takeaways of the foreign direct investment (FDI) relaxations in the pharmaceutical industry?

As such, the FDI relaxation is for the manufacturers. With such relaxations, better established companies and already established companies would enter the Indian market on a larger scale. This will not only improve the economy, but also introduce positive changes in the pharmaceutical space.

We will be able to focus a lot on quality, as well as resist the entry of spurious products in the industry. With bigger players entering the Indian healthcare sector, we will be able to set new benchmarks in the pharmaceutical industry. Overall, the domestic players will be exposed to international business models.

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Andhra Pradesh MedTech Zone Visakhapatnam 19 AUGUST 2016

New Chapter in India’s Medical Device Manufacturing Growth Story

CHIEF HOST

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Overview of Medical Assessment Tools

Pearson VUE

Pearson VUE: Ambassadors of Best Practices & Platform for World-Class Assessment Tools The need of the hour is to expose the policymakers to new high-end assessment tools and their benefits to address the growing challenges in the medical education and examinations across the Indian healthcare landscape, shares Divyalok Sharma, Senior Director - Client Development, Pearson VUE exclusively with Kusum Kumari of Elets News Network (ENN) Pearson VUE is the global leader in computer-based testing for high-stakes certification and licensure exams in the healthcare, finance, etc. Please share the details regarding geographical footprint, clients, etc.

Pearson VUE is a part of mothership called ‘Pearson’, which is a global United Kingdom (UK) based organisation. Pearson VUE is part of their assessment vertical. At this point in time, we are the world’s largest assessment & certification organisation in terms of everything, ranging from size, revenue generation, clients, geographical footprint, etc.

Overall, Pearson VUE is present in 180 countries and has more than 5,500 testing centres across the globe. We deliver more than 14 million examinations across the globe, which means we are delivering some exams at some point of time in some country. In the Indian context, we have more than 350 testing centres (brick & mortar testing centres) across 92 cities. We have more than 450 active clients globally. As such, the key value we bring to the table is convenience to students and increased reach. As the entire methodology of developing medical examinations is a very time-

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lack of hands-on experience amongst medical personnel.

In the light of the above, how do you judge handson experience of medical students through your assessments?

consuming & costly affair, Pearson VUE plays a key role in creating a very secure environment to ensure only right candidates undertake tests. We are glad that global organisations have started giving value to candidates’ convenience, which is being considered even in India, though it’s a long road ahead. The idea is to identify skills and not do filtration.

Lately, there has been an increased debate on the

Our primary goal through testing is to check the knowledge level of students and not conduct filtration.

The entire assessment has complete science behind it and that’s the reason computer-based testing is different from others, where we need to have a pretested large pool of questions for random selection.

Though various modes of testing are available, our tests enable to test a person’s knowledge and understand his/her depth on particular topics or concepts.

Psychometrics and science are included in the entire structure of the assessment. As the system automatically gives a similar level of options to candidates based on their answers, we are able to define the level of each student. In order to know the hands-on skills of medical students, we integrate real-life like scenarios virtually to determine their knowledge. Pearson VUE has created a similar kind of lab with the Australian Medical Council to test students’ practical knowledge.

Overview of Medical Assessment Tools

Pearson VUE

Technology can definitely assist global companies in finding the right candidates. The companies like Pearson VUE and others have that kind of high-end technology and know-how available with them that can assist companies to find the right candidates. It’s all about exposure about such technologies among the policymakers, as such technologies come with a cost.

Pearson VUE - Key Takeaways

Do you have in-house experts and research & development (R&D) or you outsource to others?

In order to design such high-end and world-class assessment tools or tests, we need appropriate domain knowhow and collaborations with experts to integrate their inputs in the tests. As such, we work very closely with many medical organisations (more than 450 clients), who are aware of the loopholes/gaps in the current assessment patterns and can enhance the tests through their feedback. These companies come to our experts and platforms to structure assessment based on the best practices, domain knowhow and

• Present in 180 countries • Has more than 5,500 testing centres globally • Delivers more than 14 million examinations globally • Has over 350 testing centres (brick & mortar testing centres) across 92 cities within India • Has more than 450 active clients technology. For example, we work very closely with the well-renowned Australian Medical Council, Royal College of London, etc. We cover all healthcare stakeholders by also working with the Australian Pharmacy Council, Australian Dental Council, National Council Licensure Examination (NCLEX) (mandatory nursing examination in the United States (US) undertaken by the people in the emerging markets), etc.

