asia’s first monthly magazine on The Enterprise of Healthcare
volume 7 / issue 8 / august 2012 / ` 75 / US $10 / ISSN 0973-8959
The Unsung Heroes!
Anatomy of Curing Disease
Hospital Operations Management
CT Scanners p-24
Safeguarding patient data p-10
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volume
07
issue
08
ISSN 0973-8959
10
contents cover story Safeguarding Hospitals From Data Infections As electronic medical records become inextricable parts of healthcare, we are facing new risks of data security breaches. It is time for us to investigate, how safe our hospitals are from such data related infections
50 Neil Jordan General Manager-Worldwide Health, Microsoft
By Shally Makin
case study Mapping the Implementation
Rajmohan Nair, Head – Sales (Partner), 21st Century Informatics
zoom in Preventive Tools
Mallika Kapur, General Manager- Business Development, NextGen eSolutions
Debunking the 5 myths of EMR Implementation
18 20 22
Malav Kapadia, Vice President, Sales, HealthFore
in conversation
21
Abel Garamhegyi
34
Vice President, Growth Markets EMEAI & Managing Director-India, Barco
Tech trends Anatomy of Curing Disease
CT Scanners
24
special feature The Unsung Heroes!
Hospital Operations Management
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45 48 54
Dr Rajeev Boudhankar Vice President, Kohinoor Hospitals
event report Reforms in Medical Education: Opportunities and Challenges
Health Insurance Antony Jacob
Chief Executive Officer, Apollo Munich Health Insurance
speciality
Gaurav Malhotra
MD & CEO, Patni Healthcare
power hospital
36
56
Smile Artists Dentistry
featured product
59
Intraoral camera Changing trends in Dental Imagery
hardware
60
Mark the Impression
62
News
Printers and Scanners
asia’s first monthly magazine on The Enterprise of Healthcare volume
07
issue
08
august 2012
President: Dr M P Narayanan
Partner publications
Editor-in-Chief: Dr Ravi Gupta consulting editor: Ashis Sanyal
Editorial Team
Web Development & Information Management Team
Group Editor: Anoop Verma
Sr. Executive Officer - Web: Ishvinder Singh
Health Product Manager: Divya Chawla Principal Correspondent: Dhirendra Pratap Singh Research Assistant: Shally Makin
Sr. Executive Officer – Information Management: Gaurav Srivastava
governance Manager – Partnerships & Alliances: Manjushree Reddy Assistant Editor: Rachita Jha Research Assistant: Sunil Kumar
Associate Developer: Anil Kumar Information Technology Team Dy. General Manager – IT: Mukesh Sharma Executive-IT Infrastructure: Zuber Ahmed Finance & Operations Team General Manager – Finance: Ajit Kumar
education Sr. Research Analyst: Sheena Joseph Senior Correspondent: Pragya Gupta Research Assistant: Mansi Bansal
Legal Officer: Ramesh Prasad Verma
Sales & Marketing Team Manager – Marketing: Ragini Shrivastav National Sales Manager – digitalLEARNING: Fahimul Haque Associate Manager - Business Development: Amit Kumar Pundhir Assistant Manager-Business Development: Shankar Adaviyar
Executive Officer – Accounts: Subhash Chandra Dimri
Sr. Manager – Events: Vicky Kalra Associate Manager – HR: Sushma Juyal Associate Manager – Accounts: Anubhav Rana
Subscription & Circulation Team Sr. Manager – Circulation: Jagwant Kumar, Mobile: +91-8130296484 Sr Executive - Subscription: Gunjan Singh, Mobile: +91-8860635832 Executive - Circulation: Ashok Kumar Design Team Team Lead - Graphic Design: Bishwajeet Kumar Singh Sr. Graphic Designer: Om Prakash Thakur Sr. Web Designer: Shyam Kishore Editorial & Marketing Correspondence eHEALTH - Elets Technomedia Pvt Ltd Stellar IT Park, Office No: 7A/7B, 5th Floor, Annexe Tower, C-25 , Sector 62, Noida, Uttar Pradesh 201309, email: info@ehealthonline.org Phone: +91-120-4812600 Fax: +91-120-4812660
ehealth does not neccesarily subscribe to the views expressed in this publication. All views expressed in the magazine are those of the contributors. The magazine is not responsible or accountable for any loss incurred, directly or indirectly as a result of the information provided. ehealth is published by Elets Technomedia Pvt. Ltd in technical collaboration with Centre for Science, Development and Media Studies (CSDMS) Owner, Publisher, Printer - Ravi Gupta, Printed at Vinayak Print Media, D-320, Sector-10, Noida, UP, INDIA & published from 710 Vasto Mahagun Manor, F-30, Sector - 50, Noida, UP, Editor: Dr. Ravi Gupta © All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic and mechanical, including photocopy, or any information storage or retrieval system, without publisher’s permission.
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august / 2012 www.ehealthonline.org
editorial
The miracles of technology The infiltration of information technology in healthcare has led to a surge in the use of tablets and iPads by doctors. Accessing medical reports online or on smart phones, equipped with latest medical apps, has become a common practice among healthcare professionals across the globe. With the emergence of this trend, there is a growing need for integration of these services with the hospital information system or electronic medical record systems installed at the hospital. But, the hospitals need to evolve ways of protecting the patient data from illegitimate access. The cover story of this issue highlights the role of ICT in making advanced electronic medical records a possibility, today. Experts share their mindset on how hospitals can ensure security of their patient data. Going further, the tech trends section of this issue focuses on the evolving trends in Computed Tomography scanning. CT scan is far more detailed than ordinary X-rays. The trends have evolved from blur to clearer images thus helping doctors to diagnose any disease in a much better way. The story majorly highlights technology from the radiologist’s eye, who believes that the information that a surgeon is supposed to see after operation comes out without a single stitch on the patient body in a vivid manner. The accuracy is what the images are aimed at by the vendors, from resolutions to 3D images, diseases are far easier to diagnose. ‘Healthcare managers’ play a vital role in managing complex activities within hospitals. From doctors to managers, the undying spirit of these professionals to deliver quality care is increasingly visible. Despite awareness and information rolling all over the internet, the idea of maintaining and managing a hospital is, by far, left stranded. The special feature on hospital operations and management gives throws light on the role of an ideal manager, who strives through all odds just to see a smile on the patient’s face when discharged. The Speciality section talks about the latest technology trends and research in the field of Dentistry. The Secretary General of the Indian Dental Association, Dr Ashok Dhoble, has highlighted some key initiatives that are happening across the country in Dentistry. Happy reading!
Dr. Ravi Gupta ravi.gupta@elets.in
august / 2012 www.ehealthonline.org
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volume
07
issue 08
August 2012
asia’s first monthly magazine on The Enterprise of Healthcare
Social Circle Everyday Health @EverydayHealth Get inspired by real people with #psoriasis who stay positive while controlling their condition: - http://ow.ly/ cDODu Bibek Debroy @bibekdebroy Healthcare overhaul: Indians will now get free generic drugs | Firstpost http://www.firstpost.com/ business/indias-free-generic-drug-policy-boost-forhealthcare-blow-for-big-pharma-367799.html NYTimes Health @nytimeshealth Well: Dieting vs. Exercise for Weight Loss http://nyti. ms/NIhddv CNN-IBN News @ibnlive RT @IBNLiveRealtime HC issues notice to Delhi govt on public smoking WHO @WHO About 125 million people in the world are exposed to asbestos at the workplace; more than 107000 die each year. http://goo.gl/dhjD0 Dr. Sidharth Verma @drverma Heart surgery at CMCH after a gap of five years The Hindu: The HinduHeart surgery at CMCH after a gap of five ... http://bit.ly/PpPrxi Doctors w/o Borders @MSF_USA The Need For Urgent HIV and TB Treatment in Myanmar http://bit.ly/MMzzXf Neelesh Bhandari MD @edrneelesh Digital Medicine: Using social media in highly regulated industries like Pharma http://vsb.li/Qq6enJ
Facebook Like of the Month
Kumar Thulasingam
Kumar Thulasingam is the Deputy Manager - Applications CT and X-Ray Systems at Toshiba Medical Systems. He is responsible for pre-sale and post sale demo of CT modality, which includes Toshiba’s Asteion (single and four slice) and Aquilion (16, 64, 128 & 320 slice) CT scanners.
inbox Readers Speak “Nice article.Great to see new challenges and innovation in healthcare.” Dr Dhananjay Patil on Healthcare in Bits and Bytes “Palpitations cannot show on an ECG. An ECG will show you the activity but palpitations are something you feel. If you had palpitations and your ECG is normal it just means you are one of those people who is more aware of their heart beat. Most of us only feel out heart beat after exercise or if there is a really fast heart rate but some people can feel it all the time.” Trina on Portable heart monitor sends emergency alerts and ECG as text message “A very nice medical technology, especially for the ones who suffer from aortic heart valve diseases. Kudos to Dr. Pavan Kumar who successfully performed this surgery on an old lady.” Rajesh on Fourth generation bio-prosthetic heart valve now available in India “The US has higher death rates for kids aged under five than western European countries with universal health coverage.That means that a dead American four year old would have had a better chance of life if they were born in Canada, France, the Netherlands, Cuba, Switzerland, Germany, Japan etc, all of which have universal health coverage. And no western European nation with universal healthcare has moved away from it.” Amit on Hail Obama “Over a 100 Pneumatic Tube Systems (PTS) are installed in Healthcare Facilities in India. Lack of available skills in operations and management of PTS is a critical impediment that continues to foray trouble and inconvenience to the users. Although the PTS enhances healthcare logistics to event upto 70-80% but due to lack of adequate and skilled knowledge the operations of the systems are affected.” AC Gangadharan on Accreditation is the Need of the Hour
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cover story
Safeguarding Hospitals From Data Infections
As electronic medical records, mobile devices and cloud computing become inextricable parts of healthcare environment, we are facing new risks of data security breaches. It is time for us to investigate, how safe our hospitals are from such data related infections By Shally Makin, Elets News Network (ENN)
H
ospitals are a great source of acquiring information – not only of patients, but also of staff members. There have been instances in hospitals where once a system was hit by a malware, the staff had to be sent back to work on paper records. The virus disabled the interconnectivity of hospital computers, so the devices could not communicate internally and share information. The increased use of electronic medical records, mobile devices and cloud computing in the healthcare
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environment is also increasing the risk of data security breaches. Regulators are already conducting rigorous security compliance reviews to address the serious nature of security complaints. In addition, phase I requires hospitals to perform a security risk analysis and to address all identified security deficiencies as part of its risk management process. Security issues have long been into discussions and thus are a major drawback that can impede an organisation’s risk management strategies.
The Health Insurance Portability and Accountability Act (HIPAA) and Health Level Seven (HL7) passed in the USA, which are now universally accepted, have laid down rules for access, authentications, storage and auditing, and transmittal of electronic medical records to addresses privacy concerns. On the other hand, industries and hospitals are coming together to offer and implement new possibilities to bring innovation into the clinical app development. Tamil Nadu Government’s uniform
cover story
HIPAA Compliant Dr Vinoy Singh, Head, Health Informatics, Srishti Software
health information system project was implemented by Tata Consultancy Services (TCS). This mundane building has showcased progress of electronic data basing of hospital records in the country. Microsoft tablets offer new possibilities for clinical use, but software vendors will need to bring new innovation to clinical app development. There is a huge demand in the healthcare fraternity for iPad and tablets, and these devices need to be integrated with the HIS and EMR systems of the hospitals. This actually puts hospital IT and the vendors on notice that they need to start innovating. “At the clinic and small hospital level, EMRs are used by 3-4 percent of the clinics; 16-18 percent of the clinics use some sort of a hospital or clinic management system. Core USP of an EHR is believed to be a simple to use tool, tailored for small to medium hospitals and highly secure. The installation costs can vary between `50,000 to `3 Lacs depending on the size of the organisation. This excludes licensing costs as well as cost for change requests in the system asked for,” says Nrip Nihalani, Director, Product Management, Plus 91. An accountability tool embedded in an electronic health record system could help reduce unnecessary paper reports embedded in files with X-ray and CT scan images. Such practices can expose patients to unnecessary radiation and increase healthcare costs. Lalit Surana, Chief Technical Officer, Easy Clinic says, “We have a game-changer in offing, an enterprise grade EMR solution to manage all aspects end-to-end of a medical institution. Advantages of cloud in an environment which needs a high degree of scalability is many fold, and, it poses no extra risk as compared to a typical out-of-the box dedicated hosting. There really need not be a conflict in using a cloud and achieving security compliance.” Doctors may order fewer lab tests when they have access to a patient’s electronic medical records, but the efficiency may be confined to state-of-the-art records exchanges for now. The great thing about EMR is that it allows patients to become empowered and play a much bigger role in their own medical care. They will reduce medical errors, and encourage openness and transparency. They will also help to save the patient’s time and money, because they will not need to go to the doctor’s clinic for every minor problem. MV Saneesh, Senior Manager-ICT, GCS Medical College Hospital & Research Centre believes, “Cloud computing is anticipated as the inevitable necessity of future computing, healthcare domain could not ignore the imperative advantages of the technology. Penetration of EMR is limited to select hospitals and few set standards from NABH could make a difference.” He adds, “The challenge faced by hospitals is the total cost of ownership and change management. However such scenario is not foreseen in near future, anywhere any time accessible EHR/EMR could ensure better patient safety and quality care
EMR adoption in India is approximately around 18 percent of all hospitals. There are several reasons contributing to slow pace of adoption. First, majority of the hospitals lack funds to invest in an EMR. Since the patient to doctor ratio is high, doctors usually work long hours. Out of exhaustion, they prefer to write the prescription manually than spend more time with one patient and enter their details in EMR. Below are the key differentiators of PARAS EMR- Structured EHR centric clinical modules -nursing, clinical assistant, consultant and OT conforming to global standards - Structured clinical information exchange mechanism - ‘Clinical Library’ to handle Specialty specific form sets; patient education material and templates (consent forms, OT notes etc) - Seamless integration with LIS and RIS modules showing lab results and Image thumbnails - Medical drawings annotation module integrated with EMR - Provision of integrating CDSS - Ability to aggregate clinical data e.g. disease registry, maternity register etc One of the main challenges that we face is user adoption of the new technology. It takes considerable training and encouragement to transform them into productive users. EHR can be a key to better patient care if used to its full potential. Its ability to integrate with any standard clinical system enhances patient portability. Further, availability of clinical information on real time basis helps in better diagnosis and improves the quality of patient care. Also, PARAS EMR can integrate with CDSS helping doctors in reducing diagnostic errors drastically. PARAS EMR is HIPPA compliant to protect the security, privacy and confidentiality of patient data. When hosted on cloud, it is also compatible with stringent audit control of the cloud platforms.
