eHEALTH Magazine December Issue

asia’s first monthly magazine on The Enterprise of Healthcare

volume 9 / issue 12 / December 2014 / ` 75 / US $10 / ISSN 0973-8959

Biochemistry Analyzers and Reagents

Anesthesia Machines Blood Collection Devices Health Policy

eHealth Magazine

Finding the Right Chemistry

Contents Doc Speak

Cover Stroy 12

20-Demand for Biochemistry Analyzers

The biochemistry analyzers market is exhibiting resilience and reinvention as it employs new R&D and business models to cost-effectively deliver innovation, value, and improved patient outcomes.

Dr Geeta Chopra, Chief Pathologist, Metropolis Health Care Ltd

30-Blood Bank, a Call Away

Dr Rinku Bhatia, HOD - Blood Bank, Nanavati Super Speciality Hospital

37-Safety is Paramount

Finding the Right Chemistry Blood collection devices 22

Dr SSC Chakra Rao, President, Indian Society of Anaesthesiologists

38-Multi-Speciality Pain Clinics is Future Dr Kailash Kothari, Spine and Pain Consultant, Global Hospital

53-Painkillers not Helpful Anaesthesia machines 32

in Long Run Dr J.B.S Jaggi, Senior Consultant and Unit Head (Orthopaedics), Fortis Hospital

company profile

Health of Insurance

Freedom from Pain

exclusive interview

Industry Speak

08-Tamil Nadu Health

18-Laboratory Automation

System at Crossroads MS Shanmugham, Project Director, Tamil Nadu Health Systems

10-Innovation Needs to be Core of Healthcare John R Samuel, MD– Health Vertical, Accenture India

50-Will Provide Resouces for Doctor’s Learning Terig Hughes, MD – Elsevier Health Solutions, South Asia

57-Hospitals are Last Hope Vikas Vij, MD, The Ideas Exchange

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28-Palash Healthcare Systems Pvt. Ltd. 40-Shriram Equipment Finance Co. Ltd. Health Policy 42

Sunil Dhadkar, Sr Business Manager-Biochemistry, Transasia Bio-Medicals Ltd.

19-Laboratory of Excellence Avinash Tiwari, National Sales Manager, Randox Laboratories India Pvt. Ltd.

36-Superior engineering and

unmatched quality is key to success Dr Vinod Kohli, CEO, Allied Medical

46-Present Sure, Future

Insured Sheeraj Deshpande, Head, Health Insurance Future Generali India Insurance Co. Ltd.

Health of Insurance Products

58-Draeger 61-Philips Healthcare 62-Josh Software event preview

52-Elsevier

asia’s first monthly magazine on The Enterprise of Healthcare volume

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issue

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december 2014

President: Dr M P Narayanan

Partner publications

Editor-in-Chief: Dr Ravi Gupta

Editorial Team Health Sr Editor: Shitanshu Shekhar Shukla Sr Correspondent: Anshuman Ojha education Sr Editor: K S Narayanan Assistant Editor: Parimal Peeyush Programme Manager: Seema Gupta governance Sr Assistant Editor: Nirmal Anshu Ranjan Sr Correspondent: Kartik Sharma, Nayana Singh, Souvik Goswami, Gautam Debroy Research Associate: Sunil Kumar SALES & MARKETING TEAM: Health North: Sapna Choudhary, Mobile: +91-9910998066 West: Douglas Digo Menezes, Mobile: +91-9821580403 South: Vishukumar Hichkad, Mobile: +91-9886404680 Subscription & Circulation Team Manager Subscriptions: +91-8860635832; subscription@elets.in Design Team Creative Head: Pramod Gupta Deputy Art Director: Priyankar Bhargava Sr Graphic Designer: Om Prakash Thakur Sr Web Designer: Shyam Kishore Editorial & Marketing Correspondence eHEALTH - Elets Technomedia Pvt Ltd, Stellar IT Park Office No: 7A/7B, 5th Floor, Annexe Building, C-25, Sector 62, Noida, Uttar Pradesh 201301, Phone: +91-120-4812600 Fax: +91-120-4812660 Email: info@elets.in WEB DEVELOPMENT & IT INFRASTRUCTURE Team Lead – Web Development: Ishvinder Singh Executive – IT Infrastructure: Zuber Ahmed Executive – Information Management: Khabirul Islam event team Manager: Nagender Lal Assistant Manager: Vishesh Jaiswal ehealth does not neccesarily subscribe to the views expressed in this publication. All views expressed in the magazine are those of the contributors.

The magazine is not responsible or accountable for any loss incurred, directly or indirectly as a result of the information provided. ehealth is published by Elets Technomedia Pvt. Ltd in technical collaboration with Centre for Science, Development and Media Studies (CSDMS) Owner, Publisher, Printer - Dr Ravi Gupta, Printed at Vinayak Print Media A-29, Sector-8, Noida, UP, INDIA & published from 710 Vasto Mahagun Manor, F-30, Sector - 50, Noida, UP. Editor: Dr Ravi Gupta © All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic and mechanical, including photocopy, or any information storage or retrieval system, without publisher’s permission.

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editorial

Sky is the Limit Innovations in the field of biochemistry have always kept rewriting the Patents Act. Money minted in the laboratories across the nooks and corners bear testimony to the resilient global biochemistry market grow through numerous onslaughts, including recurring twists and turns in regulation, and corporate culture building its own pressure mechanisms. Dynamics of this industry, coupled with anthropocentricism, have shown signs of reinventing itself in line with the new researches, developments, and values.

Indian biochemistry analyzers and reagents showed significant growth figures in 2014, estimated at `735 crore reagents contributed a major 75 percent to the total market. A conservative analysis attributed this remarkable turnaround to increased healthcare awareness, earnest desire for preventive health checkups, and easy availability of specific tests.

India now spends `400,000 crore annually on health, but commercial health insurance covers only `20,000 crore, not only because of low penetration but primarily also because of current health insurance products focus on hospitalization.

The recent entry of specialist health insurers appears to have changed the grammar of insurance coverage. Now an industry can shift its focus from secondary and tertiary care and include more preventive and primary care. However, retail segment, and outpatient health spends continue to be virgin territories, waiting to be explored.

Besides, changing disease and age-profiles of the market are another opportunity in terms of specialized health financing structures for chronic diseases and the elderly population.

The challenge is how to evolve health financing mechanisms to not only deliver the benefit of pooling and quality to large segments of the population, but also create a platform for health financing to encompass primary and preventive care including outpatient diagnostics and pharmaceutical coverage.

Fast raging medical inflation has made health financing difficult. Fortunately, India has stayed out of this problem. Disrupted biological clocks, reversed lifestyles have only added to the woes, though. Preventive care and chronic condition management is key to management of overall cost escalation.

It is high time a mechanism was created for primary care to get the lion’s share of health spend in India. It is indeed possible to aggregate a provider’s capacity for primary care. There can be as many kinds of providers as possible, including the government programs as well as commercial insurers. Primary care has enough space to accommodate all players. Only sky is the limit for healthcare.

Dr Ravi Gupta ravi.gupta@elets.in

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exclusive interview

Tamil Nadu Health

System at Crossroads The need of the hour is to frequently implement the technological innovations, which make the life of the medical personnel in the hospital better and help him deliver the best of care, says MS Shanmugham, Project Director, Tamil Nadu Health Systems.

H

ealthcare system in India, especially medical technology needs to reach to next level of performance. At the same time it has to be patient friendly. Technology interface will play a key role in reducing the human intervention in delivery of healthcare services, which is essentially the need of the hour.

IT initiatives in Tamil Nadu Tamilnadu, like many other states across the country, is facing the perennial problem of acute shortage of nurses and other para-medical staff in general. This is prevalent across all hospitals and is a major roadblock. To add to this, consider the ever increasing load of out-patient and in-patients in the government institutions. The need of the hour is to frequently implement technological innovations, which make the life of the medical personnel in the hospital better and help him deliver the best of care to his patients.

The Tamil Nadu Health System is a World Bank funded project primarily looking at some key areas like of communicable diseases, mother and child healthcare, Healthcare Information Management Systems (HIMS), tribal health, integrated bio-medical waste management and general activities to take healthcare for all in the state.

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As an initiative to promote use of technology at the last mile and ensure data collection is faster and more accurate, we have given laptops to the village health nurses who are given the responsibility to carry the data with them for surveys and for them to collect data at the household level in real time. We have also supported them with Internet facility via issue of a datacard to connect each laptop and transmit it to the head office.

This has eased the work process, facilitated speedier data flow and better management of the programme or project.

Innovations are centric to transformations. Unfortunately, the Government does have a dedicated healthcare R&D agency to assist the Department on many fronts. Thus we look up to leading technology companies from across the world and in India. We have created a dynamic framework under the PPP model

We have created a dynamic framework under the PPP model that facilitates the partnership for benefit of patients at the end of the day

that facilitates the partnership for benefit of patients at the end of the day. For example we have allowed our health insurance scheme companies or agencies which are implementing new technologies like ECP. This is a procedure to be done for heart patients who are not fit for heart surgery and via media of video, they can put up the entire system, put the technology and put in our hospitals. Since it is a listed procedure, the insurance will pay the company for the patients.

HMIS Today the HMIS is one of the major innovation that our state is implementing. In this we have computerized all the state government hospitals at the district level and the taluka level. So any patient who comes at the hospital need not queue up in line to get the outpatient (OP) sheet manually written. The patient just needs to furnish his details to the operator and a computer printed OP slip will be given. A unique will be registered in his name and he has to carry the slip to the doctor. He will type the PIN number and the patient details will come. The prescription is also paperless as the doctors type the prescription and comment on the computer and then the prescription will go to the pharmacy using Intranet. He will give then prescribed

Government’s Desk

drugs to the patient. This process he can do even on a repeat visit wherein the patient just needs to give his PIN number and all the details of patients will be available to the doctor at the click of a button. This is just one aspect of Outpatient management system (OPS), there are many features such as Lab Management System, HR, vehicles, equipments and many more components that are put on automation using this model.

The second initiative that has been taken by the state government is that of computerizing the tertiary care institution and medical colleges of all the 20 government colleges and 264 government hospitals. The doctor can take the entire health records that are now easily available identified by the PIN number of patients to understand the healthcare scenario of the state.

This has made the life of a patient easy

and good system for medical records to the administration to make policy decisions. These are some of the steps taken by the government at our level to make the life of our patients better and help us deliver better healthcare facilities to them. Apart from that there are umpteen number of departments and directorates starting from drug control to medical education that comes close to 21 or more. So this data collation at the state level for policy intervention is important.

Otherwise to browse through piles of files and data and understand the crux of the problem takes many days even months to act upon. Also they are aggregatable and acting in silos and this was not allowing us to take a holistic view of things in the department – thus we have created a state heath data resource centre.

That is a central repository of data,

which will integrate on a common platform all policy decisions can be taken. There is data dis-integration and there is chaos in critical situation and is prevailing in many states also.

From the medical point of view the efforts needs to come from the medical fraternity which the government would be happy to take. This will make the system participatory and help in the success of the project.

The governments are willing to take any new innovation, technology or advancement so long as it is cost effective and improved the quality of care for the patient, eases our load on manpower we are willing to take it up. We are becoming hub and are also offering huge opportunities in the domestic market too. So the healthcare innovations should increase and every government is willing to take.

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exclusive interview

Innovation Needs to be

Core of Healthcare More people are dying than ever before, left high and dry, without any medical attention or medicines. They might have been alive, says John R Samuel, Managing Director – Health Vertical, Accenture India

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lobally, 1.78 deaths are reported every second, and that translates to 107 deaths per minute. If we extrapolate it to India, there are 10 deaths every minute in the country and it is estimated that half of the numbers go unregistered.

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So we are looking at a stark statistic of 15 deaths every minute in India. Now, in this backdrop of mortality, if we map our expenditure on healthcare – the situation worsens. So, although we are an economic superpower and rank as the 10th largest nation in GDP

and we are in bottom five with respect to healthcare spending. Now most of the mortality in India that is close to 56 percent of deaths has been because of chronic diseases. Significant numbers of people die because quality healthcare does not reach them on

Corporate Desk

time. IT can come in small packages and large systemic solutions that can help transform the healthcare sector to become more efficient and patientfriendly.

Innovations at the Cornerstone We have seen that the vision of any public health organization globally has a common goal to improving patient care, efficiency and safety while lowering healthcare costs.

There are three focus areas for us that we have set our eyes on in India to scope innovative solutions and make quality healthcare affordable for the population. First is innovations to leverage technology for patient care and elder care, second focus segment is pregnant women and children and third is eye care. Let us consider patient care especially elderly population. The most critical parameters that need continuous monitoring for most of these patients are of vital signs. Even a small dip in any of the parameters can be a cause of concern for the senior citizen patients.

We explored the digital world for a smart, portable solution and have introduced a gadget called Digital Plaster. This is a wireless device that continuously monitors vital signs and transmits the data in real time. It can provide early warning signs in case of the patient health deteriorates much in advance and save his life. It monitors temperature, pulse, heart rate, blood pressure and oxygen on its own without the need of a nurse by the bedside. The patients after discharge can connect with doctor for all vital signs monitoring by resting at home.

This reduces the need for hospital visits for general check up. You can also have alerts for all parameters.

This is innovation that will paradoxically change healthcare in the way we do patient care especially elderly care. This introduces the concept of vital signs monitoring as a service to patients and hospitals.

We have created a dynamic framework under the PPP model that facilitates the partnership for benefit of patients at the end of the day Eye care has been our second focus area for innovation. Reflecting on statistics, 40 percent of global blindness occurs in India. This is over a period due to undiagnosed disease or faulty treatment. The eye care programmes conducted by government usually have a camp based approach. To streamline data and make this activity more efficient, innovation in data entry and data management for house-to-house surveys has shown excellent results with the handheld device. The hand held device is used for data entry and details of all the houses and patients is digitized. The output information can be then intelligently used for organizing treatment strategy as to

an estimate on the number of cataract surgery required and the number of patients that can be treated just by using corrective eye glasses. So earlier if the person was doing 3 houses per day it has gone up to 5 times that number now. Digitization also helps you to remind you of the tasks that need to be done, two days before the camp or one day before the camp. Private eye care bodies are very happy to pick this area of innovation.

The third area of innovation is pregnant mothers. There are 800, 55,000 anganwadi workers in the country. They used to have manually registers that we have done away with and are now fully automated for any data entry at their respective villages.

Reminders again were manual now it is done automatically. We are working on from the back office in healthcare to the head office and bring in data integration and analytics for better programmes and policies that are designed towards the key problems.

We have extensive experience in working on these and hope to partner with many states and introduce innovative IT platforms for robust healthcare ecosystem in India.

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cover story

The biochemistry analyzers market is exhibiting resilience and reinvention as it employs new R&D and business models to cost-effectively deliver innovation, value, and improved patient outcomes.

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Finding the Right Chemistry

biochemistry analyzers and reagents

T

he Indian in vitro diagnostics (IVD) market is valued at `3,000 crore, and is expected to reach `9,000 crore by 2018 growing steady at a CAGR of 20 percent. IVD covers a diverse range of products from individual reagents to testing systems that consist of reagents, instrumentation, and software. Also included are accessories such as dedicated software as well as control and calibration materials.

Indian IVD market is one of the fast-paced and growing markets in the world. This is one of the focus markets for most of the organizations connected with it.

With biochemistry analyzers becoming increasingly sophisticated, healthcare institutions are recognizing greater value for the improvement of disease management and patient care success rates. Ranging from hospitals to laboratory chains, several biochemistryrelated diagnostics providers are highly penetrated in the country among which biochemical reagents accounts for a lion’s share in the market.

In 2014, Indian biochemistry analyzers and reagents is valued at `980 crore, a 16.5 percent growth over 2013. Estimated at `735 crore, reagents contributed a major 75 percent to the total market in 2014.

This remarkable growth can be attributed to increased healthcare awareness, desire to undergo preventive health checkups, availability of disease specific tests, corporate setups promoting health focus of employees, and drift from manual to semi-automated and automated instruments.

With escalating healthcare expenditure, declining reimbursements, and new regulations which put downward pressure on the healthcare budgets, diagnostic laboratories are demanding solutions for deliv-

Indian Biochemistry Analysers and Reagents Market (2014) Total `980 Crore

25%

Source: eHealth research

Analyzers

75% Reagents

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ering high-quality efficient and timely testing. According to the Global Data Report, this has led to growing adoption of automated solutions, new analyzers that deliver high throughput in lesser time and provide high efficacy.