Currently, we have comparatively less active engagement with healthcare organisations in India. However, we are definitely looking forward to strengthening our relationships to bring in our

Pearson Vue’s state-of-the-art testing centres are enabled with high-end technologies to detect fraud activities

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technology expertise and help these corporate, hospitals and medical organisations to test doctors. We are definitely inching towards it in a positive way.

How has the feedback been about the Pearson VUE assessment tools & certifications, especially by the policymakers? As the entire Indian healthcare is going through progressive changes, are the policymakers exposed to such international tools?

As per my reading of the overall situation, these stakeholders are far more open now than before and are definitely looking forward to corporate sector or organisations with expertise in terms of technology, content, etc., so that they can adopt these global practices.

Therefore, the willingness to adopt global practices, acceptability and openness has definitely seen positive trends. The policymakers definitely want to use such technologies. With the all initial positive trends, we see people who want to adopt global practices and want to provide such services. We are very much ready to help such people. However, such a change will take some time. The key stakeholders are ready to adopt, but the change will take some time and will certainly not happen radically or rapidly. Since the healthcare system in India is very large, change will happen as a natural phenomenon.

Pearson VUE

are much more into item calibration or item equating and conducting research on that. We bring some of the best research scholars of this industry of psychometric science who are based out of the United States (US) and the UK.

With the right leadership, medical leaders, etc. to accelerate change, we see India as one of our key markets.

How are you making all test centres more secure and quite similar from the direction of state-of-the-art infrastructure across India as there are many challenges?

We have to have consistent guidelines with regard to testing centres to be created. We are delivering examinations for the who’s who of the corporate industry.

It is our responsibility to secure those examination centres, which is minimum guideline and policy.

All those people who are available at the centres as proctors are Pearson-certified proctors across the globe. Post-examination, we have a team that conducts a lot of data forensic analysis to capture any kind of anomalies. In any of the testing centre, technology assists in detecting fraud methods and in maintaining high control by freezing other windows. All these proctors follow the guidelines defined by our clients. We do not allow any electronic gadget or paper/pen, unless advised, to the examination centre. Besides the infrastructure guideline, we have different biometric capturing devices according to the needs of different testing centres. We ensure in all our examinations that we capture the photograph and digital signatures of candidates for clients.

Overview of Medical Assessment Tools

Candidate ID and digital signature

In some of our centres, we also have palm vein devices and face detection technology, which are a high-end technology.

With a growing focus in the medical segment to understand the sensitivity index or emotional quotient of candidates, how is Pearson VUE integrating content that can enable understanding of such sensitivity?

All of these assessments are standard psychometric tests, which have been developed with a huge amount of research. As such, the acceptability of such tests is very high, even in the Indian market. Such tests enable to check behavioural aspects of the candidates. As sensitivity is required in the medical field, we suggest the clients and design the assessment tools accordingly. Depending on the client’s decision, we may or may not be able to integrate all the aspects.

Our psychometricians are different from psychologists who

Indian Market - Key Observations • The willingness to adopt global practices, acceptability & openness has definitely seen positive trends • The change will take some time & will certainly not happen radically or rapidly • With the right leadership, medical leaders, etc. to accelerate change, India is one of the key markets

Please provide details of Pearson VUE’s objectives in the Indian market.

Our primary objective is to first evangelise about such innovative assessment tools as developed by us, so that people understand the technology available on date and global players accessing it. We aim to bring the best practices in the market. Business is our secondary goal. Most of our initiatives are in the direction of the primary goal.

In order to operate successfully, we believe in becoming ambassadors in bringing best practices in the Indian market.

Please provide details of the science involved behind any of Pearson VUE’s computerbased tests.