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cover story
Think Safe Rather than Big M Vennimalai, CEO, Aavanor Systems There has been a rapid increase in adoption of EMR’s in the USA, where adoption in clinics has risen from 17 to 60 percent in a short span of two years. Adoption rates in hospitals have reached 87 percent according to some surveys. There is high penetration level of state and central governmental insurance schemes in India. With schemes such as the RSBY and Arogyashree becoming very popular among the people and hospitals, it has become mandatory for hospitals to start the process of getting electronic medical records in place. We believe that there will be a significant increase of activity in the EMR space in 2012-13. Our USP is the ‘Patent Pending’ eBook EMR. The design of our EMR interface is unique in the sense that it looks like a paper file and doctors and nurses can flip through it as they would the paper file they currently use. We have nearly 50,000 approved brands of medicines while the western countries have less than 5,000 because of their patent regimes. It is here that our offerings are superior as they have been designed specifically for the Indian context and improved over the last 10 years. “Think Safe rather than Big” - this seems to be the dominant approach at this point and users seek high levels of validation and references from their peer group, thus slowing down the speed of adoption of new technologies. Entry costs can be as low as `10 lakhs for a small hospital wanting to setup an EMR, and may go up to a few crores of rupees for the large facilities. But the
cloud has brought about remarkable affordability for the EMR and users can start using our system on the cloud for as little as `2,000 per month. Apart from the low entry costs, users do not have to worry about servers, maintenance, etc. Patient confidentiality of information on the cloud is typically protected in four ways. All data stored is encrypted. If someone maliciously or inadvertently accesses the data stored in the cloud, they only see ‘gibberish’ and won’t be able to make any sense of it without coming through the application as an authorised user. VPN Access for clinicians and authorised users. This ensures that while the data is available from anywhere in the world, it is only available to those who have the appropriate VPN (Virtual Private
Network) software setup on their computer. While accessing the application through a VPN, all the data transmitted to and fro is protected and cannot be easily hacked. One time passwords (OTP) or passwords with a specific time period of validity add a significant level of security as hackers cannot reuse a password to gain access to the application and data. Machine Identification – As care givers and patients are pre-identified by the system, repeat visits to the application is permitted only from a machine that is already known and identified by its unique serial numbers. Any attempt to log in from another machine is recognised and permitted only upon confirmation by a secondary form of identification.
“The privacy issue does exist and cannot be wished away, how much ever the vendor promises about it. If someone wants to get his physical data and tries hard enough, he can do that too. Solutions can and should be found.” says Dr SB Gogia, Consultant Plastic Surgeon
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cover story
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Doctors’ Require Customised EMR Dr Aniruddha Malpani, Medical Director, HELP – Health Education Library for People Doctors, who were early adopters had a bad experience with the first generation of EMRs available in India. Many of these EMRs were very crude and the companies which offered them went belly up, because they were start-ups who could not provide the handholding and service that the doctors needed. This bad experience coloured doctor’s perceptions of EMRs – and many still feel that it is just a lot of hot air, with
a lot of promise but deliver very little delivery. They are understandably sceptical and reluctant to try out the new EMRs, since they have already burnt their fingers. Many EMRs are poorly designed, they are created by software designers, and while programmers do take input from doctors when they do the initial coding, they are still not user friendly. Sadly, most companies do not provide this kind of flexibility. Also,
companies which sell EMRs to hospitals realise that this is potentially a big market. So they are leaving no stone unturned in trying to convince Indian doctors to start using EMRs. Companies are adapting their products, to make them doctor-friendly. They are also learning from the success stories in USA. For instance, there is Practise Fusion, which offers cloud based EMRs to doctors, and has a very active doctor community.
Privacy in the Health Cloud Aditya Mani, Director - Technology, Acuity Information Systems High availability and massive scale on demand are the two forces that make a compelling case in healthcare for cloud computing as well as cloud storage. Cloud platform providers like Amazon Web Services (AWS) and Microsoft Azure ensure HIPAA compliance for Protected Health Information (PHI) addressing issues relating to physical location and security of data centres as well as policies relating to data deletion, backup and recovery in a virtualised cloud environment. While on one level the rules about information security and privacy need to be re-addressed for a virtualised cloud infrastructure, the emergence of universal identifiers
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like the UID to identify patient records requires providers to insure PHI is adequately secured in a single instance, multi-tenant application used by various clinics and hospitals. While it is imperative and non-negotiable that two hospitals sharing PHI of the same patient (same UID) working on the same instance of the application must not be able to see each other’s data, the value of a converged ecosystem is truly realized if summarized PHI owned by the patient is visible to a provider of the patient’s choice subject to the patient’s consent. PHI stored on the cloud should be encrypted while data moving between the user and server should be
across a Secure Sockets Layer (SSL) or HTTPS layer. While all these layers may seem to add complexity, it is evident that once a vendor has achieved the above in a cloud infrastructure, the same can be shared across the industry as a service rather than having the IT teams of every hospital investing in many such individual projects with varying degrees of compliance. “Such iron-clad guidelines have often been labeled overkill from an Indian perspective due to their US-centric outlook, their underlying principles can offer a strong foundation for insuring confidentiality and privacy of patient records on a health cloud.”
cover story
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augustChennai / 2012 600 089, India. DLF IT Park, Block 7, Ground Floor, No. 1/124, Mount PH Road, Ramapuram, www.ehealthonline.org DLF IT Park, Block 7, Ground Floor, No. 1/124, Mount PH Road, Ramapuram, Chennai 600 089, India.
cover story
“Each node or PC within the hospital premises can be specifically blocked from accessing the internet. This not only increases the overall security of the network, but also prevents unauthorised users from gaining access to privileged resources,” says Govind Rammurthy, MD & CEO,
Securing Hospital Networks Govind Rammurthy MD & CEO, eScan Can a hospital afford to provide unlimited bandwidth usage; will staff and clinicians use the guest network instead of the Enterprise WPA secured network because of the lack of monitoring, or probably because of an easier configuration? Moreover, with the number of phishing sites hosted online, can hospitals prevent users from accessing or being redirected to illegitimate sites? Again, what guarantee can they provide to patients of their digital records? After all, identity theft need not only be malware specific, hospital employees can also use this data for personal gains. In addition, mixing malware infected guest traffic with secure hospital applications is something any IT administrator will want to avoid. eScan corporate edition is the AntiVirus and Information Security Solution for large networks that is not only effective in securing the network, it is also very light on the system resources. With the web based eScan Management Console (EMC), network administrators can monitor and deploy a variety of security measures. To prevent usage of USB based devices, eScan comes with endpoint security. With endpoint security, network administrators can customise and monitor the needs of all connected machines. Without the proper security suite installed, the chances of being infected are close to 95 percent. Their spread is rapid and the loss they can bring to hospitals can roll into millions. To curb such threats eScan comes with Host Intrusion Prevention System (HIPS), which monitors all the network activities on the system. This process is automated and does not require user or hospital administrators to intervene.
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eScan
“US guidelines and underlying principles can offer a strong foundation for insuring confidentiality and privacy of patient records on a health cloud,” says Aditya Mani, Director-Technology, Acuity Information Systems
“The primary healthcare segment in India, receives no financial incentive from the central or state government. There are no legislative requirements being imposed on EMR vendors to encourage standardization.” says Lalit Surana, Chief Technical Officer, Easy Clinic
“HIPPA has developed a framework to mitigate the risks from these threats that is comprehensive but not as specific as to limit the options of healthcare professionals who may have access to different technology”, says Vijayshankar Andani, Senior Product Manager – Healthcare, Logica
cover story
“At the physician level, EMR’s are used by 1-2 percent of the physicians; however 9-10 percent of the physicians do use some sort of software or computer based system for clinic data management” says Nrip Nihalani, Director, Product Management, Plus 91 “Resistance from non-IT hospital staff is the last nail on the coffin. They require considerable amount of training before they can become productive users and many hospitals do not factor appropriate user adoption strategies and investments” says Dr Vinoy Singh, Head, Health Informatics, Srishti Software
“All in all, security of data on the cloud is today addressed to very satisfactory levels and often times, is a lot safer than data stored in the hospital’s servers” says M Vennimalai, CEO, Aavanor Systems “Technology solutions are available to ensure appropriate level of authentication and monitoring of sensitive data in order to secure privacy of a patient” says MV Saneesh, Senior Manager - ICT, GCS Medical College Hospital & Research Centre
delivery. In lighter side few people comment ‘Cloud is more secure, as it’s away from insiders’.” With the advent of EHRs – digitised medical history, a doctor would be able to deliver care with improved quality on the premises of information sharing/exchange. A study in the US found that 80 percent of consumer adoption of interoperable EHRs could result in a net savings of USD 19 billion/ year. On the other hand, unavailability of complete and accurate medical history often leads to extensive or repeated health examinations which delay timely treatment and increase costs. “LV Prasad Eye Institute has made every effort to upgrade technology. eyeSmart –indigenously built Electronic Medical Records (EMR) was made with a view to facilitate electronic retrieval of medical records across their pyramid model of eye care from remote rural primary care units to tertiary level experts in cities,” says Dr Usha Gopinathan, Executive Director, LV Prasad Eye Institute. In a cloud offering, more control could be exercised with private cloud, the concerns of human threats (hacking), natural environment threats and technology failures still loom – similar to public cloud. With healthcare interoperability becoming more normal, institutions shall adopt globally accepted standards, which are seriously addressing the privacy concerns on global basis. Logica has proven systems and processes to ensure patient confidentiality and role-based access solutions to support, ‘Secure data collection’, ‘Reporting that demonstrates patient safety via KPI’s’ and ‘Evidence for the Annual Health Check with the Healthcare Commission’ says Vijayshankar Andani, Senior Product Manager – Healthcare, Logica. Adopting EHRs would not only help immediate users such as healthcare providers and patients/citizens, but also other healthcare stakeholders – insurance, government. When the wealth of health information from nation’s populace is available, the government can identify diseases patterns, health afflicted regions and direct its effort towards improving the same. august / 2012 www.ehealthonline.org
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Case study
Mapping the Implementation My experience with implementation of effective clinical transformation comes from a medical institute specialising in diabetes. The institute is equipped with state of the art medical technology and it conducts advanced research and takes educational initiatives
By Rajmohan Nair, Head – Sales (Partner), 21st Century Informatics
The EMR does not integrate well with other existing or new IT systems, it is not tailor-made for the organisation’s unique business needs. It brings down clinical workflow and creates dissatisfaction. The centre decided to implement a tightly integrated EMR that provides the benefits of realising the required cost reduction and achieving the desired efficiency improvements in patient care. The applications they were aiming for not only had to capture data at the point of care, but also had to support the doctors in decision making.
T
here were various challenges faced by an institute in implementing IT solutions, as they were a new medical centre. The team there was not very IT savvy and this was basically a specialty centre, where research was also being conducted. Hence integration challenges of specialty Electronic Medical Records (EMRs) and revenue cycle management was also considered. They were also aware of the difficulties they would be facing while evaluating options to implement an EMR especially in the start-up stage. The industry reports made them take a very cautious approach - the report indicated that many organisations discovered postimplementation problems in their EMR.
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Approach taken With the primary objective of optimising the clinical operations, 21CI’s highly trained consultants proposed business process consulting study, in other words an ICT roadmap creation and solutions deployment. 21CI’s business process consulting and business process blue print document provided an in-depth understanding of clinical and business processes that helped the medical centre build an ICT roadmap. Next, we mapped the organisation’s unique ICT needs and based on the business process blueprint, and we configured our 21CI apex health information system.
A range of solutions were deployed under 21CI Apex Health Information System and proper training was provided to the key users. Clinic Information System (CIS) with day-care facility and laboratory Information system and Electronic Medical Records (EMR) and Picture Archiving and Communication Systems (PACS) were deployed.
Results One year after the date of implementation, 21CI and the medical centre jointly evaluated the benefits achieved. The study found that the centre had attained ICT-enabled revenue cycle management with diabetes management as the core pillar. This had the potential of improving care processes, delay diabetes complications, and provide adequate healthcare. A major benefit was that the time needed to service clinical processes was transformed from a semi-automated to process-driven automation. There was a reduction in transaction cost, and this resulted in a saving of almost 30 percent. The overall quality of patient service was improved, leading to increased patient satisfaction. There was an improved and effective billing capability. This eased clinical reviews and accelerated disease prevention interventions.
zoom in
Preventive Tools Imagine the world as seen in the 1997 science fiction movie, Gattaca. A world where the risk of disease is minimised even before the child is born. Gattaca projects a scenario where a controversial interpretation of liberal eugenics is being used to ensure that the children inherit only the best and the healthiest characteristics of their parents. Welcome to a brave new world where technologies can ensure that we are genetically immune to all kinds of diseases ultimately cause the vessel to block, resulting in a heart attack.
CTLM
Mallika Kapur, General ManagerBusiness Development, NextGen eSolutions
EZ Scan Predicting Diabetes and its Complications Few doctors are aware that the conventional tool used for the screening of diabetes, the fasting blood sugar, will pick up only 30-40 percent of diabetics. The rest stay undiagnosed until complications of diabetes develop. EZ Scan is a non-invasive pseudo motor function test capable of detecting autonomic neuropathy, which develops in the early reversible stages of diabetes. The machine is available at a few centres in India, and will soon be seen at Apollo Hospitals across the country.
EndoPAT Predicting cardiovascular disease, and potential heart attacks 5 years before they happen EndoPAT non-invasively assesses endothelial functions, and measures arterial tone and stiffness. Think of a normal endothelium as the surface of a nonstick pan – once the thin lining is damaged, platelets and other cells stick to it causing the formation of plaque, which
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Technologies for Patients
Computerised Tomography Laser Mammography, a tool to diagnose Breast Cancer CTLM uses near-infrared lasers to detect angiogenesis in breast tissue, and is particularly effective in dense breasts, providing a giant leap over conventional mammography.
CadiSense: Wireless thermometer The CadiSense Wireless Thermometer is a thermosensor with an RFID tag, which hooks up to a small home server. This allows a parent to get updates of their child’s temperature every 3 minutes, irrespective of where in the world they are.
Robotic Surgery
Nursing Meter: Measuring Breast Milk Production Vasa Technologies’ Nursing Meter allows breast feeding mothers to measure flow rate and breast milk consumed while her child is suckling at the breast. This little device provides a powerful motivating tool to prevent the switch to formula
A giant leap over minimally invasive surgery Robotic surgery allows surgeons to operate while sitting in a console, through the tiniest of incisions. It smacks of the potential to one day allow a surgeon sitting in London to operate on a patient in Ethiopia. The technology will soon be available in Apollo and Fortis Hospitals at select locations across the country.
RheumaScan A test to detect small joint inflammation RheumaScan measures the fluorescence of the contrast agent Indocyanine green (ICG) and thereby displays active inflammatory processes. It enables the visualisation of inflammatory activity in a variety of different diseases, such as arthritis, psoriasis, and osteoarthritis. Healthcare is also becoming more consumer-led, with individuals getting instant access to healthcare information, and becoming their own care managers.
Insulin Pump: Delivering the right dose every time This tiny sensor and pump is implanted under the patient’s skin and administers insulin to the patient. The pump allows the right dose to be delivered at the right time, and allows insulin dependent diabetics to live a relatively stress free life.
The Physician’s role seems to be changing from demigod, to a trusted advisor, who works with his patient on the basis of the information that is available.
in conversation
“Patni to Open 25 Short Stay Centres” Patni, the leading IT major, has forayed into healthcare space and will be setting-up day-care surgery centres across India. Gaurav Malhotra, MD & CEO, Patni Healthcare, provides information on this venture. Tell us about the current market size and valuation of day-care services in India? India has seen a rapid population growth over the last century and it has grown thrice its number since the year 1951. This has led to an increase in Indian consumer spend on healthcare and an increased demand of healthcare facilities. All this has resulted in a CAGR of 15 percent in the sector and a double in the market size in every five years. Which was `60 billion in the year 2010 and is expected to become `120 billion by the year 2015. The day care market in top 10 cities is expected to grow from `1,800 Cr in 2010 to `4,600 Cr in 2015 at a CAGR of 20 percent. The current evolution trend is moving from medium sized, specialty hospitals providing secondary care to asset light models like short stay surgeries centres and single specialty centres. The journey started initially from highly fragmented physician’s owned private clinics to large size super-specialty hospitals, which in turn evolved to large size medi-cities providing tertiary level of healthcare.
