V O L U M E 2 | I SSUE 12 | DE CE MBER 2007
ISSN 0973-8959
A Monthly Magazine on Healthcare ICTs, Technologies & Applications
COVER STORY
HIS Vendor Survey 2007 EXPERT CORNER
Innovation in ICT Adoption for Health System TELEMEDICINE
‘Space’ for Telemedicine IN CONVERSATION
Manish Gupta, CIO Fortis Healthcare POWER HOSPITAL
Escorts Heart Institute and Research Centre, New Delhi CASE STUDY
Global Alliance of IT Giants Powers Cancer Research TECHNOLOGY TRENDS
Sound with a Sight ZOOM IN
HIPAA for Insurance Regulation
w w w .e h e a l th o n l i n e . o r g
HIS Vendor Survey 2007 - IT Shopping Guide for Hospital CIOs
Rs. 75
ANNUAL SPECIAL ISSUE JANUARY 2008 Special Features: Exclusive Interviews Expert Articles Industry Insights Market Forecasts Target Postings Wide Circulation
Focused Sections: Policy & Business Environment Hopitals & Healthcare Institutions HIS/HIMS RIS & PACS
Your jump-start into the year ahead...
EHR & EMR Medical Equipments Diagnostic Devices Personal Healthcare Gadgets Pharmaceutical Equipments Health Insurance & Financing
For advertising/branding opportunities:
Medical Tourism
Arpan (arpan@elets.in; 9911960753)/ Dipanjan (dipanjan@elets.in; 9968251626)
w w w . e h e a l t h o n l i n e . o r g | volume 2 | issue 12 | december 2007
COVER STORY
6
HIS Vendor Survey 2007 eHEALTH Research Team
EXPERT CORNER
16
Innovation in ICT Adoption for Health System
Dr N K Singh, Dr Ram Kumar, David Yonzan and Dr Pajeesh, Sobha Renaissance IT
24
TELEMEDICINE
CASE STUDY
20
30
‘Space’ For Telemedicine Dolly Ahuja, eHEALTH
Global Alliance of IT Giants Powers Cancer Research
Susan Thomas, eHEALTH
IN CONVERSATION
22
The challenge is to create an architecture that allows seamless information flown Manish Gupta, CIO, Fortis Healthcare
TECHNOLOGY TRENDS
36
Sound with a Sight Dipanjan Banerjee, eHEALTH
22 Exclusive Interview Manish Gupta CIO, Fortis Healthcare
POWER HOSPITAL
24
Escorts Heart Institute and Research Centre, New Delhi
30 39 ZOOM IN
39
HIPAA for Insurance Regulation Susan Thomas, eHEALTH
NEW S R EV I EW
INDIA NEWS 18
20 December 2007
WORLD NEWS 26
BUSINESS NEWS 28
PRODUCT PROFILE
32
EVENTS DIARY
42
3
EDITORIAL GUIDELINES eHealth is a print and online publication initiative of Elets Technomedia Pvt. Ltd. an information research and media services organisation based in India, working on a range of international ICT publications, portals, project consultancy and highend event services at national and international levels. eHealth aims to be a rich, relevant and wellresearched information and knowledge resource for healthcare service providers, medical professionals, researchers, policy makers and technology vendors involved in the business of healthcare IT and planning, service delivery, program management and application development. eHealth documents national and international case studies, research outcomes, policy developments, industry trends, expert interviews, news, views and market intelligence on all aspects of IT applications in the healthcare sector.
Contributions to eHealth magazine could be in the form of articles, case studies, book reviews, event report and news related to eHealth projects and initiatives, which are of immense value for practitioners, professionals, corporate and academicians. We would like the contributors to follow the guidelines outlined below, while submitting their material for publication: ARTICLES/ CASE STUDIES should not exceed 2500 words. For book reviews and event reports, the word limit is 800. AN ABSTRACT of the article/case study not exceeding 200 words should be submitted along with the article/case study. ALL ARTICLES/ CASE STUDIES should provide proper references. Authors should give in writing stating that the work is new and has not been published in any form so far. BOOK REVIEWS should include details of the
book like the title, name of the author(s), publisher, year of publication, price and number of pages and also have the cover photograph of the book in JPEG/TIFF (resolution 300 dpi). Book reviews of books on e-Health related themes, published from year 2002 onwards, are preferable. In the case of website, provide the URL. THE MANUSCRIPTS should be typed in a standard printable font (Times New Roman 12 font size, titles in bold) and submitted either through mail or post. RELEVANT FIGURES of adequate quality (300 dpi) should be submitted in JPEG/ TIFF format. A BRIEF BIO-DATA and passport size photograph(s) of the author(s) must be enclosed.