Similarly, Point-of-Care (PoC) testing has gained momentum in the past years as need for quick turnaround time and reliable results have accelerated. Many PoC tests on the market today offer results within a period of few minutes as compared to hours for centralized testing. The fast access to results is particularly useful in critical situations when testing needs to be carried out frequent intervals.

Apart from catering to people in the tier I cities, IVD setups are now eye-

ing expansion in the tier II and tier III cities. This can be attributed to high revenue generating option that lie untapped in these cities clubbed with minimum investment required in order to generate high revenues. These IVD majors tie-up with the existing high reputation laboratory adding value in terms of providing technical help as well as contributing significantly in the advising physicians panel.

Global scenario Innovation and entrepreneurship has defined the biochemistry industry since its inception. Despite increased regulation, pricing pressures and the effects of healthcare reforms in many countries, the global biochemistry an-

alyzers market is exhibiting resilience and reinvention as it employs new research and development and business models to cost-effectively deliver innovation, value, and improved patient outcomes.

The global biochemistry analyzers market was estimated at USD 8965 million in 2014. This market is expected to grow at a CAGR of 5.52 percent between 2014 and 2019, to reach USD 11,728 million in 2019.

The biochemistry analyzers market is segmented on the basis of products as analyzers, reagents, and other products. Analyzers segment is further divided on the basis of sizes into four segments: Small Sized (400-800 Test/H), Medium Sized (800-1,200 Tests/H), Large Sized (1,200-2,000 Tests/H), Very large Sized (2,000 Tests/H). The analyzer product segment had the largest share of the biochemistry analyzers market in 2014, whereas the reagents product segment is expected to grow at the

The Indian in vitro diagnostics market is valued at `3,000 crore, and is expected to reach `9,000 crore by 2018 highest CAGR between 2014 and 2019.

The application segments included tests such as, basic metabolic panel, electrolyte panel, liver panel, lipid profile, renal profile/kidney function panel, thyroid function panel, specialty chemical tests. The basic metabolic panel tests segment had the largest share of the clinical chemistry analyzers market in 2014, whereas the lipid profile test segment is expected to grow at the highest CAGR between 2014 and 2019.

Rise in number of lifestyle diseases, automation of laboratories will aid the growth of this market. The market is

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biochemistry analyzers and reagents

expected to be driven by increasing awareness for preventative care, increase in aging population, increase in reagent rental agreements, and laboratory automation.

The major players in the biochemistry analyzers market include Roche Diagnostics, Danaher Corporation, Abbott Diagnostics, Siemens AG, Ortho-Clinical Diagnostics, Thermo Fisher Scientific, Randox Laboratories Ltd, Elitech Group, Mindray,and Horiba.

Function of reagents Most in vitro diagnostic assays require biochemical and chemical reagents to make them run. To meet this requirement, IVD manufacturers initially developed and produced the reagents.

This approach afforded ultimate control over supply of these critical assay components, but came with its own price. IVD manufacturers needed to invest their finite resources in reagent product development, manufacturing equipment, quality programs, and human resources to maintain these programs.

As quoted in Lab Tests Blog by Randox, the reagents used in diagnostic testing assays are one of the most fundamental and critical components necessary for a medical laboratory to properly function. Without them, a laboratory ceases to operate, as it is unable to generate the necessary tests required for the diagnosis, treatment, and monitoring of a patient’s condition. When one considers that almost 70 percent of the information that a physician requires for the assessment of a patient’s general health comes from the information supplied by the clinical laboratory, the importance of these products, and of the laboratory itself, becomes evident.

Diagnostics reagents - be they chemical, biochemical, or biological/ biochemical in design - are dependent upon several different components working together to generate accurate, precise, and reliable patient test

results. However, when one examines the basic operational principles these reagents follow, regardless of the format or platform, all of them consist of the following core steps: The volume of patient sample to be analyzed and a volume of one or more diagnostics reagents are placed together in some type of reaction vessels and mixed together, starting a chemical reaction. This test mixture is then incubated at a given temperature, usually 37C, for a given period of time. The reaction is stopped once the assay reaction time is reached, and some type of quantifiable change is observed. This change varies per given procedure but is most often an increase or decrease in a color, an increase or decrease in spectrophotometric absorbance, a change in the intensity of light produced or not produced, or an increase or decrease in the optical density or turbidity of the test mixture. This change is measured and compared against a known change that has a definitive value assigned to it (most frequently coming from calibration material, or a standard material), and it is calculated into a test result. Most diagnostics reagents can be classified as chemical, biochemical, or biological/biochemical in nature.

Chemical. These are the most basic of the three diagnostic reagents and are designed as single- or tworeagent systems. They incorporate dyes, buffers, surfactants, and basic chemicals to form working reagents.

A primary example is the diagnostic reagent used to measure serum albumin concentrations. This common diagnostic reagent routinely measures this serum component based on the binding of bromocresol green dye specifically with albumin to produce a colored complex. The absorbance of the resulting complex is measured spectrophotometrically and is directly proportional to the albumin concentration in the sample. Another classic test procedure is the measurement of serum creatinine concentrations – first described more than 100 years ago and still routinely used in the clinical laboratory. Here, creatinine in the sample reacts with picrate (picric acid, sodium hydroxide, and water) to form a creatinine-picrate complex.

The resulting increase in absorbance at a given wavelength resulting from the formation of this complex is directly proportional to the concentration of creatinine in the sample.

Biochemical. Biochemical reagents are a bit more complex in design and require more components working in

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cover story

unison together. Designed to perform alone or as part of a two-reagent system, these reagents are frequently enzyme-driven and incorporate buffers, stabilizers, co-enzymes, indicators, surfactants, and preservatives as part of their working components.

The diagnostic reagent used for the determination of glucose, one of the commonly run diagnostic tests in the clinical laboratory, fits well into this category. Here, glucose is acted on by the enzyme hexokinase in the presence of adenosine triphosphate and magnesium to produce glucose6-phosphate.

Glucose-6-phosphate dehydrogenase then specifically reacts with glucose-6-phosphate, with the concurrent reduction of NAD to NADH. The NADH produced absorbs light at a specific wavelength and can be spectrophotometrically detected as an increased absorbance proportional to the glucose in the sample.

Biological. The biological/biochemical-based diagnostic assays are frequently composed of two or more reagents. These reagent systems are highly complex, incorporating many steps and numerous working components including buffers, conjugates, wash solutions, detection reagents, and serological markers – namely antibodies and antigens as essential elements. These types of diagnostic reagents are typically referred to as immunoassays and are most often employed to measure analytes found at relatively low concentrations in the body. For example, these would include hormones, vitamins, infectiousdisease agents, and specific protein components. However, and as discussed earlier, regardless of their complexity, when you look at the basic operational principles these reagent systems follow, all inherently work exactly the same way.

In today’s environment, suppliers of IVD reagents can employ various strategies to achieve their goals.

These include sourcing raw materials and components for in-house develop-

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ment and manufacture of reagents, forming OEM relationships with key trusted suppliers to obtain a finished product, or, in many cases, a combination of both. Supplier expertise can often result in technological advantages, while in-house production of components allows for long-term supply stability of critical components. Regardless of the strategies employed, when considering the sourcing of key diagnostics reagents, be they finished products or raw materials for future reagent test kits, it is important to be aware of the following points when dealing with suppliers and vendors to produce highly reliable and accurate diagnostics reagents that the industry has come to expect.

Manufacturing capabilities. IVD makers need to manufacture capabilities for their immediate, as well as projected, needs, and make certain that their vendors can address their needs now and in the future. Additional factors to consider are vendors’ flexibility, their ability to handle bulk options, and whether their breadth of product coverage includes other associated assay components that are vital to the IVD company’s operation.

An especially important consideration regarding vendors for biological/bio-

Apart from catering to people in the tier I cities, IVD setups are now eyeing expansion in the tier II and tier III cities

chemical-based diagnostics tests (i.e., immunoassays) is whether antibodies are sourced from trusted suppliers rather than produced in-house. Antibody generation is a complicated and intricate process that takes a great deal of time and expertise. An antibody supplier should be able to offer a full range of custom antibody production services, including poly-clonal production, monoclonal production, purification and conjugation, freeze drying, and antibody fragmentation, as well as bulk custom formats, purified antigens, and sera. In addition, since the production of antibodies is complex, and their use in diagnostics assays changes over time, it is critical that an antibody supplier provides a strong quality system, technical support, and industry expertise to keep customers apprised of the latest news, regulatory issues, and potential legislation that can potentially affect key assay components.

Cost considerations. With regard to costs, it is important to keep an open mind and not to fixate solely on numbers. Since there are so many components in a typical diagnostic reagent, it is important to consider the individual components and the combination of these working together in a particular test. While each element does con-

biochemistry analyzers and reagents

Biochemistry analyzer will become faster and more efficient as technology and software are developed and enhanced

tribute to the overall cost, it is possible to achieve significant cost savings by changing one element, such as a detection buffer, which can significantly affect the sensitivity of the test, resulting in reduced volume requirements for key reagents and reduced assay costs. End-user value of the test versus component cost should also be taken into consideration. For example, a faster test, or one with improved performance, may cost more to buy, but it may be able to save the end-user valuable time and labor expenses.

Other key elements to consider are the vendor’s experience and knowledge of the IVD market, whether it has a well-established reputation and proven track record within the industry, and its financial soundness. While these factors may appear to be insignificant at first glance, they do carry significant importance in the long run.

Considerations for purchasing When choosing a clinical analyzer, research the instrument’s throughput capability (which can reach up to 10,000 combined ISE and colorimetric tests per hour), testing speed, and test menu to be sure it is a good fit for your laboratory. Will a STAT mode or random-access capability be required? Is batch, random, or continuous analysis

preferred? Consider if additional testing will be offered by the lab in the future to ensure the system offers the required capabilities. Remember that a higher-end instrument that uses less expensive reagents may prove to be more cost-effective over its lifetime.

Additional factors include sample handling, the unit’s footprint, and its ability to work with microvolumes, a valuable parameter in neonatal units.

Laboratories handling thousands of tests per hour will require bar-code handling and data management software.

Anyone looking to purchase an analyzer may find it useful to ask the following questions: • Does it represent value for money?

• Is it fit for purpose?

• What are the ‘whole life’ costs?

• What are the service costs?

• Is it flexible and easy to operate?

• Is the product of high quality?

Manufacturers usually offer a number of customizable options and functions depending on the needs of each individual laboratory. For example, throughput of photometric or ISE tests per hour, and the number of tests and assay types available. A variety of analyzers are available to suit the smallest point-of-care clinic, or the most demanding high-throughput

clinical laboratory.

Future Taking into consideration current and future trends is essential in maximizing the lifespan of any analyzer. As systems become more sophisticated, integration, convenience and application specificity are key. New assays are constantly in development to improve the diagnostic capabilities of laboratories and ultimately improve patient care. The continuing emergence of new, clinically significant biomarkers, and technological advancements have a significant impact on such assay development. Biochemistry analyzer will also become faster and more efficient as technology and software is developed and enhanced. Manufacturers strive to take into consideration customer feedback and requirements, and many are developing strategies for making analytical systems ever more user-friendly.

As laboratory workloads increase, and managers look toward total automation solutions, analyzers need to have either modular capabilities or the ability to be connected to a track.

At the other extreme, point-of-care testing is very much in demand and technology is being developed to enable near-patient chemistry testing.

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cover story

Laboratory

Automation

The key to improvement of laboratory services is implementation of correct automation technology from the right vendor, says Sunil Dhadkar, Sr Business Manager-Biochemistry, Transasia Bio-Medicals Ltd.

W

ith the increasing age of population in India and growing demand for healthcare solutions there is an increased workload in the clinical chemistry laboratories in India.

There is also a constant pressure to provide an accurate test report while managing the turnaround time in a cost effective manner by maintaining profitability.

In India, laboratories today are attached with hospitals, corporate labs, and standalone labs with high workload of samples and are facing major challenges of providing the test report in the shortest time by optimizing the total turnaround time and scheduling of the samples. This has become even more important especially since new methods and battery of new tests have to be performed with accuracy.

When the sample workload is high, pre-analytical procedures such as collection of samples in the right tube, sorting of samples according to department and tests to be performed, patient data entry with proper ID, and placing the samples at right positions and selection of tests are challenging and involve errors. With automation, bar code reading facility and automated sample loading facility onboard can eliminate such errors.

Laboratory automation can be a tool for the improvement of laboratory services as it helps decrease the cost and increase the turnaround time significantly. The key to improvement of laboratory services is implementation of correct automation technology from the right vendor. The design of this technology should be driven by required functionality.

Today the technology is evolved from hardware based approach to soft-

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While investing in highthroughput analyzers, one should look for possible future up gradation and laboratory integration with other instruments ware based approach. Highly advanced software are available for robotic operations with high throughput and to support various automated operations like auto dilution ,auto-rerun with dilution, reflex testing, sample transport management, effective handling of samples and reagent while maintaining the accuracy in volume measurement.

Quality control program, which ensures the accuracy with facility to display and record the CV and SD for more than three levels, is available in the new generation analyzers. The provision for knowing the L J chart for two levels of controls simultaneously not only saves time but also gives better reliability of results.

Cost effectiveness is the key feature which needs to be evaluated before deciding the high throughput clini-

cal chemistry analyzer. Many features such as openness, reading volume, nature of cuvette (whether disposable or permanent), result recalculation, maintenance cost and consumables are important to decide the recurrent expenses on the analyzer. It is also important to know whether the analyzer requires DI water, any detergent, or cleaning solution, if so in what quantity.

Photometer is a very important component of an analyzer and should be preferably gratings based with capability of measuring wavelengths from 340 to 800 nm. Inbuilt ISE can facilitate electrolyte analysis simultaneously with photometric tests.

Test menu has to be wide and expandable. System should be capable of performing assays of up to three reagent capabilities and for all sorts of substrates, enzymes, special chemistry parameters, drug assays, TDM, etc.

Today getting an extra space for placing any new system in the laboratory is a remote possibility, hence design and footprint of an analyzer is also very important. One should select a suitable analyzer with compact design and small footprint with flexibility of operating movements.

While investing in high-throughput analyzers, one should look for possible future up gradation and laboratory integration with other instruments. Automation should provide high speed, flexibility, convenience and be cost effective.

Transasia Bio- Medicals Ltd. recognizes this need and provides laboratories with a vast choice of analyzers from bench- top analyzers with a throughput of 100 tests/ hour to over 1000 tests/ hour.

Industry Speak

Laboratory of Excellence

Avinash Tiwari, National Sales Manager, Randox Laboratories India Pvt. Ltd. shares his views with ENN on trends and overall scenario of biochemistry analyzers and reagents market in India.

Integrate systems combining biochemistry and immunochemistry tests are gaining space. Please explain Integrate system by combining biochemistry and immunochemistry is a new trend at the market place followed now. Laboratory needs to perform both the tests onto two different machines which results into more turn-around time. Hence, majority of laboratories with high work load of both biochemistry and immunochemistry are opting for an integration because once a sample is loaded onto machine, both biochemistry and immunochemistry tests can be performed, low sample handling on machine, hence low manual intervention, fast turn- around time, convenience in reporting, saves precious time, manpower and money.

System capabilities are fuelling the growth. Kindly elaborate it in the Indian context Approximately 70 percent of the most treatment decisions are made by clinicians solely based upon the laboratory results. Moreover for precise diagnosis and treatments more and more patients are referred to laboratory for an investigation. This is leading to the higher work load and creating a demand for better and sophisticated analysers in the market place.

Moreover all mid-size laboratories have started shifting towards fully automation in their set-ups for better patients’ services and reliability of tests results. This is not only helping them to provide faster results, but also save

Clinical chemistry is mature market however it has enough scope in developing countries like India. Please explain it in reference with the Indian market

time and money.

The new generation fully automated analyzers comes with higher throughput, produces reliable results like qualifying to the internal and external quality assessment programs and less trouble shooting while being operational. This also offers more assays to be performed on same machine and save both cost of purchase of another machine and also the space. Thereby, such newer innovative biochemistry analyzers are fuelling the market growth rapidly at the moment.