`800-1000 Cr in next 5-7 years with 22-25 percent EBITDA levels. We wish to open short stay centres and want to target few key cities in Maharashtra, UP, Punjab, NCR, Gujarat and Karnataka, initially beginning with the city of Mumbai. The key growth drivers for day care centres shall be population growth, rising income levels, increase in burden of diseases, increase in insurance penetration, increased accessibility to healthcare and few other adjoining factors. The reason we want to focus on short stay surgery, is the fact that it is an attractive opportunity and in the state of
evolution. Besides being an economically better option for the health sector which is beleaguered with scarce resources, it is highly accepted modality of treatment. We shall have tie-ups with the bigger hospitals to ensure collaborative co-existence. In terms of quality of healthcare delivery, what are the NABH norms and accreditation policy towards day care centres? Accreditation bodies like NABH have not clearly spelled out the quality norms for short stay surgery centres. Nevertheless, most of the short stay centres lie under the preview of small healthcare organisation or ‘SHCO’ as mentioned by the guidelines of NABH owing to their number of bed counts. We firmly believe that short stay centres being highly advanced, in terms of technology and care, need to have a separate article on guidelines for quality standards by NABH.
What is the overall investment of Patni Healthcare in this segment? Our plan in next 5 – 7 years is to open 25 short stay centres with a total investment of `500 Cr. The break up will be `300 Cr equity and `200 Cr debt. The investment doesn’t include real estate investment. Our revenue expectation is
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Zoom in
Debunking the
5 myths of EMR
Implementation By Malav Kapadia, Vice President, Sales, HealthFore
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round the world, electronic medical records (EMRs) are being implemented to improve patient care, reduce health care expenses and fundamentally change the way in which medicine is practiced. According to Accenture, steady growth in hospital-based EMR markets is expected across North America, Europe and Asia Pacific. North America will remain the largest market, growing at a 9.7 percent compound annual growth rate (CAGR) from USD 7.4 billion in 2010 to USD 9.8 billion in 2013. Asia Pacific is projected to grow at 7.6 percent CAGR from USD 2.3 billion to USD 2.9 billion, which is heavily dependent on the evolution of emerging markets, such as India and China. Looks really enticing for most EMR vendors but we also need to discuss the growing concerns of the medical staff and clinicians and address it.
The perceived advantages of EMRs can be summarised as optimising the documentation of patient encounters, Improves communication amongst healthcare providers, improved clinical decision making, coordinated care delivery, reduction of errors, electronic billing, forming a data repository for research and quality improvement, and reduction of paper significantly. Despite the high expectations and interest in EMRs world over, overall adoption rate is pretty dismal and riddled with problems. The time is ripe to raise questions about the various myths in implementing EMR and how can a healthcare provider steer clear leading to a satisfactory implementation.
Return on Investment EMR has an impact on so many things within the healthcare organisation, but the impact is difficult to quantify in hard numbers. Many institutes don’t have any metrics in place to measure some of the so-called soft costs related to running their organisations like workflow and efficiency gains, patient safety, communication etc. In order to maximise its success, providers must establish the right internal leadership team that can govern the project and create specific and measurable goals among others.
Clinicians are averse to using EMR Although there is an initial learning curve during the EMR adoption process, an easy-to-use EMR can significantly improve workflows once an EMR is fully implemented. Tools such as dictation software, Mobile apps and customisable templates can help win over even the most technology-adverse docs. Given the time and age, Clinicians are quite tech savvy and would adopt intuitive technology. One of the leading indicators of success is familiarity with where things are located in the system. HealthFore devises a comprehensive training plan which
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Zoom in
2013 E Addressable market Total $19.78
2010 Addressable market Total $15.58
2010-2012 CAGR North America: 9.7 percent EALA: 6.6 percent Asia Pac: 7.6 Percent
Asia Pac $2.3
EALA $5.8
Asia Pac $2.9
North America $7.4
North America $9.8 EALA $7.0
Source: Accenture analysis
Growth in hospital-based EMR markets
is done through individual hands-on experience with the product to address this.
Security risk EMR Vendors are very strict about who can access patient information and give your EMR records protection beyond what’s possible with paper records. In order to open an electronic medical record, a medical practitioner needs strict login credentials. The EMR system tracks every time the records are accessed and backs up data in a safe and secure way so that records are always available to you and your doctors when needed. Also, web-based EMR systems protect from disasters, floods, building fires, and any other disasters that could easily destroy paper records.
Data exchange Applications do not seamlessly exchange data for coordinated care. Interoperability is one of the major issues that worry healthcare providers when investing in an EMR. Most of the current generation of EMR’s complies with IHE standards. IHE promotes the coordinated use of established standards to address specific clinical needs in support of optimal patient care. Systems developed in accordance with the IHE initiative communicate better and are easier to implement, and allow healthcare professionals to use information in a more efficient way.
Staff resistance This is not exactly a myth, but reality. The biggest hindrance to any new implementation may be the resistance to change by both the staff and physicians. Getting staff buy-in from the beginning, accepting their input in the change process, and openly communicating reasons or the business drivers for implementing EMR and overall benefits of the EMRwill often bring them on board more proactively from the start.
Malav Kapadia
Vice President, Sales HealthFore august / 2012 www.ehealthonline.org
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tech trends
Anatomy of Curing Disease The modern day medical science owes much to the founder of CT scan inventor (Sir Godfrey Hounsfield) as the device has advanced the diagnostic process to much extent. By Sharmila Das, Elets News Network (ENN)
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omputed Tomography Scanner or CT Scans are far more detailed than ordinary X-rays. The information from the two-dimensional computer images can be reconstructed to produce three-dimensional images by some modern CT scanners. They can be used to produce virtual images that show what a surgeon would see during an operation thus making the treatment much easier and accurate.
The Role Dr. TBS Buxi,Hony. Consultant, Head CT Scan and MRI at Sir Ganga Ram Hospital says, “CT has an all important role in diagnosing patients with diverse diseases ranging from sub-clinical infections to disseminated cancers. All organs and organ systems can be evaluated for anatomical or morbid changes whether congenital from birth or acquired. The
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diagnostic range is from the routine scans to advanced whole body angiograms, virtual endoscopies and virtual bronchoscopies, with 3D and multiplanar reconstructions aiding in planning therapy and surgery. Organ transplants, interventions diagnostic or therapeutic, are possible on CT”. Dr H Satishchandra, FICR. Prof & Head, Dept. of Radiodiagnosis & Imaging, Bangalore Medical College & Research Institutite, says, “Cross sectional imaging and reconstruction with a CT scanner is one of the best and fastest methods to image patients with acute or chronic diseases and in trauma. CT scanner can image practically any part of the body, helping the clinician in making a quick and confident diagnosis and plan further management.” Dr. Sunita Dube, Consulting Radiologist, Sonologist & Director, Aryan Hospi-
tals says, “CT scan has many advantages over traditional 2D medical radiology. It is less time consuming very rapid acquisition of images, wealth of clear and specific information, and a view of large portion of body. It helps in demining when surgeries are necessary, reducing time of explorative surgery, improving cancer diagnosing and treatment, guiding treatment of common conditions like injuries, cardiac disease and stroke and also helps in improving patient placement in appropriate area of interest”. Dr. Priya Chudgar, Senior Consultant Radiologist, Kohinoor Hospital says, “CT scan or computed tomography has revolutionised era of diagnostic imaging. Multi-detector-row computed tomography (MDCT) is the latest breakthrough in CT technology. It has transformed CT from a trans-axial cross-sectional technique into a truly three-dimensional
tech trends
imaging modality. This produces faster and better scans with shorter breath hold and less amount of iodinated contrast. It proves as blessing for morbid patients with poor renal function who require repeated scans. Newer machines also produce lesser radiation hazards”.
Cost of Installation CT scans have already allowed doctors to inspect the inside of the body without having to operate or perform unpleasant examinations. CT scanning has also proven invaluable in pinpointing tumours and planning treatment with radiotherapy. Dr Satish Chandra says, “The cost depends on the channel, software and the manufacturer. CT scanner price can range from ` 3 to 4 crore. Moreover, CT scan room with its console, air conditioners, electrical circuits to power the equipment, and radio absorbent materials for the walls will further add to cost.”
Doctors Say All organs and organ systems can be evaluated for anatomical or morbid changes whether congenital from birth or acquired -Dr TBS Buxi, Hony. Consultant, Head CT Scan and MRI, Sir Ganga Ram Hospital Depending on usage, X ray tube, detectors and other wear and tear may cost significant amount and hence regular contract with company serves as ideal deal- Dr Priya Chudgar, Senior Consultant Radiologist, Kohinoor Hospital It helps in demining when surgeries are necessary, reducing time of explorative surgery, improving cancer diagnosing and treatment- Dr Sunita Dube, Consulting Radiologist, Sonologist & Director, Aryan Hospitals CT scanner can image practically any part of the body, helping the clinician in making a quick and confident diagnosis and plan further management- Dr H Satishchandra, Jaslok Hospital & Research Centre
The Upkeep CT equipment requires proper environment to keep the performance of the machine intact. For example it needs to be kept in an air conditioned place with constant power back up. Dr. Chudgar says, “Ideally most CT scanners would require comprehensive maintenance contract. Depending on usage, X ray tube, detectors and other wear and tear may cost significant amount and hence regular contract with company serves as ideal deal. Any CT scan machine with average usage would require to be replaced or upgraded by 5-6 years”.
With such environment, the questions crops up that what are the necessary elements for a standalone diagnostic center-to this Dr. Buxi says, “The Atomic Energy Regulatory Board (AERB) regulations, for setting up diagnostic equipment at stand-alone centres and hospitals, need to be followed as far as the space needed, radiation protection of patients, medical staff and measures to avoid scatter radiation causing environmental biohazards. The Diagnostic centres need to be compulsorily evaluated by the certifying agencies for uniform quality care”.
Standalone Diagnostic Center/ Hospitals
Innovations Taking Place
Experts say due to growing aging population and widening usages of diagnostic imaging, the global imaging market is on the rise. The Web says global diagnostic imaging market is expected to grow from USD 20.7 billion in 2010 to USD 26.6 billion by 2016, at a CAGR of 4.2 percent from 2011 to 2016. Continuous developments in the imaging industry are primarily driving the diagnostic imaging market. Due to these supportive factors India is seeing an increase in the number of imaging centers/clinics.
New developments in the CT space is happening at a fast pace and the following make a noticeable impact. Low Dose CT Technology Scanner: This is a scanner that can do what’s known as iterative reconstruction and dual-energy scanning, and it can do those while reducing radiation exposure to patients and still delivering high-definition images. The Dual Source CT scanners: With the dual source CT scanner only 10 seconds is required to obtain detailed
and accurate images. In 10 seconds, an image can identify life-threatening blockages, blood clots, blockages and other heart problems. Dr. Buxi says, “The most important innovations have been the Low Dose CT technology scanners .TheDual Source CT scanners provide excellent image quality at lightning speed”.
Roadblocks While it’s certainly true that CT has become an indispensible tool of today’s healthcare, there are some issues associated with the diagnostic machine as well. Some say that the radiation that comes out of the CT is hazardous for pregnant women and children. Dr Chudgar says, “It is quite true that CT scan machine to be considered as white elephant, requiring regular maintenance and updates available in market. It is still profit making and essential component of any health care centre”. Besides high prices of the equipment, easy availability is also a concern. Sometimes understanding the handling techniques also creates hazards. However, the benefits outweigh the disadvantages associated with CT. august / 2012 www.ehealthonline.org
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tech trends
Enabling Imaging Accuracy Atul Kulkarni, Business Manager-CT, Philips Healthcare delves into CT and brings out the intricate details of the imaging machine
Share with us any innovation which has taken place in the CT scan market over last five years. With advancement in multi-detector technology, CT is becoming faster and giving finer details of the anatomy. It is helping patient management in many ways. Now, one can image whole body within five seconds with slice thickness less than a millimeter. This helps in detecting a disease at very early stage
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and changing the course of patient management, if required. It is also much earlier for patient who has to hold his breath for very short time. Iterative reconstruction techniques have evolved over last couple of years and are becoming standard for all routine application on CT imaging. With Philips iDOSE4 iterative reconstruction technique it is possible to reduce dose up to 80 percent without affecting the quality of imaging and hence diagnosis. Philips has developed iDOSE4 to make it useful for all clinical condition routinely and it is also available for older generation scanners. The focus is also to make technology affordable for all with increasing productivity and efficiency at all levels. What is your market share in the industry? Philips is a leading player in the industry and enjoys a majority share of premium segment in CT market, which is growing year-on-year.
Please brief us about the challenges/opportunities we see in the market where the technology changes every six months. Though advancements and changes are expected in any technology-driven industry but it is not as fast as six months. However, at whatever pace it happens, the care-providers have to invest regularly in up-gradation to match pace with the market. On the other hand they also have to look at return on investment when they are spending on upgrade. The benefit of up-gradation come in form of access to latest or most recent technology and getting clinical and competitive advantages. Do CT scanners require maintenance? If so, what is the stipulated time for such equipment to be replaced and upgraded? CT scanner needs preventive maintenance as it involves lots of continuously moving parts. These parts are subjected to wear tear. CT scanner needs regular maintenance and calibrations. The stipulated time period for preventive maintenance is about 3-6 months depending on the system. The CT scanner can work for several years if maintained properly but technological obsolesce is about 7-10 years. Philips has programs where one can upgrade the system in terms of hardware and software capabilities. We also offer exchange program for user to encourage them to upgrade to newer technology.
tech trends
The perfect 3D Advanced Visualization partner for your PACS TeraRecon provides seamless integration with PACS streamlining entire radiology workflow by offering advanced visualization tools to your PACS viewers TeraRecon’s iNtuition features
Why TeraRecon - A perfect 3D partner?
-True client-server architecture -Most powerful rendering technology -Broadest range of clinical modules -Vendor Neutrality -Scalability, proven in multi-site deployment -Seamless PACS integration
-Longevity, proven track record, commitment -Always an industry leader & an informatics company -Always Vendor Neutral -Best in class architecture to suit any PACS -Best in class and award winning advanced clinical applications
info@terarecon.com | www.terarecon.com | 877.354.1100 Aquarius® is a registered trademark of TeraRecon, Inc. iNtuition™ and the iNtuition logo are trademarks of TeraRecon, Inc. Copyright© 2012 TeraRecon, Inc. All rights reserved. 071812AQ_A-eHealth_A1
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tech trends
Revolutionary PET Imaging Sudhir KN, Business Head - Molecular Imaging, Siemens Healthcare, feels just as high definition TV has redefined the television viewing experience, High Definition PET (HD.PET) has forever changed the way physician sees PET.CT images.
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ET.CT as a diagnostic tool represents a quantum leap in the quality of healthcare delivered. The introduction of HD.PET has further raised the bar and revolutionised PET.CT imaging. HD.PET offers 2 mm uniform resolution across the field of view. It enables razor sharp, distortion free image quality from edge to edge, allowing the physician to precisely visualise even the tiniest lesions with unmatched contrast and clarity. This clinical benefit of HD.PET has forever changed the way PET images were viewed by physicians across the world. Implementation of this technology has impressed physicians in India by helping them resolve even the most critical cases.