ALL CONTRIBUTIONS ARE SUBJECT TO APPROVAL BY THE PUBLISHER.
Please send in your papers/articles/comments to: The Editor, eHealth, G-4, Sector 39, NOIDA (UP) 201 301, India. tel: +91 120 2502180-85, fax: +91 120 2500060, email: info@ehealthonline.org, www.ehealthonline.org
Ms. Jayashri Kulkarni’s name on page 18, October 2007 issue was wrongly spelt as Jayanthi Kulkarni. The error is since regretted.
4
www.ehealthonline.org
Volume 2 | Issue 12 | December 2007
PRESIDENT
EDITORIAL
Dr. M P Narayanan EDITOR-IN-CHIEF
Ravi Gupta GROUP DIRECTORS
Maneesh Prasad Sanjay Kumar MANAGER - eHEALTH
Dipanjan Banerjee mobile: +91-9968251626 email: dipanjan@ehealthonline.org RESEARCH ASSOCIATES
Susan Thomas Dolly Ahuja SALES EXECUTIVE
Arpan Dasgupta mobile: +91-9911960753 email: arpan@ehealthonline.org DESIGNED BY
Bishwajeet Kumar Singh Om Prakash Thakur WEB
Zia Salahuddin Santosh Singh SUBSCRIPTIONS & CIRCULATION
Manoj Kumar (+91-9210816901) manoj@ehealthonline.org EDITORIAL CORRESPONDENCE
eHealth G-4 Sector 39 NOIDA 201301, India tel: +91-120-2502180-85 fax: +91-120-2500060 email: info@ehealthonline.org
PRINTED BY
Vinayak Print Media, Noida Gautam Buddha Nagar (U.P.) India does not neccesarily subscribe to the views expressed in this publication. All views expressed in the magazine are those of the contributors. is not responsible or accountable for any loss incurred, directly or indirectly as a result of the
Trends and growth forecast for healthcare IT market in India is quite encouraging. To get a glimpse of the opportunity - the market potential is estimated to be US$ 300 million by 2012. Understandably, it sounds like a melody for the IT sector – more so, when healthcare institutions are gearing up for high-end service delivery through process modernisation, automation and technology investments. Although, IT solutions available for the healthcare sector are in plenty – confusions and controversies regarding technical suitability, usability, cost effectiveness and similar such factors are galore. IT decision-makers and technology managers of hospitals spend many a sleepless nights, battling and balancing vital parameters in finding the right solution and the righteous vendor. To save the midnight oil for hospital CIOs, eHealth commissioned a survey of HIS solution vendors to bring together some of the vital information that will ease their nerves and cut-down on time and resource spent for their selection process. In this first ever survey, we have been able to gather information from 14 vendors across a uniform set of parameters, covering – product features, product components, existing clients/installations and price range. Although this may not be exhaustive, we are hopeful to cover and discover many more of them next time around. Do let us know if we missed some of you, or otherwise, if you missed us. Catch up with all the info in our cover story. In the ‘Expert Corner,’ business head of e-Health in Sobha Renaissance IT, Dr. N.K. Singh, provides an overview of innovations in ICT adoption for health system – in view of their Digital Integrated Health Exchange concept. In our new section ‘Telemedicine’, we have covered Space Telemedicine - a company specialising in areas of client-server, component bases models, web enabled applications and object oriented technologies, which is most effective in reaching the undeserved masses of India. Get some mind-share of Manish Gupta, CIO, Fortis Healthcare, who talked about his vision for a centralised, fully integrated healthcare system to be implemented in the Fortis network hospitals. The ‘Power Hospital’ sets the spotlight this time is on Escorts Hospital & Research Centre - ranked as the best cardiac hospital in India. Ludwig Institute for Cancer Research (Australia), was finding it difficult to manage the large amounts of data piling up as part of their research - our ‘Case Study’ shows how a global alliance of three IT giants, namely – Microsoft, Dell and Intel have brought together resources and expertise to bring out a powerful collaborative computing platform for medical research. In ‘Technology Trends’ we profiled ultrasound technology - presenting an overview of how it is revolutionising medical imaging. Also catch up with a low down on HIPAA in our ‘Zoom In’ section and a profiling of innovative hardware and software solutions under ‘Product Profile’.
