The Rising State: December 2011

asiaâ&#x20AC;&#x2122;s first monthly magazine on The Enterprise of Healthcare

volume 6 / issue 12 / December 2011 / ` 75 / US $10 / ISSN 0973-8959

www.ehealthonline.org

The Rising

State With the surge of new initiatives GUJARAT is writing a new chapter in healthcare

Narendra Modi Chief Minister Government of GujaraT

14-16 December, 2011 | Mahatma Mandir, Gandhinagar, Gujarat

volume

issue

SSN 0973-8959

contents COVER STORY Setting the Stage for Health Renaissance

With the surge of new ideas, approaches and institutions in Gujarat, the state has become one of the most favoured medical destinations in the recent times.

cm message Narendra Modi Chief Minister, Gujarat,

By Dhirendra Pratap Singh

in person Anju Sharma Mission Director - NRHM, Gujarat

Gujarat Hospitals-Savouring the Taste of IT

lab focus

By Sibu George

Hospital Administration Stands on IT

Dr Kirti M Patel, Dean, Gujarat Cancer Society and Medical College (GCSMC) december / 2011 www.ehealthonline.org

GoG is Heading Towards Managing Health PK Taneja, Commissioner of Health, Medical Services & Medical Education, Public Health & Family Welfare, Government of Gujarat

Dr Vikram Shah, Founder, Chairman and Managing Director, Shalby Hospitals

We Look at Technology as Enabler, Not as Cost Centre

expert corner

leaders speak Dr MM Prabhakar, Medical Superintendent, Ahmedabad Civil Hospital

The Indian Diagnostic Industry Needs Regulation Ameera Shah, Managing Director and CEO, Metropolis Healthcare Limited

By Shally Makin

ICT for Affordable Healthcare

Thinking the IT Way Dr Ajay Angirish, COO, Apollo Hospitals, Ahmedabad

The Miracle Called 108

Pioneering Operating Room Technology

Centralised IT Architecture is Essential Dr Rajiv Sharma, CEO, Sterling Hospitals, Ahmedabad

tech trends

report

Telemedicine Congress 2011

zoom in

Next Gen Mobile Technology will Enhance Role of Telemedicine Vino Ramayah, Chairman, Medtech Global

Schiller - The Art Of Diagnostics

CARDIOVIT AT-301 Buy a single channel ECG machine and convert it to a 12 channel ECG machine with A4 size printouts.

For enquiries contact: sales@schillerindia.com Website: www.schillerindia.com Toll-Free: 1800 2098998 Indian Corporate Office: Schiller India, Advance House, 2nd Floor, Makwana Road, Off Andheri Kurla Road, Andheri (East), Mumbai 400 059. Tel: 022-61523333/29209141 Fax: 022-29209142 Email: sales@schillerindia.com, support@schillerindia.com Factory: No. 17, Balaji Nagar, Puducherry - 605 010 Swiss H.Q.: Schiller AG, Altgasse 68, P.O. Box 1052, CH-6341 Baar, Switzerland Regional/Branch Offices: Ahmedabad: 079-30612966/09327031678 E-mail: sales.west@schillerindia.com Bengaluru: 080-26564045/ 09342247250/09379036923 E-mail: sales.south2@schillerindia.com Bhopal: 0755-4274421/09303124973 E-mail: sales.central@schillerindia.com Chennai: 044-28232648/09383620520 E-mail: sales.south1@schillerindia.com Hyderabad: 040-32952969/ 09379036923 E-mail:

sales.south2@schillerindia.com

Katmandu:

00977-9841490096

E-mail:

sales.nepal@schillerindia.com

Kochi:

0484-2203264/09383620520

E-mail:

sales.south1@schillerindia.com

Kolkata: 033-23593102/09874766668 E-mail: sales.east@schillerindia.com Lucknow: 0522-4076659/09312432205 E-mail: sales.north@schillerindia.com Mumbai: 022-61523333/09821233314 E-mail:

sales.west@schillerindia.com

New

Delhi:

011-32600582/09312432205

E-mail:

sales.north@schillerindia.com

Puducherry:

09383620520

E-mail:

sales.south1@schillerindia.com

Pune: 020-24210657/09371020520 E-mail: sales.west@schillerindia.com Patna: 0612 2570745/09334833045 E-mail: sales.east@schillerindia.com

All registered trademarks acknowledged.

volume

issue

The Enterprise of Healthcare

President Dr. M P Narayanan

Editor-in-Chief Dr. Ravi Gupta

gm Finance Ajit Kumar

dgm strategy Raghav Mittal

programme Dr. Rajeshree Dutta Kumar specialist product manager Divya Chawla partnerships & Sheena Joseph Alliances Shuchi Smita, Ankita Verma Editorial Rachita Jha, Dhirendra Pratap Singh, Sonam Gulati, Pragya Gupta, Shally Makin (editorial@elets.in) Sales & Jyoti Lekhi, Fahimul Marketing Haque, Shankar Adaviyar, Rakesh Ranjan Mobile: +91-8860651635 (sales@elets.in) Subscription & Gunjan Singh Circulation Mobile: +91-8860635832 subscription@elets.in Graphic Design Bishwajeet Kumar Singh, Om Prakash Thakur, Shyam Kishore Web Development Zia Salahuddin, Anil Kumar IT infrastructure Mukesh Sharma, Zuber Ahmed

Events Vicky Kalra

inbox eHealth magazine is helping a lot in creating awareness among stake holders and health care providers about the importance of technology & IT in improving the Quality in Health Care and error-free environment. It will help to develop medical care in African Countries. All the Best! By Dr M Veera Prasad, on “eHealth Africa Survey” Oracle is strong in database and as you rightly mentioned oracle is largely support to HIS and ISV solutions, beside this does oracle has complete HIS solution, because very few players are in this segment and if oracle has such solution then care provider will get strong solution which take of end to end information of patient, which helps lot in implementing many applications those helps to patient and care provider. By Dipak Jajal on “IT is a Necessary Management Tool for Hospitals”

human resource Sushma Juyal

legal R P Verma

Accounts Anubhav Rana, Subhash Chandra Dimri Editorial Correspondence eHEALTH, G-4 Sector 39, NOIDA 201301, India, Tel: +91-120-2502180-85, fax: +91-120-2500060, email: info@ehealthonline.org ehealth does not neccesarily subscribe to the views expressed in this publication. All views expressed in the magazine are those of the contributors. The magazine is not responsible or accountable for any loss incurred, directly or indirectly as a result of the information provided. ehealth is published by Elets Technomedia Pvt. Ltd in technical collaboration with Centre for Science, Development and Media Studies (CSDMS) Owner, Publisher, Printer - Ravi Gupta, Printed at Vinayak Print Media, D-320, Sector-10, Noida, UP, INDIA and published from 710 Vasto Mahagun Manor, F-30, Sector - 50, Noida, UP, Editor: Dr. Ravi Gupta © All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic and mechanical, including photocopy, or any information storage or retrieval system, without publisher’s permission.

december / 2011 www.ehealthonline.org

Thank you for the information. This will really helpful for me. By Narendra Rao on “Implementing an Electronic Medical Record” It’s true that clinical data are very much unstructured and dispersed. It needs to integrate these data into a common platform. This repository will help in analysis of health issues of an individual as well as global context. This book is very much

relevant in this aspect and will provide the fundamentals and the methods to the readers related to biomedical data integration, storage and analysis. By Dr Pradeep Kumar Naik on “Biomedical Informatics” It’s true that governments have difficulty providing good healthcare to their citizens, often because of a lack of funds. But there are solutions. Governments can turn to public-private partnerships to tap into private sector expertise and funding to improve their healthcare systems. There are many examples, including one in Andhra Pradesh, in a recent publication on healthcare PPPs put out by IFC (a member of the World Bank Group). By David Lawrence on “Developing nations neglecting healthcare sector, researchers say” I just came to your post and reading above thing it is very impressive me and it is very nice blog. Thanks a lot for sharing this. By Rakesh Vardhan on “Cancer detection and cervical cancer treatment using Mobile Tele-medicine Unit” When it comes to the proper medical care, always invest in a good doctor. You can never put your health at risk. By Ms. Brianca on “Rationalising Medical Care”

Latest News, Articles, Interviews and Case Studies at @ www.ehealthonline.org

editorial

The Rising State The healthcare landscape in Gujarat is changing rapidly. The state has become one of the most favoured medical destinations in the recent times. Gujarat is evolving in terms of a number of hospitals, healthcare centers, number of beds and is expected to continue a positive trend in future. Doctor to patient ratio is 1:10 and nurse to patient ratio is 1:5. Healthcare systems are usually large, complex and slow-legged to respond to a change. But the surge of new ideas, approaches and institutions in Gujarat is melting away the age-old barriers to change. The state of Gujarat is writing a new chapter in healthcare. The Government is taking several initiatives to make Gujarat a global healthcare destination. Gujarat is the first state which has accredited PHCs in tribal areas by NABH, blood banks, food and drug laboratory and of course the hospitals to involve quality consciousness into the system. The most talked about programme initiated by Gujarat in the year 2006 is the Chiranjeevi Yojna which is a unique PPP initiative to partner with private sector facilities for BPL and tribal mothers. The medical tourism in Gujarat is flourishing with more and more technology-driven treatments being available in the state. The state Government believes that Gujarat will be known in the world for its medical tourism by 2025. Based on the experience of Gujarat state, other state governments can explore healthcare innovations to provide comprehensive healthcare services for the larger population in India. The magazine features eminent leaders from health department of Gujarat, hospitals, diagnostic labs and many more who talk about their current projects and plans to deliver better patient care. eHealth proudly announces the Indiaâ&#x20AC;&#x2122;s largest ICT event on enterprise of healthcare in the city of Gujarat. The December issue of eHealth showcases a glimpse of the technological advancements and initiatives being undertaken by the host state. Health being one of the most significant parameters of human development requires utmost emphasis in terms of systems strengthening, enablement and efficiency gains through innovative solutions available through healthcare technologies and hence forms a key track under eHealth India 2011. eHealth India 2011 Awards, a key component of the eHealth India, have been instituted with the primary aim of felicitating and acknowledging unique and innovative initiatives in healthcare. In this edition, eHealth has captured the leading award nominations. These are innovative programmes and projects in India and worldwide that are changing healthcare scenario around us.

Dr. Ravi Gupta ravi.gupta@elets.in

December october / 2011 www.ehealthonline.org

Power

Packed magazineS

ASIA’S FIRST MONTHLY MAGAZINE ON e-GOVERNANCE

Asia’s First Monthly Magazine on ICT in Education

The Enterprise of Healthcare

now

Subscription Order Card Duration (Year)

Issues Subscription USD

Newsstand Subscription Savings Price INR Price INR

1 12 100 900 2 24 150 1800 3 36 250 2700

900 -1500 `300 2000 `700

*Please make cheque/dd in favour of Elets Technomedia Pvt. Ltd., payable at New Delhi

I would like to subscribe: egov

digitalLEARNING

eHEALTH

Please fill this form in Capital Letters First Name..................................................................................... Last Name...................................................................................................... Designation/Profession .................................................................. Organisation ................................................................................................. Mailing address .................................................................................................................................................................................................... City ............................................................................................... Postal code .................................................................................................... State ............................................................................................. Country ......................................................................................................... Telephone...................................................................................... Fax ................................................................................................................ Email ............................................................................................ Website ......................................................................................................... I/We would like to subscribe for

Years

I am enclosing a cheque/DD No. ................................................ Drawn on ..................................................................................... (Specify Bank) Dated ............................................................................................................... in favour of Elets Technomedia Pvt. Ltd., payable at New Delhi. For `/US $ ...................................................................................................................................................................................................... only Subscription Terms & Conditions: Payments for mailed subscriptions are only accepted via cheque or demand draft • Cash payments may be made in person • Please add `50 for outstation cheque • Allow four weeks for processing of your subscription • International subscription is inclusive of postal charges.

you can subscribe online also

www.egovonline.net | www.digitallearning.in | www.ehealthonline.org | www.elets.in

“Gujarat, with its all inclusive, sustainable and rapid growth, is emerging as a globally preferred place to live in and to do business.” Over the years, the Gujarat has emerged as one of the most dynamic, prosperous, investor friendly and fastest growing states of India. The importance of well thought governance initiatives with significant use of technology in this success cannot be overemphasized. Good Governance is the key to sustainable development. The state has been constantly innovating, aiming at excellence in governance. The opportune understanding of the importance of technology in effective and efficient delivery of services has enabled the state to take up many innovative steps for empowering people. While the State’s emphasis has been on building educational infrastructure, training of teachers and computerization of schools, we have successfully been able to come up with 11 new universities, 400 colleges, 1.25lakh new teachers, 38000 new schoolrooms and to double the seats for technical courses. The State has witnessed a massive reduction in the dropout rate at all primary levels. Improvement in the health and nutritional status of the population has been one of the major thrust areas of the social development programmes in the state. Over the years, Gujarat has developed good health infrastructure and human resources. The state has initiated a wide variety of Public – Private collaborations, involving NGOs/Private Sector practitioners. Gujarat is now emerging as a global medical tourism destination. It gives us immense pleasure to share with you that Department of Science and Technology, Government of Gujarat and Elets Technomedia Pvt Ltd are jointly organizing eINDIA 2011, an annual ICT conference and exhibition at Mahatma Mandir International Convention Centre, Gujarat from December 15 – 17, 2011 as one of the prelude/precursors and warm up exercises to Vibrant Gujarat 2013. The vision roadmap that we have carved for the state will certainly get reflected in various thematic conferences under the umbrella of eINDIA 2011. We warmly welcome all delegates and look forward to participating in what promises to be an immensely enriching event.

