eHEALTH August 2015

ASIA’S PREMIER MONTHLY MAGAZINE ON ICT IN EDUCATION Volume 10

Issue 8

August 2015

PRESIDENT: Dr M P Narayanan EDITOR-IN-CHIEF: Dr Ravi Gupta EDITORIAL TEAM HEALTH Senior Assistant Editor: Garima Pant Senior Correspondent: Anshuman Ojha Correspondent: Romiya Das EDUCATION Senior Assistant Editor: Garima Pant Assistant Editor: Bhawna Satsangi GOVRNANCE Senior Assistant Editor: Nirmal Anshu Ranjan Assistant Editor: Kartik Sharma, Rachita Jha Senior Correspondent: Souvik Goswami, Gautam Debroy Correspondent: Poulami Chakraborty Junior Correspondent: Sneha Mejari Trainee Sub-Editor: Akanki Sharma SALES & MARKETING TEAM: eHealth Deputy General Manager: Siddharth Varma, Mobile: +91-8860651646 Assistant General Manager: Ragini Shrivastava, Mobile: +91-8860651650 National Sales Manager: Fahim Haq, Mobile: +91-8860651632 Project Manager: Seema Gupta, Mobile: +91-8860651643 SUBSCRIPTION & CIRCULATION TEAM Manager Subscriptions: +91-8860635832; subscription@elets.in DESIGN TEAM Creative Head: Pramod Gupta Deputy Art Director: Om Prakash Thakur, Gopal Thakur Senior Web Designer: Shyam Kishore WEB DEVELOPMENT & IT INFRASTRUCTURE Team Lead-Web Development: Ishvinder Singh Senior Executive ­– IT: Zuber Ahmed Executive – Information Management: Khabirul Islam

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Contents

AUGUST 2015 | VOLUME - 10 | ISSUE - 08

Cover Story - Patient Monitoring Equipment

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Technological Advances Offer Unprecedented Opportunity 18

Commitment to Innovation and Precision of Parameters – Anil Srivastava, National Sales Manager, Medical Equipment, Nihon Kohden India

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Building A Better Connected World – Dr Aparna Jaswal, Senior Consultant, Department of Cardiac Pacing and Electrophysiology, Fortis Escorts Heart Institute C

M

Y

Focus - Health IT Hospital Information System: In a Take-off Stage

CM

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An Evolving Space – Sanjeev Gupta, Managing Director, Accenture, India

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Emerging Trends in Healthcare – Dr Rajat Goel, HOD, Bariatric Surgery, Primus Super-Speciality Hospital

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Technology in Healthcare – Shipra Dawar, Founder and CEO, ePsyClinic

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Moving Towards - E-consultancy – Dr Sudeep Jain, Director, Spine Solutions India

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Technological Advancement in Healthcare – G Radhakrishnan Pillai, CIO, SRL Diagnostics

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MY

CY

CMY

K

Moving UP!

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Chennai 044-42125263

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Learn about Agfa HealthCare at www.agfahealthcare.com AUGUST / 2015 ehealth.eletsonline.com

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Feature - In Vitro Fertilization Hope for Life 32

Affordable IVF for All – Dr Shobha Gupta, Medical Director and IVF Specialist, Mother’s Lap IVF Centre

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IVF – A long Way to Go – Dr Indira Hinduja, Honorary Gynaecologist, PD Hinduja Hospital & Medical Research Centre

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IVF Going Footprints – Dr Kaberi Banerjee, Medical Director, Advanced Fertility and Gynecology Centre

Event Report Healthcare Summit Rajasthan

NEWS

PRODUCT LAUNCH

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Samsung Launches Premium Ultrasound Imaging System, RS80A with Prestige

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D-dimer: Empowering Laboratories

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56 57 58 60 62 66

International News Company News Government Desk Hospital News Healthcare Start-up Pharma Buzz

editorial

Public Private Partnership – The way Forward Accessibility and quality of healthcare remains a growing challenge for the country.

While the need has been to initiate a slew of measures to bridge the gap between healthcare service delivery and the right recipients, initiatives pushing for this service delivery still remain a challenge.

In a bold bid to overcome this growing disparity, Rajasthan government had announced under Chief Minister Vasundhara Raje, its intention to outsource public health services to private entities recently through Public-Private-Partnership (PPP) in rural areas, benefitting a population of 70 million. Drawing criticism from across quarters, Raje had acclaimed that PPP was the only way forward to put life back into the healthcare sector in the state.

Rajasthan Government is inviting tenders to outsource 90 public healthcare centres in rural areas under PPP mode. At present , the state government spends `32 lakh per annum on each Primary Health Centres (PHCs) in Rajasthan and the contracts will be awarded to those who bid to operate PHCs below `32 32 lakh.

Deciding the rules of the game, while the state government will provide the necessary infrastructure, medicines, equipment, and operational costs, the private sector will hire staff and manage the government’s PHCs, and special centres.

While it may seem as shirking of the responsibility of the state by some, another way of looking at it would also include taking the lead in making corrective measures to improve the basic healthcare facilities in the state.

The need to improve primary healthcare has been the driving factor across the country to initiate a slew of measures. If the Rajasthan model succeeds, it will prove to be a benchmark and a role model for the other states to follow.

Rajasthan has been taking efforts to improve its healthcare facilities using technology for reaching healthcare to both urban and rural masses. With a view to deliberate on the healthcare innovations in the State and chalking out the future roadmap of healthcare services there, and elsewhere, Elets Technomedia, in association with the National Health Mission, Rajasthan organised the Healthcare Summit Rajasthan 2015. Thus, the State has shown the way at one end to succeed in using technology to change the health paradigm in the state. It remains to be seen if the PPP model can actually infuse a new life into the PHC’s in the state.

Dr Ravi Gupta ravi.gupta@elets.in

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Patient Monitoring Equipment

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Cover Story

Technological Advances Offer Unprecedented Opportunity The patient monitoring equipment market is shifting focus towards clinical benefits with the buyers haveing realised the value of investing in clinical decision support tools, helping them in saving lives, writes Anshuman Ojha of Elets News Network (ENN)

R

reach at US$ 21 billion by 2018, with a five-year compound ecent advancements in technology has annual growth rate (CAGR) of 7.4 per cent. The North developed a number of new aspects of clinical America segment, by far the largest patient monitoring monitoring. With a growing ageing population equipment market, is expected to grow to US$ 9.1 billion and the prevalence of chronic diseases across by 2018, and register a CAGR of 7.1 per cent. the world, there is an urgent need to find new ways With growing demand from emerging economies of the to improve patient outcomes, increase access to care, world, the market is expected to witness a shift towards and reduce the cost of medical care. Advancements in developing nations. The Asian market, the fastest growing sensor technology, the ubiquitous availability of cellular regional segment overall, is growing at a significant 8.9 technology, and falling costs of embedded communication per cent CAGR. However, Asia, which was valued at US$ devices are opening up new channels for improving patient 2.7 billion in 2013, is expected to jump to US$ 4.2 billion by care and quality of life. Using seamless, continuous patient 2018, outperforming all other regions. Philips Healthcare, health monitoring, healthcare providers, insurance GE Healthcare, Nihon Kohden, payers, and the government are Increased private sector Mindray are some of the major looking to significantly alter how care is provided to patients, while investments and expansion players catering the market of patient monitors. reducing cost of care at the same plans by corporate hospitals In 2013, Philips Healthcare time. led the US, Europe, and Asiaare leading to growth of the Pacific patient monitoring market Market Dynamics patient monitoring equipment with total global market shares The global patient monitoring market in India between 16 per cent and 22 equipment market is expected to

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Patient Monitoring Equipment

per cent worldwide. In addition, the company was the global leader in the multi-parameter vital sign monitoring market with shares between 17 per cent and 42 per cent, according to a report published by iData Research.

Updated pacemakers, implantable cardioverter defibrillators (ICDs), multi-parameter vital sign monitors, electroencephalograms (EEG), electromyograms (EMG), cerebral oximeters and pulse oximetry, hemodynamic monitors are growing in use. The pulse oximetrymonitoring market alone is expected to exceed US$ 1 billion by 2020, according to a new report by iData Research. In addition, new products with smartphone integration and Bluetooth capabilities will further drive sales.

Remote Patient Monitoring: According to Kalorama Information, the global advanced patient monitoring market is currently worth about US$31.4 billion, inclusive of devices, peripherals, software, packaged services and other applications.

Advanced patient monitoring market has benefited from the demand to move to a more wireless and streamlined operation both within major health facilities and in the home treatment markets.

These monitoring systems are focused on utilising the technologies recently introduced to the healthcare field.

Advances in remote

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ADVANTAGES OF REMOTE PATIENT MONITORING For Patients • Improved health outcomes and quality of life • Real-time support and interventions • Extension of care at home after discharge, helping to prevent emergencies and readmissions • Reduced hospital stays For Care Providers • Support the extension of clinical environments into a patient’s home post-discharge through remote monitoring • Access to increased frequency of patient health data • Ability to continue monitoring patient health, regardless of patient’s location, even when not at home • Support an increased level of accuracy for clinical monitoring readings, particularly readings that would otherwise be provided by the patient themselves • Increase the level of trust and reliance that physicians place in data. This is particularly important when there are a few outlying readings, which may potentially indicate an underlying problem, but which might be attributed to errors in measurement • Reduced costs from readmissions and reduced hospital stays

Patient Monitoring Equipment

Draegar Advt

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Patient Monitoring Equipment

patient monitoring include: new peripherals; real-time audio and video for “face-to-face” interaction between clinicians and patients; wireless communication systems that “sort” the vast amount of data collected in order to put it into the context of a patient’s condition; portable and ambulatory monitors; web-based access to the patient record; systems that transfer data to an electronic medical record (EMR); and full-service outsourcing that includes a clinician to evaluate data and send a report to the attending physician.

The global advanced patient monitoring market has continued its expansion in both the institutional and home segments of the health market with the United States and many European countries at the forefront of implementation. The advanced patient monitoring market includes products in the following segments: blood management and function monitors, cardiac event and function monitors, neurological event monitors, respiratory function monitors, and other advanced monitors.

Over the past few years, the number of cases of chronic diseases such as cardiovascular disease, diabetes and chronic respiratory diseases has increased, due to the growing population in developing nations. According to the World Diabetes Foundation, 80 per cent of the diabetic population is expected to come from low and middle income countries by 2025.

Emerging economies such as India and China, with huge patient bases and an under-served market, are expected to act as potentially lucrative markets for

The global medical device connectivity market will be worth US$ 33.5 billion by 2019 remote patient monitoring equipment. An analysis from Transparency Market Research expects the global medical device connectivity market - wired hardware plus wireless hardware and software - will be worth US$ 33.5 billion by 2019. Though wired hardware accounts for 40 per cent of the market, wireless technology continues to grow as healthcare providers add Wi-Fi, Bluetooth and wireless medical telemetry services.

Wireless technology has a wide range of applications in remote patient monitoring. Remote monitoring enables a patient to undergo hospital visits of reduced length, and have constant monitoring at home. This not only improves the quality of life for elderly and chronically ill patients, but also leads to a significant reduction in healthcare expenditure. Wireless remote patient monitoring can also provide continuous and real time data to physicians from remote locations such as the home, hospice, ambulance, or other outpatient settings, thereby offering the advantage of convenience to both physicians and patients, while hospitalisation costs are massively reduced.

Indian Scenario

Indian patient monitoring equipment market is highly influenced by the economical status and technology advancement. The products range is highly segmented based on technology and price range.

Government has spent little on national healthcare, but increasing private-sector investments are resulting in more and better hospitals and clinics, with major hospital groups such as Fortis Healthcare and Apollo Hospitals announcing expansion plans in India. The addition of new medical facilities provides significant opportunities for growth in the patient monitoring equipment market in India, which is expected to grow from a value of US$ 85 million in 2012 to US$ 134 million 2019, at a CAGR of 7 per cent, according to a study by GBI Research.

The market for patient monitoring equipment in India is highly concentrated, with the four leading competitors

GROWTH DRIVERS • Decrease in the physical size of monitoring equipment • Enhanced utility, performance and sensitivity • Usability and portability of devices • Increasing availability of remote/wireless patient monitoring equipment and systems

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Patient Monitoring Equipment

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Patient Monitoring Equipment

a contact thermometer that controlling over 75 percent The global patient monitoring measures temperature, an of the market. However, a large number of smaller equipment market is expected to react accelerometer that monitors physical movement and a competitors are gaining at US$ 21 billion by 2018 contact microphone that market share. The four picks up on sound patterns from internal organs. major players are Nihon Kohden, Philips Healthcare, GE Scientists hope that eventually the device could allow Healthcare, and Fukuda Denshi, and according to a report physicians to make diagnoses remotely and monitor by iData Research, Nihon Kohden controls the largest patients once they’ve left the hospital, according to share of pie among the four. the New Scientist article. The team plans to present its Remote patient monitoring and implantable patient Bioscope system at the UbiComp conference in Seattle, monitors are areas of high growth potential that are WA, in September 2015. gaining attention. Equipment specialised for diseases or The innovation joins a host of other patient monitoring patient conditions, such as glucose monitoring devices, products under development. Earlier this month, the FDA cardiac and respiratory monitoring devices other than cleared the first sensor to monitor heart rate, respiratory patient monitors, are some of the key opportunity areas and movement in a chair. EarlySense’s Chair Sensor that hold moderate to high growth potential for future Solution is placed underneath a chair cushion and tracks growth of the patient monitoring equipment market. a patient’s health without any attachment leads or cuffs.

A new iOS device, Cue, allows consumers to test their Technological Advancements vital signs at home with simple swabs of bodily fluids.

Patient monitoring technology is a growing niche within The product consists of a small tabletop analyser and the industry, with big and small operations looking for colour-coded cartridges that detect biomarkers such as their cut of the profits. A new device from a team of testosterone, inflammation, vitamin D and fertility. Cue is nurses, engineers and computer scientists takes the trend being presold under an Investigational Device Exemption, one step further, monitoring a patient’s health through a but has not yet received full regulatory approval. bandage.

As the New Scientist reports, scientists at the National Taiwan University in Taipei are developing Bioscope, The Road Ahead a bandage-like system that tracks a hospital patient’s One of the key challenges includes enforcing regulations temperature, heart rat, movement and bodily noises and throughout hospitals in India. However healthcare wirelessly transmits the data to a computer. Sensor access remains a top priority, it needs to be done without modules are 3D printed onto the bandage, and can be compromises in quality. Non-communicable disease swapped in and out by a nursing staff depending on each burden is increasing and some of the diseases such as patient’s unique needs. The system includes a heart rate COPD do not require expert visits and can be effectively monitor that measures electrical activity at the skin surface, taken care by tele-monitoring and at home solutions. This provides a huge opportunity to take care delivery to home and can form the basis of future models of care delivery.

The medical technology industry in India needs to innovate in order to address the challenge of low penetration and meet the healthcare needs of all income segments. In a country like India, where resources are scarce but needs are high, solutions have to be affordable, reliable, resilient, easy to distribute, and easy to use.

Companies need to squeeze costs so they can reach more customers, and consequently exploit economies of scale.

Frugal approaches to innovation are particularly critical in the Indian medical technology industry to make modern care accessible, available, and affordable to all. Existing demand for medical technology in India is majorly from big cities. Innovation will help medical technology players create a new market in the lower income segments primarily, smaller towns and rural areas, and leapfrog to the next level of growth.