From the perspective of examination, the entire exam starts from identifying the right blue print (based on the population study and topics on which candidates will be tested). The blue print involves several steps, such as identification of easy and difficult options, result processing (percentile score or raw score), item equation, etc. As the entire examination development procedure is science in itself, all psychometricians and content developers collaborate at the time of research at the time of designing the assessment, blue print, etc.

The computer-based testing brings different types of items for testing knowledge of candidates, such as MMCQ, multiple choice questions (MCQ), True or False, audio items, drag and drop, etc., and is also much quicker.

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Current Debate

Inclusion of Stents in NLEM

Good or Bad? Time to debate on the pros & cons of the inclusion of stents in NLEM to comprehend both pain & gain points

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n order to comprehend the new changes in the healthcare sector, eHEALTH Magazine has started a new section ‘Current Debate’ to comprehend the overall consequences of all the new announcements.

Of the all debates, the inclusion of stents in the National List of Essential Medicines (NLEM) caught not just ours but even the healthcare stakeholders’ attention.

We aim to create right debates and arguments by bringing

all opinions on one platform. In order to understand the entire debate, we raised the following question before the stakeholders: Will the inclusion of stents in the NLEM put restrictions on patient choice & impact ‘Make in India’ campaign?

Read the excerpts below:

Dr Ashok Seth

Chairman of Fortis Escorts Heart Institute, New Delhi and Head, Cardiology Council of Fortis Group of Hospitals

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nquestionably, the cost of stents needs to come down. The cap on pricing is a good way to do it, but the methodology has to be sound. The pricing is just one of the aspects. The methodology needs to include all the stakeholders in a manner that we deliver the best to the patient at a low cost, of which capping of price is just one of the aspects. It cannot be at the expense of quality and at the expense of outdated products. It should also not stifle new technologies, new creations, new direction, and research and development (R&D).

In the medical device segment, especially in stents, in the last 20 years we have seen so many dramatic changes from crude stents to the finest stents to dissolvable stents, which have come with a large input of finance, research and science. By the way, research and development cost a lot of money. These ingredients bring up good stents. Stents

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manufactured in small outlets may or may not have the quality, efficacy and can actually be sold at low cost, such as Chinese products. Until unless we actually have robust systems in place to say that the stents are safe and efficacious as are the stents approved by the Food and Drug Administration (FDA), then we would not be able to differentiate between good, bad and ugly.

As such, price regulations are needed.

The price regulation should be based on science, research and quality.

My first choice of stents would be a FDA-approved stent. For an FDA to approve a device, it has to be pivotal, large and randomised studies, which are monitored in a span more of more than 1 year. It needs to deliver the promised benefits without any side effects and not just ensure that the person survives. Our regulations allow a 6-month study on 100 people to determine patient safety.

At the moment, the minimum sample for

Current Debate

Padma Shri Awardee

Dr K K Aggarwal

Hon’ble Secretary General, Indian Medical Association and President, Heart Care Foundation of India

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o. The Indian Medical Association (IMA) also has been asking for their inclusion in the NLEM. Whether made in India or imported, as long as they are Drugs Controller General of India (DCGI) approved they are okay to be used in clinical practice. Bringing them under the NLEM Make in India campaign will have a boost. Capping is important in the stent price as 80 per cent of the cost of treatment is borne out of our pockets.

Facts • The high burden of coronary heart disease in India has made it a public health problem. Most blockages

a clinical study by the FDA for a stent goes up to 2,200 patients, depending on the end point, and can go up to 5,000 patients for 5 years. The FDA doesn’t even consider a 6-month study and 100 people study, and the minimum is 1 year study, followed by 2 years and 5 years.

Secondly, the capping of price of stents will also decrease the scope to innovations. As a result, we would not proceed from the present generation. We need to question the inclusion of stents that have gone through extensive clinical trials with stents that haven’t. The price capping stifles innovations and foreign investments needed for encouraging science and technology. Part of the money comes out of reward one gets of creating new technology, designs and concepts. Now, all the multinationals are looking at manufacturing stents locally. We also cannot stop customers in accessing world-class stents from across the world.