(Narendra Modi)

cover story

Setting

the Stage for Health

Renaissance With the surge of new ideas, approaches and institutions in Gujarat, the state has become one of the most favoured medical destinations in the recent times. Dhirendra Pratap Singh analyses on public health services in Gujarat Narendra Modi, Chief Minister of Gujarat, usually inspires the youth by saying, â&#x20AC;&#x153;In life, donâ&#x20AC;&#x2122;t try to be something. Instead of that, try to do something. Even if you fail, do not get disheartened, there is no shame in failure. Commit yourself with full of your strength. Do not bother that someone accompanies you or not. Have faith in your inner capabilities. Have courage to go alone, march towards your goal.â&#x20AC;?

december / 2011 www.ehealthonline.org

Offering a combination of good governance, speedy implementation, brisk decision making, abundant and undisputed resources, Modi has successfully positioned Gujarat as a healthcare destination. The healthcare landscape in Gujarat is changing rapidly. Actually, healthcare systems are usually large, complex and slow to respond to change. But the surge of new ideas, approaches and institutions in Gujarat is melting

cover story

tive trend in future. Doctor to patient ratio is 1:10 and nurse to patient ratio is 1:5. By the use of latest technical equipment, efficient health insurance, major corporate investments and the services of highly skilled medical personnel, the Gujarat healthcare sector has set itself on a boom. Healthcare sector in the state has potential to grow at a much faster rate in the foreseeable future and shall be numero uno in providing healthcare facilities.

Big bet on PPP

Keshav Desiraju Additional Secretary, Ministry of Health & Family Welfare, Government of India

The state government is aiming high on the public private partnership (PPP) model for the healthcare sector in coming years as technology-driven medical services are expected to bring a makeover to the state’s image by making it a hub for medical tourism. Some experts believe that there is a need for a PPP model in the medical infrastructure and treatment delivery system in India. The government sits on one of the largest infrastructures and partners with private players which may bring in better staffing and managerial expertise. The compulsions of technology-driven treatments would make the public sector to look at private sector for capital and technology, while the private sector would look up to public sector for patient pool, thereby making the PPP model imminent for the effective medical infrastructure. Various hospitals in private sector are engaged with Gujarat

away the age-old barriers to change. The state of Gujarat is writing a new chapter in healthcare. Says Ravi Saxena, Additional Chief Secretary, (DST), Gujarat, “Increasing access to technology is one thing, but the objective is to reach the last person in the queue, and to deliver the benefits that he or she is entitled to. This is the pillar of policy that we implemented in Gujarat.” The available medical infrastructure and easily accessible healthcare facilities have improved the health of the population of the state remarkably over the years. The State Government is taking several initiatives to make Gujarat a global healthcare destination. Gujarat is evolving in terms of number of hospitals, healthcare centres, beds and is expected to continue a posi-

Government in PPP model. Wockhardt Hospitals Group (WHG) along with the Government of Gujarat will conduct and manage the 275-bed Palanpur Civil General Hospital. Civil Hospital, Ahmedabad is getting aid from the Central Government under Pradhanmantri Swasthya Sudhar Yojana’. Started in 2005-06, the hospital has till date received ` 100 crore from the centre. Under this scheme, a hospital is identified from each state and is given aid by the Central Government to develop one AIIMS-like institution. The hospital has also received aid of `20 crore from the Government of Gujarat to develop it as Asia’s largest medicity. Narayana Hruduyalaya, Fortis Healthcare, and Artemis Group of Hospitals are planning to set up medical colleges in the State.

“The dilemma in India is there are huge differences in public and private healthcare, there is need to ponder on how to bridge the gap. Robust IT healthcare system with well motivated health professionals will pave the way for betterment”

december / 2011 www.ehealthonline.org

cover story

“Increasing access to technology is one thing, but the objective is to reach the last person in the queue, and to deliver the benefits that he or she is entitled to. This is the pillar of policy that we implemented in Gujarat” Ravi Saxena Additional Chief Secretary, (DST), Gujarat

Says Anju Sharma, “Gujarat is the first state which has accredited PHCs in tribal areas by NABH, blood banks, food and drug laboratory and of course the hospitals to involve quality consciousness into the system. The most talked about programme initiated by Gujarat in the year 2006 is the Chiranjeevi Yojna which is a unique PPP initiative to partner with private sector facilities for BPL and tribal mothers. There is an evident reduction in number of maternal deaths and we could infer to have saved approximately 893 mothers.” Talking further she says, “The Bal Sakha scheme provides expert care to newborns up to one month by private pediatricians / trust hospitals free of cost. The emergency ambulance 108 was initiated in the year 2007, which answers 99 percent calls and so far has attended total emergencies to be around 15, 51,718.” It is estimated that in the state of Gujarat about 1.2 million children are born each year and 4600 of these mothers do not survive at the time of delivery because of several reasons. The maternal mortality rate for the state is 389 per 100,000 live births. Primary reason for these maternal deaths is that majority of the deliveries are domiciliary and are conducted by untrained persons in unhygienic conditions. It is argued that most of these maternal deaths are avoidable if adequate interventions are undertaken. Among the groups, below poverty line (BPL) families are the most vulnerable since they face significant risk owing to their poor socio-economic status and limited access to healthcare services.

Institutional Deliveries

Says Anju Sharma, Mission Director, NRHM on Government Initiatives in healthcare, “Gujarat has been an enthusiastic state to bring quality healthcare to the citizens with a long range of programmes such as Chiranjeevi and Balsakha Yojana (PPP), 108 Emergency Transport and e-Mamta Mother & Child tracking (IT application). We have district quality accreditation boards Quality Assurance Group (QAG), Quality Improvement Programme (QIP), NABH.” Sarva Swastha Abhiyan (SSA, an NGO dedicated to taking quality healthcare to inaccessible areas) has opened 10 centres in five predominantly tribal areas of Idar, Prantij, Bardoli, Hansot and Mundra that will be connected through telemedicine to the super speciality hospitals at Ahmedabad, Nadiad, Vadodara and Surat.

december / 2011 www.ehealthonline.org

Chiranjeevi Yojana is working towards long life of mothers and babies in Gujarat. Implemented by the Government of Gujarat, this scheme aims at encouraging the BPL families to improve access to institutional delivery. This is done by providing financial protection to these families and covering their out-of-pocket costs incurred on travel to reach the healthcare facility. The scheme also provides for financial support to the accompanying person for loss of wages. This scheme empowers the poor to seek skilled care and emergency obstetric care. The scheme uses several mechanisms to target the BPL family. Among them, the main mechanism being used is the BPL card. When the scheme was initiated, the pilot districts were selected based on remoteness and included regions facing highest infant mortality and maternal mortality. The private medical practitioners (mainly gynaecologists) in these regions were empanelled in the scheme to provide maternity health services. These providers have reimbursed a fixed rate for deliveries carried out by them. Five CHCs (Malav, Shamlaji, Rajsitapur, Mota Phospholiya, Golagandi) and PHC (Chansad) are being run by

cover story

“Gujarat has been an enthusiastic state to bring quality healthcare to the citizens with a long range of programmes” Anju Sharma Mission Director, NRHM, Gujarat community based organisations under this scheme. Under the scheme, the health department has empanelled and contracted private practicing gynaecologists who had their own small hospitals in rural areas using a few selection criteria. Centre for Health, Education, Training and Nutrition Awareness (CHETNA) has been actively supporting a total of 14 mother NGO’s working effectively to implement Reproductive and Child Program (RCH).

ICT in Healthcare Says Keshav Desiraju, Additional Secretary, Ministry of Health & Family Welfare, Government of India, “Still a lot needs to be done in health sector of India, especially adapting IT in healthcare is a huge job. Vast network of public health exists and we need to think how we can improve it using IT. IT can help tackle issues of high rate of infant and maternal mortality.” When a parent in Gujarat doesn’t remember to vaccinate an infant, Gujarat government’s e-Mamta scheme will know, and ensure it gets done in time. It is the kind of ‘motherly’ system that will remind a child’s needs — even if the mother forgets. This project, which even the Union government is now considering to replicate in various states of the country, tracks and monitors the health of pregnant women and children up to six years. Everything about a child, from his very conception to education, is tracked and monitored under this system. Also, for parents giving out their cellphone numbers, vaccination alerts would be received via SMS on specific dates. The programme has improved reporting of maternal deaths from 589 to 702 over previous year and reporting of infant deaths from 4732 to 7263 over previous year. Illustrating role of innovation in healthcare Anju Sharma says, “In healthcare delivery, innovation is important because there are challenges in healthcare delivery of access, availabil-

december / 2011 www.ehealthonline.org

ity, affordability and quality. e-Mamta mother and child tracking web based application is a credible tracking system that would enable health workers to reach above mentioned goals.” The department of Health and Family Welfare, Govt. of Gujarat has conceptualised Hospital Management and Information System (HMIS) in Gujarat to ensure the quality health using Information and Communication Technology (ICT) as the tool to provide standard clinical and diagnostic tools, hospital management tools and integration of management information at the state level to ensure online review and monitoring. The aim is management of vital patient records, analysis of the critical health related data so as to provide an updated planning and policy tool towards provision of quality health services. The programme assists the doctors and medical staff to improve health services with readily reference patient data, work flow enabled less-paper process and parameterised alarms and triggers during patient treatment cycle. Says Keshav Desiraju, “Problem exists with health human resources in India that needs attention. The dilemma in India is there are huge differences in public and private healthcare, there is need to ponder on how to bridge the gap. Robust IT healthcare system with well motivated health professionals will pave the way for betterment.” Gujarat has turned around its status in emergency medical services which was in a neglected state a decade back by bringing qualitative and grass-rooted changes in it. Gujarat Government with the Emergency Medical Research Institute (EMRI) takes care of road and fire accident victims on a 24hour basis through the year by just dialing 108. The statewide 108 emergency medical response network is providing free-of-cost, selfless and reliable emergency services. Gujarat Government had allotted GVK EMRI a plot near Kathawada to establish a high-tech emergency and research management centre in the state. The emergency ambulance 108 was initiated in the year 2007, which answers 99 percent calls and so far has attended total emergencies to be around 15, 51,718.