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Patient Monitoring Equipment

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Patient Monitoring Equipment

Commitment to Innovation and Precision of Parameters With its growing comprehensive portfolio of high-quality, high-technology, easyto-use and affordable products, Nihon Kohden is committed to fighting disease with electronics, says Anil Srivastava, National Sales Manager, Medical Equipment, Nihon Kohden India On August 7, 1951, Nihon Kohden was founded with the goal of Fighting Disease with Electronics. With more than 60 years’ innovations and product development, Nihon Kohden has become one of the significant global medical equipment manufacturers and one of the largest Japanese medical devices providers.

Its success has been deeply rooted in its commitment to invest in R&D every year for continuous innovative product development. Nihon Kohden R&D centers, scientists and engineers are working towards innovations and regular improvisation of technology.

We focus on providing quality medical services for Indian market; since India with world’s second largest population has become one of the most important global economic propellers. In order to further deliver better healthcare solutions for their clients in India, from pre-sales to customer services, Nihon Kohden Corporation Japan set the Indian subsidiary in April 2011 as Nihon Kohden India Pvt. Ltd. By endless pursuits for high quality and technology, their products have gained good recognition and reputation in Indian market.

In short period of just 48 months’ operation, the technology provider has got fantastic business from all segment of customers including many prestige hospital like AIIMS, New Delhi; Apollo Group of Hospitals; Ruby Hall Clinic, Pune; Prince Aly

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Khan Hospital, Mumbai; MIOT Hospital, Chennai; Fortis Healthcare; Paras Healthcare, Gurgaon, Delhi, Patna; Madras Medical Mission, Chennai; JIPMAR, Pondicherry; PGIMER, Chandigarh; SCTIMST, Thiruvananthapuram; Christian Medical Collage, Ludhiana; Dayanand Medical Collage, Ludhiana etc.

Innovative Technology Nihon Kohden is redefining qualityof-care with new, innovative technology – esCCO, by introducing volumetric information to all care levels. With esCCO, the quality of hemodynamic monitoring will be improved for all care levels. Emphasis is on non-invasive techniques to measure important parameters like Continuous Cardiac Output (CCO) is growing. Recent reports show that usage of the pulmonary artery catheter declined 65 per cent from 1993 to 2004 in the USA. The ambition in R&D though, was the provision of volumetric information, especially for

mid and low care levels, to improve patient care and enhance treatment outcome. With that, the challenge was to avoid any kind of invasive or minimal-invasive calibration.

By only entering patient information such as age, gender, height and weight, and an initial NIBP measurement, esCCO determines a reference value for calibration and is ready for start the measurement.

Additionally, a cardiac output value obtained by other CO devices such as by pulmonary artery catheter can be used for calibration. Both calibration modes reliably track changes in cardiac output and provide advanced monitoring of a patient’s hemodynamic status, thus helping clinicians in better patient care.

Futuristic in Outlook With investment in R&D, quality has always been their first priority. As a medical equipment manufacturer, the quality of their products is not only vital for patient’s life but also a vital part of Japanese quality culture.

We intends to keep growing as a leading medical electronic equipment company by developing innovative products based on their engineering specialty, the human-machine interface; developing competitive, high quality products in core market areas and using strong distribution network and experience in medical equipment to expand into a wider range of markets.

Patient SecondMonitoring Opinion Equipment

Building A Better

Connected World

Technology allows patients with revolutionary CRT-ICD devices to travel, work or spend time at home, says Dr Aparna Jaswal, Senior Consultant, Department of Cardiac Pacing and Electrophysiology, Fortis Escorts Heart Institute

T

he Cardiac Resynchronization Therapy (CRT) treatment when applied on heart failure patients for better treatment and management of the disorder allows the patient to enjoy life more fully.

The patient’s condition and device activity can be reviewed by their physicians from an Internet website. Using the unique Medtronic CareLink Network remote monitoring service, heart failure patients can transmit critical data from the heart using a standard phone line from home, work or while on vacation. This greatly reduces the need for time-consuming and frequent travel to the physician’s office for device monitoring.

Remote cardiac monitoring technologies provide the convenience of remote monitoring to patients implanted with pacemakers, ICDs and CRT devices. It has been observed that patients with moderate-to-severe heart failure accompanied with a risk of dying from sudden cardiac arrest have much higher energy and activity levels when implanted with CRT. With remote monitoring system at their home, they can also receive expert medical care now with less dependency on frequent device monitoring appointments. More than 10,000 patients worldwide are already using the monitoring system to stay connected with their health care providers from a distance.

It is vital to closely monitor the condition of patients, who have heart failure, and the recent introduction of CRT-ICD devices gives us access to a new level of information about a patient’s activity level, heart rate and existence of irregular heart rhythms, which are common in people who have heart failure.

To use the remote monitoring system, patients hold a computer-mouse like antenna over their chest to transmit data

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from the device to the doctor via a standard telephone line. Within minutes, the patient’s clinician is able to view the data from any location on a secure Internet website. Based on this information, the physician can make adjustments to the patient’s medication or prescribe additional therapy, if needed. Remote follow-up of these devices provides clinics with a status update on how the device is operating and allows them to view relevant patient data regarding heart failure and rhythm trends.

Additionally, clinician access to the system also can help facilitate a timely exchange of device information between various physicians involved in treating heart failure patients – electrophysiologists who implant and monitor CRT devices and cardiologists who follow the patient’s heart failure condition.

With the remote monitoring system the clinicians have a way of accurately getting information from a patient’s device at home – either at a regularly scheduled time or in the case of an unexpected event – and doing a comprehensive review of the data as if they were downloading the information from the patient’s device in the clinic. This advancement in technology will save the patient a trip to the clinic and clinicians also hope to make life more convenient and efficient for both the patient and the physician.

Health IT

Hospital Information System: In a Take-Off Stage

The increased adoption of telehealth, hospital information system, electronic health records and web-based services has expanded digital patient data, demanding the deployment of robust IT infrastructure in Indian healthcare industry, writes Anshuman Ojha of Elets News Network (ENN)

W

ith the growing awareness about healthcare products and services, hospitals are gaining a lot of importance. The growing burden of disease, along with unhealthy lifestyles, aging population, growing affordability and widespread health insurance penetration comprise some of the key factors propelling the hospital sector.

The market is clearly segmented into public and

private sectors wherein the public sector caters to a larger population base that is unable to afford the relatively expensive private hospital services. The private sector is diverting its business progressively from metro city markets and is focusing on capturing market share in tierII and tier-III cities with the introduction of hospital chains and specialty clinics aimed at attracting the masses towards quality healthcare services.

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Health IT

RESTRAINTS • Lack of experienced professionals • High maintenance cost • Service expenses

• Interoperability issues • Lack of awareness

The investment in hospital information system will increase at a compound annual growth rate (CAGR) of 5.7 per cent between 2014 and 2020 Hospitals are complex organisations with a number of departments and units coordinating with each other for patient care and all allied services. With the growth of IT as backbone for all the data processing, Hospital Information System (HIS) is gaining popularity and becoming an integral part of hospitals.

Market Dynamics

The global HIS market was valued at US$ 35.1 billion and is expected to grow at a CAGR of 7.1 per cent from 2013

DRIVERS • • • • •

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Ageing population Rising healthcare cost Increasing government initiatives Growing need for integrated healthcare system Rising investments by healthcare IT players

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to 2019, to reach an estimated value of US$ 53.2 billion by 2019.

The United States is the largest market for Hospital Information Systems with approximately 31 per cent contribution, the US is the leader in the global HIS market.

The US$ 2.3 billion US HIS market is expected to grow at a CAGR of 12 per cent and exceed US$ 5.1 billion by 2017.

The expected double digit growth in the US HIS market is the result of the healthcare reform initiatives brought in by the Health Information Technology for Economic and Clinical Health (HITECH) Act, a part of the US$ 787 billion American Recovery and Reinvestment Act (ARRA) of 2009.

The Asia-Pacific region (excluding Japan) represents the fastest growing HIS market, exhibiting a CAGR of 11.5 percent over the next few years. Despite being a smaller market in terms of revenue, the Asia-Pacific promises excellent growth opportunities for hospital information systems. Some of the major players include McKesson, Cerner, Allscripts-Misys Healthcare Solutions, Eclipsys, Computer Programs and Systems, Siemens Medical Solutions, QuadraMed, Medical Information Technology, Healthland, GE Healthcare, iSOFT Group, Agfa-Gevaert, Brunie-Software, IBA Health and Integrated Medical Systems.

The market is experiencing an increase in acceptance of customised technology such as Laboratory Information Systems (LIS) and Radiology Information Systems (RIS).

The market is also a promising ground for Electronic Medical Record (EMR) systems.

Other technological improvements such as integrated speech recognition capabilities and advanced clinical decision support systems will continue to contribute significantly in expanding the customer pool for HIS. Healthcare providers in India are expected to spend US $1.2 billion on IT products and services in 2015, an increase of seven per cent over 2014, according to Gartner, Inc. This forecast includes spending by healthcare providers (hospitals, ambulatory service and physicians practices) on internal services, software, IT services, data centre, devices and telecom services.

Internal services will achieve the highest growth rate amongst the spending categories with a 17 per cent

Health IT

Hospital Management System

increase in 2015 to reach US$ 297 million. Internal services refer to salaries and benefits paid to the information services staff of an organisation. The information services staff includes all company employees that plan, develop, implement and maintain information systems.

Software spending will grow 6.2 percent to reach US$ 103 million in 2015, up from US$ 97 million in 2014, led by growth in vertical specific software.

The increased adoption of telemedicine, HIS, electronic health records, mHealth, and web-based services has made digital patient data expand, demanding the deployment of robust IT infrastructure in Indian healthcare organisations. It has amplified growth in data, digitisation trends in health information and electronic medical records. A greater Internet penetration and a huge demand-supply gap in the HIS market will make way for more players and more competition in this arena.

Improvements in collaborative data exchange, workflows and mobility, and need for better financial management are the next phase of technological evolution in Indian healthcare. In addition, the shift to mobile devices, wireless technology and cloud computing will reduce system costs and improve workflows.

Next Big Thing

According to a new research by Frost & Sullivan, the HIS market is poised to become the next booming trend. This is an element of health informatics that focuses mainly on administrative needs. According to the research, 95 percent of non-clinical and 90 percent of clinical information systems have adopted at least a basic version of a hospital information system. However, now that a ‘post-EHR era’ has started that includes healthcare reform, changing reimbursement models, competitive threats from non-traditional providers and a rise in the health insurance marketplace, investment in new hospital information systems is going to pick up.

The investment in HIS will increase at a compound

annual growth rate (CAGR) of 5.7 per cent between 2014 and 2020. By 2020, it is expected to increase by 58.9 percent to US$ 17.6 billion. Administrative systems will grow the fastest, at a CAGR of 10.4 per cent over the forecast period. With the push toward value-based care in full effect, hospitals need to ensure that they are doing everything possible to make quality a high priority.

This means healthcare providers need to be proactive to attract and engage new patients, while ensuring that operations are financially viable. The right administrative software can offer a number of cost savings benefits including managing labour costs, driving productivity with new workflow tools, engaging consumers and maximizing operational efficiencies.

Challenges Persist - Solutions Emerging

Rising healthcare costs and rapid demographic changes have forced governments around the world to enhance the quality and outreach of healthcare, while simultaneously reducing related expenses. The world population is expected to exceed nine billion by 2050, while during the same period the population aged 65 years or older is forecast to have tripled. As such, governments around the world face increasing concerns to address financial restraints as well as efficiency and affordability limitations of healthcare.

The Indian government’s awareness about the large gap in the delivery of healthcare services is seeing both direct and indirect initiatives towards raising the level of service availability. Higher budgetary allocations, financial incentives and public-private-partnerships are some of the methodologies being adopted to bridge this gap. A number of non-healthcare related business houses are also venturing into the healthcare delivery space due to the immense growth opportunities that exist within the sector, resulting in greater competitiveness and betterment of service delivery on the part of the market players.

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Health IT

Health IT: An Evolving Space The quality and level of health IT services is also expected to evolve with time across the country’s healthcare value chain, says Sanjeev Gupta, Managing Director, Accenture in India technological advancements.

What are the functional areas where Health IT can make a difference?

How do you perceive the Indian Health IT market?

Over the past decade, IT has made continuous inroads into the Indian healthcare sector. Currently there are a slew of National Level Health IT Programs, which utilise technology and data capture methodologies including Ministry of Health and Family Welfare’s Mother & Child Tracking System (MCTS), online TB monitoring program “Nikshay” and the “National Health Management Information System” (HMIS). During the same period, private players have also focused on digitalising operations to offer price-competitive offerings packed with cutting-edge features that deliver a world-class experience to consumers.

The drivers of IT health adoption in India include advent of electronic health records, increasing healthcare data management needs, advent of private insurance and medical tourism in the country and

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• Hospital information systems (HIS) and records digitisation: Integrated healthcare delivery through efficient processes/ workflows with focus on improving citizens experience • Automation of supply chain: Better and more effective management by integrating the SCM system with other healthcare systems in the ecosystem • Handheld based data collection: Advantages include significant cost savings, data collection at source (rather than periodic data updation) and real time information availability to decision makers • Analytics enabled real time disease surveillance: Prevent infectious outbreaks by eliminating information leaks involving notification of communicable diseases

Is it the right time for public and private sectors in India to seek technological advancements for optimizing their business outcomes and improving healthcare scenario in the country?

Yes, given the growing competition, rising consumer expectations and increasing cost benefits of digitalisation, seeking technological advancements and investing in health IT is the need of the hour for stakeholders.

At Accenture, we have been

working with businesses to develop innovative health IT strategies such as Village-Aligned IT initiatives that bring quality primary care to people in rural India by empowering intermediaries (healthcare or outreach workers from each village) already active in those regions.

Multiple stakeholders help equip field workers with Decision Support System (DSS) enabled tablets or smart phones that incorporate the latest World Health Organisation (WHO) guidelines, clinical protocols and best practices.

How do you see the Health IT evolving in the coming years?

Over the next few years, we expect the level of health IT adoption to increase among healthcare facilities in India. For instance, currently we see only a 25 per cent implementation of electronic medical records at hospitals with 250+ beds and none at smaller facilities. Similarly, while clinical decision support systems have seen adoption by hospitals with 100-250 and 250+ beds, it has yet to see the light of the day at hospitals with fewer beds. This is expected to change over the coming years.

The quality and level of health IT services is also expected to evolve with time across the country’s healthcare value chain i.e. preclinical (stage 1), diagnosis (stage 2) and treatment (stage 3). While many programs have either been rolled out, or envisaged in parts of India, the implementation, almost always, has been partial or incomplete, but is expected to improve over the coming years.

Health IT

Emerging Trends in Healthcare Endoscopic devices are definitely the most innovative and may represent the real future of the bariatric field, says Dr Rajat Goel, HOD, Bariatric Surgery, Primus Super Speciality Hospital, New Delhi

T

echnology is something that can change everything in such a way that can make work effective and efficient.

It is basically an innovative idea that is converted into reality by proper execution.

Nowadays technology helps in boosting the healthcare industry.

It helps to provide better facilities.

Medicines being one important aspect can be better and can seek quick results. Minimally invasive approach can be a boon.

Imagine a situation where a patient has to wait for long hours standing in cues even if he/she is not in a condition to wait but since there is no option available they are bound to wait. So what’s important is to bring technology into play. An appointment can be booked through Internet, which can help the victim or patient to stay in a better surrounding rather than waiting into cues which can make condition worse for them.