Conventional Vs HD.PET Conventional PET scanners use the same reconstruction principles across the entire field of view (FOV) and do not take into account detector geometry and mispositioning of the line of response (LOR). This results in fuzzy edges and increased distortion further from the center of FOV. The photon further away from the center of the FOV, the less likely the LOR will be calculated correctly, because the photon will hit the crystal at an angle and continue traveling to another crystal before it lights up. HD.PET incorporates millions of accurately measured Point Spread Functions (PSFs) in the reconstruction algorithms. A PSF describes the response of an imaging system to a point source or point object. A system that knows the
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response of a point source from everywhere in its FOV can use this information to recover the original shape and form of imaged objects. PSFs are also used in precision imaging instruments, such as microscopy, ophthalmology and astronomy (e.g. the Hubble telescope) to make geometric corrections to the final image. Using measured PSFs, HD.PET effectively positions the LORs in their actual geometric locations, which dramatically reduces blurring and distortion in the final image.
Clinical Benefits of HD.PET HD•PET has made a remarkable improvement in viewing of clinical PET.CT images. It delivers uniform sharpness with virtually no distortion — even at the edge of the FOV and more consistent visualisation of fine details. With uniform spatial resolution of 2 mm throughout the entire FOV, HD•PET provides the highest level of detail to improve detection of tiny lesions, even in places that were difficult to visualise earlier, such as the lymph nodes, abdomen, mediastinum, head, neck and cerebellum. With a 2x improvement in signal-tonoise ratio, HD•PET provides sharper image contrast and greater distinctness, thereby helping in ease of reading the images. The physician gets the highest levels of PET contrast ever delivered. The key features of HD.PET i.e. HD uniformity, HD resolution and HD contrast culminate in superior level of image clarity than other PET technology.
Latest Innovation The new Biograph mCT brings accurate and reproducible quantification to PET•CT imaging, by ensuring that each element of the measurement chain is
optimised. Starting with the industry’s highest volumetric image resolution, Biograph mCT features unique daily quality control, SMART registration technologies and intelligent software, to bring accuracy and reproducibility to PET•CT imaging. In addition, innovative Combined Applications to Reduce Exposure (CARE) technologies ensure the lowest possible dose is administered. Physicians can detect, characterise and monitor the tiniest cancer lesions with reproducible quantification, making cancer treatment more cost effective. More than ever, one can rely on molecular imaging with quantification that is accurate and reproducible. For results that will redefine clinical decision making and the confirmation one would need for more diagnostic certainty and more informed treatment planning.
Market and Future The PET.CT modality is critical as the search for balance between innovation and healthcare access continues. The likelihood that universal adoption of PET.CT technology will increase with accessibility is a shared industry vision. At the same time, HD.PET has been tried and tested at various luminary clinical sites around the world and is getting widely accepted. Even in India, customers have found HD.PET extremely useful. Currently, till date ten PET.CT scanners have been installed in India with this high end HD.PET option and four more will be installed shortly. The same trend is seen world over with more customers moving towards HD.PET technology. This current trend globally indicates that more and more customers prefer accurate diagnostic technology like HD.PET.
tech trends
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tech trends
Faster Imaging Manoj Kumar Shah, Managing Director, Mastel Imaging & Research Centre thinks that the CT Scanners market has undergone a noticeable change with new and sophisticated technologies replacing the obsolete ones.
object. Since then the CT scan technology has advanced and we are witnessing the fifth and sixth generation of CT scanners.
Evolving Technologies
A key trend evident in the CT segment is development of hybrid scanners comprising of positron emission tomography (PET) and CT technologies The Background Check Wilhelm Conrad Roentgen was the physicist, who detected and produced X-rays on 8th November 1895. It was designed by Godfrey Hounsfield to overcome the visual representation challenges in radiography and tomography by collimating the X-ray beam and transmitting X-ray only through a small cross section of an
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The latest generations of high-slice CT scanners offer faster imaging and larger imaging areas compared to the former counter-parts. The next generation of scanners holds potential to offer higher resolution cardiovascular and neurology images. Incorporation of larger detectors enables imaging of more anatomy of the organ with higher resolution. The market continues to remain dynamic as CT scanner vendors divert focus from increasing slices to fundamental application challenges such as functional imaging with organ perfusion and tissue characterisation, dose management, dual energy techniques and advanced visualisation. Companies are also gearing up towards development of cone beam artifact reduction technologies that reduces radiation dosage and offer larger coverage. Another evolutionary platform is development of systems with multi-energy detectors that can scan tissues at various energy levels simultaneously. A key trend evident in the CT segment is development of hybrid scanners comprising of positron emission tomography (PET) and CT technologies. With the combination of CT that offers anatomical information, precise details on the patient condition can be obtained, that helps in oncological treatment and management.
Global Market The new market research report on CT Scanners says, the United States of America remains to be the largest regional market. Developing countries across the world, led by BRIC nations are emerging as lucrative markets for CT scanners. Our country has less than 5 CT scanners per million populations, which is lower density than China and other South Asian countries. The demand for multi-slice CT scanners is growing and this technology is finding roads, in nonmetros also, despite of high cost. Intense competition and the consequent higher research and development expenditure resulted in slice-wars in the market place. As a result, the industry has given 64 Slice, 128 Slice, 256 Slice, 320 Slice and now even 640 Slice CT Scanners. However, the 64 Slice / 128 Slice and dual source scanners remain the most popular globally as on date.
The Future A number of image reconstruction software have come in the market, which are also vendor neutral and help the radiologist in diagnosis and reporting. However, the number of radiologists is not growing at the fast pace as the demand. Therefore, it becomes imperative that IT solutions are applied and used to its full potential. This will improve the productivity of the reporting consultant drastically leading to deliver more to patients in terms of quality and quantity.
tech trends
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tech trends
An Updated Radiology Workflow Pranav Shah, Sales Manager- India Terarecon writes on 3D advanced visualization in PACS for streamlined radiology workflow
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True client-server technology and seamless integration with PACS is the key for integrating thin slices CT/ MR images and an advanced visualisation application into a streamlined diagnostic workflow
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urrently, many hospitals have a centralised PACS, where radiologists are able to see the 2D images on PACS and often go back to the modality workstation for viewing 3D volumetric images. This is due to lack of true integration between PACS which is for 2D review and modality workstation which is for 3D Advanced Visualisation and volumetric review. A paradigm shift is needed to address these issues – moving away from thinking in two separate categories PACS and 3D Advanced Visualisation and instead, using a single solution platform for enterprise-wide diagnostic imaging. True client-server technology and seamless integration with PACS is the key for winning that challenge, integrating thin slices CT/MR images and an advanced visualisation application into a streamlined diagnostic workflow. It is important to look closely at the current PACS offerings - many solutions offer some sort of 3-D capabilities, but only very few can truly archive, distribute, and visualise all the data generated by the modern diagnostic imaging modalities, especially thin slices and large 3D and multiphase (“4D”) volumes. TeraRecon’s advanced visualisation solution, focuses entirely on specialised 3D/4D applications, providing access to clinical tools for day-to-day radiology tasks and the architecture and scalability needed to serve a modern, distributed healthcare enterprise. TeraRecon’s solution seamlessly integrates with PACS so that the radiologists can
access advanced visualisation tool right from the same PACS viewing station and with client-server solution, TeraRecon’s advanced 3D software can be accessed from any PACS viewing station or an ordinary PC on a LAN. Radiologists and clinicians can now access all diagnostic imaging data and clinical applications throughout the entire hospital with the click of a mouse, including an abdomen or peripheral angiography study, as well as a CT cardiac study. 2D, 3D, and 4D studies all can be viewed with different preset protocols and these protocols can be adaptable for an individual site, group or user. All the images reside in a single, central archive and there is no need of pushing thin-slices to individual viewing station. Furthermore, remote access is playing an increasingly important role. As hospitals and even practices become more distributed, outsourcing and remote services grow stronger and diagnostic imaging professionals turn into ‘roaming experts’ that need to be enabled to work in multiple locations and for multiple institutions. With TeraRecon’s client-server technology, a radiologist does not have to download any studies on his laptop, instead they can securely connect directly to the 3D server installed at the hospital which already has the patient studies. Via a small thin client application, radiologist can access those advanced clinical tools and make their diagnosis in few minutes.
IN conversation in Conversation
Displaying Accuracy “We have reached the state where technology is completely dominating the healthcare industry,� says Abel Garamhegyi, Vice President, Growth Markets EMEAI & Managing Director-India, Barco, in conversation with Shally Makin.
What kind of role are medical displays playing in healthcare? The medical displays hold great importance in healthcare. The display is the connection between the technology and the human and it gives the best possible zero compromise support on a reasonable price to the doctor. A good quality imaging machine is capable of providing all kinds of necessary information to the doctors. While conducting surgery, surgeons have access to information, which comes through that particular machine. A display ensures that an image is uniformly visible with a comfortable vision; this translates to produce colour uniformity with zero tolerance and technical luminance. Doctors know which machine is better once they experience its features in the operation room as he/she needs to see every single detail in a very precise manner. Price is also a factor when it comes to choosing healthcare displays. How role does innovations play an effective role in such set ups? Innovation for displays depends on two factors, digital content visibility and accuracy. The idea behind medical displays is that we should have a system for providing uniform viewing to the healthcare practitioners. We have gone from greyscale to full colour diagnostics. The greatest challenge is to have a system where the human eye sees a particular colour in the same way in each and every monitor. In diagnostic imaging, it is often difficult to ensure that every single corner of the monitor should showcase same kind of colours. Barco monitors stand out as in the digital sense; they
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provide complete accuracy in imaging. With the rising number of patients, the need to take quick decisions with accuracy has grown 10 times. We are enabling the doctors with the DICOM modalities for displays and Barco calibrates every monitor with same protocol to produce the same decision by every doctor even with different Barco screens. We believe in image latency that creates a difference between capturing the image and displaying the image in time. If the endoscopy of a heart patient takes one milli second to display then there is no chance for the doctor to take quick decision. If 0.1 millisecond is required by the image the doctor still has 0.9 milli second to take the decision and save a life. The factors are size, uniformity and backlight of the image. Today, we have fusion displays where Barco combines different pictures or save it and is also capable to do through one single network. So this collaborative networking is also a unique plan in an operation theatre, which is an IP based integration, and the images can be shared and viewed through PACS. What are the factors which help you strive to create much safer and accurate product? Track number one is how you handle the picture. Track number two is the device, as the hardware is the biggest source of infection. So we need ventilators in the operation room to ensure that the air that the patient gets is 100 percent sterilised. We look forward to minimising the human error by showing the right image in terms of displaying the tissue and the densest tissue to differentiate between
tumours. One cannot use a monitor that is not designed for healthcare use not just because it’s cheaper but also as it is going to create a problem at some point of time. The other track is how do we make those displays 100 percent safe and secure. The display should not be fancy; it should be of a simple colour and design with good graphic quality supported by medical sensors. What is the cost of installation of such systems at a healthcare centre? If a hospital puts together a certain amount of money and puts out every single pixel visible through a Barco display, this shows that there is a demand. To produce a display monitor which does not compromise on quality is another challenge with every single penny spent on their display making it affordable for a hospital. The cost of installation depends upon size of the centre, doctors, number of rooms, equipments and much more. We work towards introducing workstations for reporting images from entry level to diagnostic level which starts from 10,000 Euro. DCA imaging has imaging modality for around 5 million Euro, which only includes the equipment costs and nearly 10 workstations. Share with us any innovation which Barco will be coming up in near future. There are large numbers of innovations happening in this space. For instance, we have a Barco display through which a patient can access television and internet. We are also working towards
in IN conversation Conversation
developing systems that can facilitate mobile care. For instance, we can have tablet like devices through which patients can interact with the hospital staff. Tablets can serve the purpose of reminding of schedules and updating the patient and the healthcare staff about the drugs prescribed. One thing is for sure, Barco is keen to play a leading role in the innovations that are happening in healthcare space. Lot of new interesting ideas will emerge. One cannot use a monitor that is not designed for healthcare use, as it is going to create problems at some point of time. So the innovations that happen in this space must not only focus on creating cheaper systems, they should also be efficient.
“One cannot use a monitor that is not designed for healthcare use not just because it is cheaper but also because it is going to create problems at some point of time�
Abel Garamhegyi Vice President, Growth Markets EMEAI & Managing Director-India, Barco august / 2012 www.ehealthonline.org
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The
Unsung
Heroes!
While doctors strive to keep the blood flowing and the heart beating, the hospital administrator is doing his job in keeping the hospital alive and healthy By Shally Makin, Elets News Network (ENN)
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oday, the healthcare industry has emerged as one of the most fruitful and exciting investment opportunities. The tremendous costs and inflation in the healthcare industry is extracting money to be invested in a structural format to yield exponential benefits. With increasing medical errors, malpractices and use of old equipments in nearly every hospital or a healthcare center, there has emerged a need for an operational skills set to administer key clinical commitments, to maintain accreditation status ensuring high level of quality. The foremost step while creating such a structure is to interconnect all the departments for effective communication to flow between the staff. Exchange programme for medical consultants, nurses and technicians to facilitate knowledge sharing and technology exchange are also being organised. From bottlenecks to backlog, hospitals everywhere face the same business challenges. This increasingly complex
and competitive list of challenges and opportunities is looking for the right leadership to wisely deal with the dynamic healthcare environment. Hospital operations are the processes hosted by a team to make sure the right product gets built while schedules are met and costs are contained nevertheless they are blamed for every medical error occurred in the premises under their imperative management. The success and the growth of the hospitals largely depends on the strategic planning including expansion and addressing current problems thus creating future flexibility. Many researchers, policy makers and administrators have analysed plausible causes of such lack of significant improvement, but one ‘elephant in the room’ – hospital operations management – is still overlooked. The design and infrastructure in collaboration with hospital engineering meeting healthcare standards works well when setting up a budding health-
care centre. The supply and installation of medical and related technical equipment including all relevant consumables lie under the procurement department of the medical equipment planning team. The capital defined is thus accountable to deliver the level of care and quality.
Facility management Facilities management forms the stem of the role defined for a hospital management committee. Operation of healthcare projects requires a functioning system of management to keep facilities at the highest level of operation and to avoid down time. The critical analysis of every organisation is framed with the operational efficiency achieved within the time period. The operational managers are minimising bottlenecks and driving IT implementation in hospitals to handle day –to-day affairs of the hospital. Prateek Vohra, CEO, Technocrats says, “ Airflow control solutions
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In case of procurement of material and equipments, minimum three quotations for any new material are required and then the comparative statement is prepared. A call is given to the supplier for final negotiation and the rates are fixed for at least one year. The approved quotations are informed to the accounts department and with the help of hospital information system and the special inventory management software, we can have a good control over price and quantity verification. These equipments are also considered after taking an opinion of various users.
Arti Modi, CEO, Apex Hospitals
can be installed and commissioned in an existing healthcare facility with as much ease as in a new upcoming facility. Concerns expressed by the hospital maintenance department, is often related with pressurisation/polarity/direction of airflow and ACPH. There is a dire need for airflow solutions that address, primarily, the stringent requirements of critical spaces in the healthcare sector.�
Emergency Care
Dr Usha Gopinathan Executive Director, L V Prasad Eye Institute Special attention is paid to the screening of the vendors, and the quality of equipment and materials to be procured. Before the start of the financial year, the equipment needs of the centres is collated, assessed to ensure best possible care that can be offered, and procurement takes place adhering to the purchase protocols of the organisation.