Integrated Insurance Scheme This community based health insurance scheme is run by NGO-Self-Employed Women Association (SEWA), based in Ahmedabad, Gujarat. One of its primary activities is providing financial services for women. The scheme initially targeted

cover story

just women in the informal sector but now includes men too. Members must be between 18 and 60 years old and a member of the SEWA union. They are asked to pay 85 per annum. In addition, women members can become lifetime members by paying a fixed deposit of ` 1,000 and the interest on this is used to pay the annual premium. The deposit is returned to her when she turns 60. The scheme covers: (i) Inpatient care (ii) Hospitalisation cover, plus one-time payment for denture and hearing aid. Members can use any kind of hospital, public, private or trust. (iii) Delivery benefits for fixed deposits members. The scheme is managed by SEWA which purchases medical insurance from a government insurance company subsidiary National Insurance Company (NIC) and ICICI Lombard. Reimbursement takes place on average just over three months after discharge from hospital depending on when the claim is made. In the current year 2011-12, the Rastriya Swasthya Bima Yojana (RSBY) policy in 26 districts of Gujarat is being renewed and in addition to the eligible rural BPL families, the scheme is being extended to all the eligible 9.5 lakh urban BPL families of the state as well. More than 3.0 lakh BPL families have been enrolled till date.

â&#x20AC;&#x153;New techniques are workable to address health challenges in our country, and I believe that each state government will notice a lot of potential in the ICT tools, in the years to comeâ&#x20AC;? Dr Neeta Shah Director (e-Governance), Gujarat Informatics Ltd december / 2011 www.ehealthonline.org

cover story

Upcoming Trends: Medical Tourism Gujarat’s medical expertise and the strength of its facilities are better than those of some of the South – East Asian Nations and Gujarat hospitals are trying to do a lot more hard selling abroad. The state offers tremendous potential to develop medical tourism particularly in its major cities like Ahmedabad, Baroda, Surat and Rajkot. Healthcare is available at very competitive charges so Gujarat has become a lucrative destination for people wanting to undergo the best treatment at cost-effective rates. “The medical tourism in Gujarat will flourish with more and more technology-driven treatments being available in the state. This is the state which will be known in the world for its medical tourism by 2025. Gujarat has a potential to attract at least one million medical tourists every year. For this, joint participation of private sector and public sector is crucial,” said Sri Jay Narayan Vyas at a conference on Public Private Partnership Policy Framework in Ahmedabad. According to State Ministry for Health and Tourism, Gujarat, last year 4.50 lakh tourists visited the state for obtaining medical care. The Gujarat community comprises of 32 percent of the total 20.1 million people of Indian origin worldwide. According to a study by Confederation of Indian Industry (CII), India has a competitive edge especially its cost advantage. The Cost of Medical treatment in India is less than 1/3rd of that in many European and US Hospitals. Gujarat doctors are attaining international conferences to understand latest treatment and hospital set up as international standards to give patient best quality treatment. Each Corporate hospital in Gujarat receives about 60-70 international patients per month (during October to March). Key Drivers of medical tourism in Gujarat are: highest number of airports in India, excellent rail-road connectivity in Gujarat; state-of-art multispecialty hospital and cost benefits.

december / 2011 www.ehealthonline.org

Commercial surrogacy or what has been called “wombs for rent’’ is growing in India. While no reliable numbers track such pregnancies nationwide, doctors work with surrogates in virtually every major city. The women are impregnated invitro with the egg and sperm of couples unable to conceive on their own. Anand (a district in Gujarat) is renowned globally as a pioneer in offering paid surrogacy through the in-vitro fertilisation technique. Commercial surrogacy has been legal in India since 2002, as it is in many other countries, including the United States. But India is the leader in making it a viable industry rather than a rare fertility treatment. Experts say it could take off for the same reasons outsourcing in other industries has been successful: a wide labor pool working for relatively low rates.

Research In order to initiate clinicians in the concept of scientific evidence-based medicine and to address burning medical and epidemiological questions, many hospitals in Gujarat are engaged into clinical research. VEEDA CR, India’s fastest growing Clinical Research Organisation (CRO), has opened its new clinical pharmacology Unit (CPU) at Muljibhai Patel Urological Hospital (MPUH), Nadiad, Gujarat. Pulse Women’s Hospital Pvt. Ltd is engaged into infertility, foetal medicine, embryology; Krishna Heart Institute is engaged into stem cell therapy, cardial drugs; Apollo-Radiation therapy into cancer care; Rajasthan Hospital-Plastic and Burns, Hematology, Otolaryngology, Anaesthesiology; Sterling Addlife India LtdNephrology, Oncology, Respiratory System, Cardiology and IKDRC is engaged into clinical research activities related to Nephrology. Muljibhai Patel Urological Hospital will become the only hospital in Gujarat and second after AIIMS in the country to start nephro–urological surgeries using robotic technology. Says Dr Neeta Shah, Director (e-Governance), Gujarat Informatics Ltd, “New techniques are workable to address health challenges in our country, and I believe that each state government will notice a lot of potential in the ICT tools, in the years to come.” Based on the experience of Gujarat state, other states where private providers are available and where government services are non-functional or of poor quality, the state governments can explore the options of PPP and healthcare innovations to provide comprehensive healthcare services for the larger population in India.

P U NGEB I H th F COMI 9 DEL W E N

Following the success of 2011, eHEALTH once again presents Healthcare Leaders’ Forum Series 2012

IN FOUR DIFFERENT CITIES delhi | mumbai

• Create a vibrant platform for senior industry leaders to share business experiences • Provide opportunity of mutual learning among industry players • Showcase existing success stories and best practices in healthcare industry • Germinate new business ideas and winning strategies rends and analysis

• Current market opportunities of healthcare industry • Investment trends in healthcare sector • Policy initiatives and economic factors for success • Medical Devices and Technology • Emerging business models in healthcare • Human resource and workforce development • Future trends and analysis

hyderabad | bangalore

• Government visionaries, Health secretaries • CXOs of healthcare organisations • Senior administrators, HODs and business managers of hospitals • Investors from private equity and venture capital firms • Vendors and suppliers of hospital materials, technologies, equipments and devices • Healthcare consultants and experts

For updates visit healthcareleaders.eletsonline.com

In Person

â&#x20AC;&#x153;ICT

has Played a

Seminal Role

in Health Sectorâ&#x20AC;?

Through effective implementation of health related services, Gujarat is writing a new chapter in healthcare. Anju Sharma, Mission Director (NRHM), Gujarat, in this freewheeling interview with Dhirendra Pratap Singh, shares her perspectives on various healthcare issues in Gujarat What is your assessment of the health sector in Gujarat today? Gujarat has been an enthusiastic in bringing quality healthcare to its people. The state has programmes such as Chiranjeevi & Balsakha Yojana (PPP), 108 EmergencyTransport and e-Mamta Mother & Child tracking (IT application). We have district quality accreditation boards- Quality Assurance Group (QAG), Quality Improvement Programme (QIP), NABH. Gujarat is also the first state with accredited PHCs in tribal areas . The most talked about programme initiated by Gujarat in the year 2006 is the Chiranjeevi Yojna, a unique PPP initiative that serves BPL and tribal mothers. There is an evident reduction in number of maternal deaths. We have saved approximately 893 mothers. The Bal Sakha scheme has private pediatricians or trust hospitals providing free of cost expert care to newborns for up to one month. The emergency ambulance 108, initiated in the year 2007, answers 99 percent calls and so far has attended more than 15, 51,718 emergencies.

december / 2011 www.ehealthonline.org

How effective do you think the state government has been in improving healthcare? With the goal of improving the Human Development Index, the Government of Gujarat has celebrated the last year as its Golden year. The Millennium Development Goals 4 and 5 of reducing maternal and child mortality are the Swarnim Gujarat goals. There is massive effort being made to reduce infant mortality and immunize children against measles. The reduction in maternal mortality can be achieved through institutionalisation of deliveries. The focus of the Health and Family Welfare Department is to bring down the infant mortality and maternal mortality rates as envisioned by the National Rural Health Mission (NRHM). How do you propose to bring down the MMR, IMR and Total Fertility Rate (TFR) in Gujarat? What is the role of ICT in improving healthcare scenario in Gujarat? Innovation in healthcare delivery is important because there are challenges related to de-

In Person

Anju Sharma Mission Director - National Rural Health Mission, Gujarat

december / 2011 www.ehealthonline.org

In Person

In Integrated Disease Surveillance Project (IDSP), we are using ICT for disease surveillance and forecasting epidemics. Gujarat is front runner in implementation of IDSP. State has successfully developed web based weekly surveillance system capable of forecasting an epidemic. Analysis of weekly surveillance data on regular basis, and providing feedback to reporting units has lead to containment of diseases ultimately reducing mortality and morbidity. In eMamta, we are tracking each mother and children through ICT. What kind of reengineering is needed for the effective implementation of ICT in healthcare? Please elaborate challenges in deploying new technology in health sector? Like any other sector, we require data integration in health sector. We need to integrate the data where we can get one point information. Reaching out is main challenge in deploying new technology in health sector. We have to reach out to the grassroots level to cater to the ultimate beneficiary at their door step. Another, big issue is data quality. If the data quality is not there, then you are not able to achieve the results that reflect reality. Third is data convergence, bringing the entire data under one umbrella is also a challenge.

Reaching out is main challenge in deploying new technology in health sector. We have to reach out to the grassroots level to cater to the ultimate beneficiary at their door step. Another, big issue is data quality. If the data quality is not there, then you are not able to achieve the results that reflect reality. livery, affordability and quality of services. e-Mamta, mother and child tracking web based application, is uniquely designed management tool, which aims at registering individual pregnant mothers, as well as children in the age group of 0-6. The idea is to ensure complete service delivery of antenatal care (ANC), child birth, post natal care (PNC), immunisation, nutrition and adolescent services. It also provides a management tool to the service providers at the grassroots level to determine the potential recipients of the services along with their details, through comprehensive work plans. Finally, the services are aggregated to generate reports that are reliable and valid. The approach is therefore to plan, deliver and monitor, in a proactive rather than reactive way.

december / 2011 www.ehealthonline.org

What steps should be taken to ensure healthcare for all? As for as IT roadmap is concerned, we have to see it in terms of various levels of service delivery. The issues and challenges at primary, secondary and tertiary care level are different. There is a need to handle these challenges effectively in coming period to mitigate and to deliver adequate health response. At primary level, the issues are in terms of public health delivery and basic maternal and child health (MCH) services. At secondary and tertiary level, of the issues relate to maintaining patient information for better patient management How much do you think mHealth will contribute to healthcare in the coming years? What is the current status for mHealth in Gujarat? There are unlimited opportunities for using mobile phones in implementing mHealth in hospitals, insurance and pharma companies. With increasing urban and rural tele-density, we in India, should certainly be poised, to incorporate mHealth into the very fabric of our healthcare delivery system. The opportunity for mHealth has been stimulated by a number of factors, which include technological innovation relating to systems integration, improvements in wireless networks, mobile handset innovations, and the continued growth of mobile phone subscribers. In eMamta we are using sms alerts. Socially optimal demand level in healthcare can be reached through mHealth. In health sector, a lot of patient councilling is required and mobile technology is very helpful in that. The adoption of mHealth globally has initially been based around healthcare information and alerting using SMS as a medium, this is a proven model in India, however with the emergence of smart phones this traditional model is going through some rapid change.

tech trends

The

Miracle Called

The unique, innovative, pro-poor partnership has changed the face of healthcare in Gujarat By Jashvant Prajapati

108

The 108 Emergency Management Services run by GVK EMRI and Government of Gujarat is a typical example of a PPP (Public Private Partnership) project that has won the reputation for being exceedingly prompt in their response. The service caters to Police, Fire and Medical emergencies, 24X7, all across Gujarat. GVK EMRI has signed MoUs with 12 states and 2 Union Territories for providing the 108 service. Today, the 108 service comprises of a fleet of 3000 ambulances, which are based across the country. The efficiency of the organisation comes from cutting edge technology and dedicated professionals. The launch of 108 Services in Gujarat on 29th August 2007 heralded a new era of emergency medical care in the state. The service has revolutionised the way by which healthcare is rushed to people who are facing an emergency. GVK EMRI has attended to more than 26 lakh emergencies till date and saved 1, 28,479 lives. More than five hundred

december / 2011 www.ehealthonline.org

Life saved in a critical emergency every 14 minutes

Ambulance dispatched every 42 seconds

Baby born in 108 Ambulance every hour

108

is the “Life Saviour” of Gujarat!!

108-Ambulances have covered more than 6.10 crore population in all the districts. Everyday, 108 responds to over 2500 emergencies and saves (on an average) around 100 lives. 99 percent of the calls received at the toll free number –‘108’ are attended to within three seconds, which is at par with the best global standards.