Mid-size laboratories have started shifting towards fully automation in their set-ups for better patients’ services and reliability of tests results

The estimated in vitro diagnostic market in India is over Rs. 2600 crore with CAGR of a little over 20 percent. This indicates the huge untapped market opportunity as well.

As mentioned earlier, over 70 percent of treatment decisions by clinician are based on laboratory results.

Moreover, there is a surge in chronic disease like diabetes, cardiovascular diseases and hypertension, and the like in the Indian population resulting into more footfalls into the laboratory.

A large medical laboratory will accept samples for up to about 700 plus different kinds of tests and experiments. Even the largest of laboratories rarely do all these tests themselves, and some must be referred to other labs. Clinical chemistry covers a wide array like routine chemistry, which is commonly ordered blood chemistries, for e.g.; liver and kidney function tests fall under clinical chemistry. Special chemistry consists of elaborate techniques such as electrophoresis, and manual testing methods. Clinical endocrinology is the study of hormones, and diagnosis of endocrine disorders.

Toxicology is basically a study of drugs of abuse and other chemicals.

There is an enormous opportunity for the key Market players to continue focus on research and development and offer better solutions to laboratory, which is cost effective yet maintains the highest quality standard.

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cover story

Demand for Biochemistry

Analyzers

Dr. Geeta Chopra, Chief Pathologist, Metropolis Health Care Ltd, in conversation with ENN, shares her view on various segments, functions and future of biochemistry analyzers and reagents Functioning of Biochemistry analyzers Biochemical testing in laboratory involves tests for various organ functions like liver function tests, kidney function tests, lipid profiles, hormone testing, like TSH, FSH, LH, Prolactin, special proteins, like C3, C4, IgG, IgM, IgE, maternal screen tests – Dual markers and triple markers, vitamin D3, various cancer markers and many other tests.

Integrate systems combining biochemistry and immunochemistry tests are gaining space. Please explain.

Integrated systems combining biochemistry and immunochemistry tests are gaining space in the market. These systems improve the workflow efficiency and deliver high throughput and fast turnaround. It helps achieve increased instrument capacity by linking two or more analyzer units with a single sample presentation mechanism. It increases assay diversity by combining general chemistry and immunoassay units in an apparently single instrument. Most of the leading vendors, like Roche, Abbott, Siemens, OCD and Beckman Coulter offer these integrated systems. Most of the large laboratories are using these systems due to increased efficiency, faster Turnaround Time and decreased man power requirement.

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System capabilities are fueling the growth. Please elaborate it in the Indian context.

With automated units, specimens can be identified by a unique barcode number, through which tubes can be identified and the necessary specimen processing and testing undertaken. The results can be automatically interfaced in the laboratory information system.

Clinical chemistry was one of the earliest laboratory disciplines to evolve in terms of technology and automation. With the availability of integrated systems, this journey will continue

The sophisticated systems give good quality results, avoid pre-analytical and post analytical errors, which when put together is of critical importance to generate accurate results. It improves quicker reports helping better disease management and patient outcomes, especially in critical cases. In India, it is estimated that there are 11 such laboratories. Sophistication in biochemistry analyzers and their ready availability has helped these Labs to deliver reliable reports to the customers all over India. The maintenance of these machines require good service back up and inventory management from vendors.

Clinical chemistry is a mature market; however it has enough scope in developing countries like India. Please explain in reference with the Indian market.

Clinical chemistry was one of the earliest out of all Laboratory disciplines to evolve in terms of technology and automation. And with the availability of integrated systems, this journey is still continuing. Laboratories also have to evolve their process controls and their quality systems to make the best usage of the existing platforms.

Diagnostic market is growing around 20 percent year to year basis, which implies it will keep on increasing the demand of Biochemistry analyzers for another 10 more years.

Blood collection devices

Transfusing Life Through Automation Automation is certainly the future trend that will completely take over the manual segment and dominate the whole market, with the high price competition eventually eroding the profit margin of the manual devices segment 22

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spurt in new infections sur­ facing the world over remains a huge concern to the blood banking and blood products industry.

Though awareness amongst consum­ ers and health workers helped in re­ ducing the intensity of infection, the industry is yet to free itself of various problems such as safety, and availabil­ ity of quality blood. The awareness has also resulted in the implementation of stringent safety standards for both donors, and blood screening banks to be adhered to before any transfusion.

Rigorous testing and screening pro­

cedures, along with the help of new technology have sufficiently reduced the threat of diseases being transmit­ ted through transfusions. Though the overall situation has improved, in­ stances of diseases spreading through blood transfusion are still common in the developing and underdeveloped countries. Awareness campaigns in these countries have also drawn flak, with only a few donors volunteering.

Market dynamics The blood banking and blood products

Blood processing devices and consumables market are witnessing intense competition among the players, which are willing to offer complete reliable and cost-effective products

market is exhibiting a healthy trend.

The blood collection devices market is expected to grow further in the com­ ing years owing to continuous devel­ opments and rising demand for better blood collection and transfusion tech­ nology. The global blood processing devices and consumables market was valued at `194,059 crore in 2013 and is estimated to reach a market worth ` 294,960 crore in 2019 at a CAGR of 8.9 percent from 2014 to 2019.

The growth of the market is driven by factors such as increase in ageing population, increasing cancer thera­

pies, emergence of infectious diseases (HIV and hepatitis), and significant rise in surgical procedures. In addi­ tion, strict government regulations across the world are also positively impacting market growth. Moreover, manufacturers are developing im­ proved and automated products for collection, processing, and storage of blood and blood components. Accord­ ing to WHO, it is estimated that global population over age 60 years would double from 11 percent (2000) to 22 percent (2050).

People aged 60 and above are more prone to cancer risk and other surgi­ cal procedures. Hence, greying popu­ lation and increasing demand for cell therapy will act as driving factors for the growth of this market.

Blood processing devices market is a rapidly developing field and has been witnessing numerous technologi­ cal advancements. Growth of the mar­ ket is influenced by the rising demand for pathogen-free blood. Blood being a vital component of the body is rou­ tinely used in a wide range of hospital procedures for transplantations, can­ cer therapies, and other forms of sur­ geries. Therefore, safe blood supply is integral in surgical and other blood transfusion procedures.

Manufacturers are developing au­ tomated products to reduce blood as­ sociated risks. Automaton of devices reduces human intervention, requires less number of professionals, and also

reduces the risk of pathogen develop­ ment. Therefore, automated devices and consumables have been gaining a lot of popularity in recent times. Auto­ mated cell processors and automated blood collection devices have become one of the standard procedures for blood procurement, thereby further giving a boost to this market. Other major technological advancements include blood bags with inbuilt filters, blood collection monitors, and tube sealers, which are further supple­ menting the market growth.

Blood bags used in each step of blood collection, processing, storage, and delivery account for the largest share in blood processing consuma­ bles segment. Coagulation reagents, which are used for detecting bleed­ ing disorders and coagulation rate, is the fastest growing segment of blood processing consumables market and is poised to grow at a CAGR of 13.3 percent.

North America accounts for the largest share of the blood process­ ing devices and consumables market owing to the developed economies in this region. In North America, more than 27 million units of blood and blood components are transfused each year. Therefore, to meet this huge blood re­quirement, the market is characterized by government sup­ port, increased public awareness, and presence of technologically advanced equipment. Despite the developed

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Blood collection devices

countries hold­ing a major share, the Asia-Pacific region is poised to show a significant growth in the coming years. Expanding population bases in countries such as India and China, coupled with increasing epidemic of diseases such as dengue and chikun­ guniya will boost the market demand and successive growth. Additionally, the government in these nations is focused on improving healthcare in­ frastructure, thus, in turn, further propelling the growth of this market.

Blood processing devices and con­ sumables market are witnessing in­ tense competition among the players, which are willing to offer complete reliable and cost-effective products.

Some of the significant key players in this market include Terumo BCT, Fresenius Kabi, Haemonetics Corpo­ ration, Immucor, Inc., Abbott Diagnos­ tics and others. Manufacturers are entering into strategic alliances with other players for the development and commercialization of new and inno­ vative products, for maintaining the competitive edge.

Market trends Manufacturing companies are target­ ing drug manufacturing facilities and research laboratories that experiment with blood and other organic products.

The major players in these segments are broadening their product offer­ ings through research and develop­ ment partnerships with firms that are not directly involved in blood banking.

The cost of development and demand for speed and quality research has en­ couraged firms to make strategic al­ liances with high-technology entities that can aid product development. The strong presence of biotechnology and pharmaceutical has helped the blood component industry to mark its pres­ ence in the market. The government is also making considerable efforts to maintain and promote the proper use of blood components for the utmost utilization of blood. There are definite signs that blood banking and blood

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product markets in India are on the upswing. The need for effective usage of donated blood is likely to be one of the key drivers of the markets. Moreo­ ver, the government has been making sustained efforts to reinstate the do­ nor’s and the patient’s confidence in blood transfusion services. Suppliers to the blood banking markets can, therefore, look forward to increased opportunities in this emerging sector within the Indian healthcare industry.

Technology update Technology is an efficient tool for cre­ ating connected ecosystems for in­ formation exchange. The end-to-end life cycle of a blood from the donor camp to the transfusion along bedside

Growth is moving at a slow pace, the manual blood banking devices segment is likely to remain prominent for the next ten years

can be managed by a click of a but­ ton. These specialized applications can fill the gap of non-availability of manpower or even ease up the exist­ ing manpower and clinicians for more productive work. The software basi­ cally follows the process cycle that is mandated by the safety guidelines for safe transfusion. It has in-built checks and alerts for various tests as mandated by the health authorities based on emerging disease trends.

The key assistance of software comes to ensure that unhealthy donors are not included in the blood bank. This is a major risk today especially as we keep manual records and it is difficult to track and trace an unsuitable donor from entering the blood bank. Once a donor is identified as a defaulter and he enters the computer record, he can be easily traced and barred from the hospital. The blood bags if bar coded can be managed as an inventory with­ in the software with required system safety checks prior to labelling and re­ lease. The hospital or blood bank can also create customizable warning and error messages to help prevent errors and take remedial action right away.

These are just some of the features

that you can look out for next time you would like to take on an IT system onboard. Robust software can help you streamline operations, meet donor and patient safety requirements, and deliver quality blood products - can free up many hands in the blood bank and let you do more with less.

Nucleic acid testing India has high prevalence of viral transmissions especially Hepatitis B

and C in patients that require regu­ lar blood transfusions especially for those suffering of thalessemia and re­ nal dialysis. The blood banks have to be a step ahead of emerging infections to be armed with a screening test that can identify donors with unsafe blood.

The recent advancements in nucleic acid testing ensures that an addi­ tional safety guard is taken to ensure safe blood transfusion by the blood bank or the hospital and significantly reduces the risk of transfusion trans­ mitted infections such as HIV, HBV, HCV and other diseases. Many pro­ gressive hospitals and blood banks are therefore moving towards a highly sensitive testing technique of nucleic acid amplification testing (NAT). This molecular method drastically reduces the number of transfusion transmit­ ted diseases and has been adopted worldwide already. Its time India catches pace on the new frontiers of NAT screening as well.

The future has many possibilities.

The pace at which stem cell research progresses each day, the day is not far when the world will not need any blood donors for donation- each hos­ pital will have its own blood bank with full stock of all blood groups. The initial steps were taken back in 2012, with a breakthrough technology dis­ covered by Professor Shinya Yamana­ ka, Director of the Center for iPS Cell Research and Application (CiRA) at Kyoto University. He showed the world the power of induced pluripo­ tent stem cell (iPSC) technology and its regenerative powers. At a recent conference he said that he dreams of the use of this technology for produc­ tion of blood or artificial red blood cells (erythrocytes) that are routinely used for blood transfusions. Imagine a world where the source of blood will be stem cells originated from our skin.

In medical science, the impossibili­ ties to future are few. This is a distant dream, as the ground reality in many of developing countries like India is far from ideal. These differences be­ come starker when we compare a pri­ vate healthcare service provider vis-àvis a government hospital. The bright side is that many hospitals and state government are looking forward to adopting newer techniques and tech­ nology tools and this will can surely somewhere address the blood deficit in the country.

Path ahead The Indian healthcare industry has been witnessing phenomenal chang­ es that are translating into fierce competition among medical devices, pharmaceuticals, and biotechnology players. Continuous product rollouts, automation, and innovations are com­ mon in the industry and are a critical strategy for retaining consumer inter­ est and loyalty in the highly competi­ tive environment.

Development of automated blood collection devices, environmentally compatible IV containers, and blood bags with RFID tags are just a few re­

cent instances of the furious pace of technological developments. The adult incontinence market holds significant potential for expansion particularly in developed countries, attributed mainly to age-related diseases and higher disposable income. In addition, en¬hanced reimbursement policies, gen¬eral awareness among patients, and lesser societal stigma attached with the condition have also played a vital role in stimulating demand.

Prion filters are the new promis­ ing development in the blood transfu­ sion segment, which hopes to trigger a similar effect of boosting the mar­ ket. However, innovative modifica­ tion within the manual segment tends to temporarily drive the market as opposed to inducing a sustainable growth effect. Subsequently, trends strongly suggest a strong shift toward the usage of automation.

Automated devices such as apher­ esis and whole blood collection and processing devices gain market share at the expense of the manual blood collection segment. Pro-automation arguments mainly are overcoming the obstacles of cost pressure and in­ creased regulatory strictness about blood safety. Collecting and process­ ing blood through automated devices saves time, increases efficiency, and therefore lessens the overall opera­ tional cost from the end-users side.

Quality management according to regulatory demand can also be better ensured. Another important aspect of automation is the fewer sources of do­ nors needed - less exposure to patho­ gens and bacterial infection through­ out the entire process.

Automation is certainly the future trend that will completely take over the manual segment and dominate the whole market, with the high price competition eventually eroding the profit margin of the manual devices segment. Since the growth is moving at a slow pace, the manual blood bank­ ing devices segment is likely to remain prominent for the next ten years.

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Company Profile

PALASHTM Healthcare Systems Private Limited PALASHTM Healthcare Systems is specialized healthcare information technology organization offering various software services and solutions to healthcare providers.

P

ALASHTM Healthcare Systems Pvt. Ltd (PHS) is a Pune based software technology company focused on Healthcare IT. PALASHTM Healthcare Systems was incorporated in 2006 Decade of experience in providing efficient & user friendly IT solutions in Healthcare Domain •

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Managing 6 Million plus Patients with average 5 transactions per patient record. Presence in 14 Countries across globe.

Largest chain of hospital & clinics implementations in India. Offices in Pune , Dubai , London & Amman with employee force of 110 Only company with more than 12 specialty EMR capabilities on single platform delivery. Over 180 clients (115 in India and 65 abroad), 60% in facilities with >75 beds Solution running for at least 39 hospitals/clinics for past 7 years PHS has its international business development & support presence through its Center of Excellence (COE) in Dubai and in UK through its wholly owned subsidiary PALASH Healthcare UK, LLP. Helps improve healthcare through better data access, faster retrieval, higher quality and versatility in data display. Modern product based on Microsoft technology, ready to use Android® and iOS® based interfaces Doctors on rolls (as Business Analysts & domain experts) to understand and validate functionality.

Awards and Recognitions: •

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PALASH was recognized with the Quality Brand Award for the period of 2014-16 given by the Quality Brand Times for creating a valuable brand in the market.

PALASH has been given the prestigious “Innovative Domestic Player of the year” Award, by ASSOCHAM at the ICT in Healthcare Summit Cum Awards function organized in New at the hands of Shri. Lov

December / 2014 ehealth.eletsonline.com

•

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Verma – Secretary Health and Family Welfare Govt. of India At the Maharashtra Healthcare Leadership Awards & Summit PALASH was declared HIS Provider of the year 2014 PALASH got eINDIA HIS Provider of the year of 2014 Award on 15th Nov.2014 in Kvalam National Excellence in Healthcare award was given to PALASH’s Founder CEO Mr. Dinesh Samudra for his commendable efforts in simplifying the use of IT in the healthcare industry thus improving the quality of patient care

Health Information Exchange Palash Healthcare Systems Pvt. Ltd. is a Pune based IT company focused on Healthcare domain since 2006. With sumptuous experience in healthcare IT domain, Palash has envisaged positive impact of IT in healthcare domain over the years.

Being one of the leading provider in indian Healthcare IT, Palash noticed that today each healthcare provider creates different Medical Record number for same patient which results in replication of medical records all over the industry and total health record of an individual i.e Patient Health Record is not available for access at any point.