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The strategy adopted by Manipal Hospital involves tracking inventory balances and manage consigned inventory for high value items. The strategy is to reduce cost by reducing inventory levels by eliminating procurement errors and redundancies help in reducing cost through improved decision-making about product costs. The facilitation in information technology in the procurement process reduces the processing time and material delivery and also reduces the manpower.
The patients have no patience when it comes to medical services and acquiring information. This fact emphasises -why a patient cannot wait when it comes to dealing with pain because the end sufferer is the patient and not the doctor. Reducing the delays in acquiring information, discharge summary and final bill and other patient formalities while admitting and discharging is imperative. The staff lacks empathy and concern for patients as it becomes insensitive to the pain which can further demand training of the staff on behavioral issues. As there is awareness and information rolling all over the internet, the patients and their attendants are more informed and question every action a doctor initiates and refers. The splurged demand for open and digitised medical records have now forced healthcare professionals to be transparent and organised. The healthcare professionals play a vital role in managing complex activities when critically ill patients are admitted in ICU. The problem can be easily averted if time-to-time information is given to them about the condition of the patient, what is the prognosis, what all treatment is being given and what are the charges for different services. Providing information to patients and attendants can avert a large number of conflicts. Streamlining workflow and activities need a well trained staff to manage different departments in a hospital.
Waste Management Muthanna CG Vice President – Operations Manipal Health Enterprises
Hospital waste is a potential health hazard to the healthcare workers, public and flora and fauna of the area. Hospital acquired infection, transfusion transmit-
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ted diseases, rising incidence of Hepatitis B, and HIV, increasing land and water pollution lead to increasing possibility of catching many diseases. Only 15 percent of hospital waste i.e. biomedical waste is hazardous, not the complete. But when hazardous waste is not segregated at the source of generation and mixed with non-hazardous waste, then 100 percent waste becomes hazardous. The question then arises on the need or rationale for spending so many resources in terms of money, manpower, material and machine for management of hospital waste? Based on Biomedical Waste (Management and Handling) Rules 1998, notified under the Environment Protection Act by the Ministry of Environment and Forest (Government of India), intelligent use of hospital waste and then disposing it off is part and parcel of day to today routine activities has to undergo certain process. However it is of utmost importance to supervise the waste to be incinerated and administered till the end to reduce risk of infection outside hospital for waste handlers and scavengers and at time general public living in the vicinity of hospitals.It is imperative for the administration to identify unethical practices,
The emergence of a separate pool of trained professionals has helped in creating professionals who better understand the nuances and intricacies of managing a hospital. They are able to bring in systemic improvement in the hospitals by focusing on improved procurement and inventory management, thereby freeing up medical professionals to perform their clinical duties and strengthen implementation of standard treatment protocols. The concept of Emergency Medicine Services (EMS) is now catching up in India and many hospitals are setting up specialised EM department within the hospital. Besides, hospitals are also trying to offer specialised education courses in emergency medicine.
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Dr R C Sharma, V P ( Operations), Rockland Hospital Proper hospital waste management practices should therefore be strictly followed as part of a comprehensive and systematic approach to hospital hygiene and infection control. Hospital administrators and planning officers should ensure that washing facilities are made available to people handling hospital waste. This is particularly important at storage and treatment facilities. Staff handling hospital waste should be offered appropriate immunisation, including hepatitis B and tetanus. Staff in contact with hospital waste should wear the following personal protective clothing. The overall aim of training is to develop awareness of the health, safety, and environmental issues relating to hospital waste management.
ensure legal safety and upkeep of medical records.
Technology
Charu Sehgal Senior Director, Consultant – Strategy & Operations, Deloitte Touche Tohmatsu India
The role of technology is again very essential when it comes to communication, storage, retrieval and referral purposes. Manager has to effectively invest and streamline processes with the use of technology making the system- structured and transparent. HMIS today plays a role of managing all the operations but with a vigilant eye of the manager as after all the machine cannot be intelligent than man. To achieve automation of all processes and maintaining organisational conditions that enable innovation, increased profitability and high performance. These performance measures in turn helps the manager to value resources including manpower. A scenario without trained profes-
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Role of a Manager The hospital manager plays the role of a supervisor, mentor, teacher and leader to his staff and an advocate of patients’ rights for the patients. Hospital manager tries to optimise inventory holding and ordering costs. In terms of infrastructure, we follow international norms in designing our facilities. While in the clinical areas, technology plays a major role in the medical equipment used in diagnosis, in the nonclinical areas, the use of SMS helps in Zahabiya Khorakiwala transmitting information to the attending Managing Director, Wockhardt Hospitals physician about the patients admitted under him. Information can also be given to the patients’ attendant. Managers look forward to acquire new and upcoming area is a virtual tour of patients in the ICU area, where the attendant can access/ view the patients’ condition without being physically present in the ICU.
Apollo hospitals are always learning from their network hospitals in terms of infrastructure, medical services and technology. In terms of training a manager, there is a distinct skill set required, especially when it comes to maintaining hospitals. This skill-set is very different from that of regular MBAs. Hence, today, there is a need of a doctor-manager to understand both sides of the game. A full-blown hospital information system was first introduced in Apollo, Chennai. Karan Thakur, Deputy Genral The group has also created MedmanManager, Apollo Indraprastha Hospital tra, an integrated system, developed by TCS. Periodic updates and ongoing processes need to be accessed at the policy level, and the process has to be worked upon by the hospital manager. Weekly audits for maintaining biomedical wastein a dedicated place are conducted. We incinerate the waste before transportation. DPCC certification conducts assessment for incinerating waste by the vendor. Categorisation is very clear and is taken care and transported in lifts dedicated to waste staff only. We incinerate the infected waste and make sure that the vendor is also DPCC certified. We also have formal ethics committee where complains and suggestion are filed with an unbiased approach. The patient is affected by the infrastructure of the service cape as it really influences the emotional state of the patient as he enters. A manager makes sure that the infrastructural challenges are overcome and maintained. He looks after the financial efficiency department including ratios, revenues, costs, parameters at departmental level to ensure saving.
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Quality improvements will come from more scientific applications of management principles like improving the workflow when the patient comes to the front office till the timehe gets admitted. So there is process re-engineering and process re-designing techniques that need to be done. Likewise there are many things which can be done in a better way by bringing in management principles from other industries. An important role of a manager is to manage procurement and maintenance materials in a hospital. As customers’ expectations rise, patient care becomes more complex, and resources continue to shrink, hospitals are finding that traditional approaches to defining, organising, and staffing quality assurance functions are no longer adequate.
Dr Param Hans Mishra Medical Superintendent Indian Spinal Injuries Centre
special feature
Dr Air Vice Marshal (Retd) RK Ganjoo Consultant – Medicine & Haematology Former Director – Medical Sir Ganga Ram Hospital
It is wise to remember that ‘smarter management is not costly management. It is required to ensure that the skill-sets of key clinical and managerial team members are amongst the best, to achieve and maintain accreditation status and international standards and to develop a sustainable competitive advantage for the hospital to ensure high levels of quality, customer service and competitiveness. The team has to have adequate experience in hospital administration and management as they have to perform a Herculean task. Regular performance review of various departments and clinicians, procedures and materials to ensure they are aligned with the hospital’s overall objectives and targets must be done. Statistical data through Medical Records Department (MRD) and analysing trends and monthly reports on quality performance and key performance indicators should be collected by the hospital manager. The manager must be an active member of the hospital purchase committee in the selection of medical equipment/machines to be ordered and installed. Regular The manager should also plan and manage the process of accreditation by JCI, NABH, NABL and ISO certification and ensure compliance. Another important role is to relieve demands on the ICU unit so that, when needed, beds are available for high-risk patients
The ultimate performance indicator of Operations Management is the efficiency and effectiveness in delivering good quality services: minimise the turnaround time, maximise the utilisation of resources, and employ cost reduction methods. The ‘front door’ not only drives flow, but also it drives the perception of flow which is most important to implement in the In-patients department for the operational managers. The managers also need to hardwire the clinical pathways taking full confidence of the treating doctors to ensure that the Average Length of Stay (ALOS) should be nearest to the vision of the hospital. Overall the operational managers need to develop command over all these people by adopting frequent rounding on them and using keyword at key time for both the patients and for the employees at the helms.
SS Ansari Projects Director Abdur Razzaque Ansari Memorial Weavers Hospital
Dr Atul Shah Medical Director, Metro Hospital and Research Institute, Vadodara With complexity of hospitals increasing, legal requirements and accreditation demands, there is specific need for such trained people. Too many software and experiments, helps in reducing storage space with better retrieval. Hospitals in modern days are hotels with operation theaters. More focus on waste management involving segregation at source of generation, storage in locked area, final disposal to common incinerator facility. Sufficient manpower of all cadres in all shifts, frequent review of types of emergency received and biweekly case audits as well as mortality audits is also important.
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sionals in operations is un-thinkable. The class of professionals that thrives in hospital operations is a blend of strong technical skills, exceptional people management skills, cross-functional knowledge and a knack for creatively managing situations. “We have successfully worked with an outsourced solution for web-streaming our ophthalmic education classes across our network of tertiary care hospitals and also for deriving the benefit of expert lectures from abroad through surveys,” says Dr Usha Gopinathan. Development of an adequate information infrastructure will be an essential element in obtaining an end-to-end health chain view. This information infrastructure will need to support electronic patient dossiers. This would enable an institution to demonstrate a greater ability of enterprise resource planning that is a centralised framework for all processes in an organisation, focusing on all aspects of a business.. “These professionals in leadership roles impact healthcare by bringing synergy and alignment among stakeholders. We seldom hear about these professionals who can weave magic on any given day of running a hospital. They are a rare
Hospital operations are people and technology intensive. The support services such as housekeeping, diet and nutrition services and facilities engineering have large teams and are engaged in using or managing equipment that is expensive and complex. This requires employees to be skilled and trained periodically on the job. For example: a manager of facility engineering on a daily basis has to ensure that the power back-up comes on within seconds of a power outage, the RO plant’s water quality tests are optimal, the medical gas pressure at all outputs is meeting the standards, air quality in sterile areas is upto the mark, and fire-fighting system is ready and armed. And, these are only some of the major systems to be checked daily.
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Dr Shivani Sachdev Gour Director SCI Healthcare and Isis Hospital Kailash Colony
Abhilash Pillai Project Manager Apollo Health Street
On regular basis operations management involves maintaining interface with departmental personnel to ensure there is adequate space and facilities for patient care and coordination of facilities, investigate patient/ visitor concerns and implements appropriate courses of action, assist staff in identifying clinical experts for specific patient population concerns.
This complexity of hospital business makes the lives of a hospital manager challenging but equally exciting, as he always needs to ensure that his institution provides high-quality healthcare in a manner that is safe, manage and work with a team of individuals with very different capabilities and skills to deliver optimum outcomes with excellent patient experience while complying with regulatory requirements. The healthcare business in India is fast evolving and would continue to do so to accommodate the accelerating changes in the delivery of care and the increasing demand for healthcare services in the country. This ongoing movement will bring along with it numerous opportunities for young aspiring managers.
breed and India needs more of them” says Faisal Siddiqui, Vice President, Healthcare, Technopak.
Conclusion Providing process structure in healthcare is much needed. Support for business processes that span multiple autonomous organisational entities is required in order to manage medical supply chains, intramural distributed healthcare and trans-mural healthcare. Providing flexibility to healthcare is another factor we look at. Automated support for flexibility aspects plays an important role
Faisal Siddiqui Vice President – Healthcare Technopak
at process design time and run time, including attention for explicit exception management, to deal with the many unforeseen circumstances in medical processes. Modern job demands imposed on healthcare employees imply renewed investigation of available, often limited, job resources. Providing trust in healthcare: Safety management in today’s healthcare is still in its infancy. Detailed predictive risk analysis and retrospective incident analysis and the accompanying implementation process are badly needed. Operations management is the strategic implementation of programmes, techniques, and tools for reducing costs and improving quality. Continuous quality improvement or total quality control are names for a philosophy of management that aims to help organisations of all kinds improve performance through eliminating poor quality during production or delivery of the product or service rather trying to fix the results after the product has been made or the service given.
power hospital
What are green buildings? What are the financial benefits they bring for a hospital? ‘Green’ or ‘sustainable’ buildings use resources like energy, water, materials and land more efficiently than the regular standard buildings. With more natural light and better air quality, green buildings typically contribute to improved employee health, comfort, and productivity. Green buildings, including hospitals, provide benefits that conventional buildings do not. These benefits include energy and water savings, reduced waste, improved indoor environmental quality, greater employee comfort / productivity, reduced employee health costs and lower operations and maintenance costs. Generally, buildings account for 1/6th of the world’s fresh water withdrawal, 1/4th of its wood harvest and 2/5th of its material and energy flows. Hence it would be justifiable to say ‘building green’ is an opportunity to use our resources efficiently while creating healthier buildings that improve human health, build a better environment and provide cost savings. Tell us more about LEED and why Kohinoor Hospital opted for this rating system? The Leadership in Energy and Environmental Design (LEED) Green Building Rating System, developed by the U.S. Green Building Council (USGBC), provides a suite of standards for environmentally sustainable construction. LEED certified buildings often provide healthier work and living environments, which contribute to higher productivity and improved employee health and comfort. A long list of benefits of implementing a LEED strategy include improvements in air and water quality to reduction in solid waste. Kohinoor Hospital has been designed to get the Platinum rating, which is the highest rating under LEED certifications
Creating Energy Efficient Hospitals Kohinoor Hospital is Asia’s first and the world’s second Leadership in Energy and Environmental Design (LEED) Platinum rated hospital building under Green Building Rating System. Dr Rajeev Boudhankar, Vice President, Kohinoor Hospitals, talks about the credentials of the hospital.
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power hospital
for ‘Green Buildings’, making it the 1st healthcare institution in Asia and 2nd in world to achieve this prestigious distinction. I have always believed that it is easy for a new hospital to have environmental design features that are better than those in an existing hospital. When the construction site was decided, I was convinced that we should have the maximum green features and technologies, which are perquisite for LEED certification and could be introduced in the hospital. So, we have achieved the highest parameters to be platinum rated.
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What are the key steps that you took to achieve the platinum rating? There are numerous steps suggested by the agency, and we took on aspects that were the best. To begin with the category of sustainable sites has 26 possible points for rating. The intention is to ensure that the development undertaken will not require additional infrastructure to be laid by the authorities. It is also mandated that the development be in densely populated area, with ample alternative sources of public transportation. We conserve more than 40 percent of water by using recycled water as the hospital has a state of art Sewerage Treatment Plant to aid water recirculation. The benefits of demand control ventilation are reduction in energy conservation, reduced wear and tear of the equipment and confirmed/documented indoor air quality. Carbon Dioxide (CO2) sensors are the only currently accepted method of demand control ventilation. 30 percent more of pure air is circulated as compared to other constructions. We use astronomical time switches for controlling external lighting. These switches are programmable on the basis of sunrise and sunset, and work without the use of light sensor. This saves substantial amount of electricity and increases the life of lamps. A green building consumes 0.66 watt /sq. ft. as compared to a normal construction which consumes 2.0-2.5 watt / sq. ft.
helps us to lower urban air temperatures and combat the heat island effect. It is an effective mechanism to filter out pollutants and carbon dioxide. We have a solar plant installed on the roof, these solar panels are used to harvest the solar energy which is the energy derived from the sun through the form of solar radiation. Its use is to heat water and maintain the humidity in the operation theatre. We have built-in a mechanism to store the heated water that helps us during the rainy/cloudy days. Our HVAC Design includes the chilled water plants, these generally consists of energy efficient screw chillers Variable Frequency Drive (VFD) driven chillers, multiple primary chilled water pumps, secondary chilled water pumps with variable frequency drives, condensing water pumps, Fibre reinforced plastic (FRP) cooling towers, VFD driven double skin air handling units with thermal break and variable frequency drive, fan coil units, chilled and condensing water piping, air distribution system, insulation, electrical panels, wiring, control wiring and earthing.