LED & Halogen

Indian & Imported Range

MAGNALED SLEEK

MAGNALED SERIES

Neurosurgery Cardio-thoracic Laparoscopy Orthopaedics Urology

Bariatrics General Surgery Gynaecology ERCP / Fluoro/Angiography ENT / Plastic Surgery Pediatrics

MAGNALED TRU

MAGNAPAX SERIES

Laparostar for Laparoscopy

Mobile with battery backup

Special Combo Offer

Mobile spot lights

R #97, SVC Industrial Estate, Balanagar, Hyderabad - 500 037, A. P. India, Tel. 040- 65501094, 040-66668036; Fax 040-66668037

e-mail: sales@magnatekenterprises.com; magnatek@gmail.com, www.magnatekenterprises.com

tech trends

Milestones Efficient Response – Entire State Covered way before the target!

Covered Population of 6.10 crore in 26 districts - scattered over 267 talukas, covering more than 18000 villages, providing free service, 24X7

Life Saviour – Catastrophes well managed!

22 108-Ambulances saved 62 lives during serial Bomb Blasts on 26th July 2008 in Ahmedabad Four of its employees sustained severe injuries while attending to these emergencies 15 108-Ambulances along with 65 paramedic provided relief during Bihar Floods in August 2008 Pioneered Inter Facility Transport via 6 Advance Life Saving Ambulances and shifted more than 200 victims of Hooch Tragedy, when adulterated liquor horrified the victims and their innocent families in July 2009 Prompt and dedicated services provided relief to citizens of Gujarat whose lives were threatened by Hepatitis B and H1N1 viruses in August 2009 Hon’ble Chief Minister, Mr. Narendra Modi dedicated state-of-the-art Emergency Response Centre at Kathwada to people of Gujarat on 1st July 2010

Gandhian Innovation

Amazed by the efficiency, scale and precision of this service, Dr. C K Prahlad called this project as Gandhian Innovation in Harvard Business Review in its May 10 edition.

India’s First State owned Emergency Response Centre

Hon’ble Chief Minister, Mr. Narendra Modi dedicated state-of-the-art Emergency Response Centre at Kathwada to people of Gujarat on 1st July 2010

Expansion of Services

50 new ambulances flagged off by Hon’ble Chief Minister on 1st July 2010, raising the strength of fleet to 506

Awards and Recognition

Piramal Foundation and IIMA awarded this project with Piramal Prize for democratizing health care in India in December ‘10.

Everyone is pleased with the prompt response. In particular, the villagers in remote locations consider it to be a blessing that a well-equipped ambulance becomes available so quickly at their doorstep! The Paramedic (EMT) provides affectionate pre-hospitalisation care, while safely taking them to the nearest health facility. This miraculous three-digit number has brought confidence, hope and smiles in lives of millions of people of Gujarat. The passion, integrity, empathy, motivation and professionalism of the 108 Team is a significant differentiator of this service. Headquartered at its state-of-the-art Emergency Management Centre in Kathwada, Ahmedabad, a passionate team of 2600 people and a fleet of 506 high-tech Ambulances respond to more than 70,000 Emergencies in a month. The service has directly contributed in reduction of MMR

december / 2011 www.ehealthonline.org

and IMR in Gujarat. The number of institutional deliveries in Gujarat has increased tremendously over last 3 years, as 35 percent of the total emergencies handled by 108 comprise of pregnancy-related cases. The Emergency Management Centre at Kathwada has become a centre of attraction for people from all walks of life. Students, corporates, academicians, healthcare specialist and members of panchayats and municipalities visit the centre to observe and witness the success story of this miraculous three digit number 1-0-8. “To have served 26 lakh people of Gujarat, who were distressed by varied kinds of emergencies is a matter of immense pride for us. This trust reposed by people of Gujarat in 108 Services has humbled us and further inspires us to do better. We appreciate the PPP initiative of Government of Gujarat and their continuous support to this service. The shared vision is big and with the kind support of everyone, Team 108 is committed to save lives, 24X7 and establish many more landmarks.”

Author Jashvant Prajapati, Chief Operating Officer, GVK EMRI, Gujarat

leaders speak

“ICT for

Affordable Healthcare” Dr MM Prabhakar Medical Superintendent, Ahmedabad Civil Hospital

Using technology as a tool, Dr MM Prabhakar, Medical Superintendent, Ahmadabad Civil Hospital, realises the potential of Information Technology and shares his views on how to improve medical facilities

Ahmedabad Civil Hospital is India’s largest hospital which promises to deliver tertiary care service to the patient. It has the largest medical college- BJ Medical College where students are given medical education to become the future doctors and serve the nation. Our hospital provides all sorts of facilities including free service to the patients from accommodation to food and medicine to the patient. The Civil Hospital actively took part in implementing HMIS project in pilot phase and was later made part of the administration with the success of the project. ICT has changed treatment methods with the advent of telemedicine. Its use has helped people in remote areas or areas without adequate medical facilities to access quality healthcare. Doctors are very approachable with the technological advancements.

blood banks in India. Most of the blood banks are inter-connected through a network of computers and with special software to optimise the availability of blood, especially, of rare groups. Presently, we have 108 service, but that is for providing basic emergency healthcare in the golden hour only. 108 services are not equipped to provide intensive care. In order to meet this need, the government has launched 26 new state-of-theart ambulances - ICU on Wheels - to government hospitals. These ICUs on Wheels will provide Critical Care to those in need, while they are being taken to hospital. The vehicles have transport ventilator, a sophisticated multi-parameter monitor and defibrillator-cum-pacemaker. There is also adequate back-up supply of oxygen and power, which is important for safe transport of patients.

ICT Initiatives The much applauded eMamta programme is a good example to speak about the successful IT implementation initiatives. Also, use of technology helps in better diagnosis and treatment. While it may raise the costs in private sector, in government hospitals, the focus is always on providing affordable healthcare. We had started a project to get the Ahmedabad Civil Hospital accredited by the NABH. However, at present due to cost constraints this has been put on hold. This will be reconsidered and if possible, we will go for accreditation at a later time. We have all sorts of labs which are communicated with the system and at one point pathology, microbiology labs, administration, patient records all are connected by the same network to be accessed by the logged in users. We have an ideal blood bank in the industry which is one of the topmost

Infrastructure Development IT will further enhance the quality and responsiveness of healthcare in the state. We need to improve our healthcare infrastructure and bridge the gap in meeting our requirements and availability of doctors. In Gujarat, we hope that in five years there will be no shortage of doctors. Even in Ahmedabad Civil Hospital, we are undertaking an expansion in capacity so that we can train more doctors. Similar initiatives are being replicated across the state by using technology in effective ways to augment the existing infrastructure. The overall impact has been very beneficial to healthcare sector. In Gujarat, our aim is to make affordable and quality healthcare available to all citizens. For this, government is using technology as a partner.. december / 2011 www.ehealthonline.org

Lab Focus

â&#x20AC;&#x153;The Indian

Diagnostic Industry Needs Regulationâ&#x20AC;?

Ameera Shah, Managing Director and CEO of Metropolis Healthcare Limited is a successful young entrepreneur and highly admired in the diagnostic industry. She is the Co-chairman of FICCI Healthcare Committee. In conversation with Dhirendra Pratap Singh, she shares her perspectives on the clinical laboratory business in India and Metropolis stint in this very dynamic market

december / 2011 www.ehealthonline.org

Please provide a brief background of Metropolis and its reach in India? Metropolis is one of the leading corporate chains of diagnostic centres in India and has conceptualised on growing as an institution while standardising the norms in the growth trajectory. The company is present in every state of India either through its own branch laboratories, collection centers or its referral network. It is now also present in South Africa, Sri Lanka, Seychelles, UAE, Nepal, Bangladesh, Mauritius and Nigeria. Metropolis has 62 labs operational in India and 13 in overseas markets. Our innovations like Home Health Services enable us to reach you so that going for a checkup is no longer an inconvenience. What is your outlook on the diagnostic industry in India and particularly in Gujarat? What are the key opportunities and challenges? We have laid out an expansion plan of ` 15-20 crore for Gujarat. Recently, we have acquired a brownfield project in Mehsana in north Gujarat for an undisclosed amount. The strategy behind acquiring Mehsana laboratory was to establish a hub in that region to cater the surrounding areas of Northern parts of the state. We are looking to open 10 more laboratories in Gujarat over the next two years, besides the existing five labs in the state. The company has joined hands with 18 private hospitals across country to provide laboratory services. However, we are also looking to partner with government-run hospitals in Gujarat as well as

in Mumbai to provide lab facility on a publicprivate partnership model. Which are the major areas that Metropolis Healthcare is focusing on in the diagnostics segment? Our services include Clinical Laboratory Medicine, Radiology and Imaging Services, Hospital Laboratory Management, Central Laboratory Services for Clinical Trials, Site Management Services, Home Health Services, Preventive Health Checkups and Remote Pathology Testing Services. What is the level and nature of IT applications in your laboratories? How is it adding value to your business efficiency? ICT bridges the gaps by automating entire process of testing started from the on-line patient booking to the registration of the sample and then finally getting the report digitally signed in after the analysis of the sample. Had the entire process done manually, the possibilities of human error would have been higher in risk of errors. In Metropolis, we try and avoid as much as manual intervention in the testing process. In the future, ICT will play an important role in data mining of information in pathology and diagnostic industry which is already growing leaps and bounds. What is the share of organised and unorganised laboratories in the diagnostic sector? What is the market

Lab Focus

share that Metropolis Healthcare plans to garner in the coming years? Diagnostic laboratory industry, which is estimated to be about ` 10,000 crore in India is largely fragmented and unorganised. According to estimates, there are about 100,000 pathology laboratories in India of which hardly 200 should be accredited. But ten years from now we see this industry consolidating and health insurance industry would drive the growth. About 75 percent of our revenue comes from the Indian market while the remaining 25 percent revenue comes from the international market. What is the role of accreditation and regulations in the diagnostic sector in India? Please share your perspective on the role of information and communication technologies in these services. The Indian diagnostic industry needs regulation. There are no set criteria in terms of infrastructure, technology and qualification for setting up a diagnostic laboratory. The fact that anyone with money can open a diagnostic laboratory is dangerous. Diagnostics is an important part of healthcare and thus proper regulations needs to be in place, be it regulations for opening a laboratory or mandatory accreditations. ISO, NABL, CAP (College of American Pathologists) accreditation (Mumbai) reiterate that Metropolis meets stringent national and international quality requirements - imperative in a vital service sector like healthcare. What is the average technology spends in your company and which areas would you prioritise for future technology investments? Metropolis invests approx ` 5-10 crore on R&D, cutting edge equipment and introducing new tests. This financial year, Metropolis has firmed up plans to add 100 new tests to its existing range of 4,500 tests. These high-quality tests with accurate results would be at an affordable cost. What is the future growth model of the company? What are the new test facilities Metropolis Healthcare is bringing in? We are planning to invest ` 200-300mn for adding 15 new laboratories and another ` 50-100mn investment for new equipment. This investment will be funded by internal accruals. We are also planning an Initial Public Offering (IPO) over the next three years. We are currently in talks with a few hospitals for laboratory management. By the year 2020, the vision of the organisation is to have a multibillion dollar market capitalisation. In the current financial year, the company aims to open about 18 laboratories in India with a total investment outlay of about ` 60 crore. We plan to open at least 10 greenfield labs and eight acquisitions during this fiscal and reach a turnover of ` 330 crore this year. Over the next 3-4 years we should be able to reach a turnover of ` 600 â&#x20AC;&#x201C; 700 crore.