information provided.
Do let us know how you enjoyed this issue! is published by Centre for Science, Development and Media Studies (CSDMS) is published & marketed in collaboration with Elets Technomedia Pvt. Ltd. (www.elets.in) © Centre for Science, Development and Media Studies www.csdms.in
December 2007
Ravi Gupta Ravi.Gupta@ehealthonline.org 5
>
COVER STORY
HIS Vendor Survey 2007 - IT Shopping Guide for Hospital CIOs eHEALTH Research Team
A
s healthcare industry in India continues to grow along the economic and operational scale, and widens its scope in service delivery, standardisation and best practices, the service providers are faced with an ever increasing need for IT based automation and technology adoption at levels of business. Traditionally, hospital automation was restricted to admissions and billing functions, without proper linkages and integration with vital functional areas like administration and financial operations, resource planning and materials management, clinical and diagnostic operations and care management. However, with proliferation of higher standards in healthcare services and medical practice, increased expectations from customers coupled with heightened demand of the insurance sector - most service providers are now looking at enterprise-wide IT solutions. Already, a number of tier I hospitals in India have started reaping the benefits of IT. It is often critical for more high-end hospitals which are looking to tap into the growing medical tourism market and cater to overseas patients. However, tier II and mid-segment hospitals are also increasingly opting for IT implementation – partly to keep pace with peers and partly due to the fact that now there is some pockets of evidence on returns and efficiency gains of IT adoption in hospitals. However, disappointing cases of failure in realisation of expected results and instances of dissatisfaction among
hospitals are still routinely being heard of. Many HIS vendors still bear the backlash of disgruntled clients and abandoned projects. Presently, the solution provider pool is highly scattered, disjoint and often unstandardised – adding to the woes of service providers while procuring IT solutions for hospitals and healthcare institutions. Although a number of IT players, comprising both domestic and international companies, are offering solutions for hospital automation – often decision makers in hospitals are perplexed with the sheer number of available vendors, variety in solutions, pricing factors, technical suitability and vendor credentials in terms of existing users and installations. Predicting the need to bring some clarity in the clutter of available HIS solutions, and bring them together under a single compendium for an unbiased comparative reference for hospital IT buyers – eHEALTH commissioned its first ‘HIS Vendor Survey’ ‘07. The response was quite satisfactory and sparing a few, most vendors contacted during the survey have responded in true spirit of this exercise. In the following pages we present details of 14 HIS vendors on a common set of parameters as provided to them. The listing pattern is in alphabetical order and does not indicate any absolute or relative ranking among the participating vendors.