We always see people waiting for their lab reports; they tend to visit hospitals again and again in order to collect details and information. Now technology here is easily helping them to save their time by sending reports

over Internet. It can facilitate you in another way also where reports are sent to the doctors of other countries in order to discuss big issues, which will ultimately help to come to a conclusion about what treatment should be done and get access to minimal invasive techniques for surgery, robotic surgery where some difficult areas in body can be accessed by a robot etc.

With Internet access technology can reach all around the world.

Also Facebook, Twitter, Whatsapp are very easy tools to reach people.

Nowadays technology helps in boosting the healthcare industry. It helps to provide better facilities. Medicines being one important aspect can be better and can seek quick results

All these social applications have made it is to stay connected to large number of people which was not possible earlier. Another important mass media access is radio and newspaper. Since radio is within the reach of most people it serves as a good medium of sending information and keep people updated. Now when we talk about newspapers, we know that it reaches most of the audience easily as compared to others media. Better software’s can help person searching on net easy access to technology. Media and mass awareness campaigns are very important.

Overdoing everything will lead to failure and make people think about integrity and honesty of information.

At times questions are raised on the authenticity and credibility. So whatever media advertises should give correct information, screened by experts preventing false information about medicine. Last but not the least, cost is also very important factor, should be cheaper and save time and money. It is a team work, where the companies, doctors, media work in union to get the best results.

Endoscopic devices are definitely the most innovative and may represent the real future of the bariatric field. Besides, smaller innovations are also instrumental, like motorised staplers and robotic needle-holders.

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Health IT

Technology in Healthcare Telehealth solutions will make us witness a healthier and a happier world in near future, says Shipra Dawar, Founder and CEO, ePsyClinic

T

oday technology touches every aspect of our lives. Talking about healthcare, access to quality healthcare services is extremely expensive and forget quality, basic healthcare services are still largely unavailable to a majority of people around the world. Government and other organisations spend enormous amount of tax-payers money on making healthcare service available, yet the reach and supply of these services to remotest areas of the world is still a dream. Even in metros and top cities around the world, healthcare services are limited, extremely expensive and beyond reach for most people.

Internet and IT provide groundbreaking solution to such issues.

Providers from around the world can be brought on platforms and their consultation and treatment services can reach the remotest places and at any time. Technology also makes it possible to regularly track and monitor, an individual’s health thus enabling better treatment and prevention of many diseases and health issues.

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Technology does not only make healthcare accessible, but also affordable as the cost of training, relocating the providers is enormous in comparison to the cost of infrastructure set up for making their services reach the remotest zones, aided by technology.

Market Trends Since 2009, when the telehealth concept and services rolled out commercially, the technology start-ups and IT companies have worked hard to develop a system that is easy to use for both clients and providers, anywhere accessible and is based truly helpful and powerful health data. Experts in the field of medicine worldwide believe that 70 per cent of the normal healthcare issues can be handled remotely or virtually, and in question of behavioural and psychological healthcare delivery, this percentage is even higher. Realising this, companies like IBM, Google and other companies are now putting in big bucks and their resources to develop technology frameworks and systems focused on healthcare quality and delivery.

From big players like IBM to startups like ePsyClinic, firms are working broadly on connecting providers with clients or patients on virtual platforms and providing better communication tools between the two, enabling real-time communication between the provider and the client in between consultations, and automating many assessments and evaluation. All this together can help delivering more accurate service to people and area where it is inaccessible or unaffordable.

Telehealth technology has great advantage for providers and people suffering for very less to lesser serious

health or behavioural problems, and in near future there is possibility that 80 per cent of such consultations would happens over virtual platforms only. It’s also very easy to reach out to clients, demonstrate and educate them with the use of technology. The highs of telehealth services are access, reduced costs and comfort for clients, and wider reach, network and ease for providers will create ever growing opportunities here.

Consultations moving to virtual platform also free up land, staff and other resources at hospitals and clinics for tackling with more serious conditions or inpatients. This is a huge but often underestimated benefit of telemedicine.

Limitations A big challenge is that the players must ensure that their services are designed to deliver quality healthcare consistently and at all times. Another ethical principle that should be guiding the telehealth industry players; is to know exactly when there is the need for transition of the client from a virtual platform to a traditional physical healthcare platform.

Internet connectivity issues also pose a challenge for telehealth systems but with the advances in technology will be looked after.

Summing up, new age information and communication technology has the power to solve the world’s most pressing problem of increasing reach of quality healthcare to the remotest parts of the world along with revolutionising and enabling preventive and positive health outcome driven delivery. If done right, telehealth solutions will make us witness and see a healthier and a happier world in near future.

Health IT

Moving Towards -

E-consultancy

Indian Health IT industry is moving towards the trend where a lot of hospital and clinics are adopting the policy of e-appointment, says Dr Sudeep Jain, Director, Spine Solutions India, New Delhi adopting IT in Healthcare?

What are your views on Healthcare IT market in India vis-à-vis the global market?

And how do you see the market evolving in next five years?

Globally the Health IT market is a huge one and compared to that, in India it is in a nascent stage. It is limited to few metros and has not penetrated in the small cities as much as it should have by now. But the scope is enormous. The industry is moving towards the trend where a lot of hospital and clinics are adopting the policy of e-appointment. It will take some time but we are definitely moving in the right direction. In next few years at least in major metros, tier II and tier III cities; IT will come to play a major role.

How do you see the ‘Make in India’ and ‘Digital India’ contributing to the growth of Healthcare IT industry?

Projects like these can help in lowering the cost of operations, which will directly benefit the end customers that is, the patients. As I said before, if we digitalize the system, the patients are just a click away from reaching the doctors.

What are the challenges presently faced by the Healthcare IT industry?

The biggest challenge is changing

The services like e-registration, e-consultancy will emerge as a big trend in the sector. The reach of the doctors will not just be limited to India but the whole world will be their market the mindset and overcoming infrastructure bottlenecks. Besides training and high initial costs are other impeding factors.

What according to you are the emerging trends in this particular sector and how do you see the Indian healthcare market’s indulgence in

The services like e-registration, e-consultancy will emerge as a big trend in the sector. The reach of the doctors will not just be limited to India but the whole world will be their market. This will lead to boom in health tourism. Lots of time patients just visit the doctors to show report and seek opinion. That shall be done at the level of lab itself, which will share the reports with the doctor through the use of IT technology on real time basis and moreover the reports will be available online, which will allow its access anytime and everywhere.

Besides, cloud computing is another trend where patients can share their reports on the cloud and the doctors can access the detailed records on real time basis.

There are challenges like slow speed of Internet in the hinterland, lack of general awareness on availability of the technology, lack of trained staff and initial cost of buying technology friendly devices. But since there is overall development, these issues will be sorted on its own, in the long term.

What are your present operations in India and expansion plans?

Currently, we have a Spine clinic in Delhi, but we are planning to open five new Spine clinics in Delhi and Rajasthan.

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Health IT

Technological Advancement in Healthcare Right mix of various technologies like IoT, Mhealth can boost telemedicine to the next level by ensuring better care to our rural population, says G Radhakrishnan Pillai, CIO, SRL Diagnostics

I

n today’s world, technology plays an important role in every industry as well as in our personal lives.

Even though healthcare is slow in adopting information technology, IT has played a crucial role in healthcare in transforming the way healthcare services have been delivered.

Information technology is increasingly playing a role in almost all process, from patient registration to billing, from diagnostics tests to self-care tools, thereby becoming the backbone of the business. Mobile technology has changed the landscape in healthcare. Patient can use smartphone for an appointment with doctor or undergo full consultation in the privacy of their own homes, doctor can prescribe medicines or diagnostics tests using their mobile

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device, which is connected to their Hospital Information System and partner lab/pharmacy. Patient need not to visit pharmacy or diagnostics centres to buy medicine or book the test which will get delivered or serviced based on the prescription generated by the doctor. Patient has the option to further get reminders for administering right medicine dose at the right time. Test results are directly sent to the patient’s smartphone and patients can also store the electronic medical records (EMR) for future references.

Instant messaging is also one such tool that can be used for faster internal communication, especially in healthcare, where a lot of communication/collaboration happens between different stake holders to provide better care to patients.

Mhealth and WiFi technologies are also used in healthcare to a great extent and initially it was used to avoid cords and messy cabling but now mhealth is used as a collaborative and participative tool to engage service provider and customer for better patient care by ensuring the patient is an active player in his/her treatment.

I know one case study where WiFi was used early on in one of the psychiatric care hospitals abroad not to avoid messy cabling but to avoid psychiatric patient using cables to harm himself or other patients, thereby maximising patient care. So I believe that technology can be used innovatively to give maximum service.

Social collaboration tools, IoT (Internet of Things) and mhealth together is going to revolutionise healthcare by dramatically lowering costs and improve health by increasing the availability and quality of care.

Social collaboration tool will be used as network layer to connect customer/ patient with service providers (doctor/ hospital/diagnostics labs etc.).

Patients will have wearable device and depending on the need of the customer/patient coupled with mhealth, the service providers can monitor the health of patient to provide holistic care at all times.

Hospitalised patients require close attention and can be constantly monitored using IoT-driven, noninvasive monitoring. This enables to collect comprehensive information, to analyse and store the information and then send the analysed data wirelessly to the care provider’s mobile device.

It replaces the process of having a health professional come by at regular intervals to check the patient’s vital signs, instead providing a continuous automated flow of information. In this way, it simultaneously improves the quality-of-care through constant attention and lowers the cost of care by eliminating the need for a healthcare provider to actively engage in data collection and analysis.

In my personal opinion right mix of various technologies like IoT, Mhealth can boost telemedicine to the next level by ensuring better care to our rural population.

IVF

Hope for

Life The global and Indian IVF market is escalating owing to growing awareness, availability and the acceptance of the treatment Elets News Network (ENN) elaborates an industry purview

T

he advent of new technologies and breakthroughs in science having your own child is not a concern any more. The birth of world’s first test tube baby has given hopes to millions of infertile couples, fulfilling their dreams of becoming parents.

The domestic and global IVF market is escalating and the reasons are manifold including growing awareness, availability and the acceptance of the treatment.

Market Trends

Infertility, in the 21st century, is a global issue with thousands of couples facing it worldwide. Over the past decade, the concept of IVF has gained popularity at a swift

pace in India. Given that this is a commonly found medical condition, the infertility treatment market is rapidly expanding. Besides the standard methods of treatment, which are surgical, drug and hormonal therapy, assisted reproductive treatments (ART), with technological advancements, have opened new doors for providing solutions for the male and female infertility issues.

Indian IVF market is anticipated to be worth US$ 1 billion in the next three to five years and is expected to reach US$2 billion by 2018. As on date there are more than 20,000 infertility clinics in India and majority are in Mumbai, at second place Bangalore, and at third place Delhi is there in India.

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IVF

n n n n n

Gonadotropins FSH LH (10%) HMG (15%) HCG (9%) Synthetic GnRH (16%) GnRH Analogues (7%)

n n n n n

GnRH Antagonists (5%) Growth Hormones (12%) Steroids (6%) Antibiotics (8%) Estrogen Antagonists (12%)

Among the large population of 1.28 billion people, around 15 per cent suffer infertility. The factors such as urbanisation, pollution, chemical exposure, stressful life, competitive work environment, late settlement in life, the urge to achieve maximum in a short time span etc leads to infertility. This escalates the infertility ratio expanding the IVF market. The country is becoming one of the powerful nations in the baby making business with the burgeoning fertility rate which is alarming.

Major players include Sun Pharmaceutical Industries Ltd, Lupin Pharma, Zydus-Cadila Healthcare Ltd, Intas Pharmaceuticals Ltd, CIPLA, Emecure House, Bharat Serums and Vaccines Ltd, Uni-Sankyo Limited, Serum Institute of India, Alembic Limited. Other aggressive players include Lifemedicare, Svizera Laboratories Private Limited, VHB Life Sciences Inc, Plethico Pharmaceuticals Limited and Ferring BV. Delayed pregnancy in women is one of the major drivers of the Indian IVF market, as the chances of conceiving lowers with age. Though the cost involved in the treatment stood as a limiting factor to the market growth as the patient may not conceive in the first cycle of the procedure and many cycles have to be undergone by the patient to

GROWTH DRIVERS

Technological Advancements

New techniques offer the possibility of improving a patient’s odds of having a baby through in-vitro fertilisation.

Screening chromosomes: The technique furthest along, and already used in select clinics around the world, is called pre-implantation genetic screening. In this procedure, cells are removed from the embryo on day five to see if the normal amount of genetic material is present. An embryo should have 23 pairs of chromosomes; those with extra chromosomes or missing chromosomes are considered less viable.

Chromosomal screening has shown promise in three small, randomised studies. A study co-authored by Dr. Scott, for instance, found that transferring a single embryo after chromosomal screening resulted in a similar rate of live births as transferring two untested embryos.

The procedure costs about US$ 4,000—a hefty fee on top of an already expensive process that often is paid for out-of-pocket. The average IVF cycle costs about US$ 12,400, according to the Society for Assisted Reproductive Technology.

Monitoring cell division: Time-lapse imaging, which

• Rise in infertility rate

CHALLENGES

• Fertility disorders

• Cost involved in the treatment

• Changing lifestyle

• Growing medical tourism

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achieve pregnancy, which adds to the overall cost. The average cost of this procedure is between US$ 10,000 – US$ 20,000. Major limitation stands in adoption of the technique for the people with lower income. The low awareness in the developing countries becomes a challenge in adoption of the technique. Awareness can be created through medical tourism and availability of low cost IVF treatments.

The market is poised to witness a remarkable growth, primarily due to technological advancements such as pre-implantation genetic diagnosis (PGD) and three parent IVF procedures. The lower cost for surrogacy is adding on to the booming surrogacy industry in India and the practice of reproductive tourism. Since the legalisation of surrogacy in 2002, India has become world’s largest surrogacy industry with estimated revenues at over half a billion dollars.

According to Dr. (Brig) R.K. Sharma, H.O.D IVF, Primus Super Specialty Hospital, IVF is the most common and most effective type of ART to help women become pregnant. The liberal guidelines of ICMR, permitting egg donation and surrogacy have expedited this. Also, the easy accessibility of young and healthy egg donors and surrogates in India has further attracted more international patients.

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• Low level of awareness

IVF

costs about US$ 1,500, is a less invasive method of evaluating embryos. It’s already used in clinics around the world, but new types of time-lapse screening are just becoming available commercially. With time-lapse imaging, thousands of pictures are taken to record a fertilised egg cell dividing. Eggs dividing atypically are unlikely to survive.

Companies are coming to market with products that use algorithms to automate the evaluation process. Currently most clinicians analyse time-lapse imaging subjectively.

Time-lapse imaging may also work in tandem with chromosomal screening, since it provides information about an embryo’s metabolisms unavailable through genetic testing. An initial study was promising.

The Bill

There is at present no law governing surrogacy in India, eventually the activity including renting a womb (commercial surrogacy) is considered legitimate. In the absence of any law the Indian Council of Medical Research (ICMR) in 2005 issued guidelines for accreditation, supervision and regulation of ART clinics in India. But the need for legislation became pressing with ICMR guidelines being often violated and reportedly rampant exploitation of surrogate mothers and even cases of extortion.

At the instance of the Indian government an expert committee has drafted a legislation known as Assisted Reproductive Technology (Regulation) Bill, 2010 for legalising surrogacy. The proposed legislation earlier floated in 2008 envisages legalising commercial surrogacy as well.