Technology is worth nothing if it doesn’t solve an important problem or improve lives. Also, Creating an innovative tool or app that can help doctors and patients isn’t enough. Patients, physicians, hospitals and insurance companies long for the benefits and value of new technology. Palash Healthcare Systems Pvt Ltd. is moving in this direction by creating an ecosystem i.e.

Health Information Exchange (HIE). Healthcare industry is not able to share update and manage healthcare records due to non-availability of working Health Information Exchange (HIE) Platform. The absence of unique Patient Identification Number across healthcare providers, results into Patient Health Record (PHR) Silos across the healthcare system.

PALASHTM Health Care Platform • • • • •

Web-enabled Integrated Modular HL7 compliant Supports ICD 9 / 10 & CPT codes Electronic Insurance claims management.

HIE Concept Palash Healthcare Systems (PHS)has taken up the initiative to implement HIE, which will in turn create a complete, self contained and futuristic Healthcare ecosystem. To deliever this system Palash is creating an online platform ‘Consulting Connect’, to create a patient identification platform & an advanced healthcare ecosystem that will deliver services to an individual through web-based portal. The unique identity number that is generated in this ecosystem will avoid the formation of health record silos & keep every health related details of an individual at a single point. Consulting connect will bridge the gap between healthcare providers (all clinicians & consultants) & healthcare service providers (path labs, radiology, pharmacists etc.) & the individuals by bringing all these elements on one common platform which is accessable to everyone.

For creating consulting connect, one of the major challenges is to find a way to be part of Patient-Physician interaction. This means we need a tool for Doctors to capture medical records & a tool for individuals to interact with physicians.

Palash Ecosystem In order to help trhe doctors, PHS has deviced a tool, ‘Palash Practice’. Palash Practice is a scalable ,web-based platform which gives individual and group

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Tablet& Mobile interface Graphics enabled Interface with PACS Interface with Critical care & Pathology devices Multilingual Multi Clinic / Hospital

of practitioners a tool for Clinical practice. It also caters small & medium Hospitals and Nursing Homes and enables them to function seamlessly across a number of different locations with the same flexibility and interactivity as practices with only one point of operations.

PALASH Practice will enhance doctor’s clinical practice and also give him access to consulting connect, which will help them connect to unseen oportunities. It in turn results in expanding your practice regardless of where your physical presence is.

To cater individuals need of a tool to interact with physicians, PHS is providing a specialized mobile platform for an individual called Palash Finger Tips(PFT) which involves simplified secured electronic system used to exchange and access personalized protected health Records, such as medical history, laboratory results, medications, diagnoses, procedures and demographic information on their finger tips.

This ecosystem will be valuable for every element included in it. In turn it will help physicians to streamline their clinical practice to manage their patient records efficiently and improvise interaction with patients.

It’s a Revolutionary idea to create single point health records for everyone. Physicians are major part of this initiative and they are the ones who are creating actual health record for benefit of an individual.

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Blood collection devices

Blood Bank, a

Call Away

Only challenge is that the right blood group should reach the right hospital at right time, says Dr Rinku Bhatia, HOD - Blood Bank, Nanavati Super Speciality Hospital Tell us about some of new techniques being used by your bank to screen donors and ensure they are healthy donors.

We are extremely strict on our tests for blood donors with thorough history checks and diagnostics tests. The process involves complete screening and profiling of the donor that includes for heamoglobin and we have listed other key tests that are compulsory. We have started using the Hemocue analyser. That is a haemoglobinometer. By doing this, we compute heamoglobin composition of the donor and can examine it for its compliance as per the guidelines.

We have also started doing chemiluminescence testing on all the blood bags. We have started moving away from ELISA method to this method as this is more sensitive to testing of HIV, Hepatitis B and C. We are also conducting malaria tests for our donors. It is not just the malaria smear testing, instead we are doing the malaria antigen testing that is more precise. So we choose donors without history of malaria. The advantage of the test is that it detects malaria at an early stage. We are also doing Syphilis testing that is mandatory TPHA assay instead of VDRL testing. There is lot of future upgradation that needs to start and we are eagerly waiting for the nucleic acid testing of the blood which is much safer for the patients. Our approach is ensuring patient safety and we track the quality of blood right from the donor till the blood reaches to patients by bedside.

Tell us more about the

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and do remedial steps as soon as we come to know that the temperature is not maintained. So the monitoring of temperature is very crucial when it comes to storage of components.

The state government has launched a ‘Blood on Call Scheme’; please share your views on the same.

We are currently looking for an end-to-end IT solution for our blood bank. We have lots of improvements planned using the IT tools in the pipeline technology used for storage of blood components.

We have a 100 percent component lab.

This is to keep up with times as no one really usually uses the whole blood nowadays. And we have to store each and every component at a different temperature as each component has a shelf life for different days. To ensure the temperature is maintained, we need to conduct a continuous monitoring of the storage facility. To facilitate smooth monitoring we have at our hospital a central data monitoring system that has continuous monitoring of all these at their respective temperature. These are connected to sensors and each minute is monitored for temperature

It is a good initiative coming from the state government. There is a good availability of blood among hospitals and only challenge is that the right blood group should reach the right hospital at the right time. This calls for more communication between blood banks to engage in dialogue and manage excess of a particular blood group. This ensures that the blood is not discarded and some hospitals use the same for sure. So this blood on call is a good initiative and we need to work towards its success in the state.

Please share your future plans and how IT will be used at your blood bank.

We are currently looking for an endto-end IT solution for our blood bank.

We have lots of improvements planned using the IT tools in the pipeline. We are looking at the nucleic acid testing and need the skills and machine to start work on it. It is an expensive test but we are sure to go for it. We are also looking at leuco-depletion.

We are looking cross matching and automation as well. The speed is faster and the blood is available earlier and we are looking at an IT system with software and bar coding to make the process seamless.

Hybrid Operating Room Prepared for the future

Medical solutions for the Hybrid OR from one source Key customer benefit is the multidisciplinary use of the Hybrid OR – which means it will be usable both for angiographic imaging and for open procedures. Maquet offers in cooperation with leading imaging companies complete OR solutions including the modular room concept VARIOP, OR tables, OR lights, ceiling supply units and leading edge TEGRIS OR Integration. More over, Maquet expands therapy options through offering products in the field of cardiovascular intervention, critical care, and anesthesia.

A wide variety of procedures in cardiovascular surgery, traumatology, orthopedics and neurosurgery can be carried out in a Hybrid OR. Equipped with the MAGNUS floating carbon table top from Maquet, an integrated Hybrid OR solution offers additional cathlab functionality, especially useful for cardiac and vascular interventions.

Maquet | The Gold Standard

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www.maquet.com

Anaesthesia machines

Freedom from Pain Anaesthesiologists are the new pain managers in hospitals to ensure there is a smile on each of the patient’s face. Rachita Jha, ENN explores the arrival of pain management as a speciality in healthcare in India

I

f your last surgery was pain free, then it was the magic of the hands of an experienced anaesthelogist.

These pain healers have been a part of the medical fraternity for long.

However, their role has been limited to preoperative care at hospitals.

This has changed lately, and the main driver for this change has been the arrival and mass spread of chronic pain conditions like back pain and joint pains common to the working class population primarily in the urban areas. It was the need of the hour, that anesthesia had to come out from its role of pre-operative care to single speciality care at pain clinics. So as technology and techniques evolved in anesthesia, the role of applied anesthesia grew to new leaps and bounds.

Today we have chains of specialized clinics offering pain management that is a direct offshoot of anesthesia. Hospitals also have realized the need and importance of pain management for its patients as they know that happy patient is one that is free of pain.

And who better can heal him than the friendly anaesthelogist. So hospitals now have dedicated pain clinic for pain management for their patients.

Growth Drivers Patient is at the heart of all health-

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care facilities in any hospital and there are no compromises as far as critical care is concerned as these are life-saving equipment. Technology is all pervasive especially in critical care segments of ICU and OT where each parameter needs to be monitored in real-time to track even a small risk that might indicate the deterioration of patient’s health. “More and more hospitals are going for latest technology. Market for just single parameter or 2 or 3 parameter monitors have almost disappeared. Majority of the purchases are for minimum five parameter and above,” says V Balakrishnan, Senior Vice President, Schiller Healthcare India. The second push in advancement has come from the skills and techniques of practitioners that have been brought into

The most advanced gadgets are the anaesthesia workstations that help the doctor monitor all the major parameters on one screen

pre-operative diagnosis and post-operative care.

The recent advancements in nerve blocks as a procedure have become widely used by doctors lately. The technique involves injecting a local anesthetic around a group of nerves and gives direct relief from pain to that organ or specific area of the body.

This is beneficial and has therapeutic value for patients in a variety of limb surgeries such as knee replacement, shoulder, hand and foot procedures as well as other surgical procedures.

“The block relives them of pain and they can easily recoup after doing regular physiotherapy. The patients are happy to get back to their normal lives and the hospital benefits

Refurbished devices are another segment that is of value to the small and medium hospitals and clinics as they usually cannot afford the high cost of these high end technology anaesthesia devices in nook and corner of the state. This gives lot of opportunity for growth of medical equipment industry, which is expected to grow at the rate of 15 to 20 percent,” says Balakrishnan. Together the complete healthcare ecosystem of hospitals, practitioners and government has created a demand for advanced technology and equipment in anesthesia and break away from its traditional avatar.

Technology Trends

can with better turn-around time,” says Dr Kailash Kothari, Spine and Pain Consultant, Global Hospital. The other types of nerve blocks include diagnostic nerve blocks that are being used for investigating the cause of pain, prognostic nerve blocks that help in predicting the outcome of a treatment. It can be used to decide on the decision of permanent surgery and its success rate. As most chronic pain cases are of neck and back the common nerve blocks used is cervical epidural, thoracic epidural, and lumbar epidural block that aims to stop the pain in these areas. The nerve block treatment is highly effective in pain management of both acute and chronic nature. And with growing ex-

pertise and skills of doctors in adopting them at hospitals and clinics- anesthesia is able to connect with larger population beyond the boundaries of OT. There is also a significant demand coming from the government projects as they aim to modernize and standardize their healthcare facility. “A significant growth driver is the state government initiatives to provide free diagnosis, treatment and medication for people below poverty line.

With National Rural Health Mission (NRHM) providing funding various states, the affiliated states Medical System Corporations are more focused in purchasing latest technology devices and making it available

Technology has transformed anesthesiology dramatically. Anesthesia machines come with a variety of features. One of the most advanced gadgets are the anesthesia workstations that help the doctor monitor all the major parameters on one screen.

“There is off late a big surge with healthcare facilities in India looking for slightly more advanced products as compared to the Boyles Apparatus.

More and more facilities are looking for integrated workstations with built in monitoring,” says Rajagopal Geethu, CEO, Zigma Meditech. These have hi-tech ventilators to deliver peak flow with options for variations in the volume and pressure according to the patients’ clinical condition. The same machine provides pulmonary function and ventilation parameters and could even include haemodynam-

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Anaesthesia machines

ic and other data. “We have introduced monitors with anaesthesia gas module, which is modular in design and can be used with any of our modular monitors. These measure CO2, O2, N2O and five Anaesthetic gases.

These are available in mainstream and sidestream technology and are very accurate in terms of measurement. By using these modules, Anaesthetic can maintain the dosages of anaesthetic gases and avoid over or under doses,” avers Balakrishnan Wireless technology has made it possible for medical devices to talk to each other. Today it is possible to share and transfer data at the click of a button. This creates an end-to-end patient safety and efficiency connects with the hospital and doctors. “We have also introduced Wi-Fi technology to transmit patient vital signs data to central monitor even when the patient is transported from OT to ICU or wards. We have also introduced a 3G monitor, that transmits the real time data of a patient when taken in an ambulance and the doctor can monitor the patient continuously sitting at his hospital till the time the patient is brought to hospital by using our monitor,” informs Balakrishnan.

Refurbished devices are another

Thorough research is being done on “growing” articular cartilage in the joints, which in the future would minimize the need for some people to get joint replacements. segment that is of value to the small and medium hospitals and clinics as they usually cannot afford the high cost of these high end technology anaesthesia devices. “Our target market is basically where the customer is not able to afford technology which is priced at a premium. Companies have been forced to bring affordable products in India as they feel companies like us get a better market share at the lower level. Products are tailored only for the Indian market even though these MNC’s have a global presence and these products are not offered elsewhere in the world. Many of the bigger companies do not have reach into smaller towns and cities and this is where most of our focus is,” adds Geethu. There has always been a cloud of doubt on the quality and service offered by refurbished devices

that keeps most of the hospitals away from investing in them. However with stringent quality checks and verification of the suppliers, the scope of refurbished devices to introduce better technology in anaesthesia can be explored more in India.

Challenges The roadblocks for value realization of anaesthesia as a field are many.

High cost of equipment, return on investments for the hospital, risk and caution of new drugs on patients, lack of an organized skills and training facility and absence of sufficient government support. “Anaesthesia is considered as a non-revenue fetching branch especially in private sector, as anaesthesiologists do not bring patients to hospital. Also the cost of new technology and drugs sometimes

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equipments are not available in many market places leading to sub standard support being given to the end customers,” informs Geethu. There is a need for a strong academic and supplier support environment to bring-in confidence in hospitals and anesthetics on advantages of new technology and technique that will directly benefit the patients especially in need of critical care. The government too has to bring in schemes and programmes that will push the quality and standards of practice in OT to ensure patient health is not compromised at any time.

Growth Window

does not fit into the budget afforded by patient, says Dr Pradnya Sawant, Chief of Department of Paediatric Anaesthesia, Wadia Children’s Hospital.

The absence of advanced technology instruments in hospitals leads to a vicious cycle of untrained practitioners in anaesthesia who lack any experience in using these machines. So, even when they are given the opportunity, the clinicians are hesitant to use new gadgets and drugs because fear of complications due to not having experience. Thus resistance to adopt anything new is very high in anaesthesia in most of the medium and small sized hospitals and clinics where maximum population gets their healthcare services. “Most of the technical personnel are not exposed to newer anesthesia technology and hence tend to downgrade a unit

The government too has to bring in schemes and programmes that will push the quality and standards of practice in OT to ensure patient health is not compromised at any time in terms of its usage. The process of procuring spares for even authorized dealers of MNC’s is long and time consuming. Ready and immediate availability of them is still a mirage. Technical personnel for servicing of these

The demand for chronic pain management has led to a mushrooming of pain clinics across the country. The patient today is also well informed of the technology and technique that can ensure his well being. So the demand for better technology and procedures that are pain less and assure him of quick recovery is more. The hospitals are therefore making investment in anaesthesia techniques and doctors.

“The Indian market is poised to grow very heavily and global brands tend to get the most recall. We are looking at a growth rate of about 20 percent for the coming year and feel that it can be achieved quite comfortably,” avers Geethu. The trend would change fast if the equipments become affordable.

India is a focus market for many of the companies and pricing strategy will need a relook to expand business here. “We will be introducing new design and technology in monitors and our aim is to bring latest technology at affordable prices,” informs Balakrishnan. The coming years are growth years as private hospitals are coming in all major cities. An aggressive focus on tier-II towns have now become the investment hubs for major hospital chains as well new entrants in the healthcare sector that will drive the demand of anaesthesia market in India.

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Industry Speak

Scaling New

Height

I am optimistic about the new government and hope we have some new projects and improvements in medical sector, says Dr Vinod Kohli, CEO, Allied Medical.

On your journey as pioneers in anesthesia industry I have seen this industry from the time Ether was used in anesthesia, and as an anesthetist we were told that it had no side effects and so safest to use on patients. A lot has changed from then till today, when I manufacture smart and intelligent infusion pumps that are programmed to follow any required flow in an automated way. During our early days, we have been partners to leading medical institutions across India offering latest equipment in anesthesia and critical care. We did the entire intensive care and ICU set up in many hospitals. Our focus is on anaesthe-

sia and intensive care and we make every type of life saving equipment. I am involved in R&D and manufacture of latest equipment in UK as well.

We are a leading manufacturer with close association with Association of British Healthcare Industry (ABHI), which also gives us exposure to international business.

On role of IT and its benefits IT has contributed significantly in modern medical equipment sector. All the anesthesia and infusion pumps have a large IT component. The infusion pumps that we are manufacturing also have an IT component to it and we just need to programme it according to the dose requirements.