List of HIS Vendors Covered in the Survey Akhil Systems Bbnisys Technologies Birla Medisoft Designtech Systems ibahealth
IDMSys New Steth Diagnostics Pentasoft Technologies Seed Healthcare Solutions Softlink International
Sobha Renaissance IT Systems Plus Solutions TrakHealth Wipro Health Care IT
Watch out for eHEALTH ‘Annual Special Issue’ - January 2008 6
www.ehealthonline.org
AKHIL SYSTEMS Product Name: Hospital Information System Year of Release: Version 1.0 in 1994 DOS/Clipper; Version 2.0 in 2000 VB 6.0 / MS-SQL; Version 3.0 in 2004 VB.NET / MS-SQL 2000; Version 4.0 in 2007 VB.NET / MS-SQL 2005 Product Features On-line Interactive Software Package for proper planning of the Work Flow Management; Single Window service to Patients for billing & Collection; Site implementation & fine tuning of Software for Procedures; Facilities Controlled by User-definable Parameters; Provides open-ended adaptability & stability of Software; Multiple Tariff Lists with very flexible option for Rate Revision; Covers Medical Insurance Companies requirements; Health Packages for the OPD and I.P.D. Patients; Pre-defined Multiple Medical Summary & Discharge Summary Formats; Audit Trail Facility for verification of the entries made; Powerful Search Engine for locating any type of information related to Patient; Graphical Presentation of the Data for Top Management. Product Modules & Components: Front Office Modules; EMR; Diagnostic Modules; Inventory & Pharmacy Management; Finance & Budgeting; HR & payroll; Back Office Modules; MIS; Admin Modules Technical Specs/Requirements: VB.NET / MS-SQL 2005
Major Clients/Installations: Total number of installations is 70+. Some of the major clients in India are – Apollo Hospitals in Bangalore & Noida, Mool Chand Hopital-Delhi, Paras Hospital-Gurgaon, Regency Hospital-Kanpur; Rajiv Gandhi Cancer HospitalDelhi, Metro Heart Hospital & Research Centre-Noida, Mahatma Gandhi Hospital-Jodhpur, Army Hospital (R&R)-Delhi. Some of the overseas clients are – Almana Group Hospitals-Saudi Arabia and Apollo Hospitals-Dhaka. Price Range(min, max): On demand and depending upon number of modules purchased. Contact Details: Mr. Sanjay Kumar Jain, Director Akhil Systems Pvt. Ltd. 205-206, Vardhman Times Plaza Plot No. 13, Road No. 44, Pitampura, Commercial Complex, New Delhi-110034 Tel: +91.11.42644111 Fax:+91.11.42644112 Email: sanjay.jain@akhilsystems.com Web: www.akhilsystems.com
BBNISYS TECHNOLOGIES Product Name: eHMS Year of Release: 2007 Product Features: It is powerful, flexible and easy to use and has been designed and developed to deliver really conceivable benefits to hospitals and clinics. And more importantly it is backed by reliable and dependable HMS support. eHMS is designed for Small and Medium size hospitals to cover a wide range of Hospital administration and management processes. Product Modules & Components: Administration; Registration; OPD; IPD; Store; Lab; Help Desk; Blood Bank; Clinical Investigation; Casualty; OT; Immunization; Warden; Billing & Reports; Physiotherapy; OBG; House Keeping; In-house Chatting. Technical Specs/Requirements: Build in Java/J2EE as front end, Middleware is JBoss and backend database is MySQL 5.1
Major Clients/Installations: In talks with some major hospitals Price Range(min, max): INR 3.5 Lacs for 100 Bed Hospital and thereafter INR 25,000 for every 10 beds. Contact Details: Sajal Aggarwal, Managing Director 4, Nath Kripa, Opposite Hotel Grace Jhansi Road, Gwalior - 474002, Madhya Pradesh Tel:+91-751-4010134 Email: info@bbnisys.com Web: www.bbnisys.com
The market potential for Health IT solutions in India is estimated to be US$ 300 million by 2012 December 2007
7
HIS VENDOR SURVEY 2007
COVER STORY
>
BIRLA MEDISOFT Product Name: Birlamedisoft Xenon Hospital Information Management Software Year of Release: 2006 Product Features: Unique MRN to identify a patient; International HIPAA compliance programming; ICD-9, ICD-10, ICP, CPT system implemented; Easily locate patient medical record; Drug database with formulations and contraindications; HL 7 interfaces available; Instrument Interfacing; Imaging Server, DICOM 3.0 images; Varied payment plan for Insurance/Company agreements/Credit card/Debit card/Cash/Cheque; Multi Tariff options for accounting purpose; Handheld PDA interface for doctors; Short Message Alert Service; Barcode printing & scanning, for Material, Specimen and Patient identification; Smart Card interface for patient record and access rights; Scheduling of Resources; International Coding Standard for diseases. Product Components: OPD registration, Diagnosis, Case Paper, History, Examinations, Treatment, Bill Particulars, Bill Charges, OPD Bill, Income Reports, Certificates etc., IPD Registration, Order Sheet, IPD Diagnosis, Visiting Doctor, Fluid Chart, Admission Front Sheet, IPD Bill, Room Management, Pathology, Xray & Sono, CT Scan, MRI, Accounting, Inventory, OT, CGHS Billing, Centralized Billing System, ICU module, Pharmacy Module, Sonography Video Capture Module, Cell Counter Interface, Biochemistry interface, Blood bank Software, Automatic posting of IPD/OPD billing, Web interface, Ophthalmic module, SMS alerts, PDA interface, Tally Interface, Payroll, Diet Management, Housekeeping, Ambulance Management Technical Specs/Requirements: Windows based. MS-SQL backend. Client Server as well as 3 tier application available.