Ameera Shah Managing Director & CEO Metropolis Healthcare Limited

december / 2011 www.ehealthonline.org

expert corner

“GoG is Heading Towards Managing

Health”

PK Taneja, Commissioner of Health, Medical Services & Medical Education, Public Health & Family Welfare, Government of Gujarat, in conversation with eHealth, talks about how the strengthening of infrastructure through patient record system and IT based hospital services is leading to improvement in healthcare issues in Gujarat What is your assessment of the health sector in Gujarat today? The trend of using health indicators like CDR, MMR, IMR and TFR is on a declining phase and this indicates that there is overall improvement in the overall health status of the state. The MMR is reduced from 202 as per SRS (1997-2003) to 148 as per SRS (2007-09). The IMR is reduced from 60 as per SRS 2001 to 48 as per SRS (2009). Crude Death Rate is indeed a good tool for measuring standard of healthcare of the State and lower CDR as compared to well performing states like Tamil Nadu and Karnataka shows that Gujarat has excellent healthcare facilities. The state government is fully sensitised and committed to bringing further improvement in these health indicators. Please share with us the Government’s role and initiatives in primary, secondary and tertiary care. What is GDP allocation for health in Gujarat? The state is providing primary, secondary and tertiary healthcare services through reasonably good infrastructure of SCs, PHCs, CHCs, DHs, medical colleges and super specialty institutions with optimal demographic spread all over the state. The health department is taking up many interventions and initiatives like Chiranjeevi Yojana and Bal Sakha Yojana through public-private participation model to address certain constraints in terms of availability of doctors, nurses and paramedics. Further, the gap analysis in terms of availability and shortage of necessary manpower has been done and the same is being addressed on priority basis. The state has added1105

december / 2011 www.ehealthonline.org

medical seats, 1210 nursing seats, 1095 physiotherapy seats and 800 dental seats in the last couple of years. 3 new medical colleges with 150 seats each have been set up during the current academic year. There are plans for setting up three more medical colleges having capacity of 150 seats under Gujarat Medical Education & Research Society (GMERS), an autonomous society set up for the purpose. The Total outlay for Health is increased from 1615.51 crores in the year 2008-09 to present outlay of ` 3347.62 crores, registering an increase of 100 percent in last four years. The GDP allocation for health in the State is 0.53 percent in the year 2009-10 and increased up to 0.72 percent in the year 2010-11 What is the government’s role in ensuring ‘Health for All’ in the state? The state is providing comprehensive maternal and child health services like ANC care, institutional delivery, PNC care and immunisation services with Mamta Abhiyan package and through private institutes’ involved in schemes like Chiranjeevi and Bal SakhaYojana. The Mamta Taruni Abhiyan for comprehensive healthcare services was started to take care of adolescent girls. The state has effectively controlled communicable diseases like HIV/AIDS, TB, Leprosy and Malaria with meticulous implementation of National Health programmes like RNTCP, NLEP, NVBCDP, GSACS and NBCP. The state’s success in controlling sickle cell anemia has been feted with the prestigious Prime Minister Excellence award for administration in Public Health Programme. Gujarat is associated with many high-end super-specialty institutes for heart, kidney and cancer treatment.

expert corner

Gujarat had remarkable success in Health IT initiatives in recent years. What are the key ICT-based programmes in the State? Hospital Management and Information System (HMIS) is a total hospital and patient care management solution to provide better care through patient record system and IT based hospital services. HMIS has reached out to 30 hospitals in Gujarat. Then there is E-Mamta, which has received the best jury award for care delivery through innovative use of technology and best public choice award for improving maternal health at e-world forum, e-Health world Awards 2011. BADEA System has been developed since 2005 to store and monitor statistical data of birth, death and stillbirth. Demographic analysis and various reports can be generated through this application. The state is deploying more than 100 mobile Health Units and Mobile Medical Units in remote and difficult areas .It is absolutely necessary to monitor and track these units through a tracking system, GPRS technology based tracking services are being outsourced for the purpose. The health department has a few projects lined up, such as 104 (Non-emergency Health Help Line). It will be set up for the people to get timely advice on health related issues available in three languages – Gujarati, Hindi and English. Another project will be set up soon to connect health through the application of Information and Communication Technologies i.e. the Telemedicine Project. The key goal of this project is to provide citizens living in distant places of Gujarat with access to high standard health care services. What is the secret behind their success? The state has its own strong State Wide Area Network (GSWAN) up to Taluka level and this has provided us with high quality connectivity. Government officials have been provided with government e-mail IDs for faster communication and knowledge sharing. Most of the state health facilities are equipped with required hardware and internet facility. Government has framed policies and has made mandatory for every employee to get certain level of IT knowledge for promotion. A separate entity namely Gujarat Informatics Ltd. (GIL) has been set up to support all Government departments for ICT initiatives. What are the initiatives being taken for making Gujarat a global Healthcare destination? The State has gone for NABH/NABL accreditation in a big way. Please share the status of the same with us. Government of Gujarat (GoG) has introduced Total Quality Management (TQM) System in its key medical institutions. The system covers the state’s Medical College Hospitals, Medical College Blood Banks, Medical College Laboratories, Dental Colleges, Mental Hospitals, Paraplegia Hospital, District Hospitals, Community Health Centres and Primary Health Centres as per the NABH and NABL standards. The Health Department has a mission which states “To enhance the patients quality of life by providing specialized medical treatment and preventive healthcare at free / affordable cost’.” We have around nearly 6 centres accredited by NABH/NABL. These include Dist. General Hospital Gandhinagar, Primary

“The state has increased 1105 medical seats, 1210 nursing seats, 1095 physiotherapy seats and 800 dental seats in the last couple of years. Three new medical colleges with 150 Seats each have been set up during the current academic year and there is a plan to set up three more medical colleges having capacity of 150 seats under GMERS, an autonomous society set up for the purpose” Health Centre Gadboriad, Dist: Vadodara, Medical College Hospital Labs Bhavnagar, Blood Bank (BJMC Ahmadabad), Food & Drug laboratory Vadodara, Mental Hospital Vadodara. India’s 2nd NABH / NABL Accredited Govt. Facilities are Primary Health Centre Mahuwas, Dist: Navsari, Govt. Medical College lab (BJMC Ahmadabad), Civil Hospital Sola, Ahmedabad (Progressive) and Blood Bank (Government Medical College Surat). There are many others PHCs in the state, which are NABH and NABL accredited. The facilities which complete final assessments as per NABH / NABL are District Hospital Junagadh, Rajpipla, Panchmahal,Medical College lab-Surat and mental hospital, Amdavad. Gujarat has received various accolades for their initiatives towards improving health facilities in the state. It was awarded to establish Quality Assurance framework in providing quality healthcare to the people of Gujarat in 5th National Quality Conclave, New Delhi. FICCI Health care Excellence Award to Dist Hospital Gandhinagar and PHC Gadboriad, Govt of Gujarat in FICCI Health 2010, New Delhi and FICCI Health care Excellence Award to Dist. Hospital Gandhinagar, Govt of Gujarat in FICCI Heal 2011, New Delhi. What are the Plans ahead? The state government is working towards improving the skewed child sex ratio by effective implementation of PC and PNDT Act including ICT based applications in the state and and substantial improvement in Immunization. The state government is fully determined to address the Malnutrition related issues and has decided to setup a state nutrition mission for convergence, integration, monitoring and evaluation of targeted interventions to bring about improvements in a time bound manner. The state has setup an autonomous society for Sickle Cell Anemia (SCA) related state interventions for full and faster coverage of tribal population in 12 tribal districts and plans are afoot for online tracking of such beneficiaries through ICT initiative. We expect a substantial increase in budgetary outlays in the happening health sector in the next plan period and integrate various initiatives taken under NRHM with state health systems to sustain it for all times to come. december / 2011 www.ehealthonline.org

tech trends techtrends

t a g r n i a r j u u o v G pitals-Sa Hos te of IT s a T the

er with m m i l g e to r chanc e h t o n sa ls jarat ha hospita u f G o f e o r u age tect T archi ising im r C I a l e o h p t ine The d redef n a e t a integr kin

lly Ma

a By Sh

december / 2011 www.ehealthonline.org

plans to e s o i d n its gra

tech trends

At some point of time, all of us encounter a case with doctor or a hospital with all hopes that we will not see them again. Weak infrastructure of some Indian hospitals and disorganised management keeps us busy while we try to quit and wish to stay in a diseased state rather than get it treated. To our surprise, Gujarat proves us wrong where most of the hospitals have now integrated various systems through IT and organised to serve patients. Ganapati Budaji Thakur, undergoing treatment at civil hospital in Sola, Gujarat misplaced his prescription he got from the doctor. Undergoing the whole process of meeting doctor just to ask for another prescription was a cumbersome job for Thakur to do. Since he did not have another option, he spoke about his dilemma with a hospital official. Fortunately, the prescription was entered into the hospital’s record and he received all the details again in a jiffy.

“ Gujarat is E-enabled state as its broadband network connects 14,000 villages, 24 hours electricity to more than 18000 villages and high quality tertiary care across the state.” Devendra Patel Director, Medisoft Telemedicine

Why Gujarat? The per capital income in Western India is highest in the country at US$ 850 (per person). It would be appropriate then to assume that this would have an impact on the level of automation of medical care in the region. Gujarat is one state where the various big hospitals are planning to expand in the state as it has a good infrastructure. Over half the hospitals surveyed (55 percent) belong to the Mission/Trust NGO category. Nearly 40 percent are privately owned and majority of them have less than 150 beds and only 17 percent are large, i.e., over 300 beds each. The hospitals survey said that the most important reason for automation is the need for better service quality. New hospital set up is now going for IT. There are more than 1000 hospitals in Gujarat having more than 50 beds, out of which, 300 are multispecialty hospital and around 70 hospitals have more than 100 beds. Most of the multispecialty hospitals have software facility. The demand is increasing and availability of IT manpower is also available. So, new hospitals are coming up and established hospitals are opening their branches in small cities which further create a viable market in Gujarat. Devendra Patel, Director, Medisoft Telemedicine, says, “Gujarat takes credit to be a pioneer in ehealth and Telemedicine system development and implementation, since year 1998-99. Now, Gujarat is E-enabled state as its broadband network connects 14,000 villages, 24 hours electricity to more than 18000 villages and high quality tertiary care across the state. All these make Gujarat an ideal destination for Information Communication and Technology (ICT) and Telemedicine implementation.”

ICT infrastructure Redefined Gandhinagar Civil hospital was the first to launch the Health Management Information System (HMIS). Today the patients in

Gujarat do not maintain their medical records in bulky files, but have it all recorded in the hospital’s system every time they visit the doctor. HMIS is to build trust and confidence for the general hospitals in the hearts of the citizen by providing efficient and quality health services through IT application. Conceptualised by the Department of Health and Family Welfare, the streamlined operations have improved patient care and effective administration and control. This ensured quality of health using ICT as a tool to provide standard clinical and diagnostic tools, hospital management tools and integration of management information at the state level so as to ensure online review and monitoring. The Civil hospital touched the standard levels of delivering effective treatments with trained managers with the deployment of such software into the administration. The pilot project of HMIS programme gave desired fruits and from Gandhinagar Civil hospital it spread to other hospitals in the state. The initiative was scaled up to cover all 25 districtlevel hospitals along with six other major hospitals in the state. HMIS proved so successful in Gandhinagar that the Gujarat government scaled up the initiative to cover all governmentdecember / 2011 www.ehealthonline.org

tech trends

Present Status of HMIS No. of Users 7000 + No. of Modules 30 Size of Database 4 - 6 GB at each hospital. 95 GB at central server No. of Non Teaching Hospitals covered 24 No. of Teaching Hospitals covered 6 No. of LIVE Hospitals 30 No. of registrations Overall Gujarat 11,705,736 Average No. of Transactions 90069494 Total Transactions till date 13,000 + No. of Users Trained Source: www.gujaratinformatics.com