The bill aims to regulate and supervise the ART procedure happening throughout the country. It also recom-

mends setting up State Boards and a National Advisory Board that will exercise the powers and duties conferred on them by the legislation.

The ART bill also provides special guidelines for foreign nationals seeking surrogacy in India. Looking at all the constraints concerning the field, the ART Bill seems to be quiet fare and balanced. The positive part of the bill is that it states that ART bank and ART clinics should be separate entities. This is in order to promote more transparency; especially in cases that include egg donation and surrogacy.

Legal experts are of the view that the draft Bill is a step in right direction as it will end the present confusion and help regulate the functioning of the IVF centres and ensure quality check and accountability of ART clinics.

There are worries too as to what impact it will have on the society in terms of commercialisation. Poor illiterate Indian women with the lure of money could be forced into repeated surrogate pregnancies risking their lives. There are also ethical and moral issues as well as the human dignity involved besides questions about the rights of surrogate mother.

As such the draft legislation on surrogacy needs to be debated threadbare in social, legal and political circles as well as by the civil society before it becomes a law.

Way Forward

The most important economic issues in contemporary IVF market are access to treatment and treatment success, as measured through birth rates and multiple birth rates. These issues of access and quality are also the central concerns for Indian healthcare industry in general.

Across the healthcare sector of the economy and in IVF market in particular, altering the competitive structure of markets or the extent of insurance coverage can improve both access to care and quality. In the market for infertility treatment, mandatory insurance coverage is predicted to bring new patients into the market and reduce the incentive to transfer a dangerously high number of embryos during treatment, thereby increasing the quality of care. While price reducing competition is likely to improve access to IVF, there exist concerns that competing clinics will attempt to win new patients by inflating birth rates using treatments that also raise the risk of multiple births.

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IVF

Affordable IVF for All

With the growing market of In Vitro Fertilization (IVF), government should make the treatment affordable and accessible to economic weaker sections, says Dr Shobha Gupta, Medical Director and IVF Specialist from Mother’s Lap IVF Centre in conversation with Romiya Das of Elets News Network (ENN) Could you brief us about the Indian and Global IVF market?

The global IVF market is expected to reach US$ 11.3 billion by 2021, at a CAGR of 7.0 per cent from 2015 to 2021, according to a report by Reportstack. Reduction in conception rates mainly in women aged 40 years or above, delayed pregnancy in women suffering from gynecological conditions, changing lifestyle and fertility disorders are the major factors that drive the market growth.

The IVF market in India is estimated to be worth Rs 5,000 crore in the next three to five years and cross the Rs 10,000 crore mark by 2018. The clinics offer services such as artificial insemination by husband or donor sperm, gamete intra fallopian transfer (GIFT), in vitro fertilisation and embryo transfer (IVF-ET), intra cytoplasmic sperm injection (ICSI), donor egg treatment, donor embryo treatment and endoscopic diagnosis as well as the use of a surrogate mother. Presently, the field of reproductive medicine is witnessing a paradigm shift with new techniques being added and the same being educated to the people at large. India, being at the forefront of reproductive medicine, has become a Mecca for all the IVF treatments available around the world. The Indian IVF sector accounts to around five billion dollars and has around 500 plus IVF clinics across the country. So, the opportunity lies here when we see the market growth and thereby increase in country’s GDP too.

What are the current market trends?

The infertility treatments have improved, options have expanded, and doctors are more skilled at the techniques such as IVF treatment, cost effectiveness, awareness about IVF and surrogacy, and new IVF methods like Intracytoplasmic sperm injection

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(ICSI), Blastocyst culture, treatment for male infertility, egg or embryo freezing, donor eggs are the latest techniques for treating infertility. The cost of fertility treatment is comparatively less in India to other western and European countries, owing to readily available surrogate mothers, egg and sperm donors. Further on, benefits associated with fertility tourism are numerous. India is great place for getting high quality medical treatments in affordable manner. An average IVF cycle in the US cost US$ 10,000 whereas in India it is available for about US$ 3000. We have progressed in the field of medical sciences at par with western countries and live well up to the expectations of our inland as well as overseas patients.

What according to you are the major issues need to be addressed by the government in this sector?

A system must be introduced to provide affordable IVF treatments in private hospitals for the economically weaker section patients. Expensive medicines should be made available at affordable rates across all the medical stores in the city. As the medical tourism adds to the GDP of the country, the patients coming from abroad for treatment, there must be a provision to avail visa benefits for their caretakers as well.

IVF

IVF - A long Way to Go Individualised approach, personalised treatment and prevention of complications are the current trend in IVF modality says Dr Indira Hinduja, Honorary Gynaecologist (IVF and Infertility specialist), P D Hinduja Hospital & Medical Research Centre in conversation with Elets News Network (ENN) What are the current trends, opportunities, challenges of the IVF industry?

Individualised approach, personalised treatment and prevention of complications are the current trend in IVF modality. This makes treatment more specific and improves the success rate. The desire to have a child is found in every couple irrespective of economic status, educational background and social status.

Every couple wants to try for conception if the treatment of choice left is only IVF then everybody cannot afford this treatment. Hence the major challenge with IVF is cost.

How does the cost and services in IVF in India compete with other competitive nations?

As far as quality of services is considered IVF in India has got expertise to serve. India is known for hardworking, skilled, knowledgable, experienced clinicians performing IVF. Our success rate is comparable with the leading nations performing IVF worldwide. The only lacunae existing are social acceptance towards gamete donors and surrogates as well as reluctance of society towards IVF. We are also lagging behind in upcoming research work due to financial hurdles.

How do you see the growth of medical tourism by way of IVF? India has been recognised for advanced therapeutic modalities like US and UK. The availability of advanced diagnostic modalities, interventions

by minimally invasive procedures (endoscopies and laparoscopies) and advanced screening techniques have made India the leading country doing IVF. There are also novel modalities available in terms of study of endometrial receptivity, genetic screening of gametes which improve not only the success but avoids failures and complications. Such therapies are not available everywhere. Hence medical tourism should be encouraged. In India IVF is done at lower cost with success ‘at par’ with experienced hands as compared to other nations. Hence India is always been an active part of medical tourism.

Could you share some insights into Infertility treatment at Hinduja hospital ?

At Hinduja hospital along with the IVF treatment but the psychological and genetic counseling is also carried out. The treatment approach is individualised with thorough clinical work up. Every procedure is well explained to all couples and an informed consent is taken before each procedure. All recent advanced treatment modalities of IVF are available at one place. An equipped laboratory with advanced research work helps the success in every case. Our take home baby rate is 50 per cent.

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IVF

IVF Going

Footprints What are the key factors leading to the growth of the IVF market in the country?

India has a large population base and 10 per cent of all couples in reproductive age are known to suffer from some fertility issues. In the cities, this 10 per cent can go as high as 32-40 per cent.

Any couple who is in the reproductive age group for instance 20-35 years, normally 10 per cent face difficulty. But in metropolitan cities this is as high as 30-40 per cent.

This is because of late marriages, work commitments, different time schedules, stress, inability to give to time to each other, pollution etc. Therefore, the number is huge who need the fertility assistance. Now, not every fertility treatment is IVF. The general awareness in increasing with the mushrooming of various centres and also people are being able to access and afford the treatment. On top of that the problem per se is also mounting.

How do you see the government regulations in the IVF sector?

The government has been quite open as far as being able to practice few regulations and licenses that we need which is the Pre-Natal Diagnostic Techniques (PNDT) or nursing home, it is more or less streamlined. Interestingly, the criterion which governs

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India is the most affordable place for IVF treatment as drug cost, professional charges, and equipment charges are less than the west, says Dr Kaberi Banerjee, Medical Director at Advanced Fertility and Gynaecolgy Centre in conversation with Romiya Das of Elets News Network (ENN) IVF clinics is governed by Indian Council of Medical Research (ICMR). They have put down the necessities required for an IVF centre that includes MD gynecologist, full time embryologist, PCPNDT and a nursing home.

The organisation has allowed almost every MD gynecologist to be able to open an IVF centre.

But, it has not streamlined what should be there training and experience.

What are the reasons behind the increase in medical tourism in this industry?

There are two main factors driving the inflow of patients is cost effectiveness and services.

There is a boom of fertility centres but not all of them have reached the standards that are meant to be. A specific duration of training is required to be able to deliver such services. There are many gynecologist for instance who have spent three years abroad, come back and provided the services while others may go for a week and return and do the same. Now the question is how a consumer differentiates between these two centres, as no one gets into depth analysis. The cost of IVF in our country is much more less in comparison to the west. The drug cost, professional charges, the equipment charges there are much higher than India. Even in medical tourism there are two strata - simple IVF, donor egg and surrogacy. In India surrogacy is commercially allowed unlike other countries where it is not. All the couples where surrogacy is indicated come to countries where surrogacy is allowed like the US and India where professional surrogacy is allowed. With higher (20 times) surrogacy rate in the US, couples visit India in hoards. However, the numbers have reduced in the past few years due to the government regulations which stopped the single parent surrogacy. The number of surrogacy cases flocking the country has reduced.

EVENT REPORT

SUMMIT RAJASTHAN CONFERENCE & EXPO CONFERENCE, AWARDS & EXPO

Jaipur 10May July2015, 2015, Jaipur

Heralding Healthcare

In the present scenario of efficiency challenges and budgetary constraints, technology has emerged as a key enabler in the healthcare sector, igniting innovations and improving the delivery of services. Among the Indian states, Rajasthan has emerged as one of the top states using technology for making healthcare reach to both urban and rural masses. With a view to deliberate on the healthcare innovations in the State and chalking out the future roadmap of healthcare services there, and elsewhere, Elets Technomedia, in association with the National Health Mission, Rajasthan organised the Healthcare Summit Rajasthan 2015. The Summit showcased how the various government agencies are successfully implementing numerous healthcare schemes and initiatives through the Public-Private-Partnership (PPP) mode. The meet also highlighted the constructive role played by development partners and health professionals, and how Corporate Social Responsibility (CSR) is being leveraged in the healthcare ecosystem of Rajasthan. We reproduce here the success stories and views expressed by healthcare professionals and other stakeholders in the field.

The Summit was a conglomeration of the leaders from state, community and government with private players, investors, development partners, social enterprises, healthcare innovators on a single platform. The event showcased various initiatives and schemes implemented by the Rajasthan Government in the health index of the people in the state. The Health Ministry and industry leaders including GE Healthcare, Philips, GVK EMRI, Vodafone Bank of Baroda, Trivector, and many more shared their contribution towards healthcare industry.

The UNICEF launched eJanSwasthya, an android based application for ANMs, for Rajasthan: better delivery of health services in the remotest area using technology. Tablets inThe Hub of Innovations stalled with this application were given away by Rajendra Singh Rathore, Minister in Healthcare of Medical, Health & Family Welfare, Government of Rajasthan to the ANMs. $/

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eHEALTH Magazine

A special issue of eHEALTH, focusing on Rajasthan healthcare was launched at the summit. Topics like PPP in healthcare, Corporate Social Responsibility (CSR), medical technology advancements, accessibility and affordability, best practices in healthcare were the focus of the summit. The event report carries opinions and viewpoints of the speakers who shared their opinion at the Summit.

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Rajendra Singh Rathore

Minister of Medica Health & Family l, Welfare, Government of Rajasthan

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Inaugural Session INITIATING THE BATON

Arun Chaturvedi, Hon’ble Minister for Social Justice & Environment & GAD, Government of Rajasthan In the state where we were not able to facilitate the basic health services, we plan to deliver them in partnership with the private players. Nearly 60 per cent of the population of Rajasthan resides in the rural areas and the state shares the majority of the border area, in such case extending health services to these areas is one of the major challenges. To overcome this challenge we are planning to set up health centres under the PPP mode.

This is possible only through usage of information and other innovative technologies. Rajasthan Government is already working under a visionary leadership and has also made changes in policies to make it industrial friendly. There are several plans that we intend to implement and some of them we are already working on.

We have health data of about 1.80 lakh pregnant women through digital tracking, which exists with the government. We have also planned to integrate GPS system in our 104 services for real time information.

I hope the summit would come up with a road map for Rajasthan government to take forward the solutions.

Naveen Jain, Mission Director – National Health Mission, Special Secretary – Medical, Health & Family Welfare, Government of Rajasthan In Rajasthan, various innovative works have been taken up in healthcare sector in the last few years, and, as a result several health parameters improved in the state. However, developments in certain areas are still required. Technology in the healthcare sector has advanced the reach of healthcare services to the next level.

This is for the first time that such a huge platform has been created where all the stakeholders of the healthcare system from renowned hospitals, investors, medical and nursing professionals, and ASHA workers participated. I thank Elets Technomedia and WISH Foundation for organising such an event in Rajashthan. WISH Foundation has already started working on many ‘out-of -the-box’ innovative works since last few months. Telecom player like Vodafone will be discussing the establishment of telemedicine centre in Rajasthan under the PPP model, which is also successfully incorporated in other states of the country.

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Dr Ashok Panagariya, Professor Emeritus, Neurology India, despite its significant economic achievementsits health situation is still in a predicament. We encounter a toxic combination of high cost and uneven distribution of sources.

We have challenges, resources and limitations, but we need innovations as per the requirement of the state. The dual burden of non-communicable diseases and changing lifestyle in India can be dealt with providing a system such as Universal Healthcare. There is no doubt that the state government has worked in bringing down the Infant Mortality Rate (IMR) and Maternal Mortality Rate (MMR). Now, we need skilled human resources, which can be achieved through step by step solutions.

EVENT REPORT

Dr Niraj K Pawan, Additional Mission Director, National Health Mission, Government of Rajasthan Clarifying the misconception of taking PPP as privatisation he said that in Rajasthan, PPP started with some hassles and the perception of private sector was such that Rajasthan Government might not be willing to go for involvement of private sector in the healthcare domain. PPP is different from privatisation.

The tasks that cannot be accomplished by the government due to any reason can be achieved by the private players in a more cost effective manner. The government is not withdrawing from the healthcare delivery, but the areas where the government is unable to reach to monitor or to provide quality care, that is when the involvement is required.

PPP may be one of the panaceas and by working together we can chart out solutions to overcome the hurdles in the healthcare delivery system.

Soumitro Ghosh, CEO, WISH Foundation Before asking to spend more GDP in healthcare sector, it is essential to figure out how to improve the effectiveness of the allotted sources and to be more cost effective. We spend 1.2 per cent of the GDP in the healthcare. Rajasthan healthcare has its peculiar challenges. The state has 50 per cent of the population living in rural areas.

Before asking for more resources, we should look at how well we can play around with the resource available. Rajasthan has been open and supportive of new ideas and we will have to design something so that we can get the nod from the cabinet.

Samuel Mawunganidze, Chief, UNICEF Field Office, Rajasthan Health has the potential to take the healthcare services to the deprived areas.

Healthcare needs to be taken especially in the desert and in the tribal regions, which is possible through information technology.

It is good to see that technology is the priority for the Chief Minister, who is willing to transform the healthcare scenario of the state.

Shekhar Agrawal, SVP & Head, Vodafone There are significant challenges in healthcare service in rural India. Huge grants and funds that are available to state government for the healthcare sector are not being used. In overcoming these situations, a significant opportunity also comes before the private sector. In rural India due to repetition of diagnosis during a visit to the doctor adds to the financial burden that abstain people from visiting a doctor. Connectivity of rural and urban healthcare units is another area where the government should participate and actively think about it. To deal with this, a cost effective process in which electronic health record, web based services with ASHA workers and other ground level workers is the way forward. As a telecom provider, we can mobilise patient care, which is possible through the deployment of robust IT infrastructure. We play a role of identifying the process of each health centre and mobilise those processes. In the state of Gujarat, Haryana and Assam we actively participate with ASHAs and other ground workers to ensure that the data of each pregnant woman is captured through expertise and through our partner ecosystem.