Major Clients/Installations: More than 15 large HIMS installations in India. Ranging from 100-500 bed hospitals. Some of them are - Kashibai Navale Institute of Medical Science-Pune, N.M.Wadia Institute of Cardiology-Pune, Sane Guruji Hospital-Pune, Icon Hospital-Mumbai, Ayushman HospitalBhopal; Narmada Trauma Centre-Bhopal; Dr. Paliwal Hospital-Bhopal, Unique Children’s Hospital-Pune; Astha Hospital-Kalamb, Alam Hospital-Ranchi, Kanke Hospital-Ranchi, Siddiqui Ayushman Hospital-Delhi.
Hospital-Mumbai,
International clients are - County Hospital-Texas, USA; Systems And Medical Softwares Development Company-Riyadh, Saudi Arabia; Dr. Ken Obeson-Canada; Shriners Hospital for children-N.America; Siloam HospitalW.Jakarta; RelabMty-Mexico; Govt of Bhutan, Health Dept; Clinical CoreNew York, USA Price Range(min, max): INR 5 – 20 Lacs Sales Contact: Shrinivas Birla Birlamedisoft Pvt. Ltd. 111, Gulmohar Centre Point Pune Nagar Road, Near Viman Nagar Corner Pune - 411014 Tel: +91-20-32302662 Fax: +91-20-27036459 Mob: 09422521434, Email: info@birlamedisoft.com Web: www.birlamedisoft.com
DESIGNTECH SYSTEMS Product Name: Asclepius - Hospital Resource Management and Administration Systems Year of Release: 2002 Product Features: Modular, robust, open ended offering full scale integration with third party applications, incorporation of international standards like HL7, DICOM, ICD coding etc. It has a range of solutions for hospitals and organisations that are engaged in providing healthCare services. This range of solution start with the entry level Asclepius Lite and scale up to Enterprise-wide solutions. The Lite is primarily for small and medium sized hospitals while the Enterprise versions are for large and multi-specialty hospitals. Product Components: Asclepius has more than 25 modules to choose from. These are scalable and can be plugged in, at any time. Covers HIS, RIS/ PACS, LIS.