“Leveraging government resources, GVK EMRI has woven together the latest telecommunication, computing, medical, and transportation technologies. Public Switching Telephone Network, Servers, Data networks, Computer Telephony Integration, Telephone ERS, GIS database, specialised applications, Voice loggers at GVK EMRI have created new capabilities in the field of Emergency Management” Jashvant Prajapati Chief Operating Officer, GVK Emergency Management and Research Institute run hospitals to connect with the State Health Commissionerate and the Secretariat in Gandhinagar. This not only makes for greater accountability and transparency, but also facilitates prompt and vital policy decisions to tone up the hospital administration and improve health services. The system is aimed at management of vital patient records, analysis of the critical health related data so as to provide an updated planning and policy tool towards provision of quality health services. ICT in hospitals has achieved a number of objectives from creating electronic medical records to manage time for effective delivery of services to reduce manual transmission of data. The technology enabled workflow management reduces human error and improve data integrity with an opportunity to analyse cost

december / 2011 www.ehealthonline.org

and compare data. This unique project costs around ` 250 million and aims to create a single network for most of the hospitals across the state. So far the project covers more than 9000 users across 30 hospitals with the effort developed by Tata Consultancy Services (TCS) on the Microsoft .NET technology platform. The hospital needs much less monitoring as the planning and control of medical data is integrated with the use of management tools, encourages eco friendly processes and parameterises alarms and triggers during patient treatment cycle. Shalby Hospitals is one of the most organised private hospitals as each and every process is managed with in-house software such as purchase process, MIS reports, MRD management and pharmacy management. Some of the most commonly used software are electronic health records, chronic disease management systems, computerised practitioner order entry, clinical decision support system, electronic transfer of prescription, electronic appointment booking, personal health record, telemedicine, RFID and bar-coding and business intelligence. Shalby Hospitals took few more steps towards adapting new technologies by recently acquiring plasma sterilizer, 5-part blood cell counter, Vitros 250 dry chemistry analyser, ECQI immunology analyser and fully-automated urine analyser-U411. Jashvant Prajapati, Chief Operating Officer, GVK Emergency Management and Research Institute (GVK EMRI), an innovative pro-poor not–for profit (Public Private Partnership), speaks to us about the initiatives in Gujarat. The institute has provided an integrated emergency response 24 X 7 for any type of emergency, medical, police and fire through easy to remember - three digits, toll-free number – “108”. Technology and streamlined approach has enabled 108 to respond to more than 13.04 million emergencies and save 3, 55,216 lives in critical condition. In Gujarat, since its launch in Aug 2007, 108 has handled more than 2.6 million emergencies and saved 1, 28,479 lives with 506 ambulances. Sterling Hospitals is engaged in providing high quality medical and surgical care in a host of critical specialties for effective patient care uses technologies in various sections including Philips and Siemens Cathlabs, digital panel and radiology diagnostic equipments such as CT scan – 40 slides, MRI 1.5 Telsa (GE), 4D color doppler, mammography and radio imaging solutions, Hi-end automatic biochemistry analysers, hematology analysers, microbiology analysers, PCR lab, immunology analysers and blood bank. Software applications have been in-

tech trends

december / 2011 www.ehealthonline.org

tech trends

• • • •

Doctor Pharmacist Nurse Case Writer

Patient Services Appointments Registration Clinical Pharmacy Patient Billing

• •

Laboratory

Blood Bank

Wards

Nursing Care

Ancillary Modules

Patient/Visitor Nurse

Information Kiosks

National Program

Bio Medical Waste

Linen Management Inventory Modules

Stores in Charge Nurses

Stores

Purhase Equipments

• • • •

Patient EMR Short Expiry Drugs Multi Date Appointments In Patient Management

• • • •

Hospital Info Camps Held Waste Details Hospital Linen

• • •

Indent Quotation PO Order

• • •

Employee Info Bills Scheduling

• • • •

Dashboard Disease Trend Exception Report Medical Indicator

Administrative Modules • • •

Administrator Clerks System Administrator

• •

System Admin Hospital Management

Employee Payroll Hospital Admin Complaints

Financial Accounting

Resource Scheduling

Human Resource

Leave Management

Transportation Security

Reporting Modules

MIS Reports

EIS Reports

Source: www.gujaratinformatics.com

stalled in the hospital for front-office and back office operations, in-house systems are developed which includes SMS solutions, surveillance system, MIS system and many other customised solution developed on latest .net platform.

Metamorphosis

“Increasing access to technology is one thing, but the objective is to reach the last person in the queue, and to deliver the benefits that he or she is entitled to. This is the pillar of policy that we implemented in Gujarat” MM Prabhakar Medical Superintendent, Civil Hospital Ahmadabad, Gujarat

december / 2011 www.ehealthonline.org

Science and technology has created a new age today with a world of high speed and reach in every corner which necessitates in-tandem emergency assistance and health care management. Integrating the larger objective of GVK EMRI to provide the “Right to Safety” for common man, Gujarat looks forward towards synergising with upcoming projects like unique identification (Aadhaar), health management databases as well as telemedicine and emulous innovations in diagnostics and therapeutics, to strengthen the endeavors in health scenario and bring improvement in quality of life. With the advent of technology, Gujarat has seen a metamorphic change since the establishment of healthcare entities. The hospital staff now has every reason to cheer up where the tasks are made effortless with the creation of a knowledge repository for research and development. The life of a computer operator has also become easy with the implementation of HMIS, as all reports are entered by five in the evening to be accessed by every doctor along with the medical history of each patient. The whole software gives a 360-degree view of the quality of services in government-run hospitals. The hospitals were reorganized and

tech trends

updated with the level that monitoring of malaria showed that the total number of patient registered was reduced from seven to one. With such a technology, there is no room for any error leading to a more rational planning for combating a disease. Apollo hospitals have started thinking an IT way now. They have considered all the uses of digital technology to help individuals, businesses and organisations use information. The software like CRM, CAD, DTP data base software words processing, HIS, MIS are generally used in the hospitals along with equipments including personal computers, digital television, robots, scanners (e.g. CAT, MRI etc.), use of computers to process data, microprocessors are used in a variety of medical devices, computer guided lasers in surgery, all are the intrigued part of the system. Gujarat health department has given freedom and flexibility to implement one health project for service to general public. ICT has very well been utilised in every district to provide medical facilities 24X7 in rural areas along with biometric attendance and citizen centres for the public service. Sat com project majorly deals with the implementation of telemedicine health consultancy with super speciality hospital. There is an upstream rural population which is now adopting ICT for handling medical issues as it does not suffer from any social, demographic, economic or geographical barriers. The youth is now mobile savvy and needs to be updated with information. The Migration Information Package (MIP) contains information on HIV/AIDS and general health. The whole system is integrated into four different modules which takes care of appointments to patient billing, managing waste to administrating complains, the whole system updates reports with minute details for each and every staff responsible in the department. The technology article is very well articulated in the figure presented by Gujarat Informatics Limited (GIL) which had undertaken the HMIS project. Kumarswami, Director, Red Sun Communications, highlights the need of ICT in hospitals to improve coordination. He says, “PARAS HMIS is a web-based application engineered to Web 2.0 standards that provides ease of development, deployment and maintenance. The software is developed in latest Web Development Framework called Ruby on Rails (RoR).”

Gen Next Hospitals The increased efficiency of staff, easy access to electronic medical records and treatment recording cycle has set an example for the non ICT hospitals. The monitoring of day to day hospital functions has given a holistic view of management along with an effective decision support system. The Sanjivini Hospitals has set up an ICT center in Palsana taluka, Surat district which proves to be an obvious advantage for the ICT project to provide basic health facilities and educate the patients about basic healthcare. The centre has a great medical awareness potential to change the lives of the common citizen totally through technology. In Gujarat, most of the midsized to large hospitals are equipped with HMIS, a complete end-to-end patient centric comprehensive business solution from Sai InfoSystem (India) Ltd. Based on Windows platform with SQL backend; it not only provides great ease of use but also ensures security of

“The function of the HMIS includes accurate recording and updating every patient’s demographics. We have given one system in Mithapur in Gujarat and in Zydus Cadila Group. We are now concentrating in Gujarat Market.” Kumarswami Director, Red Sun Communications data. Proper monitoring software provides visibility of the entire throughput process. Although the initial cost of implementation of this technology is high but in the long run we can reap many benefits through the integration of external systems. This approach results in improved productivity and sustained profitability. It also offers superior clinical decision making, reduce operating cost and achieve a positive ROI. MM Prabhakar, Ahmedabad Civil hospital, had all the good words for the upcoming technology. He adds, “While it may raise the costs in private sector, in government hospitals focus is always on providing affordable healthcare. The overall impact of ICT has been very beneficial to healthcare sector.” The digitised medical equipments further fasten the processes as it reduces human error and produce results immediately so that proper treatment can be started at the right time. Focused training and orientation programs to hospital staff for right use of HMIS is required especially where there is deficiency of doctors. The software can be customised as per organisation and study system requirement and analyse work flow of the existing system to understand how hospitals function. Telehealth services are again a new trend in the hospitals where companies like EMRI and SIS offer various technologies to connect remote hospitals, provide time-saving, cost-saving and life-saving services. ICT can thus prove to connect remote hospitals and reduce cost of medicare through consultation, guidance and imparting education. ICT has now bridged the gap between clinicians and patients to overcome the barriers of distance and time. The technology has developed virtual communities that interacts and shares knowledge for improving access to health care in remote or isolated areas. december / 2011 www.ehealthonline.org

leaders speak

“Hospital

Administration Stands on IT”

Dr Vikram Shah, Founder, Chairman and Managing Director, Shalby Hospitals, Ahmadabad, focuses on providing medical facilities to the lower middle class people with the aim to use ICT effectively for everyday functions. Hospitals use ICT every day, they use it in the administration department mostly where they check the number of patients received. We also use ICT to help amend, create and delete patient records, without ICT it would be really hard and a waste of time in the hospital. Private healthcare cost in India is actually much cheaper than other parts of the world including Thailand, Philippines which are considered third world countries providing first world treatment just like India. Moreover, 40 percent of Indian population today is not able to afford 2-square meal a day, than how are they going to afford the cost of the medicines. Thus, there are substantial efforts required to uplift the level of these people, in order to provide the affordable healthcare to all.

Adapting Technology In Shalby, each and every process is managed by inhouse software such as purchase process, MIS reports, MRD Management, Pharmacy Management etc. Some of the most modern technology used are electronic health records, chronic disease management systems, computerised practitioner order entry, clinical decision support system, electronic transfer of prescription, electronic appointment booking, personal health record, telemedicine , RFID, bar-coding and business intelligence. The hospital took few more steps towards adapting new technologies by recently acquiring plasma sterilizer, 5-part blood cell counter, Vitros 250 dry chemistry analyser, ECQI immunology analyser and fully-automated urine analyser-U411. Keeping abreast with the globally developing technologies is an integral part of Shalby’s mission. The hospital has invested heavily in IT infrastructure with CISCO and Nortel networking infrastructure. It has fully integrated Hospital Management and Information System (HMIS) which is designed to manage every aspect of information

december / 2011 www.ehealthonline.org

flow and control across the hospital. Right from vendor records to patient records, everything is electronically managed. Imaging technology has enhanced further by incorporating a mini OACS radiology viewing system. This enables doctors to view patient’s scan online, saving time taken for reporting. The hospital offers more space per patient for increased comfort and at-home feeling with the patient area of over 900 sq. feet. It has also incorporated infection control measures like HEPA filters, laminar air flow, body exhaust system, plasma steriliser and maquet operating tables. The hospital also initiated cardiac stem cell transplant, ozone therapy for non-invasive and painless uterine fibroid embolism and Kyphoplasty to treat painful, progressive vertebral compression fractures (VCFs) in the western region. It is believed that this is the first hospital in Gujarat to procure fractional laser for high-end cosmetic treatments. ICT has penetrated in to providing emergency services. Emergency has been handled quickly due to Code red and code blue SMS application.

Need of ICT Yes, with the implementation of new technologies, we have been able to reduce the cost of manpower and other stationary and administrative costs considerably. Today, the need to provide healthcare facilities to lower middle class at the right time is very important. In addition, some treatments are not available to all the classes. However, the way high quality treatments are available in western and advanced countries are at present not available in India. All stakeholders including the government should work in the right direction to overcome the challenges and ensuring quality healthcare for all.

leaders speak Dr Vikram Shah Founder, Chairman and Managing Director, Shalby Hospitals

december / 2011 www.ehealthonline.org

Leaders Speak

Dr Kirti M Patel Dean, Gujarat Cancer Society and Medical College (GCSMC)

â&#x20AC;&#x153;We Look at

Technology as

Enabler, Not as Cost Centreâ&#x20AC;? Gujarat Cancer Society (GCS) aims to create stream of value based medical professionals to reach a large part of the population by gradually implementing various ICT tools. Dr Kirti M Patel, Dean, Gujarat Cancer Society and Medical College (GCSMC) throws some light on the initiatives taken by GCS towards transforming systems.

december / 2011 www.ehealthonline.org

Leaders Speak

of trained medical professionals. Government of Gujarat had given 25 acres of land and at present MCI had given permission for 150 students’ admission in MBBS course annually.