Modern ventilators both for anesthesia and intensive care have major IT role. However, there still remains much to be done for the medical industry. Unfortunately our IT industry has excelled in outsourcing to other countries but has missed to focus on medical field and contribute to smarter equipment and software.

On major challenges In India it is a tough terrain to be a manufacturer of medical devices and equipment. Medical devices manufacture requires large Investment. The first roadblock that hits us is funding as banks lend us at very high interests rates as compared to the perks that importers or global companies get.

Export is a problem in India for healthcare manufacturers. Sec-

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ond major challenge is to find highend vendors, suppliers and manpower with latest and in-depth technical knowhow.

On quality and standards When safety is considered there is no compromise. Today anaesthesia is the safest specialty of medicine. As a medical field in its practice and applications, both surgeons and machines have grown to high standards. This was mainly because of the technology and engineers that have raised anesthesia specialty to new heights. The dependence on technology has also increased; this has another side to it as well, as any deficiency in the technology can become fatal too in today’s high tech equipments.

On your vision My vision is to make this company going on a growth path both technically and economically. It is a competitive environment and I compete with the best in the medical sector. Our products are of highest quality standards.

My focus is more on R&D. Our R&D is biggest asset and we keep spending inspite of constraints of funds. My aim is to become one of the major multinational players in medical equipment industry. We have already forayed into number of countries through our UK associates. We will be soon in Russia and African countries.

I am optimistic about the new government and hope we have some new projects and improvements in medical sector.

Doc Speak

Safety is Paramount More than workstations, we need basic equipment that are more helpful, says Dr SSC Chakra Rao, President, Indian Society of Anaesthesiologists Your views on the latest technologies in Anaesthesia.

Anaesthesia is not a therapeutic state. There needs to be a word of caution and safety in addition with more awareness to increase the depth of anaesthesia across hospitals and clinic, which is more important.

We know that almost all Anaesthetic drugs depress the Cardiovascular system hence caution is needed as certain patients with poor functional capacity can decompensate and have an impact on their health. In these information critical environments, equipments such as workstations are high it can be used in OT and for information on critical parameters in the ICU. Otherwise more than workstations, we need basic monitoring machines are more helpful. The workstation is just like any other anaesthesia it can be used to provide a one device that holds all the critical information on key parameters of the patient. However, there are standards for these products that are not maintained except for leaders in the workstation segments. In India, the need of the hour is not a high tech machine; instead we need quality basic equipments.

Your views on the progress of Anaesthesia and its evolution in medical field.

As the skills of the Anesthetists are increasing the technique is improved.

As the safety will increase in Anesthesia the techniques will keep on improving. It depends on the understanding of physiology and biochem-

We have also given standard protocols for procedures but we do not have the powers to ensure implementation of the same istry of the body. One can improve the skills by the understanding of the human mechanism, blood flow and circulations. We are doing focused skill training programmes in our Centres for Skill Development and Training located in three cities, and we are also training the third world countries such as African countries. India is vast country with many university and medical colleges giving education on Anesthesia. However these are not of benchmark quality and they need a revamp to be of global standards.

The students who finish their studies and are entering the hospital environment are not ready for the job. This

due to lack of available techniques that are taught to them that leads to sub-standard anesthetics in the healthcare ecosystem. ISA is providing a platform for skill development.

We have also given standard protocols for procedures but we do not have the powers to ensure implementation of the same. India has to start somewhere on the standard protocols in the OT to ensure safety of the patient that is sacrosanct. We have also suggested for the inclusion of Anaesthesia as a subject in the undergraduate curriculum of MBBS, where we can catch the doctors when they are young and teach and create awareness among the medical students.

This way of imparting knowledge of resuscitation and basic life support will help them to serve better.

Your recommendations for the Government.

We have recommended minimum essentials in operation theatre such as continuous supply of oxygen cylinders, Boyle’s machine with two oxygen and a nitrous oxide input connections.

One small oxygen cylinder mounted on Boyles other than jumbo or central line and nitrous oxide cylinder along with cylinder valve opener should be available. Boyles machine with hypoxic guard safety system working suction machine with all connectors, tubing’s, and catheters, multi-parameter monitors including pulse oxymeter, ECG, NIBP, EtCO2 in Laparoscopy, thermo probe for temperature monitoring for pediatric patient and a defibrillator among others.

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Anaesthesia machines

Multi-Speciality Pain Clinics

is Future

Many patients post knee and lower limb surgery have severe pain, says Dr Kailash Kothari, Spine and Pain Consultant, Global Hospital Please share with us the latest treatment trends for acute pain management.

Anaesthesia aims to reduce the patients’ surgical pain. Earlier only pre-operative care was done by an anesthesiologist and postoperative pain management was done by the surgeon, however as the role of anesthesiologist has grown as peri-operative physician. Pain management in post operative period has become more specialized, the service provided today by anesthesiologists. Role of an anaesthesiologist as Acute pain management specialist involves planning and giving round the clock safe medication in correct doses, training a nurse in the hospital called a pain nurse/ residents who ensures that all surgical patients’ pain is controlled within limits and follows a protocol of treatment to reduce the pain. The idea is to make the patient happy by keeping them pain –free. There are various techniques like insertion of epidural catheter in cervical, thoracic or lumbar area for targeted pain relief. Now, there are pumps available to deliver the drug into the body through epidural catheter or IV lines, called patient-

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controlled analgesia (PCA). PCA provides a fix flow of drug in the body. Patients can control their pain themselves just by the click of a button on PCA which deliver a pre-designed dose of the drug and patients feel relief in minutes. There is a lock-in facility (for safety and to avoid overdose) which ensures only the prescribe limit of the drug is take by the patient in a day.

Many patients post knee and lower limb surgery have severe pain. To help them recover quickly, we put in a catheter under guidance of USG/nerve stimulator/both in the peripheral nerve supplying surgical area. This provides local analgesia we inject small dose of the drug or a placement of catheter for continuous infusion of drug. Thus a small dose can provide a very good pain relief.

As the patients recoup faster, there is huge saving in the hospitalization cost.

Please share some new techniques in chronic pain management.

As we move into chronic pain management, this is an area where the concept of pain clicnics has come up. Chronic pain have various causes.

Back and neck pain constitutes is the most common and is a huge burden on healthcare system. This is followed by cancer pain and neuropathic pain (due to direct damage of the nervous system). In pain clinics pain physicians deal with these problems in a peculiar manner. Many patients we cannot diagnose the source of pain. We do nerve blocks technique with patients to diagnose the source of pain. This is called diagnostic block, wherein we give local anaesthesia under X Ray or ultrasound control and observe the pain following drug administration, to review if the pain is relieved or not. Diagnostic block helps us to understand the exact source of the pain. Once the pain generator is identified and treatment easier and faster. If we look at back pain, the pain management system has evolved over time for treating spine pain coming from herniated discs, facet joint and spinal nerve pains. Facet Joint is very complicated and many details get missed even on MRI. Our approach is to inject a small dose of local anesthetic drug using fluoroscopic guidance, Once diagnostic block relieves the pain, for permanent relief you can do radio

Doc Speak

frequency ablation of the nerves supplying the joint. The common and effective treatment offered to slip disc patients is transforaminal epidural steroid injection (TFESI).

This works as diagnostic and therapeutic injection. Most times patients get lasting pain relief and may avoid surgery. Even if the pain comes back, the cause of pain is understood and we can conduct a successful surgery at perfect level to address the core source of pain generation. This new method that helps the surgeon about outcome of surgery is used very commonly in hospitals all over the globe The patients benefit the most from this technique. In addition, there is a new technique such as the spinal cord stimulator (pacemaker in the spine) that is used on patients that have already had multiple surgeries but severe pain continues. This involves putting a catheter electrode inside the epidural space and we connect it to pacemaker with a battery. These blocks all the pain sensation and can relive pain for 10 -12 years. The control (remote) of the device is with the patient and they can control the pain themselves at whatever time they need.

The role of new imaging techniques Technology to relieve pain has improved and so has the technique for surgery. Earlier it was X-Ray guided in radiology suits; now it is the C-Arm or the Fluoroscope (a live X-Ray machine in Operation Theatre) under which we can guide the needle to a particular area and inject the drug. We use the radio-opaque dye that can be seen flowing in the right area which is to be injected with pain drug or apply radiofrequency current. Ultra Sonography and Colour Doppler are also beneficial in localizing and placement of drugs under direct live imaging.

Pain clinic is coming up in a big way in the future, especially in India. In other countries, pain management clinics are one of the biggest day care department in large hospitals Tell us about the scope and use of pain management for cancer patients.

The most commonly used technology for long lasting pain relief is the radio frequency generator. There are some nerves that only perform sensory functions, thus we use radio frequency to burn that nerve and relive the pain it was causing the patient. This technique is also used in many other conditions including facet joint pains as mentioned above.

The patients’ sufferings from cancer have to undergo pain management and palliative care. Each part of body has nerve supply carrying the pain sensation to spinal cord and brain. We can use the nerve block technology from head to toe depending on where the pain is? We can also apply radio frequency technology to control the

pain for prolong duration. We also use chemicals like alcohol and phenol in different concentration to perform neurolysis for cancer pain relief.

With newer techniques cancer pain is managed very well and the patients can live the life well. Pallative care itself has developed into a speciality.

This involves management of drugs like morphine and many other newer drugs which have come up for providing better quality and sustained pain relief. Today there are sustained release formulations of morphine for longer duration and sustained pain relief. Newer drugs like Fentanyl and Buprenorphine are available as skin patches and after the patch is applied the patient’s pain is relived as the drug is absorbed in the body. These technologies are a boon for patients today as these were not available 10 years back. Once applied these patches provide 3-7 days of pain relief for Fentanyl and Buprenorphine respectively.

Please share your dream technology that you are waiting to arrive in India.

Pain clinic is coming up in a big way in the future, especially in India. In other countries, pain management clinics are one of the biggest day care department in large hospitals.

They have a dedicated separate area for pain management. Many clinics are multispecialty pain clinics.

In spine surgeries, now we are going for minimally invasive spine treatment, through an endoscope without any cut using a needle we can remove an entire bulging part of the disc. These endoscopic surgeries are very beneficial for the patients.

This is a selective procedure that we have started already but I am awaiting for it to gain pace in India.

Spinal Cord Stimulator is another transformational technology which can be used to recover paralysed patients of spinal cord injury. These can be technology of the future.

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company Profile I

Medical Equipment Finance Company Profile Shriram Equipment Finance Company Ltd (SEFC) is a part of the “SHRIRAM” Conglomerate which has significant presence in financial services. SEFC is a fully owned subsidiary of Shriram Transport Finance Company (STFC) which is India’s largest NBFC with assets under management of over INR 520 billion. SEFC is a leading NBFC in infrastructure equipment lending, having started its operations in October 2010, it has already attained a most prominent position in Construction Equipment Finance space in the country. With a customer base of over 20,000, employee base of over 1200 and Assets under Management of over INR 35 billion, SEFC operates through a wide network of over 165+ branches across India while catering to needs of all classes of customers across the geography of the country.

SEFC has launched Medical Equipment Financing business primarily focusing on diagnostic and dentistry equipments. SEFC intends to aggressively finance equipments like X ray machines, CT scan, MRI machines, Ultrasound, Doppler & Monitors, Mammography machines, Dental chairs & lazers, Dental Radiology equipments, cathlabs i.e. to Diagnosis Centres, Nursing Homes, Hospitals as well as individual Doctors and specialists.

Having started its operations at 15 key cities spread across the country, SEFC aims to expand into 60+ centres catering to all customers in this segment in next 3 to 4 months. Eventually this business will be operated out at all 165 branches of the company.

Shriram Equipment Finance with its focused approach in industry brings in pronounced advantages for both customers and manufacturers: Simplified & fastest loan processing: Shriram Equipment Finance has simplified and efficient deal processing system aided with cutting edge technology support to provide shortest TurnAround-Time in the country. SEFC conclude finance and due-diligence aspects of deal within time that is

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50% of industry average TAT. Largest Retail focused company: Understanding the distributed customer profile across geography, the risks associated with the profile and segment, Shriram Equipment Finance is focused to empower small and medium enterprises/ Individuals with easy and attractive finance option available at their doorstep. Today SEFC is one of the largest retail segment financer in Construction Equipment segment and same would be replicated for Medical Equipment Finance business as well.

PAN India Coverage: Leveraging Shriram Transport’s presence in more than 650 branches, SEFC has manned its operations at 165+ locations thereby covering entire geography of the country. Having started Medical Equipment Financing in 18 branches currently, intends to spread into all 165 locations across the country.

Superior Product Offering: Shriram Equipment Finance with its superior industry understanding and underwriting skills has evolved product offering in terms of asset selection, Loan-To-Value, tenor and other finance terms flexible that is by far the best in the industry.

Covering all & everywhere: Shriram Equipment Finance believes and demonstrates financial inclusion of all asset classes/ models and customer grades with best in industry product offering. Complete coverage to the matrix of assets and customer grades make Shriram Equipment Finance a comprehensive solution provider in this segment.

Shriram Equipment Finance – “makes it happen”

health policy

Health of Insurance Health Insurance is becoming a cash cow. The companies are rolling over with cash. A customer is pampered to the fault

G

iven the poor health infrastructure and complete absence of doctors and hospitals in the faraway places, health insurance in India is a fast growing segment of India’s economy. 3.9 percent of India’s gross domestic product was spent in the health sector three years ago. According to the World Health Organisation (WHO), this is among the lowest of the BRICS (Brazil, Russia, India, China, South Africa) economies. Policies are available for both an individual and a family cover.

The expenses incurred on hospitalization are covered or taken care of by health insurance policies in India. The choices and preferences have multiplied to suit the needs of a customer.

A variety of products are available offering a range of health covers, depending on the need and choice of the insured.

Launched in 1986, the health insurance industry woke up to the needs a little too late. Trying to catch up with lost opportunities, however, it

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has grown significantly mainly due to liberalization of economy and general awareness. By 2010, more than 25 percent of India’s population had access to some form of health insurance. There are standalone health insurers along with government sponsored health insurance providers.

Until recently, to improve awareness and reduce procrastination for buying health insurance, the General Insur-

The key aspects of health insurance and payment options are direct payment or cashless facility. Under this facility, a patient does not need to pay the hospital in the same way as the insurer pays directly to the hospital

ance Corporation of India and the Insurance Regulatory and Development Authority had launched an awareness campaign for all segments of the population.

The first health policies in India were Mediclaim policies. In 2000, the Government of India threw the insurance companies open and allowed private players into the insurance sector. The advent of private insurers in India saw the introduction of many innovative products like family floater plans, top-up plans, critical illness plans, hospital cash and top up policies among others.

Health insurance in India is unique, paying for only inpatient hospitalization and treatment at the hospitals.

It is a major departure from many countries which offer comprehensive health cover including hospitalization, medicine, subsequent consultations with the doctor. Outpatient services were not payable under health policies in India. The government control led to many structural problems. Broadly,

we can divide the health insurance plans in India into two categories:

Hospitalization Hospitalization plans are indemnity plans with a different name that pay cost of hospitalization and medical costs of the insured subject to the sum insured, an amount an insured can avail of at the most. These

policies do not normally pay any cash benefit. However, there are specific policies to offer a number of additional benefits like maternity and newborn cover, day care procedures for specific procedures, pre-and post-hospitalization care, domiciliary benefits where patients, restricted by ailments, cannot be moved to a hospital. The offers go a long way to help the insured out of the crisis. The sum insured can be applied on a per member basis in case of individual health policies or on a floater basis in case of family floater policies. The sum insured can also be utilized by any of the members insured under the plan in case of floater policies.

There is still another kind of hospitalization policy called a top-up policy.

The several top up policies have a high deductible typically set a level of existing cover. This policy is targeted at people who have some amount of insurance from their employer. If the cover provided by an employer is not good enough, people are free to supplement their cover with the top-up policy, depending upon their requirements.

Hospital daily cash benefit plans: The daily-cash-benefits are a well defined benefit policy that pays or can pay a defined sum of money for hos-

pitalization every day. Premium for these benefits are a little higher than normal. Reflecting the policy of an insurance company, the payments are for a defined number of days in the policy year and may be subject to deduction of few days. Although laid out in detail, the insured and the company often lock themselves into an argument.