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Enabling Access through Disruptive Innovations Shyam Prasad Rajan, CTO, GE Healthcare South Asia

Shyam Prasad Rajan, CTO, GE Healthcare South Asia:Stated how GE Healthcare has been delivering affordable healthcare solutions by enabling access through disruptive innovations. And, the services are particularly in the needful areas like villages and towns, where the access is limited. ‘Low cost doesn’t low tech’, he said. He further added, “Against the traditional practice in the market where low cost products involves less features, GE Healthcare has been providing innovative quality products up to 30 per cent less price”. He referred to the GE Healthcare’s successful product ‘Lullaby Warmer Prime’ used as infant warmer that makes safe and reliable thermoregulation accessible for primary care settings even in remote and rural areas. Though certain parts of the product are expensive, GE made it affordable by looking at things that can be made at low cost.

In addition, the products are designed to be user friendly so one doesn’t require special skills to operate them. For the accessibility, an ecosystem is co-created involving people like ASHA workers and other frontline health workers. “GE targets to develop 100 low cost solutions in India to address India’s and world’s healthcare challenges in the area of cancer, cardiac diseases and maternal/infant care and medical,” he added.From medical imaging, software and IT, patient monitoring and diagnostics to drug discovery, biopharmaceutical manufacturing technologies and performance improvement solutions, GE Healthcare helps medical professionals deliver great healthcare to their patients. “GE Healthcare has already established partnerships with doctors and physicians in Maharashtra, Tamil Nadu, through different projects”, Rajan added.

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EVENT REPORT

Public Private Partnership to Deliver Quality Primary Healthcare: Privatisation or Restoration of Citizens Rights to Good Health?

Dr Niraj K Pawan, Additional Mission Director, National Health Mission, Government of Rajasthan

Clarifying the misconception of taking PPP as privatisation, he said that in Rajasthan, PPP started with some hassles and the perception of private sector was such that Rajasthan Government might not be willing to go for involvement of private sector in the healthcare domain. PPP is different from privatisation.

The tasks that cannot be accomplished by the government due to any reason can be achieved by the private players in a more cost effective manner. The government is not withdrawing from the healthcare delivery, but the areas where the government is unable to reach to monitor or to provide quality care, that is when the involvement is required. PPP may be one of the panaceas and by working together we can chart out solutions to overcome the hurdles in the healthcare delivery system.

Moderator - Soumitro Ghosh, CEO, WISH Foundation Rajasthan Government has made the state an important station of making the PPP as a strategy to strengthen the primary healthcare system. This the first time the state has taken such step, which makes it critical. When the pressure is built through the good qualities, all the bad things are set aside.

Dr H Sudarshan, Chairman, Karuna Trust We want to deliver good quality comprehensive primary healthcare services. We provide preventive, procreative, curative and rehabilitated services, which includes mother and child health, communicable and non-communicable diseases. But, most important is the community processes in comprehensive primary healthcare, the right way to approach.

We need to have trust between the NGOs and the government.

Dr Balaji Utla, CEO, Piramal Swasthaya The key question is to reduce multiple key partnerships to the multiple stakeholders. The mandate is with the government to provide the basic healthcare solutions. However, there are challenges and gaps, but despite that the institutions are ready to partner with the government.

Rajasthan is the earliest state to experiment with the large scale public service provision.

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Pankaj Jethwani, Consultant, Boston Consulting Group Primary healthcare as a whole needs strengthening, which includes good quality, accessible, affordable and comprehensive primary care to the population.

The administrative and political will must be there to change things. The three key messages, accountability of the scheme at the basic, sub-centre, block level, district and centre is required. Secondly, the technology leveraged requires accountability, monitoring and helping doctors to make those key necessities to save life. Thirdly, it is the government’s call to strengthen the primary healthcare system and the private sector is the enabler to help the government.

Lt Gen Dr K K Singh, MD, SDMH Hospital, Jaipur Sharing his experience in both government and the private sector he said, “The state has an established infrastructure which we can improve upon, a strength that Rajasthan has.

To bringing in private partners inside the healthcare system, Rajasthan has accomplished both sides.The SDMH hospital has a robust outreach programme which is definite enough to have a good partnership with the Government of Rajasthan.

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Himani Sethi, Head of Programmes, WISH Foundation Our focus is to deliver quality and affordable healthcare for base of the pyramid (BOP) population using high potential innovations that can be scaled up. Therefore, primary healthcare is important for us. BOP constitutes a population, which is not categorised as BPL and do not get the entitlement unlike BPL and our focus is to bring affordable healthcare for this population.

As a foundation, our focus is to provide funding, to identify capable innovations, to work with entrepreneurs and enterprises, to see how innovations can build the rural market. We provide on-site demonstration as we are doing in Rajasthan. We provide a platform and private partners and number of other peoples such as foundations and donors who are already working can be brought together. If we want the changes and desired impact, the primary healthcare has to be strengthened.

EVENT REPORT

Technology for e-Initiatives in Healthcare in Rajasthan: Opportunities for Public Private Partnership

Rajendra Singh Rathore, Hon’ble Minister of Medical, Health & Family Welfare, Government of Rajasthan The workshop has discussed in detail on how healthcare services can be made accessible to needy for whom the government designs various healthcare schemes. Over 125 crore Indians and particularly more than 6.5 crore people of Rajasthan are looking with hopes at the experts and intellectuals here, so that they provide best healthcare services to them. In the present time, a human being who wants to stay healthy is struck down by several modern diseases. It is the time of technology in healthcare sector where equipment identifies and also cures diseases. India is talking about e-Governance and our Prime Minister has the vision of ‘Digital India’, which coincides with technology aspect in health sector. Private players have several opportunities in the health sector of Rajasthan under PPP.” The biggest challenge before the state government in health sector is to provide accessibility to our health schemes and services to majority of state’s population in rural areas. We entered the trend of eGovernance and central government has boarded up on the ‘Digital India’ initiatives. We, as the state government have embarked up on initiatives involving technology. These endeavors of ours also faced resistance, but, we need to accept that there is a need for open acceptance of technology for well being of people. There is a necessity for balance in business and services.

Naveen Jain, Mission Director – National Health Mission, Special Secretary – Medical, Health & Family Welfare, Government of Rajasthan “Many partners in this event are those who make medical equipment and those who create technological software for healthcare sector.

Rajasthan is geographically the biggest state of India. There are 13 districts that include tribal areas, so which ever national pilot projects that comes up in the state, are taken up in these 13 districts. I would suggest the partners here to come up with software’s and business processing engineering that is with lower cost for makers and users,” he said.

Quoting Chief Minister Vasundhara Raje, where she stated, “I want governance to be more visible than government,” he further added, “I think e-governance is working towards that.

Till date in Rajasthan, hospital management system, ASHA soft, the IMPACT software and other e-governance system are operational. We were able to track each sonographic tests happening in the state. Out of 18 lakh pregnancies in the state, we were able to track the record of most of the sonographic tests.

Based on the performance, we are paying the ASHA workers online. I think Rajasthan is the only state where all 6,000 ASHA workers have been paid up to date till June 25th. ASHA soft is known more for analysis than just data. Through ASHA Soft, we know how ASHA is working in 34 districts.”

Gaurav Sahai, Chief Manager CSO, Bank of Baroda Our banking network has become the knowledge hub for various health schemes making it a vital part of governments’ health IT initiative. Through our widespread network of ATMs, we are able to use the centre as a powerful tool for creating health awareness and educate people. Moreover, through our “gram choupal” programs, the educated employees of the bank can spread awareness through flyers and pamphlets.

Further, as people use about 100 utility service payments through our bank, it becomes another interface to spread health information at the click of the mouse.

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Chhitiz Kumar, CEO – Philips Capital & Head – Govt Business & PPP, Philips India Ltd He stated that in many areas of health sector, the PPP mode can run successfully if a mixed balance is struck between the works of government and the private partners.In health sector PPP comes in a place where installation of equipments is essential, and this can be taken forward with a focus on affordability and accessibility of the system. Kumar shed light on the five successful PPP model of Phillips in health sector initiated in the country. One of them is Sawai Mansingh in Jaipur.

“It clearly indicates that you don’t have to compromise on the quality of technology while enabling access through affordability. There were no facilities earlier here. Even though there are over eight CT scanners in the area, government ends up paying Rs 18 lakh towards its maintenance annually. Meanwhile, if the same system was taken up in a PPP mode, then government can even think of revenue, besides giving accessibility in affordable price. It is an opportunity for the Rajasthan government to bring in the equipment such as CT and MRI in the district hospitals, which can be easily converted under PPP,” he added. He also added that similar equipment and clinical services are being successfully run in Hyderabad.

Here, clinical experts sit at one centre to monitoring the mobile services and advice through audio-video communication. “Another example he mentioned was about the mobile cancer screening van that is being run since last three years in Chandigarh under PPP mode. Through this facility cancer is detected in stage I and II, and all the cancer diagnosis is carried out through female medical worker.”

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Dr Ajay Bakshi, Managing Director & CEO, Manipal Hospitals He said that large scale interventions can be done with the use of mobile and electronic technology in the health sector. Citing an example of a PPP model in the state of Kerala, he said that the government has decided to create women entrepreneurs to run clinics where the expertise is created by technology from private partners. Certain amount of money of the revenue goes to technology,” he said. “There are over six lakh ASHA workers in the country, but they do not have the expertise. There is a lot of possibility to enhance the capabilities of ASHA workers who remain in the frontline. “Manipal which is known for its medical education has converted a coastal town in Karnataka into a global centre for education. For training the frontline ASHA workers we can help the government, and all these are automated,” he said.

EVENT REPORT

Investments in Healthcare in Rajasthan: Challenges and Opportunities Dr Harish Kumar, Director, UNDP Norway India Partnership Initiative “The weakness in extending the healthcare facility to the child is implementation of the plan. We are into mobile diagnostic facility system filling the existing gap. We have designed innovations that extends utmost healthcare in the first month of a child’s life. For child’s survival, ASHA teams have already been instructed to visit these places on priority basis. Through our innovation mobile facilities, several data that the state government did not have, except for those date from UNICEF and WHO, are being compiled. We got approvals from the Rajasthan state government to extend the facility to 10 more districts.”

Dr Sarvesh Joshi, Secretary, Jaipur Medical Association Rajasthan is the higher exporter of patients, where 30 per cent are going to Gujarat and remaining 40 per cent are visiting healthcare facilities in Delhi NCR area. If we can cater the healthcare facility here in the state then it would be a greater boost to the doctors and investors here. But, there is a contradiction in the present scenarios where on one side corporate companies with huge investments are looking at the state with hesitation, while on the other side there are plans for low cost and free healthcare.

To achieve this, there is a need for Clinical Establishments Act of the state to be changed according to the need of the Rajasthan’s scenario allowing doctors to work freely.

S P Singh, Joint Secretary, Medical Education, Government of Rajasthan “The state government is already on the path of promoting Rajasthan as a medical tourism hub.

Ours is a state of heritage value with added features of well connected path of national highways to super specialty and other healthcare institution. ”He underlined that there is a huge unmet demand of medical services in the state, which holds immense potential for growth in the sector. “We have world class hospitality available in the state and medical tourists are likely to increase at a rate of seven per cent per annum. To give impetus in the hospital sector, deluxe and multi-deluxe cottages are proposed in medical colleges across the state.” He further added, “To attract private investments, policies have been changed in 2006 letting medical leaders like Narayana, Manipal hospitals and the likes to establish their institution in the state. Even electricity, tax deduction systems have been tuned to be industrial friendly.” He also stated that diagnostic facility in the government hospital have been outsourced to private parties increasing the facilities. Expansion of existing hospitals and establishments of new ones (that are likely to be functional in city as well in the district areas) that have potential medical service demand are on the cards. Several institutes have already come under MoU with the government. Some of the existing investments that are around `120 crore is set to go up to `500 crore. Similarly, SMS hospital with investment of `100 crore, cancer hospital with the venture of `120 crore and other hospital investments worth of `300 crore are underway.

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W J Vanderwal, Innovative Financing Lead – GRM Futures Palladium Group of Companies He observed that “Indian healthcare industry is mainly the ‘impact investing’ where the investments have social impact that bring commercial gains. We basically bring group of companies together for investments. In the health sector through extending the healthcare and system, we saved lives of 15,000 babies and 1455 mothers in Bihar and Odisha.

“We would be implementing the same venture here in Rajasthan with similar passion and commitment.”

There was increased use of contraception by 2.6 billion, saving the health system 48 billion pounds. We aim to bring together investors to invest Rs. 250 crore and save lives of over 30, 000 children lives, 3,000 mothers. The numbers are large but are tangible,” he said.

Anagha Khot, Manager – Strategy & Partnerships, South Asia, Children’s Investment Fund Foundation (CIFF)

She stated, “CIFF is a UK based financial organisation. We are working with seven partners in Asia to bring about transformational change in the lives of children. “CIFF’s main focus is on the health, education and nutrition of the child. Through our Initiative - Rakshita we ensure increased child survival through improved quality of child care,” she adds, “We are also doing innovative works in collaboration with NGOs on girl child education where the attention to girl is improved in schools aged between 0-3 years. These transformative programs are in collaboration with the existing partner and also new players.”

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EVENT REPORT

Best Healthcare Practices in India: Lessons to be Learnt Dr KK Kalra, CEO, National Accreditation Board for Hospitals and Healthcare Providers He said that the healthcare industry in India is seen to be growing at a rapid pace but still its quality remains a serious concern. He said that total healthcare expenditure in India is just 3.9 per cent of GDP. Private share of expenditure is 73.8 per cent, however, the government’s share is 26.2 per cent. He further said that a small negligence in healthcare might lead to the death of a patient hence quality in healthcare has to be maintained. Dr Kalra laid emphasis on need of quality healthcare in India and said that many countries have established a system for quality services. He also pointed out that an individual is not responsible for loopholes in healthcare but the entire system is which includes process, people and other resources involved in a task. He termed healthcare as the most dangerous industry and said that safety is very important in health sector therefore certain protocols have to be strictly followed. Explaining about role and functions of National Accreditation Board for Hospitals & Healthcare Providers (NABH), he said that NABH is an institutional member of International Society for Quality in Healthcare, which gives accreditation of healthcare facilities and also provide education and training for quality services and patients’ safety.

Niranjan Kumar Ramakrishnan, CIO, Sir Ganga Ram Hospital, New Delhi

Dr Ajit Gairola, Director NP, Government of Uttarakhand Rajasthan is the largest Indian state constituting 10.4 per cent of geographical area of the country and accounting for 5.67 per cent of the population of India. The geographic vastness makes it a colossal task to provide proper healthcare delivery to both rural and urban population. But, with the implementation of various progressive initiatives and schemes, the state government has escalated the health index of the people.

We have started Nephrodialysis Centres under PPP mode at Coronation Hospital, Dehradun and Base Hospital, Haldwani.

We provide free dialysis services to BPL patients and for APL patients it cost around Rs. 936. The staffs are provided by the private partners, we have 10 doctors, 61 nursing staff and 14 technicians at Base Hospital, Haldwani.