Tell us more about the Green roof and HVAC system at Kohinoor Hospital? Green roof provides insulation for the building from outdoor environment. It
How does the integrated building management system (IBMS) work? Building Automation System (BAS) is a micro processor control system which is used to monitor and control all the param-
august / 2012 www.ehealthonline.org
eters of HVAC, electrical, fire protection, elevators and other building services/ utilities. The DDC (Direct Digital Control) system interfaces with sensors, actuators and environmental control systems, carries out various functions of energy management, alarm detection, time/event/ holiday/temporary scheduling, communication interface/control and building maintenance and report generation. Internal electrical system uses the latest technologies and fundamental principles of energy conservation and safety that encompass protection against electric shocks, thermal effects, over current, fault current and over voltage. Dimmers are provided for lighting circuits to reduce the lux level at times when higher lighting level is not required. Also sensors are provided to switch off lighting when the space is not occupied or where natural light is available to achieve the required lux level. The use of Earth Leakage Circuit Breakers (ELCB) is to safeguard against electrocution through direct or indirect contact with a live circuit. Most of the smart features of energy and water conservation technologies are monitored and regulated by these systems. Thus we go green on an automated mode. What advice would you offer to new hospitals and existing hospitals that are intending to start green initiatives? There are many out-of-the-box ideas that can be adopted by other hospitals, which might want to tread the green path. However, it is much easier for a new hospital project, than for an existing hospital to make changes in their infrastructure with structural changes for energy and water conservation. They can begin with the energy and lighting systems to save energy and then plan few aspects of use of materials; indoor air quality and green landscaping for reduce their resource consumption. The benefits will be terms of lower electricity and water costs. Small steps make significant impact on the environment. We have new hospitals planned in the coming years in Maharashtra and will be building on the LEED green design modules.
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eVent report
Reforms in Medical Education
Opportunities and
Challenges L
ike the inaugural year this year too the World Education Summit (WES) 2012 has garnered grand success. It could create an impact in the minds of attendees to speak about the relevant issues of the sector while discussing about the milestones achieved so far. The 2nd edition of the WES 2012 was being jointly organised by All India Council for Technical Education (AICTE), Centre for Science, Development and Media Studies and Elets Technomedia Pvt. Ltd. between 23-24 July 2012 in Le Meridien, New Delhi. Prof S S Mantha, Programme Chair, All India Council for Technical Education (AICTE), Government of India was the Programme Chair of the Summit. While the mega summit was able to bring together most of the eminent names of education eco-system, the special session on Reforms in Medical Education: Opportunities and Challenges was equally successful in bringing together healthcare stalwarts like Dr Shakti Gupta, HOD, Hospital Administration and Medical Superintendent, RP Center of Ophthalmic Sciences, Dr Balasubramanyam, Domain Consultant: Medical E-learning, Professor –Department of Anatomy, St. John’s Medical College, Bangalore, Prof Manisha Jindal, Prof of Physiology, Convener Medical Education Unit, School of Medical Sciences, Sharda University, Dr Tarun Seem, Additional Commissioner of Income Tax, Office of Chief Commissioner of Income Tax, New Delhi, Prof Tapan Kumar Jena, School of Health Sciences, IGNOU and the Chair of the session Dr Girdhar J Gyani, Past Secretary General, Quality Council of India and currently Advisor, National Accreditation Board for Hospitals & Healthcare services (NABH). The session witnessed a huge footfalls and it has gifted many takeaways to each attendee. The following were the broad areas of discussion of the track: • Dearth of human resource and colleges in the healthcare sector • Role of Government as well as private sector to provide further impetus to medical education • Lack of quality institutes for medicine • Benefits of ICT-enabled learning modules in medical education • Need for a comprehensive policy to address the acute shortage of human resources in healthcare • The urgent need of reform in medical education
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“We want to bring some good doctors from private healthcare space, want them to contribute in medical education, so that the transformation can happen although it will take some years to see the impact” Dr Girdhar J Gyani, Past Secretary General, Quality Council of India & Currently Advisor NABH “Content of the training programmes (for doctors) need to be changed in connascence with our changing needs,” Dr Shakti Gupta, HOD, Hospital Administration and Medical Superintendent, RP Center of Ophthalmic Sciences
“The state of medical education in India is more of a wishful thinking rather than building blocks for holistic healthcare” Dr Balasubramanyam, Domain Consultant: Medical E-learning, Professor –Department of Anatomy, St. John’s Medical College, Bangalore
“Self directed learning should be introduced in medical education” Prof Manisha Jindal, Prof of Physiology, Convener Medical Education Unit, School of Medical Sciences, Sharda University
‘Simulation is an important medical education tool,’ Dr Tarun Seem, Additional Commissioner of Income Tax, Office of Chief Commissioner of Income Tax, New Delhi
“There is no organised medical education and a mismatch prevails in thoughts and sought” Prof Tapan Kumar Jena, School of Health Sciences, IGNOU
event report
Glimpses Dr Girdhar J Gyani chairing the session
Dr Shakti Gupta addressing the conference
Delegates at the World Education Summit 2012
Dr Balasubramanyam talks about the importance of elearning in medical education
Prof Manisha Jindal on MBBS curriculum development
Prof Tapan Kumar Jena delivers a talk on distance learning for medical students
Dr Tarun Seem emphasises on need for regulations to enhance quality of education august / 2012 www.ehealthonline.org
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expert speak global leader
Neil Jordan General Manager-Worldwide Health, Microsoft
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global expertleader speak
“India is a Key Market for Microsoft Health” “One of the key opportunities that we see in India is helping healthcare providers design, build and operate a modern ICT infrastructure that effectively supports the important work of caregivers,” says Neil Jordan, General ManagerWorldwide Health, Microsoft
Give us a brief overview of Microsoft’s footprint in Indian health IT space. We are very involved in the Indian healthcare market and are working closely with various stakeholders within the industry, from hospitals to government agencies to non-profit organisations to deliver better healthcare through technology. Some of Microsoft’s clients in the healthcare industry in India include Razi Healthcare, Kamineni Hospital, Akhil Systems, Renaccess and gloStream. Earlier this year, the Indraprastha Apollo Hospital, New Delhi, implemented Microsoft SharePoint Server 2010 to eliminate manual tasks and automate business processes from a centralised location. It is recognised as a superior healthcare provider at the forefront of medical technology and expertise. The hospital needed modern business management software to ensure greater transparency and control over its largely manual processes. With no integrated system, employees lacked holistic insight into important data that would have helped make quicker and better decisions for patient treatment. As a result of automating procurement with SharePoint, the hospital now saves considerable time, streamlines processes, and has reduced costs by 25 percent. Additionally, the hospital expects to improve employees’ access to information, reduce errors, improve efficiency and above all, boost collaboration. How do you see the advancement in the field of health IT over the last decade? Technology has revolutionised healthcare over the past decade, and is growing exponentially. Think back ten years ago, before electronic medical records, personal devices, and video conferencing. Now, we can train and collaborate with healthcare providers all over the world and transfer information, medical records, and lessons once trapped inside heavy and expensive
books without leaving our offices. Even more, we have access to a world of information with the devices we store in our pockets. The storage and access to health records is one area that has benefitted from technology. Microsoft HealthVault is a personal health application platform that enables individuals to store and manage their health information in a personal, online account, while providing a platform for healthcare providers, professional organisations, insurance companies and others to easily provide applications and services that will help patients manage a chronic condition or improve their well-being. HealthVault is a tool that enables people to take more control and interest of their health, which is vital to arresting the exploding cost of healthcare that nations are grappling with today. What is the portfolio of health IT solutions that Microsoft is currently offering in India? Health organisations in India are using solutions based on Microsoft technologies for electronic medical records, imaging systems, clinical and business intelligence, Telehealth and Caregiver Collaboration as well as to connect patients to their personal health records and help them take an active interest in their wellbeing. We work closely with our partners to extend the benefits of healthcare IT solutions to as many people as possible, including those in rural areas without access to specialist healthcare. For example, Renaccess Healthcare is founded by two IIT Bombay and Indian School of Business graduates in 2010 with the aim of making dialysis treatment more affordable and accessible to at least 50 percent of kidney failure patients in India. To contribute back to society, the two founders, Saurav Panda and Gaurav Porwal, pledged to penetrate the expensive dialysis treatment in metropolitan areas august / 2012 www.ehealthonline.org
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and take it to the masses in tier one and tier two cities, with a cost effective and no-frills approach. Operating under the brand name Sparsh Nephrocare, they collaborated with Affordable Business Solutions (ABS) to implement a Hosted Microsoft Dynamics AX 2009 solution. With a cloud computing model, all the assets at Sparsh were integrated, optimised and holistically managed to respond with agility and speed. The solution guarantees zero downtime, helping the company save up to Rs. 50,000 per annum, improving patient care and ultimately lowering the cost of care for patients. Increasingly advanced communication and collaboration technologies such as Office 2010, Office 365, and Lync are helping to ensure the patient remains the focal point in healthcare. What is market opportunity for health IT solutions in India? India is one of the world’s largest healthcare markets and there is a wealth of opportunity for the health IT industry to grow. We see the provision of infrastructure software and hardware as an important way to improve the way clinicians and nurses can work and collaborate together. We also see huge opportunities for simplifying, making sign on and sign off easier, enabling people to take
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their mail and appointments with them wherever they go on their phone or PC, helping IT manage and deploy systems faster and so much more. In the end it is about making ICT a quality technology experience that enhances and amplifies the caregiver’s ability rather than getting in the way. India is a key market for Microsoft Health. In fast developing economies like India, cloud computing can give healthcare organisations the opportunity to improve the quality and access of care, and reduce costs. Microsoft’s cloud and cloud-enabled hybrid solutions help healthcare organisations focus on patient care, while cost-effectively consuming IT services. Do you think ICT can act as an effective interface, where there are no hospitals or healthcare centres? Absolutely, ICT is an essential tool in bringing better healthcare to areas beyond the geographical reach of hospitals or healthcare centres. For example, in 2008, we worked with local partners and medical facilities to pilot a telehealth project in the Barielly and Madhubani districts, where it was common for villagers to travel 10 to 12 hours or more to see a doctor without knowing if they can even find one willing to care for
them. With the assistance of a medical facilitator and by means of a computer and dial-up Internet connection, villagers were able to discuss their health concerns with a medical professional based at an urban centre. Vital signs, photos, medical records and other information can also be shared often be addressed almost immediately, while patients needing more care can be referred for an appointment in town, but with greater assurance that when they make the long trip to get there, they will see the most appropriate specialist for their particular condition. Access to ICT is also extremely important when faced with a disaster response scenario. For example, the day after the Japan tsunami disaster struck in 2011, Microsoft began to help build and migrate websites which used cloud services to relay emergency information. We also worked with our hardware and NGO partners to provide computer and Internet access to disaster-struck regions, allowing volunteers to collaborate and coordinate aid efforts in places where even cellular networks were disrupted. What do you predict will happen within Health IT space in the next 5-10 years? What are your future plans? We foresee that the industry will start taking all the information that’s being digitised and turn it into useful information and knowledge that will enable people to use the information at a personal level. By making information easy to access and use, we multiply its value by empowering people to be stewards of their own health data and wellness programs. We also see Natural User Interface (NUI) technologies becoming increasingly the key for widespread adoption of healthcare ICT solutions. We will continue to work closely with health-related constituents across the globe – from governments to industry to individuals – to help them move away from today’s fragmented delivery system to a connected network that is flexible, interoperable, scalable and secure.
15 - 16 November 2012 hyderabad international convention centre Hyderabad
Envisioning Healthcare Through ICTs eHEALTH India, an integral part of eINDIA conference and exhibition, is designed to create a unique platform for visioning and knowledge sharing in the domain of ICT-driven healthcare and facilitates multi-stakeholder partnerships and professional networking among governments, industry, academia, civil society organisations and international funding agencies.
Track Chair Rajendra P Gupta Member, Advisory Group (TRG), Ministry of Health & Family Welfare, Government of India
Components • Conference for sharing of knowledge, challenges, ideas and best practices driving ICT initiatives in healthcare • Exhibition of most innovative technologies and products in the healthcare IT market • Awards felicitating the most innovative initiatives in healthcare across the globe Themes • Transforming public healthcare through technology • Envisioning hospital of the future – putting technology at the heart of care • Health insurance – Leveraging technology for scalable models • Online and mobile healthcare – exploring technologies, services and business models • Telemedicine: Bridging barriers to revolutionalise diagnosis & care .....and more
eHEALTH India Awards Recognising Innovative ICT-enabled Initiatives in Healthcare
eHEALTH India Exhibition Showcase Cutting Edge Products & Technologies in Healthcare
For Enquiries, Contact Divya Chawla; divya@elets.in; 91-8860651643
ORGANISERS
eINDIA.eletsonline.com
partner publications
Special Sessions Hospital CIO Conclave Health Secretary Conclave
In conjunction with 8th
health insurance
‘100 Percent Guaranteed Life-long Renewal’ “Health insurance is expected to increase its share manifold in the coming years, it is slowly becoming a buyers’ market,” says Antony Jacob, Chief Executive Officer, Apollo Munich Health Insurance How do you see the advancement in the field of health insurance in India over last decade? From being an openly competitive market to nationalisation and then back to a liberalised market again, the insurance sector in India has now completed a full circle. If you care to trace the developments in the Indian insurance sector, you are confronted with a 360 degree turn around. Although there has been rapid growth of the sector over the last decade, insurance in India still remains at an early stage of development. Insurance is one sector whose contribution to the GDP has been quite significant. During the last three decades, insurance penetration as a percentage of the gross domestic product has more than doubled from around 3.5 percent in 1970. The insurance sector thus has grown more strongly than the overall economy. The biggest development in this industry was the opening up of the industry, following the 1999 IRDA regulation. Also, with the proliferation of bank assurance, there is a rapid change in the way insurance products are distributed in India. This has strong implications on the process of financial convergence and capital market development in India. Please give a brief about Apollo Munich Health Insurance offerings in the health insurance domain. Apollo Hospitals and Munich Health have developed unique products and services which are based on careful researched. The products and services are developed with clear understanding of the changing and varied needs of the customers. Having said that, we already have some of the best products
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in the market, and the scope for growth is quite substantial. We have introduced an innovative multiplier benefit in our new product ‘Optima Restore’. The multiplier benefit is a no claim benefit offered as a renewal incentive. Under the multiplier benefit, if the insured person has had a claim free year, Apollo Munich will increase the basic sum insured by 50 percent and, if the second year too is claim free, then the basic sum insured is doubled. This benefit is offered at no extra charge and without any hassle of paperwork. That’s not all, under ‘Optima Restore’ we also offer another unique restore benefit which automatically reinstates the basic sum insured in case the insurer exhausts their sum insured in the policy year. The reinstated sum insured can be utilised to cover against any other illness or in case anyone in the family (in case of a family floater scheme) falls ill later. This unbelievable benefit is also being offered at no extra charge. Apollo Munich includes maternity benefit, which is incidentally the single largest reason for hospitalisation in India, in an individual policy - an example of trying to understand the market and make it easy, friendly and innovative for consumers. Apollo Munich was the first to introduce ‘100 percent guaranteed life-long renewal’. This means that if our customer lives for 105 years, he can continue to be insured with us. We were one of the first ones to launch a truly comprehensive cashless OPD + IPD insurance product in India by the name ‘Maxima’. The same was developed after thorough understanding and research. We offer multi variant options across various sum insured levels where a customer is free to choose as per his or her affordability and perceived need for cover. In terms of affordability we have policies ranging from `30,000 (for the State of Meghalaya), right up to policies with a premium of `20 lakhs. We cater to the entire health insurance schemes for the different income levels, starting from below the poverty line and reaching above the poverty line.