Critical illness plans: There are several policies to take good care of an approximate sum if an insured is diagnosed with one of the ailments specified in the policy. Some of the policies require a survival period for the payout to take effect. A very long road, indeed. The key aspects of health insurance and payment options are direct payment or cashless facility. Under this facility, a patient does not need to pay the hospital in the same way as the insurer pays directly to the hospital. Under the cashless scheme, the policyholder and all those who are mentioned in the policy can undertake treatment from those hospitals approved by the insurer. As suggested by the name, the benefit can be availed of without paying a single penny unless the expenses are incurred on the subjects other than mentioned in the policy.

Reimbursement at the end of the hospital stay means that the patient, after staying for the duration of the treatment, can claim a reimbursement from the insurer for the treatment covered under the policy undertaken.

Cost and duration are two critical components of the health policy, taking care of an insured. For example, the insurance companies offer health insurance from a sum insured of Rs. 5000/- for micro-insurance policies to a higher sum insured of Rs 50 lacs and above. The commonest insurance policies

for health insurance are usually available from Rs 1 lac to Rs 5 lacs. However, the health insurance policies offered by non-life insurance companies usually last for a period of one year. The life insurance companies also offer policies for a period of several years. Actually, they have a deep pocket trying to play Santa to every playful child.

Under the Income Tax Act, under Section 80D, the insured person who takes out the policy can claim for tax deductions.

Global market: Health insurance is a type of insurance coverage that covers the cost of an insured individual’s medical and surgical expenses, unless cost of medicines is separated from hospitalization. Depending on the type of health insurance coverage, either the insured pays costs out-of-pocket and is then completely reimbursed, or the insurer makes payments directly to the provider.

In some countries, such as the United Kingdom or Canada, health care coverage is provided by the state and is rightly seen as every citizen’s right - it is treated at par with public education, the police, firefighters, street lighting, and public road networks, as a part of a public service for the nation. It may be added here that the executive in foreign countries is not as inept as in India where actual health coverage is severely crippled.

In countries without universal health care coverage, such as the USA, health insurance is commonly included in employer benefit packages and seen as an employment perk.

However, that has equally impacted the benefits in other sectors.

I n other countries, such as the USA, health insurance coverage is seen somewhat differently - with the exception of some groups, such as

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43

health policy elderly and/or disabled people, veterans and some others, it is an individual’s responsibility to be insured. More recently, the Obama Administration has introduced laws making it mandatory for everybody to have health insurance, and there are penalties for those who fail to have a policy of some kind. Though the policy has run into huge opposition. The deadlock snowballed into shutdown. The economy took a body blow. When medical care is required, ideally the patient should be able to concentrate on getting better, rather than wondering whether he/she has got the resources to pay for all the bills. This view is finding acceptance in nearly all the developed nations.

Future Outlook: Health insurance in India has taken roots deep into the rural hinterlands.

The populace has no option, left without any doctor or hospital much less any pr imary health centre, a solemn objective laid long ago by our forefathers in the constituent assembly but conveniently forgotten in the corridors of power. Vulnerable to the pressure and pull, the gullible people are easy prey to monstrous marketing blitzkrieg unleashed by the fat companies. The markets in urban areas and metros are saturated. The people are still learning about the benefits and what it actually means to have a health insurance. Insurance com-

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panies are seeking to expand their customer base. They are always introducing new products and variants into the market almost every day. In such an environment it is easy for a customer to pick and choose from among a basketful options. Plenty is often the problem.

Whether you are looking for health insurance in Gurgaon, health insurance in Delhi or health insurance in Noida, investing in a good health insurance product is a great idea fast catching up with the rural populace. The rest of India is not different.

Therefore, when you buy a health insurance policy you can rest assured of receiving the care you need, when you need it. Invest a part of your savings for your own secured future and feel free to eat wrong, live happy.

India’s health insurance market has witnessed emerging trends in recent past.

It has several new players to contribute. With their innovative healthcare policies, insurance providers are making way for improved healthcare conditions for people. They have made easy for all to obtain security against health risks.

The choice of a health cover is again a key to calculating the total expenses incurred on a household. This decision must be taken prudently. Some companies are always at prowl. They intend more to mint money than to mend the morbidity. While selecting the medical care policy, it is required to pay attention to all the included features. The hidden costs at the bottom are often so cleverly inserted with small sized letters as to escape even the most scrutinizing eyes. Although all medical insurance plans provide coverage against health uncertainties but they all have variations. Policies differ on the grounds of sum insured options, list of

benefits, number and kind of critical illnesses if in case the benefit is included, copayment, maximum entry age, exclusions, deductibles, renewal terms and claim process. The policies need a careful deliberation. It is thus imperative to keep a note of all the above mentioned features.

In addition, all medical insurance plans adhere to the specific terms and conditions. They are not the last word in any case, always open to a prospective customer to extract many benefits whether mentioned or assumed. They differ from policy to policy; hence they must be cross checked before taking any final decision. People are becoming health conscious these days. They have started following a healthy diet and are maintaining a healthy routine. But it is to bring to your notice that it is not enough for health security.

But before investing in medical insurance, it is extremely important to develop proper understanding of the policy. Providing genuine information about all the products and in simple policy wording is an ideal and professed objective but often followed more in breach than in conformity.

Same holds true for keeping the process transparent. One can avail ‘cashless treatment’ with our products in more than 4000 network hospitals in over 800 cities.

Failure to bear the expensive treatment cost forces people to end up compromising with the quality of treatment.

It can have an undesirable and avoidable bearing on the health of the person in the longer run. Opposed to this, an insured person has somebody to turn to.

He/ she can leave the financial worries for the insurance company to deal.

It not only takes care of your financial concerns in times of a health emergency, but also gives you an easy customized access to routine and preventative healthcare elements which might have been out of your bounds earlier. In addition to that, in times of a medical crisis, your insurance policy ensures what goes comes back. The cash outflow is an inflow with a different name.

Where healing meets passion Largest private sector hospital in Delhi Spread over 6,50,000 sq. ft.

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BLK Super Speciality Hospital Pusa Road, New Delhi.

Call: 011- 30403040 Visit: www.blkhospital.com

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Interview

Present Sure,

Future Insured We are fully committed to consistently ensuring that our products, processes and services are customer focused and are rated highly by our customers and partners, says Sheeraj Deshpande, Head, Health Insurance Future Generali India Insurance Company Ltd Why should one accept a health insurance plan offered by Future Generali?

We have a wide range of products / plans under health insurance. Future Health Suraksha is our flagship health insurance product which has basic, silver, gold and platinum plans.

This is basically a hospitalisation insurance product. The sums insured options vary from Rs 1.50 lakh to Rs 10 lakh. This product is very competitively priced and has some unique features like patient care, additional SI for accidental expenses, accompanying person benefit, etc. We also have Future Critical Illness (Critical Illness Product Covering 12 critical Illnesses), Future Hospi Cash and Future Health Surplus. One of the most important USP of Future Generali is that we have an in-house servicing unit- Future Generali Health (FGH) for servicing health insurance policies. We are very proud to say that we have established ourselves as the one of the best service provider in the industry as far as servicing health insurance policies is concerned. The most important aspect of any health insurance plan is the servicing, especially when the person is hospitalized and awaiting cashless authorization.

As of now our major portfolio consists of Corporate Group Health and we are also steadily increasing our retail

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health business. It would be pertinent to add here that Future Generali India Insurance Company Ltd is a JV between Future Group and Generali Group and Generali Employee Benefit is the largest Employee Benefit Insurer in the world. Servicing Health Insurance customers requires special empathy and judgment and we ensure we have a very efficient team to manage our health insurance portfolio and our customers do experience delightful service levels.

What is philosophy of the Future Generali?

We at Future Generali aim at offering and tailoring a bright combination of protection, advice and servicing. We are fully committed to consistently ensuring that our products, processes and services are customer focused and are rated highly by our customers and partners. We play a proactive and leading role in improving people’s lives through insurance.We tie a longterm contract of mutual trust with our people, clients and stakeholders. We commit with discipline and integrity to make an impact within a long lasting relationship.

We look to grow respectably but also sustainably bringing in value as we grow. We are a totally customer focused organization and all our efforts are towards ensuring the best product and service offering for our customers at an appropriate price. We strive to grow profitably ensuring our clients live a very peaceful and happy life.

We also realize unless the growth and business is sustainable we can never achieve our goals.

Health insurance has long been held back in urban spheres.

What has Future Generali done to make up for the lost opportunity in the rural areas?

We look at the rural markets as a very good opportunity to increase our penetration, growth and profitability. We do have a good presence in rural ar-

One of the major reasons for insurance companies not being able to introduce innovate and comprehensive products in the Indian market such as Prescription Drugs cover, etc, is the unregulated health care sector in the country eas through MFIs, NGO and co-operative Banks. Our Future Health Suraksha Product has the Basic Plan which is targeted at rural areas as well as smaller towns and is also priced accordingly. We are increasing our penetration by tying up and working with various MFIs, NGOs, RRBs, CSC etc, in the rural areas. The challenges of rural market includes the product has to be simple to understand, should be priced affordably and a cost effective distribution strategy. We are making use of technology to reach the rural masses and service them efficiently.

We have been participating in RSBY schemes and reaching out to the masses.

Health insurance is an attractive sector for the foreign companies asking the Govt for more liberalization. What is your opinion?

Health Insurance is the second largest portfolio only next to the Motor in the Non-Life Insurance Industry in India and also the fastest growing segment. Approximately 65-70 % of the Health Insurance business is Group health insurance which over the years has been a loss making business (especially corporate group health). Retail Health Insurance in India is still growing at a rate lower than anticipated and there is a large scope for growing the retail lines of business.

There is definitely more space for new companies.With new entrants coming in, there would be increased competition as well as newer products and services introduced in the Indian market which would ultimately benefit the end customer.

If I were to ask you one thing you would like the Modi-led Govt to change in its policy, what would it be and why?

The government appears to be going in the right direction.

Some countries offer insurance even on the medicines. Is it possible in India, especially in the rural areas?

Medicine expenses as a part of hospitalization treatment is even covered under the present polices in India.

Some companies have also introduced OPD coverage under hospitalisation health policies in a restricted way.

One of the major reasons for insurance companies not being able to introduce innovate and comprehensive products in the Indian market such as Prescription Drugs cover, etc, is the unregulated health care sector in the country. Today a prescription can be available without a consultation and drugs and medicines can be available without a prescription and so also bills and receipts available without any prescription, actual purchase of drugs and medicines or consultations. There is no regulator for the health care sector and until something is done to address this it would be very difficult for newer and innovative products to come in the Indian market.

How do you think can the Govt achieve hundred percent health insurance cover for all its citizens?

I would suggest the following approach for making available affordable and effective health care for each and every citizen of the country. The small table explains the approach.

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news

Pacemaker via His Bundle Pacing I n a major breakthrough in the field of cardiac electrophysiology in India, leading cardiologists at Fortis Escorts Heart Institute & Research Centre have performed the country’s first pacemaker implant via His Bundle pacing, a technique that saves more lives in the longer run as against the traditional implant procedure.

A team led by Dr T S Kler, HOD cardiology and director, electrophysiology at Fortis Escorts Institute & Research Centre, performed the new procedure on two patients, a 75-year-old man and another 63 years man, who needed a pacemaker implant.

It is the one of the first time that cardiologists in India have performed this pro-

“I

n normal heart functioning, the electricity generated in the upper right chamber of the heart travels to the A-V node (atrioventricular node) & His bundle, which is the bridge between the upper and lower chambers of the heart. This impulse then divides and travels to the left ventricle and the right ventricle. So, naturally speaking, AV Node & His bundle is the point that acts as a natural conductor of electricity from upper chambers to lower chambers of heart. When

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cedure. In fact, this is the first time this technique has been executed anywhere in the SAARC region.

A human heart needs a pacemaker when heart rate drops to abnormally low levels either because of inability of natural pulse generator center (sinus node) or when there is electrical block of impulse when it travels from right upper chamber to right lower chamber usually at the AV node or below that. An artificial pacemaker replaces the heart’s original electrical impulse generating system with an alternate power generator.

In traditional pacemaker implant, the lead of the pacemaker (or its wires) is attached to

the AV node is blocked due to a malfunction, the electricity supply interrupts and this necessitates an artificial pacemaker.

In traditional pacemaker pacing, which is the norm across the world, there is a long-term risk of patients suffering from heart failure. In fact, 10 to 15 percent people in traditional pacing do tend to suffer from heart failures in the longer run. The alternate His Bundle pacing is the physiological way of pacing and therefore cuts this risk”.

the right ventricle apex, a point located at the bottom of the lower right chamber of the heart. The electrical input then travels all the way from this lowest point in the heart upwards towards the base. Normal impulse travels from base of heart to its apex. So in apical pacing electrical impulse travels just the opposite to natural way. A section of people (about 10 to 15%) who undergo pacemaker implant through this traditional mode suffer from heart failure due to decrease in pumping capacity of heart caused by right ventricle apical pacing.

The new technology involving pacing through His Bundle pacing cuts this risk of future heart failure to almost zero percent. In this breakthrough technique, which is performed by very few doctors across the world, the pacemaker lead is put on directly on the His bundle, which is the junction between the upper and lower chambers of the heart. This replicates the physiological functioning of the heart as the heart’s natural electrical impulses travel in normal human heart.

After conducting the first such two procedures, the doctors are now preparing for a third His Bundle pacing procedure. Right ventricular apical pacing – as the traditional method is called – is not an ideal procedure for permanent pacing because of a risk for ventricular function deterioration, mitral valve dysfunction, or proarrhythmic effects. His Bundle pacing provides a safer and better technique of providing electricity to lower chambers of heart. But only problem is it is technically more demanding and takes little extra time for the procedure. The cost of this pacemaker is almost the same as previous available devices.

Exclusive interview

Will Provide Resources for

Doctor’s Learning

Terig Hughes, Managing Director – Elsevier Health Solutions, South Asia discusses his expectations from the new government, initiatives and future plans with ENN.

Mention the significant growth in your company in the coming years and what is your action plan for the same?

I believe the most significant growth in India is yet to come. In terms of timing, a lot will depend on the initiatives of the new government. In addition to traditional books and journals, Elsevier provides electronic resources such as ClinicalKey, which hosts a vast amount of content that is easily searchable to provide doctors with fast, reliable and relevant answers. ClinicalKey, launched about two years ago, is a big part of our plan to lead the way in healthcare delivery.

As a digital information solutions provider, we integrate workflows of doctors and practitioners into our systems to deliverthe most current and useful information to those who need it

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What is your vision and future plan for realizing organizational goals?

As a digital information solutions provider, we integrate workflows of doctors and practitioners into our systems to deliver the most current and useful information to those who need it. In addition, we want to help with the education needs of medical students, nurses and allied health professionals. As of now, there are over 50,000 medical students entering India’s medical education system every year. Our job is to help educate them by providing them with the best resources and tools available for their learning. With such strong growth in human talent, the challenge will be to maintain the quality of education and to produce better doctors.

How can the brand grow at the national level?

Elsevier’s growth strategy has always been about collaborating with various institutions and government bodies as well as leveraging our global platforms to deliver local solutions. For example, products like Clinical Learning are being used by medical faculty and students in India to improve learning outcomes efficiently. So we are growing our product range, and collaborating with medical institutes and the hospital industry to improve healthcare education and clinical outcomes. It is only through partnering with organizations like JCI to deliver events like the Hospital Executive Education program, and working with medical institutions and other organizations that our goal can be achieved since we can’t do it all alone.

How important are these events?

These events are definitely crucial as they attract the leaders of hospitals across the region, whothen advocate

It is only through partnering with organizations such as JCI and other organizations that our goals will be achieved, since we can’t do it all alone. and socialize these topics amongst the community to raise awareness and engage the industry.

This is an APAC wide program being rolled out across 6 countries including Australia, India, China, Japan,Indonesia and the Philippines (. This pilot project has been a huge success across the region and we intend to expand our collaborations with JCI in the future..

Your take on societal issues like going green, global warming, minimizing organic wastes?

up with changing preferences of the new generation of students and medical professionals. I have no reservations about constant changes taking place. Although, we are the market leader, we cannot afford to sit back and relax. There needs to be a constant cycle of innovation to keep pace with changing market needs and demand.

What are the challenges you face and how do you plan to resolve it?