Discussing on cost analysis and accounting he said, “I think a lot of hospitals do not understand the difference between costing and accounting. In accounts we put our expenses in balance sheet and we come up with profit numbers, which is not the real profit.” He further added, “We do not know what is the cost of particular surgery, if someone come up with a equipment purchase, whether it is state government or individuals hospital or government hospital, decision makers do not have enough information to decide whether the equipment has to be procured or not. Outcomes analysis has to be done like number of surgeries, what is the research situation etc. So, we should try to implement outcome analysis to whatever extent it is possible because these things will increase quality of care without increasing cost of care.” He further added, “Similarly with the process for the implementation of HIS or HIT solutions, one should never go for department wise implementation, the moment you get into department wise implementation your resource utilisation will be very high. Try to implement it in a uniform wise, for instance if all the specialties can be grouped together. Also every resource you hired please ensure that the quality of the resource is very good. The quality of resource is really important; please include this in your HR process.”

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Raghavendra Shenoy, Vice President, Ethicon Surgical Care, Johnson & Johnson Private Limited

Ajay Sankhe, Director, Bhaktivedanta Hospital, Mumbai “The World Health Organization (WHO) defines health as a complete state of physical, mental and social well-being, and not merely the absence of disease or infirmity. Yet, we are so unaware of these factors.

Generally, when we discuss about health it is about physical health.

He discussed about the spiritual aspect of healthcare, which is missing from our healthcare system.” He suggested that if the spiritual care is a part of our healthcare and part of the policies then automatically all stages will be taken care in a proper way. He said that a Universal Holistic Principle is required as an innovation and we have done it and results are coming out to be amazing.

“We have results on patients of depression, angioplasty, and cancers. This is the missing link in our healthcare discussions and this is the innovation I have brought in and urged that the policymakers may take a note of us.”

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Focusing on effective frameworks for technology assessment he said, “It is very important to raise standards of our healthcare systems”. The goal of healthcare is to maximise value for patients, defined as health outcomes achieved per unit of cost spent. Everybody being providers, hospitals and medical device makers we all are working towards a common goal, which is patient safety.

So, if our goal is common and if we all are trying to achieve the same goal by different means I think that all of us are in need of evidence. I want to share an article appeared in newspaper, where Tamil Nadu Medical Services Corporation has blacklisted 24 brands of drugs and medical devices in the last eight months after test found them to be substandard. Why we want to measure quality? What quality means to us? Outcome, by and large, remain the ultimate validation of the effectiveness and quality of medical care. He further said, “Now every procedure irrespective of its speciality in every kind of hospital setting the core objective is to deliver absolute high standard of quality healthcare at an affordable cost.” So what is the right framework or tool? It is the systematic evaluation of properties, effects, and/or impacts of health technology- addresses both the direct, intended consequences of a technology as well as the indirect unintended consequences Improves the allocative efficiency - by enabling policy makers make informed decisions; promoting the introduction and adoption of inventive and cost-effective medical technologies; and prevent the uptake of technology with little beneficial value.

Dr N K Pandey, Chairman and MD, Asian Institute of Medical Sciences, Faridabad I am very thankful to National Accreditation Board for Hospitals and Healthcare Providers (NABH) for setting out measurable quality standards. The outcome of that is now we share antibiotics profile with all our doctors every six months. We have cut down the 20 per cent cost of antibiotics in our hospital and we have step down from top antibiotics to medium. We are cutting down bacterial resistance that has huge cost saving for the future.

We have experience that we could reduce the cost by nine per cent just by following quality standard regime. If we implement the best practices right from the nursing home to big setups we can make huge cost saving by giving the best practice.

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Syed Kadam Murshed, AGM-IT, Medica Synergie, Kolkata “Technology is not all about IT, for a dentist the technology starts from dental chair. So, if we think in that dimension, it would be better for our future innovations approach. I would like to discuss few initiatives taken up by Rajasthan government along with stakeholders such as implementation of display unit outside the hospital by Philips Healthcare and Kolkata Accident Rescue & Medical Assistance (Karma) project. We have a call centre in our hospital and we have installed eICU at public care organisations. Now, patient can have information about the availability of our doctors. Kolkata has long suffered a lack of properly established and coordinated trauma and ambulance services that can come to prompt assistance of road traffic accident victims. Kolkata police has been working to bridge this gap with 18 ambulances placed at strategic locations in the city to ferry trauma victims to the nearest hospitals. With the strategic collaboration of Kolkata police, Medica Super Specialty Hospital and Eastern India Healthcare Foundation, was incepted. KARMA is a project that aims to provide 24 hours trauma care service to the people of the city. As most of the states are ahead of us I have an idea of having a preventive care call centres supported by EHR and mHealth, which in turn can reduce emergency admissions. As a result we will have less occupancy of hospital beds and less hospital stay that can promote our healthcare initiatives in a different way.

Healthcare Summit through The Lens Eye

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Leveraging Corporate Social Responsibility

Naveen Jain, Mission Director – National Health Mission, Special Secretary – Medical, Health & Family Welfare, Government of Rajasthan “We approximately receive 15,000 calls per day in Rajasthan and unfortunately out of these calls only 3,000 authentic calls are for some service, while 50 per cent of the calls are bogus. We are struggling with it to control these fake calls and approximate 1600 dispatches per day. Dispatches are less during afternoon and late night.

Sumanta Ray, Chief Marketing Officer, Narayana Health He said as part of the CSR initiative Naryana Health has introduced ‘micro health’ insurance scheme for farmers in Karnataka. “Now, all the farmers in Karnataka who are part of the cooperative society in Karnataka are paying Rs.15 a month through which they can avail over 2,600 surgical procedures in corporate and noncorporate hospital. The micro finance initiative has been administered into a trust, which is very successful.”

He continued, “CSR is all about affordability and accessibility. Also, to make the health services accessible to inaccessible area, we are working with like-minded corporate companies like HP. Together we have launched over 22 fully equipped telemedicine centres.”

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Dr Balaji Utla, CEO, Piramal Swasthaya He indicated that corporate social responsibility (CSR) plays a major role in overcoming the challenges of lack of trust between governments and corporate. He said, “It is (CSR) all about technical capabilities and managing capabilities. If the partners of CSR- corporate and government trust each other, I am sure India in less than a decade will overcome the challenges it is facing.”

Shashwat Kulshreshtha, Corporate Affairs Team, Cairn India Limited Our CSR contributions are mainly for the health sector. Since drinking water supply is a challenging issue in the country, we, in first of its kind initiatives are setting up 350 water dissemination harbour plants across the country. We will supply the water to the households. The project is likely to roll out in next few years. On account of preventive health practices, sanitation hygiene is one important aspect. We are manufacturing sanitary napkins at an affordable price and hope that National Health Mission Rajasthan will support us.

EVENT REPORT

Subroto Roy, Operations Head, GVK EMRI, Rajasthan Throwing light on the GVK CSR initiatives, he said, “Our ambulance and helpline services like 108, 104 and 100 are a combination of PPP and CSR. These services have been in operation through the partnership with respective state governments. Through GVK CSR funding, we manage these companies.” He added, “Sustainability remains constant in all of GVK's projects and initiatives. One of the highest priorities during project implementation and planning is safeguarding nature. Instead of being an add-on, sustainability has always been a starting point at GVK and is inbuilt in all our processes.” Through these ambulance services we are able to address the issues of mother and child healthcare, road accidents, suicidal attempts and trauma cases. “In Rajasthan we handle 36 per cent pregnancy cases, 18 per cent road accidents and 46 per cent trauma cases,” he informed.

Prateem Tamboli, Director, Fortis Hospital, Jaipur He shed light on the lines of social initiatives

by Fortis Hospital as part of its CSR. Our initiative ‘Saksham’ provides basic life support training to ‘first responders’ who prove to be a lifesaver. ‘First responders’ could be anyone including a police, a driver and so on. So far over 4,500 people have been trained who can refer the patient to the right destination. “We also celebrate the birth of a girl child where we help the family in the plantation of the tree with the birth of a girl child-indicating prosperity of the girl child with the growing tree. So far over 25,000 plantations have been carried out,” he said. Similarly, addressing the incidence of a large number of congenital heart diseases, Fortis hospital has rendered heart surgeries on the low cost basis. He added, “Till now we have performed over 400 such surgeries.” ‘Umeed’ is an example, where we worked with the government and conducted preventive health checkups for the underprivileged children.

Stressing the importance of CSR, he said, “An organisation can be successful and sustainable if it addresses the problems of the society and CSR is the only solution to the problems.”

Gautam Patel, Senior Policy Manager, J-Pal He underlined the necessity of CSR implementation in the remote areas where the access is almost nil due to absence of connectivity for the sources to reach the place. As part of their CSR initiative, the company took up immunisation of the people in the remote areas of Bihar and Udaipur where the healthcare access is still rare. “We got the immunisation process done throughout the year, convincing the reluctant locals to get the immunisation done,” he said.

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EVENT REPORT

Healthcare Infrastructure: Challenges and Opportunities

Dr Samit Sharma, Commissioner, Bureau of Investment Promotion (BIP), Government of Rajasthan

He highlighted the areas of investment opportunities in the health sector of Rajasthan. He observed that the role of private players in state’s healthcare sector is increasing and widening the gap of demand and supply in health services by the public institutions. “The existing medical colleges, primary, secondary and tertiary health outlets are able to cater to only 30 per cent of patients, while, the other 70 per cent patients are catered by private players,” he said. He cited the excellent transport connectivity and availability of the skilled manpower in the state as some of the reasons for the private players to invest in the state. He also highlighted the Rajasthan government’s industrial policy, offering various tax exemptions and subsidies up to 50 per cent, and also the customised tax exemption for mega project investors to encourage investments in the state.

Dr Dinesh Dvivedi, Executive Director (Logistics), Rajasthan Medical Services Corporation (RMSC) He highlighted how the RMSC model has been studied by other states that work to provide free drugs and diagnostic facilities.

“65 per cent of Indians lack money to access essential drugs, budget 2011-2012 allocation opened the way for free medicines and diagnostic facilities. He further added, “Before RMSC’s creation, the state budget was not properly utilised. However, with the implementation of an appropriate methodology and leveraging the budget, the drugs were being provided to all at the government healthcare institutions. Several essential drugs are being provided by RMSC at a huge price difference along with free investigations.”

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Nagarajan M, District Development Officer, Sabarkantha District Panchayat, Gujarat He highlighted how the RMSC model has been studied by other states that works to provide free drugs and diagnostic facilities. “65 per cent of Indians lack money to access essential drugs. Budget 2011-2012 allocation opened the way for free medicines and diagnostic facilities.

He further added, “Before RMSC’s creation, the state budget was not properly utilised. However, with the implementation of an appropriate methodology and leveraging the budget, the drugs were being provided to all at the government healthcare institutions.

Several essential drugs are being provided by RMSC at a price difference along with free investigations.”

EVENT REPORT

Dr (Maj Gen) S C Pareek, Medical Director, Bhagvan Mahavir Hospital, Jaipur

He said that the need of hospital infrastructure as a user should be taken into consideration.

The need of healthcare infrastructure is evolving with the growing demand. Each specialty hospitals have specific requirement in terms of infrastructure. However, there is a need for hospital developers to come with the engineering needs like location of hospital, availability of water etc., as they are lot dependent on the companies that provide equipment like MRI, CT scanners.Another aspect he underlined is whether to come up with single hospital building or healthcare complexes where all the individuals involved in functioning of hospital are accommodated. He also pointed that green building is the need of the hour as most of the hospitals’ rooms need power for air-conditioned and other equipment utility.

U K Ananthapadmanabhan, Group President, Rainbow Hospitals, Hyderabad He highlighted how building chains of multispecialty and super-specialty hospital have become faster with hospital industrialist outsourcing the construction work to developers in the form of warm shell project.“In conceptualising a hospital and coming up with structure it used to take at least twothree years. But, since 2005 through warm shell project method, hospital owners started outsourcing building work to developers by giving out a plan,” he added. “We are 10 year old in the field and our first hospital in Hyderabad has now multiplied more hospitals in Andhra Pradesh.”

Pointing on how information technology has become a part and parcel of the hospital building we recently introduced ‘Rainbow digital project’ where all the data is being stored in cloud. In cloud architecture we connected all our hospitals,” he informed.

Dilip Patil, Managing Partner, Trivector Biomed He discussed how the popular infection control methods including disinfectants, sanitizers, chemical fumigation Ionisers, UV lights and others have their own limitations.

How use of the latest ‘Plasma Technology’ is proving to be effective and hassle-free, reducing the rate of contact infections and also airborne diseases. “It is a technology that has been validated by the NASA. This technology not only disinfects effectively but also removes bad odour that accompanies the infections. In plasma technology the pathogens are attracted to the plasma, which then are killed. NASA has done it and proved. It even consumes much less electricity, and also runs for three years. Studies on the technology have been completed in different countries,” he said. He also called on the Rajasthan government to take the lead in installing the technology and said would sample out devices to bring it in practice.

Harpreet Singh, Head – Channel Sales, Antriksh Group “Tier II and tier III cities are the areas that do not have access to quality infrastructure. We are into providing world-class infrastructure and our target is to cover at least 15 of the proposed smart cities announced by the Government of India (GoI). Real estate is one sector that is non-characterised with most transaction taking place through cash, be it the purchase of raw material or land dealings. Our company as developer executes all our projects through prior documentation and currently, more than 20,000 customers enjoy our properties. We want this expertise to bring it in the healthcare infrastructure also.”

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EVENT REPORT

Recognising Innovations & Initiatives in Healthcare

Special address Princess Diya Kumari, Hon’ble Member of Legislative Assembly, Rajasthan “This is one of its kind events organised in our state, which will benefit everyone right from the grassroot level, from villages to bigger hospitals.

There is a huge difference between what the state was two years ago and what it is today. Being the ambassador of ‘Beti Bachao’, the government in the centre is committed to the cause. The difference in the female sex ratio has also decreased.”

Innovative use of Technology by Hospital - Bai Jerbai Wadia Hospital for children PPP Initiative of the Year - Bhaktivedanta Hospital Reseasrch Institute ( A Project of Sri Chaitanya Seva Trust)

Best use of IT in Healthcare - MDIndia Healthcare NetworX Pvt. Ltd.

Best Use of Technology by Hospital in Rajasthan - Santokba Institute of Digestive Surgical Sciences received the Award

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Government Initiative in Healthcare District Panchayat, Sabarkantha

Best CSR Initiatives in Healthcare - GVK Emergency Management and Research Institute

Government Initiative in Healthcare Award - Aarogaysri Health Care Trust

EVENT REPORT

Best Multi-Specialty Hospital of the Year - Dr B L Kapur Memorial Hospital

Best Single-Specialty Hospital of the Year Sancheti Institute for Orthopedics & Rehabilitation

Banking Initiative for Healthcare - Bank of Baroda

Best CSR Initiative in Healthcare in Rajasthan - Fortis Escorts Hospital, Jaipur Best Multi Speciality Hospital in Rajasthan Fortis Escorts Hospital, Jaipur

Innovation for Social Cause in Healthcare - State PCPNDT Cell, Govt of Rajasthan

Real Estate Initiative of the year - Antariksh Group

Fertility Preservation Initiative - Trivector Biomed

IT for Public Health UNICEF& SIHFW

AUGUST / 2015 ehealth.eletsonline.com

s were

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EVENT REPORT

Thank you

Technical Support by UNICEF

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International News

Mindray to Buy Remaining Interest in Dragonbio for US$ 72.6 Million

Abbott Obtains FDA approval for iDesign Advanced WaveScan Studio System Abbott has received approval from the US Food and Drug Administration (FDA) for its iDesign Advanced WaveScan Studio System. Said to act as the brain of the laser assisted in situ keratomileusis (LASIK) procedure, the system generates a high-definition scan, which measures and maps irregularities of the eye that may impact vision. These measurements will allow the system to create an accurate and personalised LASIK treatment plan based on the unique blueprint of each person’s eyes. The system captures around 1,200 micro readings of the eye, as well as identifies shape of the cornea, its curvature and how light passes through the eye and pupil diameter under different lighting conditions.