8
Technical Specs/Requirements: Windows compatible system running in client server mode Major Clients/Installations: Seth Ramdas Shah Hospital & Research Centre, Pune, Gujrat Cancer Research Institute, Ahmedabad, Artificial Limb Center, Pune Price Range(min, max): INR 5 Lacs – 1 Crore and above, based on system configuration. Contact Details: Designtech Systems Pvt. Ltd. Abhijit Sane Business Development Manager Mob: +91 93733-36448 Email: abhijit.sane@designtechsys.com Web: www.dt-healthcare.com
www.ehealthonline.org
ibahealth Product Name: IBA eHIS Year of Release: New Version 5.2 released in 2005 Product Features: Covers Administrative, Clinical and Departmental Functions including lab and radiology Product Components: Integrated Solution with more than 35 modules capable of working in an enterprise environment Technical Specs/Requirements: Front end JAVA and Backend Oracles Major Clients/Installations: Major Provicial Hospitals in South Africa, Ministry of Health-Malaysia & 3 Customers in India - Sri Satya Sai Institute of Medical Sciences, Whitefield,
IDMSys Product Name: IDMsys Hospital ERP solution Year of Release: The first version was released in the year 1996. The Hospital ERP solution has undergone many changes with many enhancements suiting the current changing requirements of the healthcare sector. Product Features: IDMsys Hospital ERP Solution operates under an adaptable and efficient onsite-offshore delivery model providing cost effective software development, migration, testing, implementation and maintenance of large-scale systems across a wide range of needs. Product Components: Patient Appointment Module; Prescription Module; Dietary Management; House keeping Module; Ambulance Management; # Doctors desktop Module (complete patient diagnostic history with drug details like contra indications, allergy etc); Insurance Management Module; Electronic Medical Record Module; Specialty Module; Nurse Desktop; Radiology module; Admission – Transfer – Discharge (ADT) Module; Nursing Station Module; Pharmacy Management Module; # Hospital Inventory Module; Patient Master Index; OP Nursing Station; # Billing Manager; Electronic Medical Records; Insurance and Claims Management; Pharmacy; Laboratory (Pathology, Microbiology, Hematology, Histopathology, Biochemistry etc); IP Management; IP Nursing Station; OR Management; Discharge; Equipment Management; HIPAA Security; HL7 Compliance; Utilities; Master Setup; ACCPAC comprehensive finance module tightly integrated with entire Hospital ERP modules; Hospital Diagnostic Equipment Interface Module. Technical Specs/Requirements: The Hospital ERP is designed on multi-tiered environments. Multitiered processing capabilities are advancements over simple client-server two-tier designs. They enhance scalability and deployment capabilities over wide area
December 2007
Bangalore (330 beds); Artemis Health Institute, Gurgaon (500 beds); Sri Satya Sai Institute of Medical Sciences, Puttaparthi, Andhra Pradesh (400 beds) Price Range(min, max): INR 2 Crores Contact Details: Madhu Kumar Commercial Manager IBA Health (India) Pvt Limited 73-D, Electronics City, Hosur Road Bangalore - 560 100, India Tel: +91 80 2852 0230 Fax: +91 80 2852 0231 Email: madhukumar.mk@ibahealth.com Web: www.ibahealth.com
networks (WANs) and the Internet, as well as local area networks (LANs). Major Clients/Installations: Belhoul Specialty Hospital, Dubai; American Academy of Cosmetic Surgery hospital , Dubai Healthcare City, Dubai; Arabian Health Care Hospital, Ras Al Khaimah; # International Modern Hospital, Dubai; Al Rafa Hospital, Dubai; Belhoul European Hospital, Dubai; Emirates Hospital, Dubai; Neuro Spinal Hospital, Dubai; Rochester Hospital, Dubai; MedCare Hospital, Dubai; Jebel Ali Hospital, Dubai; Rustom, Dubai; Dar Al Shifa Hospital, Abu Dhabi; Al Reef Hospital, Abu Dhabi; Middle East Specialist Medical Center, Abu Dhabi; GDC Clinic and hospital, Abu Dhabi; Jindal Naturopathy & associated Manav Charitable Hospital, Bangalore; Bangalore Baptist Hospital, Bangalore. Price Range(min, max): The price depends on the requirements of the client. However the following factors will play important role while arriving at project cost - a) Present facilities b) Requirements of the client c) Forecast of the client with respect to service to be provided, now and for the future d) Hardware and network capability. Contact Details: For India & Asia Pacific regions Mr.Ratnakar.S., Mob:09886010025, ratnakar@infdim.com, For Middle east & pacific regions Mr.Shashidhar, Mob:09916175969, sjakkali@infdim.com, For USA, UK & rest of the world Mr. Abdul Zahir, Mob;(India) 09901555166, (Dubai) 00971507760592,azahir@infdim.com