The preference for print over electronic products is posing some challenges at the moment. The lack of a robust infrastructure is hampering some of our customers’ access to the Internet causing them to miss out on the benefits of our online products.

This will take time to resolve but in the meantime we continue to offer a vast array of print products.

Your expectations from the new government

Yes, we at Elsevier do care about environmental issues and take measures to protect the environment.

The company supports activities to safeguard the environment.

Traditional publishing tend to use a lot more paper, but our evolution into a digital information solutions provider means that we now can minimize usage of material resources.

And going digital eliminates the need for physical transportation, further reducing the reliance on fuel energy and physical space.

The election Manifesto mentioned improving healthcare and using electronic resources to help achieve that. I am hoping that they follow the manifesto and can make use of Elsevier’s resources to have a bigger impact and reach more people in an efficient and effective way. As long as the intention turns into action, the result will be good for everybody, so I do have faith.

How do you see yourself in changing the company and emphasize upon your role in that change?

Firstly, we are the largest provider of scientific, technical and medical information solutions. Some of our products like Clinical Learning are unique to the Indian market and reflects our industry leading position via the quality of our content and delivery of cutting edge technology.

With that, Elsevier is leading the way in advancing health, science and technology.

My role as Managing Director is to lead the organization towards driving and executing our strategy. Over the next few years, we must innovate to deliver solutions that address the issues faced by medical professionals and students alike; we need to keep

What sets you apart from other companies, please explain this difference?

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Event Preview

Elsevier to provide resources for learning to health professionals Recently, the CEOs of around 30 hospitals and JCI consultants attended the workshop held in Gurgaon, which started with a brief overview of JCI and its goals in the near future.

E

lsevier and Joint Commission International (JCI) conducted a Hospital Executive Education Program that mainly focused on topics such as building a high reliability organization and evidence-based practices, which are of high relevance to most hospital executives today. The Elsevier-JCI workshop was held at Westin hotel in Gurgaon on November 19th. Around 30 hospital CEOs and other JCI consultants attended this workshop, which started with an overview of JCI and its goals in near future..

The speaker at the workshop was Dr. Hyunok K. Do, RN, CRRN, DNSc, a JCI Consultant. Dr. Hyunok Do is a consultant for Joint Commission International with more than 30 years of leadership and management experience in operations. She is a recognized expert in performance improvement, outcomes management, program development, and statistical tools and techniques.

In the first half of the JCI workshop Hyunok focussed on the topic; High Reliability Organisation. This topic served many solutions for the issues faced by the hospitals. Most of the time, hospitals do most things right, but the constant failures in critical procedures have a terrible consequence for a patient. Then she talked about creating a culture and processes that radically reduce system failures and effectively respond when a setback occurs. According to the speaker, these aspects are the focus of high reliability thinking.

This program presented a high reliability concept and discussed the thoughts, achievements and failures of hospital leaders, who have used concepts of high reliability and aspire to help hospital leaders start the transformation of their organisation. This involves a system of secure, highquality, and efficient care being given to each and every patient at the hospital.

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The main purpose of this topic covered was to define high reliability concepts and describe the importance of these concepts to various hospitals by identifying five characteristics of high reliability organisations. There was also a discussion about describing applications of high reliability concepts within health care organisations and the present challenges of implementing these concepts of high reliability organisation.

The second half of the workshop highlighted on Clinical Leadership and Evidence-Based Medicine. The main goal of this topic covered was to concentrate on “Evidence-based practice� (EBP) in hospitals. Today, EBP is receiving good attention within the field of healthcare services like medicine, nursing, psychiatry and also the social work. The goal was to step toward making sure each patient gets the best services available. Thereafter, the workshop highlighted how adopting and implementing evidence-based practices within a real healthcare organisation setting has been facing several obstacles.

The presentation provided a general overview of EBP and discussed the basic characteristics of EBP, implementation measures and existing challenges in disseminating as well as implementing EBPs in hospitals. The main purpose of this topic discussed was to showcase history and developments of evidence-based practice in healthcare services. Firstly, the workshop attempted to recognize effective measures for successful implementation of EBPs across hospitals and to describe application of EBP criteria for quality patient care services. Lastly, the workshop also highlighted the challenges of disseminating and implementing EBP and the roles of leadership in successful implementation of EBPs.

Doc Speak

Painkillers not Helpful

in Long Run

Dr J.B.S Jaggi, Senior Consultant and Unit Head (Orthopaedics) at Fortis Hospital, Gurgaon, in conversation with ENN shares his views on technological trends and role of IT in orthopaedics What type of patients do you come across every day?

Nowadays people come with chronic back aches, shoulder and diffused pains; recurring on frequent basis.

Then middle-aged patient with chronic aches where a lot is related to high stress levels, lack of vitamin and lack of exercises that causes orthopaedic problems. Two age groups, 25-40 year and 60+, suffer from slip disc and spinal problems. Basically, these are mainly two types of age group of patients I come across. These must be addressed carefully as painkillers won’t be helpful in the long run. In addition, the older adults complaint more about wear and tear while for youngsters its back aches due to erratic lifestyle.

How has IT been extremely helpful?

Definitely, due to advent of IT, my practice is hugely dependent on Internet and computers. Paper work is largely reduced now and most things are carried online. This ultimately saves time, money, and efforts. Today people use social media, online portals, and also read a lot on web, iPad, and kindle. Also, IT has helped in maintaining records and journals for longer period, so storage is an advantage. New products are coming up every day, but there is cost attached with advanced medical equipment,

up towards treatment and not for preventive measures. That is because in prevention measures, there is absolutely no money.

What risks are involved in orthopaedic surgery?

surgeries and treatments. The innovative cycle of robotic and navigational technology related to orthopaedics are developing, but gradually. Joint and knee replacement surgeries are done through computer and image system that reduces time.

Risk of surgery does change, like if it is a hip and knee replacement and the person is diabetic or has high blood pressure then instantly the risk of surgery changes. Also, if anaesthesia is given then the surgery becomes of high importance. Actually, painkillers do not work for longer time. There are huge disparities between implants and stateof-the-start implants.

There is no major or minor risk, but yes risk of surgery increase because implants are both high in cost and state-of-the-art implants.

What are the current challenges faced in orthopaedics?

What would you suggest to people who can’t afford high health costs?

Biggest challenges in India are misconceptions, superstitions, wide disparity between hospitals and qualityof-care. In addition, lack of public awareness, negligible access to health facilities and also basic knowledge about orthopaedics pose a big obstacle in eradicating orthopaedic problems. Patient education must be well implemented as it is done in the west.

And lack of trust on doctors too is another major issue. We are only geared

I have developed a personal pain clinic, where physiotherapists and counsellors are available. If they think counselling is more important then they are most welcome to use the services. We should be honest enough to test an individual’s need and not waste money in treatment. Their issue may or may not require medicines and since painkillers do not work for long, the focus must be to eradicate the problem from its root.

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Advertorial

First in the Country to Perform

Day Care Angioplasty Short hospital stay, less medication and lesser costs are the future says Dr. Tapan Ghose, Director & HOD, Cardiology, Paras Hospital, Gurgoan Recently, you hit the headlines for performing a successful day care angioplasty surgery. Please tell us something about it.

Yes, indeed, Paras Hospitals has become the first hospital to successfully perform a day care angioplasty.

Angiography is performed in many centres as a day care procedure (including ours). However, angioplasty has not yet been performed in our country as a day care procedure.

Recently, I had a patient from Balia, Uttar Pradesh, Mr VK, who suffered from chest pain/angina even while walking for some distance. Angiography was performed earlier on the patient and it showed 80-85% blockage and hence he was advised angioplasty. The patient wanted short hospital stay, best treatment /therapy at the lowest cost. I offered him transradial day care angioplasty with deployment of bio-resorbable vascular scaffold (vanishing stent or biological stent), transradial (through the wrist artery) angioplasty using BVS as a day care procedure. Short hospital stay translated into lesser cost. We admitted the patient in the morning and discharged him in the evening the same day after successful angioplasty through the wrist artery using BVS. He has been doing quite well ever since. It was quite a challenge to provide the patient the treatment plan that he had requested for and desired. The entire

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cardiology team accepted the gauntlet and came up with a novel way to achieve our goal. We certainly wish

that our efforts are accepted on a wider platform and soon people start opting for the same.

What preparations were made for the surgery?

We had to move with utmost caution.

We understand after all that it is human life that we are dealing with. All the blood investigations were carried out as a day care procedure beforehand. He was put on dual anti-platelet therapy (double blood thinner). He was admitted in the day and the angioplasty was performed through the wrist as a standard procedure. The arterial sheath was removed in the cath lab and he was observed in the hospital for 5 hours and discharged in the evening. We maintained a close telephonic contact with him till the next morning visit and thereafter. Our cath lab and ER was activated for any emergencies. Our cardiac surgery team was also alerted beforehand.

Luckily everything was fine and none of the services were required.

We were confident about our skill and the cumulative team work. The vision was clear and we all were certain about the objective and goal that we had to achieve.

What new developments have taken place in cardiology department at Paras?

Since Nov 2013 many new and positive initiatives have been pursued.

We started transradial angioplasty programme including transradial primary angioplasty programme at Paras which offers 24X7 365 angioplasty facility through the wrist artery. We also started doing device closure of the congenital heart defects (ASD and VSD closure). Gradually our department shifted to trans-radial route in 90% of cases.

Our management was kind enough to re designate the cardiology department as ‘Paras Transradial Cardiology Centre’. We also did the first transradial day care angioplasty in India, recently.

More than 10 research papers have been presented at various international and national meetings from our department in the last few months. We have all understood that positive change can

only take place if there is cumulative initiative. Paras Hospitals, Gurgaon has an excellent cardiology team with a keen insight in patient care delivery, diagnosis and treatment.

How is “day care radial angioplasty” unique in India?

Day care angioplasty had been in practice in Europe for almost 10 years.

Ironically, United States and India have lagged behind. This applies to even transradial procedures. Starting transradial procedures in 2006 I initiated transradial primary angioplasty centres in Delhi NCR region. With this experience and with a very good clinical infrastructure at Paras Hospital, I thought the time has come to move forward. Fortunately there was a patient asking for the same treatment modality. This led us to successfully perform the first day care angioplasty in India. I am not aware of any centre offering routine day care angioplasty in this part of the country. I sincerely hope that India is soon recognized as a country that advocates transradial angiography and angioplasty. I also wish that in the medical colleges training and development is given on the same.

Short hospital stay, less medication and lesser costs are the future- after all medicine is all about evolution!

What are the hindrances for transradial angioplasty in India?

I think this transradial angioplasty / angiography depends on 3 aspects training, skill and the will.

Training - Transradial procedures are only taught in small single centre meetings and as a part of national meetings. There should be structured

Day care angioplasty had been in practice in Europe for almost 10 years. Ironically, United States and India have lagged behind

training programs in trans-radial procedures in all the university hospitals.

National Board of Examinations and other bodies should formulate a structured training programme in transradial procedures and ensure the quality and outcome.

Skill- It has a steep learning curve.

Supervised training by mentors is essential to mastering the skill.

Will- The ease of operating through the femoral route is not there in radial route. The radiation exposure to the operator is higher at least at the initial part of training hence a strong willed person, well conversant in femoral route, can embrace the radial route very easily.

Please recount some of your past success stories.

I reported reciprocal ST segment changes in the ECG in acute pancreatitis simulating acute myocardial infarction, first time in the world literature. I have also presented the utility of atorvastatin in Indian patients in 2000 for the first time. I also recently reported in a multi centre study about the innominate tortuosity (Tapan Sign) encountered during transradial and transulnar procedures. This has been presented in many national and international meetings. A new technique “Wire first technique “during right internal mammary graft angioplasty has been described by me at an international meeting in Singapore in 2013. I have initiated transradial angioplasty program including transradial primary angioplasty program at two prominent corporate hospitals in the country, including Paras Hospitals. I also have the credit of doing first prospective study of direct culprit lesions angioplasty to LAD artery without prior knowledge of RCA anatomy. This has been recently presented at TCT 2014 held at Washington DC. Last month we performed the first day care angioplasty of the country and started the day care angioplasty programme at Paras Hospital.

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advertorial

Future of Paints Royale Aspira is the international gold standard in paints. Technologically, amongst one of the most advanced paints in the world, it is the perfect choice for your hospital infrastructure.

T

he paint is the first interface for any infrastructure to protect it from damage and deterioration over time. Often we tend to overlook the many benefits that might, along with the usage of a high quality paint, provide cover for our hospitals and healthcare infrastructure. There are many innovations and infusion of smart technology that are going behind the product designing of paints and interior emulsions.

Unmatched Protection The major challenge for any infrastructure is that of water and humidity. The new range of paints under Royale Aspira has an unsurpassed water beading technology. When water comes in contact, it does not wet, penetrate, trickle, or spot. Instead, its hydrophobic nature forces water to roll down as little beads, just as a lotus leaf would do.

That translates into an easy to clean, smooth and highly durable painted surface. This is very beneficial for hospitals that need to maintain a dry, humid-free environment to avoid decay or support pathogens in the premises.

Another apt feature for the hospitals is that of an anti-bacterial, anti-fungal formula retards microbial growth, thus creating a more hygienic and healthier living environment. It is certified by PRA Coatings Technology Centre, UK. The added feature of exceptional crack bridging property is a complement to the anti-fungal property as the elastic film stretches to almost 400 percent, covering up

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the hairline cracks and ensuring that they are not visible. The paint also promises superior stain resistance. A Teflon surface protector on your hospital fortifies your walls against tough stains, increases your durability and

The paint also promises superior stain resistance. A Teflon surface protector on your hospital fortifies your walls against tough stains, increases your durability and reenforces the strength of the paint film.

re-enforces the strength of the paint film. It creates non-porous, high density surface that is almost stain phobic, which essentially means stains are prevented from penetrating to provide easy cleanup and maintenance.

Fire is a major risk to any hospital infrastructure. Royale Aspira has an enhanced fire safety and security properties. It has the distinction of the slowest flame spread rate in its category. This product conforms to international Volatile Organic Compounds (VOCs) specifications and contains no hazardous raw materials like lead, heavy metals, Alkylphenol Ethoxylates (APEO) and toxic materials as per the guidelines laid out by the International GS -11 (Green Seal) standard.

Global Benchmark Royale Aspira from Asian Paints is the international gold standard in paints. Technologically, amongst one of the most advanced paints in the world; it is certified by global benchmarking institutions. When applied on walls, it imparts a soft sheen finish. It is the first product in India to offer a 5 year performance warranty for interiors. The warranty covers film integrity, protection against flaking or peeling, shade fading & fungus attack. . It represents a new wave in the world of architecture and design. The exclusive colour palette and colour tool introduces you to unlimited possibilities. Its world-class performance stems from its perfect balance of revolutionary properties.

exclusive interview

Hospitals are Last

Hope

The investors are showing interest in the healthcare delivery system like hospitals, clinics and diagnostic chains, says Vikas Vij, MD, The Ideas Exchange Tell us more about the recent trends in hospital infrastructure segment The healthcare sector in India is considered one of the largest sectors in terms of both revenue and workforce employment. A large and growing population, a booming economy, rapid urbanisation which has expanded the middle class, rising diseases and increased awareness level has enabled the sector to grow at much higher rates than the global average.

Changes in the lifestyle of the population are further resulting in a dual disease burden. This emanates from the complexity of communicable and non-communicable diseases in the rural and urban regions of the country.

Occurrence of these disease patterns has impacted the healthcare infrastructure requirements and has resulted in infrastructural challenges for the government and private players.

Latest trends in hospital infrastructure have helped the healthcare industry grow at this rapid rate. The Clinical Decision Support System (CDSS), Computerised Physician Order Entry (CPOE), e-Learning, advanced virtual training is also available today to make processes easier.

Please share insights about the investment in hospitals in India.

What are the growth drivers?

The Indian healthcare sector has always been one of the preferred investment destinations but primarily across the pharmaceutical and medical equipment segments. Of late, investors are showing interest in the healthcare

among Indian healthcare providers to drive revenue growth, and with the new government putting infrastructure and development at the heart of its offering the healthcare sector in particular is expected to grow rapidly over the next decade and beyond.

Please share some highlights of the HIM - Conference and Expo.