Abbott’s vision business research and development head Leonard Borrmann said: “The iDesign System for LASIK is a leap forward for laser vision correction in the US, enabling a highly personalised treatment unique to the vision needs of each person”.

The iDesign system allows doctors to treat higher levels of astigmatism in people with nearsightedness, wider range of pupil sizes and people with 18 years of age and older. Since 2012, the iDesign system received approval in different countries across the globe, including China and the European Union.

Mindray Medical International has signed an agreement to purchase the remaining interest in Wuhan Dragonbio Surgical Implant, for around US$72.6 million. Dragonbio supplies medical orthopaedic products in China. The company is a domestic medical orthopaedicproduct provider, which is specialised in trauma, spine, joint and other surgical products. In 2012, Mindray acquired controlling stake in Wuhan Dragonbio Surgical Implant, for around US$ 35.5 million.

“The transaction is expected to help us manage and expand the business more efficiently and effectively through our strong capital position, largescale operational experience and worldwide presence,” said Minghe Cheng, Co-chief Executive Officer and Chief Strategic Officer, Mindray Medical International.

The deal is expected to complete by the end of this month. Based in Shenzhen of China, Mindray develops and markets medical devices and it operates primarily in three business segments, including patient monitoring and life support, in-vitro diagnostics and medical imaging systems.

ResMed buys CareTouch ResMed has purchased Internet-based solutions provider CareTouch. Under the deal, CareTouch will be rebranded as ResMed ReSupply and its employees, including CEO Matthew Dolph were placed in ResMed’s commercial team in the Americas. CareTouch also offers therapy-focused resupply programs for home medical equipment providers (HMEs), and helps healthcare providers to offer patients the personal attention, equipment and supplies they need to maintain therapy without interruption.

“With this acquisition, ResMed is further helping HMEs streamline communications with their patients about ongoing therapy needs, said Raj Sodhi, President, Healthcare Informatics Global Business Unit ResMed. The CareTouch 360 portal allows healthcare providers to manage and monitoring their patient populations. It also offers live and multi-lingual call centre contact with patients through their preferred mode of communication and helps in checking therapy adherence, taking orders, handling payments or collections, and providing customised reports.

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Company News

Umbilical Cord Stem Banking Becomes More Affordable

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ifeCell, the stem cell bank, unveiled an affordable umbilical cord stem cell banking service. The brand is also planning a new media campaign with actress Aishwarya Rai Bachchan who is also the brand ambassador, to give an impetus to the popularity of the service.

According to the official statement the new lowered price of the services in the market is `9,990.

Mayur Abhaya, CEO and Managing Director, LifeCell said that there are many necessary expenses that expectant parents face around the time of childbirth. At LifeCell we believe that price should not be the reason in pushing stem cell banking down or out of the list of things to be done before the arrival of the baby.

According to Abhaya Kumar, founder and vice chairman the company is committed to making consistent investments to ensure that this critical healthcare service is affordable for expectant parents across the country. This increased access service will be benefit the future generations to live longer and stay healthier.

Godrej Appliances forays into Healthcare Refrigeration Space

Godrej Appliances will be investing `35 crore in healthcare refrigeration space in the next two years.

Kamal Nandi, Business Head and Executive Vice-President, Godrej Appliances said that the company is to invest `35 crore in three phases over the next two years on ramping up production and marketing of medical refrigerators.

The present production capacity is 10,000 units and will be increased to 30,000 in next two years, he added.

The company has manufacturing units in Mumbai and Pune at present. It has entered into a technology transfer agreement with UK’s Sure Chill Company for developing and manufacturing these medical refrigerators.

These refrigerators will be marketed in India and neighbouring nations including Pakistan, Bangladesh, Bhutan, Nepal, Saudi Arabia, the UAE and African nations.

As per media reports the Godrej medical refrigerators will be available in two variants priced in the range of `65,000 and `1.35 lakh for diferent storage capacities.

Siemens CT Completes 40 years

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iretom, the first Siemens computer tomograph, began series production in 1975.

Siemens shaped image-based diagnostics through innovations such as Spiral, Multislice, and Dual Source CT Somatom Force, are the latest top-of-the-range model, proves Siemens Healthcare’s technological leadership.

After 40 years of launch of its first series model, Siretom, Siemens Healthcare is looking back on the successful development of its computed tomography division with a ceremony held at the Siemens MedMuseum in Erlangen, Germany. With innovations such as Spiral, Multislice, and most recently Dual Source technology, Siemens has been driving the CT market and clinical diagnostics for decades. Today, three patients are scanned with a Siemens CT system every second. The company’s portfolio ranges from robust systems for basic care, such as Somatom Scope, through to the world’s fastest and most powerful CT scanner, Somatom Force.

Its peak values show how rapidly technology has progressed for physicians and patients: While Siretom took around nine minutes to perform a complete head scan back in 1975, today Somatom Force can scan the entire upper body in under one second with an X-ray dose of less than 0.1 millisievert – around the same amount of radiation exposure as an intercontinental flight.

Other Siemens technologies are now also common throughout the CT market, such as the Spiral scan, which Siemens brought to the market in 1990. Here, the detector continually rotates around the table, which moves steadily through the gantry. The measurement system therefore moves on a spiral track around the patient. This meant that Somatom Plus-S, which could precisely map entire regions of the body in one pass, was the first volume spiral scanner on the market.

In 1998, the multislice technology in Somatom Volume Zoom made non-invasive vascular imaging possible in routine procedures for the first time. This played a key role in the breakthrough of heart CT.

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Government Desk

Distribution of Free Medicines Under NHM

Regarding the action plan for distribution of free medicines, as public health is a state subject, it is primarily for the states and UTs to draw up such action plans as per their need. However, under the National Health Mission (NHM), financial and technical support is being provided to the states/UTs for strengthening their healthcare delivery system including support for provision of free drugs to those who access public health facilities based on the requirement posed by the states/UTs in their Programme Implementation Plans. An incentive of up to 5 per cent additional funding (over and above the normal allocation of the state) under the NHM is provided to those states that introduce free medicines scheme. Under the NHM-Free Drug Service Initiative substantial funding is available to states for provision of free drugs subject to states/UTs meeting certain specified conditions. Detailed operational guidelines for NHM-Free Drugs Service Initiative have also been released to the states on 2nd July, 2015.

The number of free drugs provided by the states varies from state to state and most states have their own list of essential medicines to be provided free in public facilities.

As such, support is available to the states/UTs if they decide to provide free essential medicines as per the national list.

The steps taken by the Government to check spurious/sub-standard drugs in the country include - under Drugs and Cosmetics Act, 1940 and Rules made there under, the regulatory control over the drugs imported in to the country is exercised by the Central Government through the Central Drugs Standard Control Organization (CDSCO). The manufacture, sale and distribution of drugs are regulated under the said Act & Rules by the State Drugs Control Authorities appointed by the State Governments. The regulatory control over the manufacture and sale of the drugs is exercised through a system of licensing and inspection. The manufacturer is required to comply with the requirements of Good Manufacturing Practices specified under Schedule M of the Drugs and Cosmetics Rules and conditions of the licence so as to ensure that the drugs manufacturers in the country conform to the standards prescribed for them.

The Government has taken various steps to check the menace of spurious/substandard drugs such as the Drugs and Cosmetics Act, 1940 was amended under Drugs & Cosmetics (Amendment) Act 2008. Stringent penalties for manufacture of spurious and adulterated drugs have been provided. Certain offences have also been made cognizable and non-bailable. The States / UTs have been requested to set up special Courts for trial of offences under the Drugs and Cosmetics Act for speedy disposal. 25 States have already set up designated special Courts for trial of cases related to spurious and sub-standard drugs. A Whistleblower scheme has been announced by the Government of India to encourage vigilant public participation in the detection of movement of spurious drugs in the country. The scheme provides for suitably rewarding the informers for providing concrete information to the regulatory authorities in respect of movement of spurious drugs. The details of policy are available at the website of CDSCO (www.cdsco.nic.in).

Guidelines for taking action on samples of drugs declared spurious or not of standard quality in the light of enhanced penalties under the Drugs & Cosmetics (Amendment) Act, 2008 were forwarded to the State Drugs, Controllers for uniform implementation.

The Government has decided to strengthen both the Central and States’ drug regulatory system during the 12th Five Year Plan enabling them to keep more effective watch on these unscrupulous elements indulging in unlawful activities.

The number of sanctioned posts in Central Drugs Standard Control Organization (CDSCO) has been increased from 111(as on April, 2008) to 474(as on Feb, 2015).

Provision of quality assurance for the drugs provided in public health facilities under the NHM.

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Kochi to Get Motorbike Ambulance System Kochi is all set to get a motorbike ambulance system like Kozhikode, Bangaluru and other cities. The Karnataka government has already launched the initiative in April, while Maharashtra is mulling the possibility of launching the service next year.

This service is a private initiative in Kochi while in Kozhikode it is operated by both a private hospital and ANGLES, an ambulance network agency.

A two member team will be on call at the hospital, and there will be a 24-hour cell working to coordinate the service. People can call toll-free numbers 155 and 126 for the motorbike ambulance service.

Government Desk

AIIMS like Institutes under PMSSY

Under the Pradhan Mantri Swasthya Suraksha Yojana (PMSSY), the Government plans to establish AIIMS like institutions in every State in a phased manner. Six new AIIMS at Patna (Bihar), Raipur (Chhattisgarh), Bhopal (Madhya Pradesh), Bhubaneswar (Orissa), Jodhpur (Rajasthan) and Rishikesh (Uttaranchal) are functional.

Construction of residential blocks at the site of AIIMS in Rae Bareilly has started.

Timeline for AIIMS to be set up in various States, as per budget announcements, depends upon the receipt of various due approvals and will be made functional as soon as infrastructure is in place.

No Monitoring Committee has been established by the Government, as AIIMS are statutory bodies established under Section 3 of the All-India Institutes of Medical Sciences Act, 1956 as amended in 2012. The Institute is a body corporate and the Institute Body regulates the functions of the Institute as per the provisions of the Act. Governing Body, Academic Committee, Standing Finance Committee and Standing Selection Committee have been set up by the Institute Body in terms of Section 10(1), 10(5) and 10(6) of the All-India Institutes of Medical Sciences Act, 1956 as amended in 2012, to assist the Institute in discharging of its functions.

Phase-I of PMSSY ◗ ◗ ◗ ◗ ◗ ◗

Patna (Bihar), Raipur (Chhattisgarh), Bhopal (Madhya Pradesh), Bhubaneswar (Orissa), Jodhpur (Rajasthan) Rishikesh (Uttaranchal)

FRESH ANNOUNCEMENTS

PPhase-II of PMSSY ◗ ◗

Rae Bareilly (Uttar Pradesh) West Bengal (AIIMS could not be taken up due to non-providing of suitable land/site)

Budget FY 2014-15 ◗ ◗ ◗ ◗

Andhra Pradesh West Bengal Vidharbha (Maharashtra) Poorvanchal (Uttar Pradesh)

Budget FY 2015-16 ◗ ◗ ◗ ◗ ◗ ◗

Assam Himachal Pradesh Jammu & Kashmir Punjab Tamil Nadu Another AIIMS in Bihar

Punjab Government to Introduce Patient Feedback In order to analyse and rectify the problems faced by the patients across the state, the Punjab Government is soon going to introduce patient feedback forms in hospitals.

According to an official release the necessary directions have been given by Vini Mahajan, Principal Secretary, Health and Family Welfare, Punjab in this regard.

At present a patient satisfaction survey through PGIMER, Chandigarh is in progress. Based on the questionnaire developed by PGIMER, this feedback format shall be developed, added the release.

The patient feedback form would emphasise on key service delivery areas at the health institutions. Also, a mechanism to install feedback boxes is being discussed and will be finalised soon.

According to Vini Mahajan this will put in more accountability and better behaviour by government hospital staff and provide better healthcare facilities to the patients.

Based on the feedback the government shall identify areas and services that need improvement.

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Hospital News

Nova Specialty Hospitals is now Apollo Spectra Hospitals

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pollo Health and Lifestyle Limited (AHLL), a wholly owned subsidiary of the Apollo Hospitals Group, acquired Nova Specialty Hospitals and is all-set to re-launch the facilities under the name of Apollo Spectra Hospitals. Through this launch, AHLL endeavours to ensure that the patients get access to comprehensive, affordable and personalised quality healthcare.

Mr Neeraj Garg, Chief Executive Officer, Apollo Health and Lifestyle Ltd. said, “Apollo Spectra’s evolution is guided by a ‘patient-centric’ approach. The exclusive surgery center model minimises hospital acquired infections resulting in elimination of unnecessary hospitalisation and remarkable medical outcomes. Given the immense potential and the need for quality healthcare delivery closer to home, Apollo Spectra enables AHLL to significantly expand its’ footprint and will catapult it into a leadership position in this segment of healthcare. Apollo Spectra is strengthened by the introduction of quality systems built on Apollo’s deep expertise in the hospitals space. We believe this format has strong potential and with the brand equity of Apollo, combined with rich hospital expertise we bring to bear, AHLL will nurture this business significantly in the next few years.”

Sudhir Diggikar, Director (Secondary Care), Apollo Health and Lifestyle Ltd. said, “Apollo Spectra endeavors to provide world-class treatment and is the only healthcare service provider equipped to undertake over 1100+ surgical procedures across all major specialties. Apollo group has always been proactive in offering healthcare to meet the changing patterns of diseases and constantly strives to make quality medical care accessible to all.

Through this launch, AHLL delivers on its promise to create newer ways to deliver high quality healthcare, through enhanced service delivery models, which will benefit the entire health eco-system including its physicians & patients.”

Apollo Spectra provides quality healthcare for patients from all over the world including the USA, Europe, Africa, the Middle East and South East Asia.

Sir Ganga Ram Hospital launches Digital Health Card

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ir Ganga Ram Hospital (SGRH) has launched a multi-purpose Digital Health Card to provide patients with easy access to medical care. The health card contains a micro-chip with Smart-Chip Technology which stores all information related to patient’s health.

According to Dr D S Rana, as a part of Digital India Programme we have launched SGRH Health Card – a multipurpose smart card, designed to provide patients with easy portability of their healthcare information and give the consultants faster access to their clinical data.

With this card the patients will not have to carry his films, medical reports and details when he visits the hospital.

This card will be given to the treating consultant, who by inserting it in a card reader will get to know about his past medical history.

The card will also be a eWallet cash in which the patient can store cash and use it to pay money at any department at SGRH, without the need to carry physical cash. It holds an added advantage for the outstation patients as money can directly be transferred from bank to this card.

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Hospital News

Kauvery Hospital Launches Orthogeriatrics Department

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auvery Hospital has launched the department of Orthogeriatrics for comprehensive orthopedic care in an extension of its healthcare services to the senior citizens. The department combines the medical specialities of orthopedic and geriatrics to provide holistic care with top-of-the-line infrastructure and patient-friendly amenities.