9
COVER STORY
>
HIS VENDOR SURVEY 2007
NEW STETH DIAGNOSTICS Product Name: CORTEX : Hospital Management Information System Year of Release: 1996 (upgraded in 2007 to web based solution)
Major Clients/Installations: 17 Hospitals of various sizes
Product Features: A complete product. Administration, Finance, Inventory, Patient records, Lab, Pharmacy, General Stores, 4500 Disease reference, differential diagnosis from signs and symptoms, systemic examination
Price Range (min, max): Free installation / Upgradation / NO AMC
Product Components: Web based Software solution for single and multiple hospitals. Internet/ intranet access Technical Specs/Requirements: Developed on Windows platform
Contact Details: Jose ES, CEO New Steth Diagnostics Pvt. Ltd. 35/3017 H, 1st Floor, Vylopilly Road, Palarivattom, Cochin - 682025 Tel: +91 484 3243446/3236449 Email: jose@newsteth.com Web: www.newsteth.com
PENTASOFT TECHNOLOGIES Product Name: Penta Hospital Management System Year of Release: 2007 March Product Features: Graphics, Animated, user interface friendly screen; Easy data retrieval with single mouse click; Reduce time and adds value to your Human Resources; No need for handful of computer Knowledge; Application and Database we can use from open source; Easy Customization according to customer’s requirement. Product Components: Out-Patient Administration; In-Patient Administration; Casualty and Emergency Registration; Ward Management; Diagnostics; Operation Theatre; Blood Bank.; Pharmacy Management; Stores Management.; Purchase Management; Integrated Financial Accounting; Human Resource Management; CGHS; CM/PM relief Fund; Medical Records; Equipments Maintenance; Central sterilization & stores Department; House Keeping Activities; MIS Report; Canteen
Technical Specs/Requirements: OS - Windows NT, 2000 and 2003 with Windows XP and 98; Front End - Java, Servlet and JSP; Back End - MySQL and MS-Access. Hardware Minimum PIII 500 MHz, 256 MB RAM & 20 GB HDD Major Clients/Installations: Raj Nursing Home, Chennai; Logidasans Hospital, Trivellore Price Range(min, max): INR 70,000 - 3.5 Lacs Contact Details: Isaiah Selvakumar Sr. Executive – Project Pentasoft Technologies Ltd. ‘Taurus’ No. 25, United India Colony, Chennai - 24 Tel: 91-44-24722518 (Ext: 127) Mob: 91-9444496492 Email: project@pentasoftech.com Web: www.pentasoftech.com
SEED HEALTHCARE SOLUTIONS Product Name: CareDynamixTM Year of Release: July 2005 Product Features: CareDynamixTM offers a wide range of functionality for clinical, administrative and support functions. CareDynamixTM is divided into various modules, based on the functionality they offer. The functionality offered is comprehensive to cover the functioning of multi-specialty hospitals. CareDynamixTM is simple to use and can be effectively used with minimum data entry. It can be easily used by all within a hospital whether it is the front desk personnel or nurses or doctors and clinicians. The proposed application is modular in design, with various modules that
10
address specific functional requirements. All these modules are seamlessly integrated to form a complete system. The software is seamlessly integrated software, across every module. The same data can be accessed across the hospital, based on user rights without any duplication of data entry anywhere. CareDynamixTM is totally GUI based and has a windows-oriented point and click interface. It makes extensive use of icons, pull-down menus, buttons, check boxes, radio buttons, list boxes etc, thus making it easy to use by the hospital staff. Entry of text is minimized and data can be selected from lists wherever possible. The proposed system generates a large number of standard analytical and statistical reports in the various modules and also in the MIS module for use by senior management. These reports are completely downloadable to Microsoft office and merged and consolidated as required.