What is your vision for HIM 2014?

delivery system like hospitals, clinics and diagnostic chains. To tap the vast potential of the sector, continuous capital inflow is required and India’s health start-ups may not be able to tap the market completely without some kind of capital infusion. Hence, the role of investors in the form of angels, venture capitalists (VCs), private equity (PE) players is crucial. PE funding is expected to play a crucial role in the expansion of the healthcare industry.

The hospital sector, especially the super-specialty services, will continue to be the main area of interest to private equity investors.

Infrastructure improvement, capacity addition and development of manpower are critical for the Indian healthcare sector. The growing demand for quality care and increasing ability to pay, rapid growth of India as a destination for medical tourism, increasing penetration of medical insurance, increased technological use and innovative business models are trends

Key highlights for HIM 2014 include an exciting line up of seminars addressing latest techniques and innovations from around the region and world which will translate into the development of better healthcare facilities for the India market.

In addition to the seminar series we are also excited to have leading Indian and global brands displaying innovative solutions for the hospital build segment, new flooring solutions to improve the clinical management side for hospitals and clinics and many other solution that can ultimately result in a safer hospital environment benefiting those running hospitals as well as the end user. And ultimately the key highlight is the opportunity for thousands of buyers and key decision makers from across the region to interact and understand new developments from the hospital build and construction point of view, ensuring India gets the opportunity to further build world class hospital infrastructure meeting the critical healthcare needs of Indian citizens. At HIM our vision is to become the leading industry platform serving the needs of India’s healthcare development needs over the coming years.

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PRODUCT SHOWCASE

Polaris 100 and Polaris 200 now mobile and height adjustable

OR Light on Wheels

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ith the Polaris 100 and Polaris 200 mobile, OR teams have for the first time mobile OR lights, which can be adjusted in height depending on the situation in the OR and the size of the surgeon.

The mobile Polaris 100 and Polaris 200 lights can be used in addition to ceiling-mounted OR lights when the surgeon needs an additional light source for more complicated surgeries. In the case of several adjacent treatment areas, for example in emergency rooms, the physician can move the Polaris 100 or Polaris 200 between the treatment areas and use it on site as a single light for minor surgeries. The all new Polaris 100/200 surgical illumination systems provide cool light with natural colors and rich-contrast for thousands of hours of carefree operation without straining on your hospital’s budget.

Each of the four clearly marked control buttons performs a single function, and an optional, wall-mounted control panel is also available. The smooth, seamless casing makes cleaning quick and simple, while its lightweight construction ensures practically effortless positioning.

The straightforward design philosophy of the Polaris 100/200 makes installation and maintenance very easy.

The light heads are controlled by the proven Powerline Communication (PLC) system.

Easy to transport In its transport position, the light has a height of approximately 6 feet (1.85m) so that clinical staff can easily push it through standard doors. In its operating position, the physician has a working height of up to 6 feet 7 inch (2.17m) under the light body at the operation site or in the treatment room. The mobile Polaris 200 has an illumination intensity

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of 160,000 lux. The built-in battery allows for mains-independent operation for at least three hours with full light intensity. A visual and acoustic warning informs the OR team when the battery charge falls below 25 percent. With the Polaris light your hospital is equipped with state of the art, high performance LED technology combined with a functional, high quality design. The product is approved as both a surgical light and a treatment light and is available with a choice of light intensity and colour temperature. Height adjustment supported by pneumatic springs allows for effortless adaptation to transport and operating conditions.

Applications

The mobile Polaris light can be used as an additional single light in the OR – for example, for cardiovascular interventions where the patient has to undergo several procedures at the same time. Of course the high-quality mobile light can also be used in the ER or in treatment rooms. The mobile Polaris 100/200 is especially useful when it is not possible to install a fixed, ceiling-mounted light due to unsuitable infrastructure. The trolley features a fully closed cover; which ensures the light is easy to clean. The rear double castors are equipped with locking brakes. It offers everything you need for reliable OR illumination and can also be used for minor procedure and dedicated endoscopy rooms, providing quality illumination that‘s within your budget. The cardanic and suspension systems for both the Polaris 100/200 light-heads were designed for maximum mobility and let you combine both light heads of your choice.

For more information: Contact us on 022 4084 3838 or email us at info.MT.india@draeger.com or log on to www.draeger.co.in

news

Maquet Adds Feather to Cap Maquet Medical India Pvt Ltd wins coveted award of ‘Operating Room Solutions Company of the Year’ for 2014 at Frost & Sullivan’s 6th Annual India Healthcare Excellence Awards.

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rost & Sullivan’s Operating Room Solutions Company of the Year award acknowledges the best practices adopted by Maquet Medical India Pvt Ltd, in the Indian operating room solutions industry.

The thought process and the vision of Maquet Medical India Pvt. Ltd., has showcased an uncompromising focus on quality, customer satisfaction, and innovation, coupled with recruitment of medical professionals for best clinical support in its entire bouquet of operating room solutions (which includes operating tables, lights, pendants, anesthesia systems, and operating room integration solutions).

Further, with a strategic intent to offer high quality services in India, Maquet Medical India Pvt. Ltd., has started offering consultation to hospitals ranging from design to installation for its comprehensive range of operating room solutions, thus making the company a very trusted and dependable partner of choice for its customers.

Speaking about this award, Bhavesh Y Bhatt, General Manager - Maquet Medical India Pvt. Ltd., said “We would like to thank Frost & Sullivan for this award. We started our journey in India 10 years back as an equipment selling company and gradually moved to the therapeutic selling model recruiting Clinical Specialist, Respiratory Therapists, and a Perfusionist. The healthcare market in India is definitely a challenging one and like all challenges, it has made us stretch ourselves to higher levels of delivery. We would like to thank our sales, clinical marketing, service team for their support, and last

but not the least, the healthcare fraternity in India, for its appreciation, support, and patronage.”

Jayant Singh, Director, Healthcare and Life Sciences Practice, Frost & Sullivan, said, “It is recognition for the tireless efforts of Maquet Medical team which has helped them in establishing the company as a one stop solution for operating room needs of a hospital, best in class products, along with an equally good sales and service support system which makes the company stand apart from its peer group.”

The Frost & Sullivan India Healthcare Excellence Awards are presented to companies that demonstrate best practices in the Indian healthcare and life sciences industry. Other crucial factors used to evaluate the nominees included leadership qualities, strategy, growth, service, innovation, integration, marketing, and financial performance.

About Maquet The name Maquet has been synonymous with innovation, quality, and

trust since its founding in 1838. The company is also a leading provider of medical systems that meet the highest requirements for medically challenging interventions. At the same time, these systems exceed the expectations of the hospital teams that are responsible for the care of patients.

Maquet designs, develops, and sells innovative treatment solutions and infrastructure functions for extremely demanding hospital departments, including operating rooms, hybrid operating rooms, catheter laboratories, and intensive care units as well as intra- and inter-hospital patient transportation.

The company’s unique history of surgical innovations has direct links with the rapid development in medical research and surgery. Since its foundation, clinics all over the world trusted in Maquet products and later in its solutions. By the end of the 19th century, Maquet had been honored with 36 international awards for its outstanding achievements. Rapid developments followed in the areas of surgical infrastructure and solutions for ventilation, cardiovascular surgery or anesthesia. During the next decades, the product range was expanded and the company developed a global presence of about 50 sales companies and a network of over 230 retailers, service organizations, and partners. In 1999, the company established its first surgical academy, one out of seven worldwide today. These unique international training and development centers also serve as conference locations for industry, medicine, and research.

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news

Postmenopausal women more prone to Osteoporosis

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ostmenopausal women who suffer from Hypoestrogenism, lower than the standard level of primary sex hormone for women, can be gravely affected by Osteoporosis. “In future, postmenopausal women may suffer from Osteoporosis and bone mineral density also decreases significantly when they achieve Menopause because of the lack of oestrogen,” said Mary Ann Lumsden, Head of Reproductive and Maternal Medicine, University of Glasgow. Although fracture is rare under 60, low bone mineral density is a significant risk factor in later life when combined with problems with balance and increased likelihood of falling about, Lumsden said at the Indian Obstetrics and Gynaecology Dr. Stya Paul Awards 2014, held recently.

According to Lumsden, both Hormone Replacement Therapy (HRT) and the combined oral contraceptive pill were useful in treating the long

term problems of menopause as they maintain bone density and decrease risk of fracture. She also said meno-

pause was not always a natural, straight forward experience for women and almost 25 percent would have severe symptoms that cause them to seek help from doctors.

Doctors though know about the problems and issues, but they are not comfortable in discussing the problem actually, she added.

The symptoms are of two types including short term and in the women are hot flushes, insomnia, headaches, moodswings, irritability,” said Lumsden. Hormone Therapy could be thus considered as the best way long term.

Known for her guidelines issued to her patients and others, Lumsden advised women to take all sorts of important steps to cope with the menopausal problems among women and also and treat them with utmost care and efforts.

Mind your headache

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f there were an underdog in the directory of medical symptoms, it would be the headache. “Headaches are often ignored by patients who prefer to self-medicate.

They’d rather pop a pill than investigate the cause,” explains physiotherapist Dr Anjana Laungani at her Bandra clinic Physio Rehab.

This may provide temporary relief without solving the cause of the pain. A headache, says Laungani, could be a red flag for a more serious condition. While the pain manifests in the head or upper neck, the cause could be located in a completely different

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part of the body.

“Headaches are a general symptom. There are lifethreatening headaches and red flag ones. These could be caused by a tumour or bleeding in the brain,” she warns.

Either way, ignoring the pain

in your noggin, isn’t advisable.

Here’s a guide to the types of headaches that warrant a visit to the doctor.

Cervicogenic headaches: This kind of headache is characterised by pain emerging from the back of the neck, in the junction between the skull and the upper neck. These headaches are named after the cervical spine or C2 junction from where they originate. “The pain is common since it is triggered by poor posture. “ You are likely to suffer from this if you have a tendency to slouch or hunch for prolonged periods of time since it can jam your C2 junction,” says Laungani.

product launch

Philips Pain Relief Product Note

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hilips has introduced its latest range of products in the Pain Relief category under the consumer lifestyle division. This new category is in line with Philips India’s focus on health and well-being and its emphasis to promote healthy and active lifestyle. With this introduction, Philips would like to promote innovative solutions that meet the needs of consumers.

Designed for in-home usage, these devices are based on infrared technology, which is more effective and safer

InfraCare HP3643

InfraCare HP3621

than other pain relief solutions such as painkillers, balms, and sprays. Infrared rays have been proven to effectively relieve aches and pains in the muscles and stiff joints. The comfortable warmth created by infrared light penetrates deep to stimulate blood circulation and warm muscles. As muscles are soothed, they automatically loosen up and relax. Because it makes the tissue more pliable, the warmth generated also reduces stiffness and makes joints more flexible

Features: 650 Watt infrared halogen lamp The Philips InfraCare HP 3643 has been optimised for effective relief of pains in areas covering 60 x 40 cm, such as the entire back, both shoulders and neck or thigh. The InfraCare features innovative infrared halogen lamp technology. The special optics, filter and the powerful halogen lamp of 650 Watt have been optimised, enabling half-body treatment (60 x 40 cm), and much more comfortable warmth, as the infrared warmth is more equally divided over the treatment area.

Adjustable angle with rotation The InfraCare HP 3643 is easy to use for half-body treatment and for different situations (e.g. lying

Features: 200 Watt infrared halogen lamp The Philips InfraCare HP 3621 has been optimised for effective relief of pain in areas covering 20 x 30 cm, for example shoulder, elbow, calf or neck. The InfraCare features innovative infrared halogen lamp

halogen lamp of 200 Watt have been optimised to provide a clear focused treatment as the infrared warmth is more equally divided over the treatment area.

Adjustable angle The infrared lamp can easily be positioned up to 40 degrees backwards.

Other Highlights:

technology. The special optics, filter and the powerful

Robust handle, Easy to carry around, 2 meter cable.

on a bed or sofa) due to its maximum flexibility. In addition to the height adjustment, the lamp house can easily be positioned for optimum treatment of the right body part by moving it into a horizontal or vertical position (left/right 90 degrees) and by tilting it up or down (45 degrees).

Digital timer with automatic shut-off Treatment time can easily be controlled by setting the advised or preferred number of minutes. The digital timer automatically counts down and automatically shuts off at the end of the session.

Other Highlights: Improved even field distribution; No hot spots; 3 meter cable; 2 robust handles; and easy to adjust position.

InfraPhil HP3616 Features: 150 Watt infrared lamp with extra focus The Philips Infrared lamp has been optimised for pain relief in areas covering 20 x 30 cm for example shoulder, elbow, calf or neck. The concentric rings help to focus the beams on a specific area.

On/off switch

lamp, so the appliance does not have to be unplugged after each treatment.

Cord storage The infrared lamp has a cord storage holder at the back of the appliance.

Simply wrap the cord around it and it

Easy on/off switch at the back of the infrared

can easily be stored again.

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product launch

An Application for Neonatal ICU An innovative NICU platform that eases Total Parental Nutrition (TPN) calculation and help improve premature neonates for faster recovery.

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osh Software, a Pune-based software development company focused on developing web based applications based on Ruby on Rails framework, recently developed an application for Neonatal ICUs (NICU) in India called as Kimaya TPN solution. This NICU application has proven to be a boon for neonates who are born prematurely or weak.

Neonatal deaths accounts for 41 percent of global deaths among children below five years of age. Around 28 precent of the global neonatal deaths are attributed to India, and according to the National Family Health Survey, these deaths have increased by 52 percent in the last decade. The primary causes of these deaths are premature birth, low birth weight, infections, and birth asphyxia.

During a premature birth, the neonate’s body lacks the necessary growth nutrients to facilitate healthy in addition to dextrose by easy and quick calculation growth. Depending on the weight of the premature baby, using our platform. Today just by using our platform a specific amount and concentration of key nutrients are the doctors at KEM alone is giving better nutrition to given through intravenous therapy to facilitate healthy neonates at NICU and that has decreased the mortality growth. Currently in India, the calculations for the rate by 45 percent. The survival rate has gone up to 90 correct concentration of nutrients are done manually, percent�, says Gautam, CEO, Josh Software. and then given to the dietician to mix the right dosage The Kimaya platform is easy to use and only requires for the intravenous therapy. This process does present the doctor to input certain basic details. The application a margin of error, and neonatal deaths can occur due to will then prescribe TPN information as per the guidelines miscalculations in the concentration. The manual process programmed into the application. The solution has of nutrient concentration calculations is tedious process in-built restrictions which prevent the doctor from any and can take 40-45 minutes for each neonate. errors in input data through field restrictions. Kimaya Identifying an opportunity to develop an efficient and will give a precise and accurate nutritional concentration high performance solution in this space, Josh Software to be given to the baby. This process takes not more than developed a solution to reduce few minutes and due to its programmed the time consumed and creating nature, restricts error in nutritional 45 minutes of an error-free process. The online concentrations. The pilot version of the doctors time solution called Kimaya is a one-screen software was used in a few hospitals across Pune, including KEM, which application for aggressive nutrition down to seconds houses one of the biggest NICUs in the for rapid growth and development.

Error free and country. At KEM, the solution was able The breakthrough solution allows guarantee to to contribute in reducing the neonatal NICUs to calculate the exact amount effective nutrition mortality rate by close to 45 percent due and concentration of nutrients to for neonates to its high performance and efficiency. be administered to the baby based After seeing the results, the hospital on certain basic inputs such as Increased provided its technical expertise and body weight and special nutritional survival rate by inputs to work with Josh Software team requirements. “Neonates can get 90 percent towards the final software version nutritional supplements via TPN

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March 2015 New Delhi

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Digital India vision of Prime Minister Narendra Modi aims at building Safe and Secure Cyber-space, which augurs well for the security market in India. No wonder that research firm Gartner sees the domestic security market going beyond $1bn by 2015.

With a view to better understand and assess the challenges and opportunities in the sector, Elets Technomedia is coming up with 6th Annual eGov SecureIT 2015.

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Key Attendees • Ministry of Home Affairs, Government of India • Department of Electronics and Information Technology (DeitY) • Central Bureau of Investigation (CBI) • Central Reserve Police Force (CRPF) Academy • Various states’ police establishments • National Crime Records Bureau (NCRBs) • State Crime Record Bureau (SCRBs) • National Informatics Centre (NIC) • Paramilitary Forces • Security Experts For Enquiry Contact: Souvik Goswami, souvik@elets.co.in, +91 - 8800 745252