Orthogeriatrics department houses 15 in-patient beds, senior friendly amenities such as low level cots and bathrooms with grab bars, spacious corridor for physiotherapy and rehabilitation apart from advanced medical equipments and devices.

“The United Nations Population Fund (UNFPA) in its study jointly brought out with Help Age International, points that the number of people in the 60+ age group will increase from the current 100 million to 323 million by 2050, constituting 20 percent of India’s total population by then. It further predicts the number of people over 80s to increase seven fold. It is also of concern that the study discloses, that around one-fifth of the elderly live alone or only with spouses in both rural and urban areas. These findings underline the fact that with a growing elderly population in the country, there is a need to strengthen geriatric care services so that the increasing health care demands of the elderly can be met”, said Dr. Aravindan Selvaraj, Chief Orthopaedic Surgeon & Executive Director, Kauvery Hospital.

M S Ramaiah Medical College Launches HeartRescue India

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S Ramaiah Medical College, M.S.Ramaiah Memorial Hospital, MSR Advanced Learning Centre, University of Illinois at Chicago and Medtronic launched HeartRescue India. The US$4.4 million is a collaborative program funded

by Medtronic Philanthropy that supports community-based demonstration projects designed to expand access to lifesaving interventions for cardiovascular events such as heart attack and sudden cardiac arrest.

The HeartRescue India partners convened on July 15 at M.S. Ramaiah Memorial Hospital in Bangalore, with representatives from state government, local and national medical experts to launch a bold and unique initiative aimed at dramatically improving survival from the leading cause of death in India–acute cardiovascular disease.

While M.S. Ramaiah Medical College will lead the effort, other HeartRescue India partners will contribute varied levels of support and expertise: Research Triangle Institute International will help coordinate global and country level activities.

The Institute for Health Metrics and Evaluation at the University of Washington will drive monitoring and evaluation. And the University of Illinois Center for Global Health and the University of Arizona Emergency Medicine Research Center will provide emergency care technical expertise.

HeartRescue India’s overarching goal is to implement a model of care for patients with acute cardiac emergencies in the community that minimizes critical delays to treatment and saves lives.

Building on a successful five-year program in the United States, HeartRescue India partners will coordinate implementation in Bangalore, which will include community outreach efforts to improve knowledge of the signs and symptoms of heart attack and sudden cardiac arrest, teaching families how to call for emergency help and if necessary perform life-saving CPR. Partners will collaborate with regional emergency medical services to identify and reach heart attack patients more quickly and provide ambulance transport to receiving hospitals for life-saving care. “Our plan is to work with local and national partners to design an integrated and scalable emergency response system using community health responders, 108 emergency dispatch, and designated hub and spoke hospitals,” says Dr. Aruna C Ramesh, head of emergency medicine and trauma at M.S. Ramaiah Hospital, and the principal investigator on the HeartRescue India program. “We believe we can substantially boost the number of patients who receive timely, effective care, and ultimately save many more lives in the process,” adds Ramesh.

“Improving access to healthcare is at the core of what we do,” says Milind Shah, a board member of Medtronic Philanthropy, and vice president of Medtronic South Asia and managing director of Medtronic India. “Our global and local partnerships lead to a strengthened continuum of care for the patients we serve, which in turn leads to better outcomes, and healthier communities.” Shah adds.

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HealthEminds

Online Therapy for a Healthy Mind Government of India studies show 1/5th of the Indians suffer from mental health disorder. To counter these alarming statistics, HealthEminds is an online psychiatry and counselling services allowing people to seek a happier and healthier lifestyle.

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he company was started to provide quality counseling that is affordable, convenient and easily accessible to clients around the world through a proprietary and innovative video based online technology platform. A recent WHO report states that India is the most depressed country in the world, and, mental and emotional healthcare is heavily stigmatised by society. Mental well-being dictates how people connect with each other and affects personal and professional life.

HealthEminds start-up seeks to transform the negative perceptions surrounding counseling by spreading awareness & by allowing people a confidential, secure platform people can access in the privacy of their own home.

HealthEminds, self-funded by the founders, at present has 45 mental healthcare professionals nationally empanelled. By the end of the calendar year, the company looks forward to an addition of 100 more professionals.

For the next five years the company aims to make millions of lives around the world happier and healthier, influencing people to focus on emotional and mental fitness, bringing quality mental healthcare to people no matter where they live, and increasing awareness levels

Healtheminds provides various online psychiatry and counseling services

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Ankita Puri is the Co-founder and CEO of Dr Sunita Maheshwari is the Co-founder Healtheminds and Strategic Adviser at Healtheminds

about mental health issues and its effects on health and families or society and how seeking help can make all the difference.

HealthEminds claims to be a platform that can save one’s time in travelling and waiting. It works towards ensuring India’s mental health while advocating the fact that “It’s good to get help”. Pan-India, experts come together under the HealthEminds umbrella, and depending on the availability of the expert, sessions can be booked for a convenient time and day depending on one’s schedule. Other benefits includes accessibility from location of choice and convenience, access to professionals who are not geographically inaccessible, hence access a wider range of professionals, straightforward booking and payment system – sound cancellation and refund policy for minimum ambiguity and maximum satisfaction, transparency about expert qualifications/experience/approach, assured anonymity, people with limited mobility.

Viewpoint

Battling Infection Control Healthcare facilities need to re-evaluate their infection control plans, says Dilip Patil, Managing Partner, Trivector Biomed

H

ealthcare facilities are waging a constant battle against infection control.

From hands to surfaces, everything in a healthcare facility has an infection prevention protocol.

Conventional control plans have been in place for decades - change linens, wash hands, sterilize instruments and surfaces - yet outbreaks persist.

Add to this the fact that more and more pathogens and bacteria are developing antibiotic resistance, and it’s becoming obvious that Healthcare facilities need to re-evaluate their infection control plans Healthcare acquired infections (HAIs) are a major problem facing long-term and day care facilities all over the world. Especially in developing countries the magnitude of this problem is enormous and must be tackled today for better healthcare tomorrow!

Outbreak of Swine Flu and regular out-breaks of other viral infections has become a norm of a sort in India with change in seasons and climate. Beyond the thousands of avoidable annual fatalities, there are extreme costs associated with HAIs, with some reported figures exceeding tens of billions of dollars.

There are no practical, effective and affordable ways to kill airborne viruses. The solutions available are either cumbersome, too expensive or less effective. The established ways of sterilisation and cleaning are not enough. Even these viruses and bacteria have become immune to most commonly used antibiotics.

One way to combat HAIs is to understand more about their root causes. Here are some startling facts and figures about HAIs (pertaining to USA). For example HAIs claim an average of 271 lives every day. Most of these fatalities are caused by drug resistant “superbugs� such as methicillin-resistant staphylococcus aureus (MRSA), noroviruses and clostridium difficile. All told, HAIs kill more people in US than automobile accidents and breast cancer combined.

Healthcare-acquired infections are a major drain on hospital resources. HAIs cost an average of US$ 25,000 per patient. Consider there are approximately two million HAI cases per year, their total burden is in the neighbourhood of US$ 50 billion.

Patient-to-patient contact is not the most common transmission route of HAIs. While many cases can be traced back to patient-to-patient

contact, the majority of HAIs are transmitted through contact with contaminated surfaces/equipment, or via airborne transmission.

Many HAIs are drug-resistant.

While there are numerous viral HAIs, including new strains of avian flu and swine flu, most HAIs are bacterial in nature. Worse, more than 70 per cent of the bacteria that cause HAIs are resistant to one or more of the frontline medications used to treat them.

Current infection prevention protocols remain heavily focused on hand and surface cleaning, but neglect the air. Even air filtrations systems which use HEPA/UV are not effective in eliminating many viruses, bacteria and odours. Numerous portable air-purifiers are available in the market, but they may not be able to kill all the pathogens in the air.

As pathogens and bacteria become more antibiotic resistant, healthcareacquired infections are becoming more commonplace.

In western countries one trend that more and more successful healthcare professionals are exploring is to utilise new technology backed up by solid science as a way to complete their infection control plan.

Unique technology like Novaerus Plasma (Dielectric Discharge), which is validated by NASA promises to reduce the threat of bacteria and pathogens in your facility by scrubbing the air. This innovative, effective and affordable technology is now available in India.

Visit www.trivectrobiomed.com or write to info@trivectorbiomed. com for further information!

AUGUST / 2015 ehealth.eletsonline.com

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Product Launch

Samsung Launches Premium Ultrasound Imaging System, RS80A with Prestige

S

amsung Electronics has announced the launch of a premium ultrasound imaging system ‘RS80A with Prestige’ with an enhanced diagnostic package designed for radiology departments. The RS80A with Prestige strengthened research ability to the existing RS80A over a broad spectrum of diseases related to abdominal, breast, cardiovascular, and musculoskeletal ailments, to provide higher clinical value. After the launch of Samsung’s first radiology system RS80A last year, RS80A with Prestige will come with additional research functions to enhance user experience.

The system is equipped with S-Fusion, which is a function that can compare the body parts intended for diagnosis through ultrasound imaging with CT or MRI imaging simultaneously for analysis. Users can determine the location of lesions more precisely that the existing ultrasound imaging couldn’t locate with high resolution of CT and MRI imaging. In particular, S-Fusion allows auto-registration that aligns imaging of CT or MRI within 30 seconds to enable a quick diagnosis.

S-Shearwave, which helps analyse the characteristics of body tissue without biopsy, provides numerical measurements of stiffness using the shear wave produced around the region of interest. The function supports accurate diagnosis by providing Reliable Measurement Index (RMI) and statistics for repeated measurements including the median and standard deviation.

The system provides Samsung’s new advanced 3D technology, Natural Vue. The feature strengthens morphological expressions than the existing Realistic Vue that creates realistic expression of internal body images.

With the application of the 3D/4D reflection mode, Natural Vue can show even a minute protrusion that basic imaging is unable to display. The system also features Arterial Analysis, which supports earlier detection of cardiovascular diseases by executing both morphological and functional analysis of the vessel.

The system was first launched in Korea in June 2015 and will be followed by launches in other regions around the world, including the United States and Middle East in due course, targeting research and general hospitals. The product was introduced earlier in March at the 2015 European Congress for Radiology in Vienna, through seminars on clinical values of its main functions. The RS80A with Prestige also drew keen attention at the 31st Korea International Medical and Hospital Equipment Show in Seoul.

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AUGUST / 2015 ehealth.eletsonline.com

Product Launch

D-dimer: Empowering Laboratories

V

enous Thromboembolism (VTE) is a common, lethal disorder affecting hospitalised and non-hospitalised patients. VTE is one of the most common cardiovascular illness, third only to acute coronary syndrome and stroke. It contributes substantially to patient morbidity, mortality and cost of management.

Testing Scenario in IndiaD-dimer testing is of clinical use when there is a suspicion of VTE and is nowadays a commonly referred test. Unfortunately, not many laboratories in India can perform these tests due to limitations of manual systems. Most of the estimated 40,000 clinical laboratories in India still do not have this testing facility due to financial constraints, demographic challenges, non-availability of reliable tests kits and trained expertise.

Different D-dimer Assays There are multiple technologies available for D-dimer testing however, not all are specific, sensitive and at the same time affordable. Another limitation is that these kits are often available in large pack sizes, with reagents of limited expiry. As a result, a lot of prospect centres with a small workload, postpone the procurement decision.

Comparison of various methods of D-dimer Assay Method

Sample type

Sensitivity

Specificity

Calibration required

QC possible

System required

Remarks

Microplate ELISA

Plasma

High

Low

Yes

Yes.L-J possible

Manual

Long procedure with ELISA readers

Fluorescence Immuno Assay/ ELFA

Plasma

High

Low

Yes

Yes.L-J possible

Automated

Costly FIA System

Chemilumescence Systems

Plasma

High

Low

Yes

Yes.L-J possible

Automated

Costly FIA System

Immunofilteration & Sandwich type Systems

Plasma

High

Low-High

No

No

Automated

Low specificity for boronate method

Semi Plasma Quantitative Latex agglutination slide tests

Moderate

Moderate

No

Basic

Manual

Outdated slide test, manual

Manual Whole Blood agglutination Rapid test

HighModerate

Moderate

No

Basic

Manual

Kits not easily available

High

Moderate

Yes

Yes.L-J possible

Automated

Whole Blood

Second Plasma Generation Latex Agglutination Test

Possible only on fully automated system

Empowering Every Laboratory The latest semi-automated coagulation analysers from Transasia Bio-Medicals Ltd., the ERBA ECL 105 and ECL 412 are equipped to perform the D-dimer assay. The ERBA D-dimer reagents are available in a small pack size of 50 tests only, with no reagent reconstitution. Moreover, it is ready to use with a stability of 4 weeks. The affordability and easy availability of the D-dimer assay, ensures that every laboratory can perform this test, on the ECL 105 or ECL 412 semiautomated, coagulation platform.

AUGUST / 2015 ehealth.eletsonline.com

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Pharma Buzz

Torrent Pharmaceuticals Acquires Zyg Pharma

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hmedabad based Pharma Company Torrent Pharmaceuticals Limited has acquired Zyg Pharma Private Limited which manufactures various dermatological formulations such as creams, ointments, gels, lotions and solutions. Zyg Pharma is a part of Encore Group.

Torrent Pharma had signed a share purchase agreement to acquire 100 percent stake in Zyg Pharma on May 05, 2015.

This acquisition will help the company to strengthen its position in niche dermatological segment in the US and Europe markets. Torrent Pharmaceuticals said that it will fund aquisition through internal accruals.

Biocon sets Price Band for Syngene

B NPPA Regulates Price of 39 Drug Formulation Packs

N

ational Pharmaceutical Pricing Authority (NPPA) has regulated the prices of 39 formulation packs including drugs for diseases such as diabetes, infections, digestive disorders and pain among others.

An official release by NPPA said that it has fixed/ revised the prices in respect of 39 formulation packs.

According to the notification the prices of formulations including Ciprofloxacin Hydrochloride, Cefotaxime, Paracetamol, Domperidone and Metformin+Glimepiride has been fixed.

In May, NPPA had regulated the prices of 30 formulation packs including drugs used for tuberculosis, diabetes, asthma and antibiotics.

The government, at present, caps prices of essential drugs based on the simple average of all medicine in a particular therapeutic segment with sales of more than one percent. It had notified Drug Price Control Order (DPCO), 2013, which covers 680 formulations, with effect from May 15, 2014, replacing the 1985 order that regulated prices of only 74 bulk drugs.

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AUGUST / 2015 ehealth.eletsonline.com

iocon has set the price band at `240-250 per equity share for the initial public offering of its initial public offering of its research arm Syngene International Limited.

According to media reports the offer shall open for subscription to public on June 27, 2015 and shall close on July 29, 2015. The price has been fixed between `240 to `250 per equity share.

Red Herring Prospectus filed by Syngene with the Registrar of Companies, Bangalore was approved on July 15, 2015 said the company.

According to the draft papers the company plans to sell 22 million equity shares including reservation of up to two million shares for Biocon shareholders, through an offer for sale. The stake dilution will be 11 per cent of the postissue diluted equity capital of Syngene.

Of the total shared on offer, 50 per cent has been reserved for qualified institutional buyers, 15 per cent for high net worth individuals and the rest for retail investors.

Biocon in the month of January this year concluded a sale of 10 per cent stake in Syngene for `380 crore to IVF Trustee Company. The deal had put the entire valuation of Syngene International at `3,800 crore.

ASIA’S FIRST MONTHLY MAGAZINE ON THE ENTERPRISE OF HEALTHCARE

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