If we are going to be a country producing cheapest stents not accessed for quality, this is going to impact patients adversely. At the end,

require either stents or a bypass surgery.

• Coronary stents now are labelled as essential drugs under the Drugs and Cosmetics Act. Stents can be indigenously made or imported. Based on efficacy, safety and performance, new generations of stents are made available in the market on a periodic basis.

• Drug-eluting metallic stents are of choice, though bare metal stents are still useful in selected situations. Currently, there is no definite superiority among currently available metallic drug-eluting stents in terms of mortality outcome.

• Stents are now in the national list of essential drugs under the category, bare metal stents; drug-eluting stents (includes metallic stents and bioresorbable vascular scaffold or biodegradable stents).

no one is measuring the outcomes. In order to ensure larger benefits and also maintain the world-class quality, either the Government of India says that we will have capping on price, but there will be a differentiator, which is in terms of research, science and proof. The price capping is acceptable when we create ceiling in the entire system. There is also great discrepancy as not all stakeholders are included in the policy changes, which is a stumbling block.

We may fill our market with cheap alternatives of stents that go through substandard research and development (R&D). Our pricing policy should integrate the rewards for creating an effective device. The side effects of poor quality stents are that the stent may actually clot or reblock post implantation and thus needing reimplantation process.

We need to have profound regulations and involve experts in the entire policymaking. We need to bridge the gap between the private sector and government.

Anjan Bose

Secretary General, NATHEALTH

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e have been constantly engaging with several government agencies to explain that due to their uniqueness, medical devices cannot be treated through policies and frameworks made for pharmaceutical products. However, the notification on 19th July shows that we still have some work to do.

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Current Debate

Dr Arun Kumar Chopra

Interventional Cardiologist and Director, Fortis Escorts Hospital Amritsar

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hile evaluating the pros and cons of the recent inclusion of stents in the NLEM, it is important to keep the following points in mind: Firstly, at present, the capping on stent prices is only applicable in government hospitals, and it has not been extended to private institutions in India.

Secondly, the price cap has also been implemented on only two categories of stents, namely drugeluting stents and bare metal stents.

There is as yet no guideline regarding the bioabsorbable stents, which are also available since December 2012.

And lastly, the exact price cap has not been finalised yet, making it impossible to determine if large stent makers will be able to provide latest

generation stents at the given price.

Overall, the step has been welcomed by the medical fraternity, for it will help make quality heart care accessible to the masses. We can expect a large section of the society to benefit from the move for they will get access to reasonably good and sometimes very good stents at affordable prices. The tremendous variation in stent prices from one hospital to another will also disappear making the entire process more transparent.

Regarding its impact on the Make in India movement, it may or may not boost it. If international stents which are backed by years of research and data are available at the same price as locally made stents, people are bound to opt for them. However, if quality Indian stents are available at a much

lower cost, then a majority of the population is certain to opt for them.

Talking about a restriction in choice, those who do not have any financial constraints may be affected if the government does not allow a premium category of stents to continue to exist in the market. If they do, it really will be a win-win situation for all.

Dr OP Yadava

CEO & Chief Cardiac Surgeon - National Heart Institute

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he capping of price of drug-eluting and bare metal stents is indeed a welcome step and I support it for essentially four reasons: It will increase affordability and help bridge the gap between the demand of angioplasty or stenting procedures and the actual numbers carried out, a felt need of the cardiac fraternity – both the patients and the doctors.

This move will certainly give an impetus to the ‘Make in India’ campaign as more and more entrepreuners will be encouraged to develop quality Indian stents because their demand will increase, despite a pari-passu

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reduction in their prices.

Corruption in medicine in the form of kickbacks for devices is an open secret and the culpable industry shall, hopefully, be constrained to address and eradicate this ubiquitous malady.

And as a domino effect, the menace of “Un-necessary” stenting shall be reigned in and transparency shall be the buzzword.

However, reduced funding for research and development (R&D) will lead to compromise in quality, especially sans any credible regulation.

This proposal will succeed depending on the government funding for R&D.