What is your perspective on the role of IT in health insurance? Information technology (IT) plays the most critical role in automating the fulfilment processes in customer facing businesses such as insurance. We believe that the fulfilment processes can be segmented into sales stage and claims stage. In the past decade our industry has seen considerable development and innovation pertaining to the sales process which involves the sharing of information at the application stage. But sadly the pace of development has been slow when it comes to the claims processes. This may be due to the fact that the processes related to claims require integration of multiple stakeholders including thousands of healthcare providers. At Apollo Munich, we believe IT should play a significant role in enabling real time data sharing requirements between the claims facilitators and providers. This may be possible by creating a data highway where each customer, provider and claims facilitator can work in tandem for faster decision making through real time sharing of information. What has been your marketing and business strategy in India? Our strategy is to design the right products, where the price is as per the customer’s expectations. Most importantly, we are focussed on providing the right kind of service. We know healthcare and health insurance because of our parentage of Munich Health, the largest composite health insurer globally and Apollo Hospitals, one of Asia’s largest healthcare providers, and this gives us the competitive edge. Also, our approach to health insurance lies in our positioning - ‘Let’s Un-complicate’. We have positioned Apollo Munich as a straight-forward, user-friendly and hassle-free health insurance company that will consistently tackle the general concerns faced by people when it comes to healthcare and health insurance. We focus on the easy uncomplicated process we have for people seeking comprehensive health insurance for themselves and their loved
ones. This positioning has enabled us to create a unique brand identity for Apollo Munich. How important, from a healthcare insurance point of view, is it to have a national health IT policy? Information Technology is one of the most significant enablers of growth in the health insurance sector. Health insurance has benefitted, and will continue to benefit, from the efficiencies that technology brings to traditionally paperdriven processes. The implementation of a standardised IT processes across the industry will play a major role in efficient capturing and analysis of data, product designing and fraud detection. There is the need to establish standards and invest in initiatives to help healthcare providers transition to the next generation of healthcare technology. What are your future plans? Do you think making health insurance mandatory for everyone can address the issue of low health insurance penetration? A compulsory health insurance has good precedence in a country where the sector is characterised with very low penetration. Making health insurance compulsory for all Indians is a move that Indian government should think about. Subsidising the cost of providing health insurance for SMEs and allowing them to participate in larger ‘pools’ to increase buying power is a model that India should consider emulating. Customers today demand different product benefits according to their needs and lifestyles. Spending on healthcare in India is expected to double (and touch `2,250 billion) by 2014. We believe that in the next five years, health insurance is expected to be the biggest contributor in the non-life segment, as the awareness levels are fast increasing. One size no more fits all and to keep pace with the changing consumer behaviour and demographics, we have many products in the pipeline that will bring flexibility to our product portfolio. august / 2012 www.ehealthonline.org
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Specialty
Smile
Artists
Technology as advancements in the field of dentistry have aided the development of dental fixtures with no pain and easier surgical techniques
By Shally Makin, Elets News Network (ENN)
S
mile makeover is a rage these days among the youngsters. Despite the cost and inconvenience as most cosmetic procedures are not covered by dental insurance. The early composite resins tended to stain, chip and change color over time and thus was a serious drawback. New composite resins are much better. Porcelain veneers cover the entire front of the tooth. Computer imaging, another useful technique, allows dentists to create ‘virtual restorations’ on a computer screen. The most popular cosmetic dental procedures include bonding front teeth, whitening the teeth and using tooth-colored fillings, which blend with the natural color of teeth. Dental adhesives also have improved. Cosmetic dentistry can improve one’s self image, particularly if the teeth are damaged or discolored. Even simple procedures such as bleaching or bonding can be real confidenceboosters. Smartphones and iPhone allows scheduling of appointments. Laser technology has a range of benefits, including improved healing, reduced risk of infection, improved accuracy, reduced pain and reduced treatment time. Diagnodent is a new dental instrument, which enables dentists to detect early signs of decay.
Technology at the Forefront Dr Sameer Sachdev, Cosmetic Dentist, Dr Sachdev’s Dental Clinic believes, “In our field constant upgradation with technology is the key to success. With the help of technology, we are able to
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help the patients better. They get better, efficient and more effective treatment.” Nanodentistry is a branch of dentistry that employs nanotechnology for precise and better results along with maintenance of oral health by use of nanomaterials, nanorobotics and nanomedicine. Nucalm is a revolutionary new treatment, which has been developed to help patients with dental anxiety or dental phobia. Nucalm treatment involves chewing on tablets, which are designed to counteract the effects of the release of adrenaline, which often causes a rush of excitement and anxiety. The final stage involves the patient wearing black out glasses and earphones.
Cerec is a technology, which enables dentists to design and fabricate dental restorations on site. Cerec can be used to produce new onlays, inlays, crowns and veneers by using digital camera images; then be converted into a computerised 3D model of the tooth. Many people may not realise that CT scanners are also used in modern dentistry. Digital X-rays are relatively new but an increasing number of dentists are switching to digital machines, as they have a range of benefits. The images can then be stored on the computer, which will reduce the amount of paper used by dentists and waiting time. iTero is a scanner, which produces exact replica images of the
Specialty
Gautam Khanna Executive Director, Healthcare Business, 3M India
Technology developed at the leading universities and companies of the world now enable digital replication of the oral cavity, rendering hi-end imagery and data capture to create a virtual model of your teeth. These virtual models can then be used by sophisticated laser and CAD/CAM milling systems to create perfectly fitting teeth. An example of one such material is Zirconia, that came to being used in dental a couple of decades ago and is not fast replacing age old materials like porcelain fused to metal (PFM) due to its benefits. Lava Zirconia from 3M offers sophisticated state of the art digital crown and bridge solutions for your teeth. Ugly margins at your teeth, ill fitting crowns, and fragile teeth are a thing of the past due to this technology wave overtaking dentists. Now it’s possible for your dentist to have digital images of your teeth in relation to your facial bone structure through Cone Beam CT imaging, helping you get a perfectly positioned implant and designing lasting prosthesis for your tooth.
“Laser-assisted procedures allow for minimally invasive dental treatment”
Dr Manisha Soni Consultant Periodontist & Dental Surgeon, Kokilaben Dhirubhai Ambani Hospital
Laser dentistry was developed to specifically repair decayed and damaged teeth as well as treat gums and other soft tissues. Laser dentistry uses a patented technology that combines laser energy and a gentle spray of water to perform a wide range of dental procedures. It is less traumatic to teeth and gums than conventional treatment modalities with the drill and scalpel. Dental lasers are usually divided into hard and soft-tissue lasers. Soft-tissue lasers such as diode lasers can be used for periodontal treatment and oral surgery. The diode laser is a cheaper technology and is in the affordable range, but is limited to applications on soft tissues such as gums; also as it uses a dry technique, if not used carefully can lead to charring of tissues. Laserassisted procedures allow minimally
invasive dental treatment that offers many benefits to the patients, such as less pain, minimal bleeding, reduced need for stitches and faster healing. Laser dentistry is the safest option for patients with concomitant medical conditions that require blood thinners (anticoagulants), including heart disease and stroke. In conventional treatment the risk of bleeding in cardiac patients on anticoagulant medication is very high; this is eliminated in a laser-assisted treatment as it establishes blood clotting and prevents bleeding. Lasers are a huge practice differentiator in dentistry. Thus, lasers make it a win-win situation for the dentist, patient and the profession. The Indian Academy of Laser Dentistry is trying to promote and build awareness about laser technology in India.
Evaluation of resorbable membrane in treatment of human gingival isolated buccal recession is the ongoing research. Gingival recession in its localised or generalised form is an undesirable condition, which results in root exposure. The necessary improvement and standardisation are the things to be taken care of.
Dr Sameer Sachdev Cosmetic Dentist, Dr Sachdev’s Dental Clinic
august / 2012 www.ehealthonline.org
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mouth in a matter of seconds. Dr Latika Dhawan, Consultant Orthodontic Department, Skin and Smile, says, “Ceramic veneers made primarily from high quality, very aesthetic eMax ceramic allow the dentist to change the teeth colour, shape and position to some extent. Ceramic braces are a good amalgamation of looks and good function.” She adds, “Lingual orthodontics or invisible braces are placed on the inner side of the teeth and are completely invisible. Invisalign, as its name suggests is another near invisible appliance to move teeth.” Velscope is an instrument, which enables dentists to check for early signs of
Dentistry is a lot to do with ‘smile designing’. Ceramic has a lot to contribute in the field of dentistry. From veeners to braces, ceramic has proved it all.
Dr Latika Dhawan Consultant Orthodontic Department, Skin and Smile
oral cancer. The instrument projects a blue light into the mouth. The light causes the tissue to fluorescence and healthy tissue usually gives out a bright green
glow, while unhealthy or abnormal tissue gives a much duller, darker glow. With X-ray equipments now becoming commonplace and CT and 3D imaging scanners being quickly accepted as daily dental practice tools, it will not be long before dentists go the digital way, using new technology. Technology now makes it possible to view before-andafter images of teeth before the work even begins. The industry is also looking at innovative technologies such as DVD glasses to help ease any dental anxieties patients. Most dentists are slowly but surely getting accustomed with this change enveloping.
Evidence Based Dental Practices
Dr Ashok Dhoble, Hony. Secretary General, Indian Dental Association
The past decade and a half has seen sweeping changes in dental technology, product and materials, in particular technical procedures that are of great clinical relevance to dentists. While the changes affect all specialisations of dentistry, there is growing interest in implants and cosmetic dentistry. Lasers, Cone-Beam Computed Tomography (CBCT), a new medical imaging technique that generates 3-D images of teeth, roots, jaw and even the skull as
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compared with conventional computed tomography (CT), stem cell technology, invisalign or invisible braces, air abrasion, CAD/CAM technology. The use of ozone in dentistry is gaining its place in every day’s dental practice and is used in almost all dental applications. The dentists are able to follow evidence based dental practice integrating the best available evidence with clinical experience and patient preference. CAD/CAM technologies to produce different types of dental restorations, including crowns, veneers, inlays and onlays, fixed bridges, dental implant restorations and orthodontic appliances are in use today. CAD/CAM-fabricated crowns and bridges are unbreakable and less expensive than traditional ones, besides being a fast process.
Research in the technological aspect of dentistry Constant research into ways of improving oral health that leads to new technology, and new ways of treatment. The aim is to improve the quality of dental care provided in India. Stem cell research and lasers fall in this category of constant research. While global research leads the way, IDA has also set
up a research foundation to promote strategic research initiative and to develop a strong infrastructure for research and to apply scientific knowledge to aid patients. IDA has been hosting World Dental Show for the past four years as its annual activity to pave the way for collaborative endeavors and investment to make the latest technologies to penetrate the expanding market in India promoting employment and income and making global brands available locally. Apart from these, in its crusade against oral cancer, IDA has established Oral Cancer Foundation for early detection and treatment of the dreaded disease with the help of SPOT Centres (Spot and Prevent Oral Cancer Trauma). An Oral Cancer Registry exclusively to register case of oral cancer has also been launched. Tobacco Intervention Initiative (TII) Centres help tobacco de-addiction and dental surgeons are setting up these centres across the country. The SPOT and TII Centres are IDA’s contribution to oral healthcare management. Child Dental Centre to prevent dental caries among children and Emergency Dental Centres to make dental care available 24 x 7 are notable contributions by IDA.
featured product
Intraoral camera
Changing trends in Dental Imagery Dental Imagery technology is poised to be one of the most common and cost effective technology applications for a dental surgeon. New age intraoral cameras are powered with highest quality of imaging power and ehealth solutions that make it easy to share and print anytime anywhere
I
t was in 1980s that the field of dentistry saw its first intra-oral camera being launched and used by dentists; they were primarily a miniature video camera inserted in the mouth to take sharp, close-up images or videos of teeth and mouth. Today powered with many add-on features for image quality, flexibility and image sharing and storage, these have become an essential for better diagnosis and documentation of cases by dental practitioners. An advantage over traditional dental X-rays is that these cameras are connected to a computer that provides immediate, accurate feedback and real-time images. Also, whereas the conventional imaging methods are often bulky and obtrusive, digital intraoral cameras are lightweight, compact, and have flexible design to increase maneuverability for the doctors.
Resolution revolution The intraoral camera promises the highest image quality in its class at an affordable price and is easy to integrate into existing workflows. With resolution power of image resolution of 1024 x 768, the latest range of these cameras can capture crisp, clear images that reveals even the smallest cracks, caries and other anomalies. In addition features such as 6-LED illumination system automatically adjusts to ensure perfectly and uniformly lit images in any lighting condition, and the camera’s wide focus range
captures a variety of images including macro, single teeth, arches and smiles. “Dental professionals want to obtain the highest quality images for optimal diagnosis, treatment planning, patient communication and case documentation,” said Edward Shellard, D.M.D., Chief Marketing Officer, Director, Business Development, Carestream Health.
Storage and Sharing Designed with convenience and flexibility in mind, the new designs of intra-oral cameras come with features of USB 2.0 high speed connection, enabling easy sharing between operatories. Packed with all the advanced features and high image quality, the product is also has a fully TWAIN-compliant camera, wherein images can be stored and archived in Carestream Dental’s Imaging Software, as well as other leading imaging software. “The
CS 1200’s unique ability to store up to 300 images within the camera, it thus streamlines practice workflow with no memory cards or extra storage devices required,” said Pinkesh Garg, General Manager, Carestream Dental India. The new designs launched include options of wired and wireless connectivity for convenience of the doctors. As the adoption and use of these cameras increase across India, the prices will witness a sharp dip ushering for more dental practioners to use this technology. The future of dental imagery promises to witness what probably the mobile industry witnessed – smaller, more powerful and easy to share images on cameras. When planning to buy one, dentists should initially evaluate cameras that can give them the best combination of image quality, ease of use and portability to find the best system for their practice. august / 2012 www.ehealthonline.org
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hardware
Mark the
Impression Even though modern healthcare has notched great heights in offering efficient services to all, the need of documentation is not fading away soon and hence choosing the right medical printers and scanners is crucial. A closer look. By Sharmila Das, Elets News Network (ENN)
T
he healthcare sector has traveled to a point where the need of proper documentation increased manifold. Although the arrival of digital medium like Electronic Medical Record (EMR) has made the task much easier yet the traditional method has not faded away. The modern day practitioners still need different kinds of printers and scanners in their day to day operation. The reality is that medical practices manage an enormous number of paper documents in the office in the form of referral requests, consultation reports, his-
torical patient data, diagnostic reports, and reports from third parties. After the documentation, this information has to make its way efficiently into the EMR and documents generated by the EMR such as prescriptions and handouts have to be provided to patients, medical colleagues, and a multitude of additional individuals. Thus, the need to have good printers and scanners in a medical infrastructure to manage the documents is extremely important. When talking about document scan-
Rajeev Tewari
Director & Divisional Head, Consumer Systems Products Group, Canon India
“IT deployment has gained paramount importance in the Indian healthcare delivery segment. It’s being implemented of the hospitals, ranging from billing and finance to administration and even patient care� 60
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ning management needs, documents can be divided into two distinct categories based on the need. • Documents that need to be stored and archived for historical purposes. For instance, the treatment history of a patient including all the report charts. • Documents generated on a day-today basis in the management of patient care and in the other management functions. Each of these document categories has different scanning requirements. A host number of small footprint scanners are available in the market to manage day-to-day scanning of documents in a hospital infrastructure.