ICT in the making

Gujarat Cancer Society (GCS) is a 50 year old charitable trust pioneering fight against cancer with the help of Government of Gujarat. In the year 1971 Gujarat Cancer & Research Institute (GCRI) was established as first public private partnership venture between GCS and Government of Gujarat where Governor of Gujarat presides over the organisation. GCRI is a regional cancer centre for western India. Our humble efforts are acknowledged at National and International level. More than five lakh people have benefited from services offered by GCRI. GCRI is running a super specialty course DM in Medical Oncology, MCh in Surgical Oncology and MD in Radiotherapy with B.J Medical College and Gujarat University. GCS has tremendous record of capabilities in health care, education, research and community services. Our expertise prompted Gujarat Government to invite us to start a healthcare facility to serve the under privileged citizens at affordable cost and create a stream

We have planned capacity of 800 beds of which more than 400 are operational. After one year of operation, now we cater to 700+ Out Patients and 200+ In-Patients daily. To manage this volume and to grow, we understand the importance of right ICT tools. Our core functions are managed by software which extends to support and provide auxiliary services very shortly. We would even consider a ‘healthcare suite’ to proactively drive Hospital and College (150 MBBS seats) operations. Next phase of our 25 acre campus wide networking is in progress and we have fibre optic backbone. We have applied very meaningful usage of technology tools and barcode is already generated on patient registration and most of the laboratory equipment is interfaced. All our state of the art diagnostic equipment contributes to effective healthcare delivery. In house competency is being built to take the ICT implementation to the next level. ICT tools were helpful to have better inter departmental coordination, avoid duplication; reduce errors and appropriate record maintenance. We are yet to claim breakthrough innovations in method of treatment but far ahead of traditional treatment methods. Our campus already has made envious reputation for its excellent ambience, facility planning, eco friendly design and timely completion of the projects. We would be centre of excellence and role model for other institutes in the state and even in the country. We look at technology as enabler, not as cost centre. To serve high volume of patients, integration of latest technology is very much essential; this would reduce our treatment cost per patient in the coming days. I do agree implementing technology do stress us on budget but with generous donors, we are sure we would make it. NABH is doing a commendable job for the sector. While hiring professionals we do give preference to those from NABH accredited facilities. We have quite few on our board pioneered NABH accreditations at their previous institutes. As we are committed to quality healthcare and education, way ahead we would be a NABH and NAAC certified institute. In our old institute GCRI, our pathology department is NABH certified. We are yet to make a substantial impact through the ICT implementation applicable to emergency services. The world is watching us as a trend setter in affordable healthcare delivery with meaningful usage of right technology. More penetration of health care facilities is desired to reach whole population. december / 2011 www.ehealthonline.org

ehealth india 2011 awards nominations

Nominations

eHealth India awards are instituted with the primary aim of felicitating and acknowledging unique and innovative initiatives in healthcare. The awards saw active participation from the government agencies, private sector, academia, and other key stakeholders in healthcare. Here are some of the awards nominations at eHealth India 2011awards.

Project Category Best Civil Society/ Development Agency Initiative of the Year

Project Name: Empowering the impaired through Computer & ICT Implementing Agency: Turning Point The project provides computer literacy to the disabled people and utilising computer for livelihood generation through handicrafts, jewellery production and selling through computer.

December / 2011 www.ehealthonline.org

Project Name: Megh Sushrut (MS) Implementing Agency: Centre for Development of Advanced Computing (C-DAC) It is an ERP Solution for health delivery in SaaS model using Garuda network as the computing cloud.

ehealth india 2011 awards nominations

Project Name: IIHMR PGDHHM with Specialisation in Healthcare-IT Implementing Agency: International Institute of Healthcare Management & Research The objective of the project is to build human capital that can use the powerful combo of IT, management and healthcare knowledge for solving healthcare problems.

Project Category Best Government Policy Initiative of the Year

Project Name: Community Health Initiative Implementing Agency: Impact India Foundation Community Health Initiative (CHI) is in partnership with the Maharashtra Government to correct existing disabilities by curative measures in Thane, Maharashtra.

Project Name: GVK EMRI 108 Emergency Response Service

Project Name: Tripura Vision Centre Project

Implementing Agency: GVK Emergency Management and Research Institute (GVK EMRI) It provides an integrated emergency response 24 X 7 for any type of emergency -medical, police, and fire through three digit toll-free number – “108”.

Implementing Agency: IL&FS Education & Technology Services Limited Vision Centres are envisaged as the next generation delivery points for eye care services which will enable to achieve the effective eye care delivery channel.

Project Category Best Health Insurance Initiative of the Year Project Name: Rajiv Aarogyasri Community Health Insurance Scheme Implementing Agency: Rajiv Aarogyasri Health Care Trust Scheme provides universal coverage to BPL families for all pre-existing diseases in the identified 942 procedures. The sole criterion to be covered under the scheme is to hold BPL ration card with photo and name.

Project Category Best mHealth Project of the Year Project Name: ECG on Mobile project by telemedicine centre of Nanavati hospital, mumbai Implementing Agency: Telemedicine centre, Nanavati Hospital Development of ECG facility on smart phone initiative was taken up in year 2010. It was successfully launched on BlackBerry smart phones subsequently after trial on 100 heart patients.

december / 2011 www.ehealthonline.org

ehealth india 2011 awards nominations

Project Category Best ICT Enabled Diagnostic Service Provider of the Year Project Name: SevenHills Health City Implementing Agency: SevenHills e-Health Pvt Ltd The hospital is delivering safe, effective and high quality patient care relies heavily on access to accurate and comprehensive information.

Project Name: eHospital for Communicable Diseases Implementing Agency: Fever Hospital e-Hospital is state of art ICT based solution to manage the ever expanding volume of health information, and for harnessing the latest in information technology for the benefit of patients, doctors and health care providers.

Project Name: IPM-Diagnostics Implementing Agency: Food (health) Administration, Hyderabad The objective of the Project is to make use of IT for delivering services to the citizens with greater reliability, availability and serviceability with minimal resources in terms of cost and human resources.

Project Name: Integrated Online Portal for AIIMS Trauma Centre Implementing Agency: All India Institute of Medical Sciences The project is meant for common citizen who can access the data and see how their tax money is being utilised. Patients will have a choice to go to a hospital that has the best clinical audit.

Project Category Best Private Sector Initiative of the Year Project Name: IndiaHeartBeat.Com Implementing Agency: DreamWeavers InfoCom Pvt. Ltd. Placed at the intersection of healthcare and IT, IndiaHeartBeat. Com is deemed to be the worldâ&#x20AC;&#x2122;s first medical networking & resource portal architectured on Web 2.0.

Project Name: Delight Implementing Agency: Eram Scientific Solutions Pvt.Ltd. Delight is positioned as the ultimate solution for providing stateof-the art public sanitation infrastructure which would address the key sanitation issues viz, maintaining hygiene, energy conservation and sustainability of public sanitation facilities.

Project Name: Reduction in TAT and optimum utilization of Manpower (For Patient Registration) Implementing Agency: IL&FS Technologies Ltd (for ERP) and eInfotree (for DMS) This project was initiated to improve our overall TAT (Turnaround Time) of Patient Report.

Project Name: MBBS CONSULT Implementing Agency: ELSEVIER MBBS Consult â&#x20AC;&#x201C; is a unique e-learning and training tool for use by medical colleges in order to supplement teaching.

Participants

December / 2011 www.ehealthonline.org

leaders speak

“Centralised

IT Architecture is Essential” As the steering lead of Sterling Hospitals, Dr Rajiv Sharma, CEO, Sterling Hospitals, Ahmedabad shares various technologies to operate healthcare facilities and follows a patient centric approach Sterling Hospitals, Ahmedabad was started in the year 2001,with a vision to be a preferred choice provider for ethical, superior and holistic healthcare solutions. As a healthcare organisation we would like to have a humans, viable and patientcentric approach in our services. We aim to build and operate world class healthcare facilities using latest medical technology by optimally trained medical professionals. Information communication technology enables effective communication to all stakeholders and hence helps a healthcare facility achieve operational excellence. ICT plays an important role to support organisation vision by seamlessly integrating all functions of hospital as a single system and delivering right information to care providers at right time which is critical for delivering quality patient services.

IT architecture Sterling group of hospitals have its presence in six cities of Gujarat and we have centralised IT architecture that connects all six units to one location with point to point connectivity. Our HIS application hosted at central location and all units access application remotely. We have implemented HIS system to all units which takes care of front-office and back office operations with equipment interfacing. We also use SMS technology to send various transaction events to doctors, patient’s relatives and care providers. Sterling Hospitals is engaged in providing high quality medical and surgical care in a host of critical specialties for effective patient care we use technologies in various sections including Philips and Siemens Cathlabs, digital panel and radiology diagnostic equipments. We have CT scan – 40 slides, MRI 1.5 Telsa (GE), 4D colour doppler, mammography and radio imaging solutions and in pathology equipments we have Vitros 5.1,

december / 2011 www.ehealthonline.org

Vitros 250 and 950, Hi-end automatic biochemistry analysers, hematology analysers, microbiology analysers, PCR lab, immunology analysers and blood bank. In software applications we have centralised Hospital Information Management System (HIMS) which take care of front-office and back office operations, in-house systems are developed which includes SMS solutions, surveillance system, MIS system and many other customised solution developed on latest .net platform. We use Microsoft exchange for communication and also use internet for academic and connecting to external world. We have Sun servers with oracle database for managing applications and redundant connectivity with all locations to provide high uptime to care provider. ICT enables up gradation in method of treatment starting from patient Electronic Medical Records (EMR) which helps to understand patient history. All historical information can easily be accessed and shared to doctor instantly. With the help of ICT in healthcare, patient treatment has become more inclusive. Diagnosis and method of treatment is critically dependant on the availability of high-quality, fast and accurate data and reporting. Once a diagnosis has been made then correct method of treatment can be chosen. Smart embedded processor based devices monitor patient condition and make dynamic changes based on patient condition. Such devices send SMS alerts to care provider which helps in treatment of patient.

Benefitting through ICT With the help of audio and video equipments expert doctor’s advice in critical operations and patient condition can be monitored by doctors sitting at any place in the world. Telemedicine and teleradiology help to eliminate distance barriers and can improve access to medical services. ICT innovations like

leaders speak

in e years iv f t s la in nificantly delivery ig s e r p a u c h e lt n a e n has go cost of o take h io t t in s p r o e e s d iv a a g re hnology the care o an inc comes t t d u d le o b le t a n s n Yes, tec a ie e xtent it h etter pat d it has e b n a y in t b a a t t r r e e ja s c f Gu t gets of vel. To a a le h t t x e e v n e li to the but I be . d e r e f f o hnology c e t e c services n a e of adv s u o t e du touch screen clinical workstations and unique power systems to guide low-skilled healthcare workers through the diagnosis and treatment of patients according to national protocols. With the help of various communications technology, patient avail emergency services as needed and get access to medical facilities. For instance, GPS system and mobile technology help track ambulance, patient location and nearby facilities which help in effective delivery of emergency services. Yes, Technology adoption has gone up significantly in last five years in Gujarat and it has enabled the caregivers to take healthcare delivery to the next level. To a certain extent it has led to an increase in cost of services offered but I believe that gets offset by better patient outcomes due to use of advance technology. We aim to achieve affordable healthcare to all and

this can be achieved through various innovative models that allows active partnership of government and private sector in healthcare delivery i.e. PPP model. Healthcare sector in our country remain underserved on all counts â&#x20AC;&#x201C; infrastructure as well as trained manpower. Also, there is great disparity in terms of medical facility available in urban and rural areas. There is a huge gap between demand and supply of medical services in country. Beside this we also face shortage of skilled medical and para-medical staff which also affects the delivery of medical services. Considering the challenges prevalent in health sector and to ensure availability of quality healthcare to all, government is inviting and encouraging private sector participation in healthcare delivery.

december / 2011 www.ehealthonline.org

leaders speak

Dr Ajay Angirish COO, Apollo Hospitals, Ahmedabad

Thinking the

IT Way

With the vision to be the worldâ&#x20AC;&#x2122;s largest healthcare service provider, Dr Ajay Angirish, COO, Apollo Hospitals, Ahmedabad, shares his experience with integrating operations and management through ICT

december / 2011 www.ehealthonline.org

leaders speak

ICT in Medicine

Patient Records Internet Equipment Research Expert Systems Communications

Most success stories start with the dream. The story of Apollo Hospitals is intrinsically tied to the story of Dr Prathap C Reddy, Founder and Chairman. His wondrous journey from rural Andhra Pradesh to architecting modern healthcare in India is synonymous with Apollo’s sweeping achievements in making India a global healthcare hub. Today, Apollo Hospitals group is the largest healthcare service provider in Asia and the third largest in the world. As a group, Apollo has touched and enriched over 20 million lives. Healthcare is one of the India’s largest sectors. In terms of revenue and employment the sector is expanding rapidly. During the 1990s, Indian healthcare grew at a compound annual rate of 16 percent. Today the total value of the sector is more than US$ 34 billion. This translates to US$ 34 per capita, or roughly 6 percent of GDP. By 2012, India’s healthcare sector is projected to grow to nearly US$ 40 billion. The private sector accounts for more than 80 percent of total healthcare spending in India. Unless there is a decline in the combined federal and state government deficit, which currently stands at roughly nine percent, the opportunity for significantly higher public health spending will be limited.