What to choose? Greater print efficiency and wireless capability are some of the most important considerations when choosing a printer for medical infrastructure. Small footprint printers that can easily be installed in an examination room are desirable if practitioners would like to print and hand information to a patient without disturbing the clinical encounter. Also, if one needs to walk out of the examination room to collect every document that is printed, can be very unruly to patient care. Again there is higher ongoing maintenance cost with an inkjet printer than the same laser printer. It may be cost-effective to have a number of multifunction printer/scanners in the clinic/hospital premises wirelessly connected to a network. Also if the hospital management is dependent on a single multifunction printer/scanner and the device fails, one will lose all the devices at the same time. It is best to keep a spare in reserve in case of emergencies. Rajeev Tewari, Director and Divisional Head, Consumer Systems Products (CSP) Group, Canon India, says, “IT deployment has gained paramount importance in the Indian healthcare delivery segment. It’s being implemented in various departments of the hospitals, ranging from billing and finance to administration and even patient care, thereby simplifying the operations to a great extent. These days hospitals are in-
Jasmeet Singh
CEO, Portronics Digital
creasingly using printers and scanners for archiving databank and document printing. This saves time and ensures error free documents and investigation reports. Printers offer high quality color prints, color prints are being used for medical reports, investigations etc and also help in clear understanding of the symptoms etc”.
Criteria to Choose a Printer/ Scanner Jasmeet Singh, CEO, Portronics Digital says, “Brand name, servicing capabilities of the company, pricing and delivery schedules are the major cri-
Greater print efficiency and wireless capability are some of the most important considerations when choosing a printer for medical infrastructure
“The scanners and printers vary as per requirements. They could have a very basic requirement of document printing and scanning. They could have special requirements of Ultrasound scanners and other technical ones also”
teria hospitals follow for the purchase. The scanners and printers vary as per requirements. They could have a very basic requirement of document printing and scanning; in that case they buy some basic scanners and printers or all in ones. They could have special requirements of Ultrasound scanners and other technical ones also”. Hemant Rai, Kyocera Mita says, “Hospitals use body scanning equipment, X-rays, Ultra sound, MRI scanning etc. The printer is used to print the output of these scanned file from above devices. Depending on work load and usage of division - Finance, Purchase, HR, Logistics etc like any other organization the printer/MFP is used”. Tewari adds, “The requirement for a printer or scanner depends on the hospital’s operational need and infrastructure. It also on the type of healthcare centre i.e. whether it is a full-fledged hospital or just a path lab or diagnostic centre. For instance a multi facility hospital would require large format printers and multifunction devices to carry out various tasks at one time whereas a small path lab or a diagnostic centre may need a small printers and scanners for their official use”. To conclude, it would be safe to say that depending on the usages one should go for installing printers and scanners so that ultimately the objective does not go haywire. august / 2012 www.ehealthonline.org
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News Review
Philips Healthcare and
Rotary Club of
Coimbatore Launch ‘Save a Life’
R
otary club of Coimbatore and Philips Healthcare have launched ‘Save a Life’ project under which 10 Philips Automated External Defibrillator or AED devices will be installed across the city at public places. It is estimated that in India the annual incidence of Sudden Cardiac Arrest (SCA) is 0.55 per 1000 population, i.e. over 600,000 arrests takes place per year in India. During SCA, the electrical system of the heart becomes chaotic causing the victim to collapse and stop breathing. Sadly, survival rate from sudden cardiac arrest is less than one percent, because medical services cannot reach the victims in time. But by providing assistance at the earliest possible moment through Cardio Pulmonary Resuscitation (CPR) and defibrillation using an AED, the victim has the best opportunity of survival and virtually anyone can save a life. AEDs can be used by common bystanders without prior medical knowledge, by simply following the voice instructions provided by the device. Dr Balavenkatasubramanian from Coimbatore is the man behind the mission. During the launch Dr Balavenkat disclosed that a doctor colleague died of sudden cardiac arrest a few months ago in Coimbatore. It was then that he pledged to do his part in making life-saving AEDs more accessible to common man. “My colleague’s life could have been saved if a shock had been delivered in time”,he said. Dr Balavenkat approached Rotary Club of Coimbatore with the idea and received immediate support for the noble initiative from the Club’s district President Rtn. PHF.K.S. Balakrishnan.
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Speaking on the occasion Jitesh Mathur, Senior Director, Philips Healthcare, said that a cardiac arrest victim requires immediate medical attention in less than 10 minutes. In India, though the situation is improving by each day, reaching a hospital or getting an appropriately equipped ambulance within 10 minutes is still a distant dream. This makes access to emergency devices such as AEDs in public places very critical. Onlookers need not feel helpless; rather they can feel empowered to save a life with the help of AED technology available nearby in case of an SCA. With over 800,000 automated external defibrillators installed worldwide, Philips is the leader in public access defibrillation. Philips HeartStart defibrillators are used by over 140 airports and 75 airlines worldwide, numerous communities and companies in various segments (such as manufactur-
ing, retail, finance, transportation, and hospitality). Philips has also recently launched the website www.savelives. net in India as a part of its corporate social responsibility initiative to spread awareness on the issue. An AED is a portable electronic device that automatically diagnoses the potentially life threatening cardiac rhythm disturbances in a patient. If a shock is required the device delivers it (called defibrillation), which allows the heart to regain normal rhythm. When turned on, the audio instructions, clearly spoken by the machine, coach the user through the process. The device is small and rugged and can be easily carried to the place of requirement. Along with the use of the AED, CPR is required. This is an easily acquired skill, which can be effectively imparted to any lay person within a few hours by a certified trainer.
4th Healthcare Technology Resource Guide 2012
october 2012
Healthcare ICT | Medical Equipment eHEALTH is pleased to release the fourth edition of the Healthcare Technology Resource Guide, a unique compilation of the leading technology providers catering to the Indian healthcare sector.
Segments • Profiles of leading healthcare ICT and medical equipment vendors • Vendor listing with contact details of technology and solution providers in both segments • Product matrix with product-wise mapping of companies
Highlights • One year shelf life • Wider reach among key decision makers • Strong brand presence and strategic positioning • Complimentary product profiling with matching page space Maximum return on investment
For Free Listing, Visit www.ehealthonline.org To Participate, Contact Divya Chawla; divya@elets.in; +91-8860651643
news
Early Detection of Breast Cancer Saves Life
Statistics says nearly 115,000 new cases of breast cancer were detected on an annual basis in 2011. This number is expected to go up to 250,000 by 2015. While the statistics are alarming, this dismal situation can certainly be improved by increased awareness about breast cancer. With this
thought in mind, in October 2011, Siemens globally launched the “Turn your City Pink Campaign”. (Pink is the international color of breast cancer awareness). The new campaign is a step toward informing the public about the disease and the importance of early detection. In India too, they
Teleradiology Solutions Launches New Clinical Trial Imaging Core Lab Teleradiology Solutions has entered the Clinical Trials Imaging Market with the launch of its niche unit- Image Core Lab (ICL). The new entity has been formed recognising that medical imaging now plays an increasing role in the development of new therapeutics, either as a surrogate endpoint or an endpoint in its own right. ICL is positioned to assist sponsors and Contract Research Organisation’s (CRO) in the clinical trial arena where medical images are involved. Ankita Puri, Head of New Business Development for ICL says “The regulatory issues to standardise the data and to remove bias from site evaluation have also led to the strong need for centralised labs such as ICL. We are confident that ICL will provide a highvalue service to the Pharma, Biotech and CRO industries and give them significant impetus in the imaging component of their drug development activities. The forthcoming workshop will serve to increase awareness of the role imaging plays today in Clinical trials”
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organised this campaign for their women employees. Now, they are using the IndoGerman Urban Mela platform to create awareness and garner support to fight Breast Cancer in Bengaluru. Besides raising awareness, Siemens Healthcare’s portfolio of innovative breast care solutions allow early detection, precise diagnosis and targeted treatment and follow-up care of this disease. Their innovations make screening and diagnosis more reliable, efficient and comfortable enabling early and therefore more effective therapeutic intervention. Siemens’ latest MAMMOMAT Inspiration mammography system comes with improved image quality and more efficiency. It allows stereotactic biopsy, which helps avoid unnecessary surgical biopsies. Siemens introduced the elastography technology and Automated Breast Volume Scanning (ABVS), which have changed the way ultrasound was viewed in the past. With these technologies, it is possible to avoid unnecessary biopsies thus reducing trauma among the patient and also allowing early diagnosis.
Vodafone Launches Ask a Doctor Health@5: An Online Platform With the objective of bringing patients closer to doctors, Vodafone has launched Ask a Doctor - Health@5, a WAP health portal in India. With this launch, Vodafone subscribers can ask health related queries for Rs. 5 per day. The panel of medical professionals will get back to the subscriber with the answer within 24 hours. Ask a Doctor - Health@5 doesn’t only allow the subscribers to ask questions, but one can also browse through information on disease management, myths, trivia, general remedies, latest updates, diet and fitness information. According to Vodafone India company spokesperson, “mHealth is one of the key focus areas of Vodafone Group and the teams are doing a whole host of services across other countries. This is our first step towards mHealth in India and we are optimistic with the response in first few days of launch”.
Healthcare as VAS service A mobile device can enable doctors with effective technology driven solutions so that basic healthcare could be managed through remote locations. The service works in two ways - one to educate consumer and make people aware on basics of health management such as
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Fortis Healthcare and GE Healthcare Innovations Elevate Indian ICUs to Digital Age Fortis Healthcare and GE Healthcare have announced the launch of Asia’s first electronic Intensive Care Unit (eICU) facility, called CritiNext. The eICU services being offered by CritiNext makes specialty critical care accessible and affordable to critically ill patients in small towns of India. The CritiNext e-ICU is powered by GE’s Centricity High Acuity Care Solutions and operationalised by critical care experts from Fortis Healthcare. CritiNext is live and operational, covering 34 ICU beds in two small hospitals based in Raipur and Dehradun. Commenting on the launch Aditya Vij, CEO, Fortis Healthcare Ltd said, “We are pleased to be the first healthcare institution in India and Asia to offer valuable life-saving eICU services. The brilliance is not in the technology alone, but the fact that we can use the technology to help physicians practice evidence based medicine. In a couple of years, we believe that this will be the accepted standard of care for patients in India and help to save more lives.” The CritiNext eICU enables a remote hospital to provide advanced consultation, care and monitoring to their critical-
Dr Amit Varma, Executive Director CritiNext, Fortis Group of Hospitals, Terri Bresenham, President & CEO, GE Healthcare South Asia, Aditya Vij, CEO, Fortis Healthcare
ly ill patients without having to physically transfer them to super-speciality hospitals. Transporting a critically ill patient from one facility to another, especially a distant hospital, can be risky. Patients are at the risk of clinical deterioration that may lead to adverse events including threat to life, due to the stress caused by transportation. However, CritiNext eICU helps provide expert care to the patient at the local hospital helping avoid interhospital transfer and risks. ICU care at
diet, fitness, nutrition, disease management and second to enable them to ask any query to a Doctor. Vodafone India spokesperson says, “We wanted to experiment mHealth in a completely different way for users who understand technology and its applications better. We decided to choose DATA (WAP) for our mHealth experimentation and we are very happy to see initial traction. Services on other bearers like SMS, Voice etc. are in the pipeline and we should be launching the same in the coming months”.
local hospital allows patient get better support from family as well as help reduce costs by shortening the stay in ICU. CritiNext addresses the shortage of critical care staff in remote areas and enables physicians in remote units to manage ICUs more efficiently. Remote ICU Monitoring Technology combined with expert set of eyes can help reduce medical errors and infection within ICUs leading to reduction in patient mortality by up to 60 percent.
groups on this medium are more mature and tuned to new age services/technology like apps, browsing, blogging etc. Doctor-Patient connect is an interesting feature of the service which enables user to directly ask a question to our panel of Doctors and the team answers a query within 24 hours.
Advantages of a WAP platform for mHealth Service providers have experimented with mhealth delivery on Voice and SMS. Services range from content dissemination in form of education/awareness to live interaction with Doctor. Overall there have been positive and negative responses for the concept. Mobile data is an evolving medium and the user
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Trivitron Healthcare Won Best Employer Branding Award Trivitron’s key focus areas are Imaging Sciences, Laboratory Medicine and Cardiology (equipment and devices) and will be looking forward to futuristic areas including Ophthalmology, Dental and Critical Care & OR, boasting of Industry’s one of the most comprehensive product offerings in both Value and Premium segments. With the stated goal of bringing high quality, cost effective medical technology solutions to emerging markets around the world, Trivitron is currently present in Sri Lanka, the Middle East, South Africa and are expanding our presence in South Asia, South East Asia and Africa. Trivitron Healthcare has been awarded with Asia’s Best Employer Branding Award for Innovation in Retention Strategy endorsed by Asian Confederation of Business. Global employer branding leader, Universum, announced this new addition to their annual Universum Awards events which was held in Singapore on July 19th 2012 in conjunction with partner World HRD Congress & Employer Branding Institute. Moreover, the company Founder and Managing Director Dr. G.S.K Velu, has been awarded with Entrepreneur of the Year (Manufacturing) 2012 by Franchise India at New Delhi on the 18th of May 2012.
FDI in Pharma Takes a Final Shape The final decision of allowing FDI in Indian pharmaceutical industry has taken a shape. An inter-ministerial group on foreign direct investment (FDI) in pharmaceuticals has decided that investments resulting in an equity holding higher than 49 percent in an Indian pharma company will have to apply for the approval of the Foreign Investment Promotion Board (FIPB), a part of the ministry of finance. Investments resulting in an equity holding lower than 49 percent as well as those made in subsidiaries will not need approval and will go through what is called the automatic route. The group has also decided that a multinational firm buying a stake higher than 49 percent in an Indian pharma company will maintain the same level of investment in research activities and production of essential medicines for five years. A finance ministry official, who spoke
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on condition of anonymity, said a consensus had been reached on the contentious issue. The ministries of health and commerce were earlier in favour of routing all proposals for foreign investment in Indian pharma companies through FIPB, while the finance ministry insisted that FIPB should only scrutinise proposals for investment that would result in an equity holding above 49 percent. The decision will adversely affect FDI, said Ranjit Shahani, president of the Organisation of Pharmaceutical Producers of India, the lobby group representing multinational firms. “In a climate where India is already FDI-starved, any policy which restricts freedom of trade and investment will further restrict capital flows. This will not only have a chilling effect on FDI flows to the pharma industry, but will also have a serious knock-on effect in other industries—particularly since it is a reversal of policy liberaliza-
tion which took place only 10 years ago. Today, when the world is looking at India to kick-start the economy following changes at the Centre, this certainly is a retrograde step,” he added.
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