IT in Apollo The roles are clear to improve availability, continuity of care, empowerment, patient safety and quality of care. As far as im-

plementation of IT in Apollo Hospitals is concerned, we have introduced ten setups for telemedicine services and electronic appointment bookings, electronic transfer of prescription and Electronic Health Records (EHR). A good way to think about ICT is to consider all the uses of digital technology that already exists to help individuals, businesses and organisations by disseminating information. ICT covers any product that will store, retrieve, manipulate, transmit or receive information electronically in a digital form. The software like CRM, CAD, DTP data base software words processing, HIS, MIS are generally used. Equipment like for example, personal computers, digital television, robots, scanners (e.g. CAT, MRI etc.) use computers to process data while microprocessors are used in a variety of medical devices, computer guided lasers in surgery as all are an integral part of the system. From human to robotic doctors, advances in telecommunications are revolutionising the delivery of out-patient healthcare. A “robot doctor” can be kept up-to-date and continually add knowledge faster than any human being. Remote diagnosis can be used to diagnose and treat patients remotely. Self monitoring by patients can be beneficial to monitor or treat their own conditions at home without the need for a visit to hospital. The telemedicine shows the significant growth in Gujarat state. We have almost ten centers in Gujarat including the center at Sabarmati jail to provide consultation for prisoners.

ICT model Yes, The implementation cost is high initially but it has long term benefits like decreasing waiting times and better utilisation of resources, better coordination and information sharing among care providers, patient involvement in their own care activities, reduced risk of patient harm, effectiveness and efficiency of care service provision. All these activities directly or indirectly will be benefitted to us in long term. We need to keep a check on the cost drivers (cost of capitals, operational cost, human resource cost) in order to provide affordable healthcare. India still needs to work a lot to improve emergency services through technology. We can really improve the medical services to all with the accessibility through a PPP model and affordable model for common population. december / 2011 www.ehealthonline.org

report

International

Telemedicine Congress 2011

The report

Telemedicine Society of India (TSI) has organised International Telemedicine Congress - Telemedicon’11 at Hotel Westin, Mumbai, November 11-13, 2011. On November 13, the launch of the Continua Health Alliance is scheduled.

Rajendra Pratap Gupta, Chairman, TSI, talked about the theme of the congress to take telemedicine beyond the pilot phase and to leverage technology for healthcare. The event was graced by a lot of distinguished speakers including: Aneesh Chopra, CTO, and assistant to the President, USA; Sachin Pilot, Minster of State for IT, Government of India; Dr Pratap Reddy, Chairman, Apollo Hospitals group; Shankar Aggarwal, additional secretary, DIT, Government of India; Jayanth Banthia, additional chief secretary, Public Health, Government of Maharashtra. Dr K Ganapathy, President, TSI, stressed about the progress that TSI has made in the field of telemedicine in the last couple of years. In his special keynote Lord Nigel Crisp, former CEO, NHS, and Member house of Lords, UK, spoke about the global challenges for telemedicine and the progress that telemedicine has made till date. Shankar Aggarwal, additional secretary, DIT, Govt. of India, spoke about the economic/political growth in India and the role that government is playing in promoting/implementing the Telemedicine. Vishal Gupta, VP-CISCO, informed about the key issues faced by the telemedicine growth in India and the role that CISCO is playing in promoting/implementing it. Sachin Pilot focused on the approach to collaborate and make telemedicine a success in India. He emphasised about the ways in which technology can play an important part in helping us achieve our goals. He also stressed upon the fact that government is open to new ideas and actively involved in making new policies for better IT connectivity for applications such as Telehealth. Dr K Ganpathy, President, TSI, discussed the journey of Telehealth in India since 1996 and the accomplishments that he has achieved in his career. He also discussed the associations with other countries like Mauritius, Uganda etc., and also the

december / 2011 www.ehealthonline.org

Rajendra P Gupta, Chairman, TSI with Shankar Aggarwal, Additional Secretary, DIT, MCIT, Government of India

Pan Africa network. Jayanth Banthia spoke about the progress of telemedicine in the state and the steps that state government is taking to promote telemedicine. Aneesh Chopra, US Chief technology officer, was excited about potential of telemedicine not only in India but also across globe. He spoke about the US-India partnership in making telemedicine a global success. Rajendra Pratap Gupta, a leading healthcare expert and chairman Telemedicon’11, said that TSI intended to work relentlessly for making Telemedicine a success in the country. Gupta further added that DMAI – Disease Management Association of India & Continua Health Alliance - will co-host and incubate ideas like NCD’s and health education and awareness in telemedicine to address rural health. Gupta also said that three major global leaders were committed to fund the telemedicine project, which will reduce costs in the developing world.

At your side at the hospital: Dr채ger. In the fast-paced, cost-intensive and technology-driven field of acute care medicine, you have to face the most complex challenges every day. Technology solutions from Dr채ger offer more than just direct value for your patients and support for your clinical team. They help you to enhance cross-departmental or even hospital-wide management activities. It is our passion to develop Technology for Life to improve quality and reduce the cost of care.

zoom in

Vino Ramayah Chairman, Medtech Global

december / 2011 www.ehealthonline.org

zoom in

“Next Gen Mobile

Technology will Enhance Role of

Telemedicine” Medtech Global is improving healthcare service delivery in India through the deployment of innovative and comprehensive technologies. Vino Ramayah, Chairman, Medtech Global, in an interaction with eHealth, shared his perspective on Medtech’s journey and how the company is working to position itself as a preferred healthcare provider.

Please give us a brief overview of Medtech Global. Medtech Global is a leading healthcare technology products and services provider, with more than 27 years of experience in the sector. The company has been enhancing the quality of patient care through development of cutting edge technology products. Currently Medtech Global’s products and services are being used in India, New Zealand, Australia, Ireland, United States and South Africa. Medtech India was incorporated in 2009 and is a subsidiary of Medtech Global. We are the largest provider of technology solutions in New Zealand and the second largest in Australia. What are your main product and service offerings? Medtech’s comprehensive suite of technology solutions consists of real-time endto-end healthcare management systems. These systems improve practice management, and also enhance patient safety and healthcare delivery. They facilitate electronic health records management, reporting, and Telehealth and Telemedicine solutions. Medtech currently provides solutions across for primary, secondary and personal

healthcare. Some of these solutions are Practice Management Systems, Clinical Knowledge management, Electronic Medical Record Management, Digitisation, Telehealth/Telemedicine, Health Assessment Tools, Clinical Decision Support, Population Health Tools, Personal Health Portal, Hospital Information Systems etc. Medtech has been active in digitisation and electronic medical records space. Tell us about the major clients you have been working with. Medtech has mastered the ability to digitally convert traditional paper-based medical records and images to an electronic file for online and offline distribution. Medtech is currently working with several hospitals in India to digitally convert their traditional paper based medical records and images to an electronic file. Some of our reputed clients are Apollo Hospitals – Chennai, JIPMER – Pondicherry, Rajiv Gandhi Cancer Institute – Delhi etc. In your view how will the field of telemedicine develop over the last few decades? The idea of performing medical examinadecember / 2011 www.ehealthonline.org

zoom in

There is a growing movement in India to establish a health grid that connects medical institutions and practitioners throughout the country. Telemedicine can help achieve this while also serving as a tool for educational institutions to provide practical training to young doctors. tions and evaluations through the telecommunication network is not new. The earliest form of Telemedicine, developed in 1906 by Einthoven, envisaged ECG transmission over telephone lines. Since then, the field of Telemedicine has evolved from supporting the transfer of patient’s vitals data to live video conferencing via satellite feed. With the advent of 3G/4G services and other advances in wireless communication, Telemedicine has now taken off in a big way with the bandwidth supporting the transfer of audio, video and clinical data over the Internet. Which areas of the healthcare industry do you think will benefit most through the development of telehealth technologies? Telehealth has huge implications for rural primary healthcare delivery and can help bridge the gap between patients in remote areas and doctors who are mostly based out of the cities. Apart from this, there is a growing movement in India to establish a health grid that connects medical institutions and practitioners throughout the country. Telemedicine can help achieve this while also serving as a tool for educational institutions to provide practical training to young doctors. What telemedicine products and services do you currently offer in India? Medtech has its own state of the art telehealth solution called VitelMed, which provides direct access to emergency care for the recovery from serious illness or accident in remote locations or within an ambulance environment. VitelMed also finds application in providing quality remote care and connectivity between doctor, family and patients. Based on established technology used throughout the world, VitelMed combines audio and video, clinical data and work flow information with remote connectivity between doctor and patient to reduce the medical administration and care cycle and improve the effectiveness of emergency response care. What benefits can Medtech’s telehealth solution provide to India’s rural population? Only 25 percent of India’s specialist physicians reside in semiurban areas and a mere 3 percent live in rural areas. 66 percent of rural Indians do not have access to critical medicine. We believe that Medtech’s telehealth solution VitelMed can bridge the gap between doctors and patients in rural areas through remote diagnosis, monitoring and treatment of patients via videoconferencing or internet. This is facilitated through the establishment of rural health centres, which can be manned by semi skilled people

december / 2011 www.ehealthonline.org

and these centres can be connected to some of the best doctors/ hospitals in the cities. Can you give us a brief outline of the telemedicine pilot project in which you are collaborating with National Agro Foundation? Medtech under the aegis of the New Zealand Govt has signed a MoU with the National Agro Foundation (NAF), a public charitable trust, to run a pilot project in the remote village of Chunampet located close to Pondicherry in the state of Tamilnadu. NAF intends using the technology when it establishes a rural health care centre in the state of Tamil Nadu. This will be run as a pilot for 12 months, after which the scheme will be rolled out to rural areas. What future innovations will you be bringing to the market? With growing education levels, lifestyle related diseases on the rise; patients will seek out ways and means to keep track of their own health condition. In line with this, Medtech has developed a revolutionary personal health portal called ManageMyHealth. ManageMyHealth is a secure personal Internet health portal allowing healthcare providers to empower individuals to take a more active role in the management of their health and well-being. It enables individuals to access appropriate medical records and results uploaded by the doctor. It also allows patients to engage electronically with their healthcare providers to support positive lifestyle changes. What changes and advancements do you foresee within the medical information technology space over the next 5-10 years in India? The basic improvements of Electronic Medical Records from paper based records will be a key advancement for adoption of more sophisticated Information Technology such as decision support and disease management tools. The next 5-10 years is going to be very exciting for the medical technology space. We can expect applications that specialise in personalised healthcare, preventive healthcare, with a view of providing healthcare at the doorstep of the patient. The role of telemedicine will be further enhanced with introduction of next generation mobile technologies, as these can bring down the costs. Our response to the challenges of access in remote areas will improve. As handheld mobile smart phones become more popular, niche mobile applications will provide personalised health services and instant care. Better access to healthcare and greater awareness and higher expectations of patients will require new services and expertise from healthcare providers.