www.ehealthonline.org
CareDynamixTM is an enterprise-wide resource planning software and it will be the backbone of all the clinically sensitive transactions in the hospital. It is very important to have a high level of security to protect the data. Product Components: CareDynamixTM Gold / Premium; CareDynamixTM Diabetic; CareDynamixTM Polyclinic CareDynamixTM Dental; CareDynamixTM Medical College; CareDynamixTM Psychiatry CareDynamixTM IVF; CareDynamixTM Skin; CareDynamixTM ed; Technical Specs/Requirements: (i) Hardware Requirements: Server Minimum Configuration - PIV, 3 GHz, 40 GB HDD, 512 MB RAM. Recommended Configuration - PIV, 3 GHz, Two 80 GB HDD, 1 GB RAM. Tentative No. : 2 in No. Main and Mirror server Client Minimum Configuration: PIII, 1.3 GHz, 128 MB RAM Recommended Configuration: PIV, 2 GHz, 512 MB RAM. Tentative No.: 40 - 60 in No. (ii) Software Requirement: Server Minimum Configuration: Windows 2000/2003 Server with Service Pack 4.0, SQL Server 2000/2003 Server, MS Office 2003, Crystal Report Distribution Wizard; Tentative no.:- 1 Enterprise Edition of the license
Client Minimum Configuration: Windows 2000 Professional with Service Pack 4.0 or Windows XP Professional with service pack 2.0, SQL Server 2000/2003 Client, MS Office 2003. Crystal Report Distribution & Wizard Major Clients/Installations: Vrundavan Hospital, Goa; M V Diabetes Hospital, Chennai; Dayanand Sagar Dental College& Hospital, Bangalore; Kashibai Navale General Hospital & College, Pune; Jalan Diabetes, Pune; Inlaks & Budrani Hospital, Pune; Medipoint Hospital, Pune. Hardikar Hospital, Pune; Adarsh Hospital, Valsad; Balaji Hospital, Baroda, Sinhgad Hospital, Pune Contact Details: Mr. Swapnil Joshi Lead – Business Development +91-9225505762 Mr. Harish Soni Corporate Account Associate +91- 9960640601 Mr. Avinash Ingale Corporate Account Associate +91 9881154254
SOFTLINK INTERNATIONAL Product Name: PANACEA (Hospital Information System) Year of Release: 2003 Product Features: The PANACEA system is a fully integrated, single-solution information system designed for large and medium size hospitals. It has an integrated yet scalable modular system with client-server architecture, HL7 compliance, seamless integration with RIS and PACS and fool-proof security system. It has a robust round the clock system with a user friendly and GUI based system. Product Components: HIS Core Modules - Administrative Services, Billing and Receipts System, Patient Care OT Module, Laboratory Information System Back Office Modules - Stores and Material Management, Pharmacy, HRMS, Financial Accounting Module Supplementary Modules – CSSD, Biomedical Engineering & Maintenance, Marketing Module, Executive Information System, Master Health Checkup, Web Enabled Services Security & Configuration Module, User Access Control, Managing Users and User Groups System Configuration, Backup and Restore Technical Specs: Developed on Windows Platform, Client-Server Architecture, Supports RDBMS like SQL, Oracle.
December 2007
Major Clients/Installations: BALCO General Hospital, Korba; The Bangalore Hospital, Bangalore; SPANDAN Heart Centre, Nagpur; VIVUS Heart Centre, Bangalore; HERITAGE Hospital, Varanasi; S.M.R.C., Goa; Vivus Hospital, Mercara; Orange City Hospital, Nagpur; Tabba Heart Institute, Karachi, Pakistan Price Range(min, max): The Pricing for Panacea depends on varies factors like modules opted for, number of client access licenses, level of customization etc. It also depends on the variant of the HIS. PANCAEA Lite – a basic HIS solution with core modules like IPD/OPD Registration, Billing, Ward Management, Discharge etc. Price without customization is in the range of INR 7.5Lacs-10Lacs PANACEA HIS – This in addition to HIS core modules, has all other Backoffice functions such as Stores, Pharmacy, HRMS, Finance, Marketing etc. Price for this version starts from INR 12.5L and goes up depending upon the exact configuration. Contact Details: Rakesh Budhe - Regional Manager, SoftLink International Pvt. Ltd. 2, Anand Park, Aundh, Pune – 411 007 Tel: +91 20 6604 4444 (Ext. No. 615) Cell: +91 99230 02684 Email: rakesh@softlinkinternational.com sales@softlinkinternational.com Web: www.softlinkinternational.com
11
COVER STORY
>
HIS VENDOR SURVEY 2007
SOBHA RENAISSANCE IT PVT. LTD. Product Name: RCare Magnum 3.0 Year of Release : 2006 Product Feature: RCare Magnum is built on the latest of technologies, using .Net for the presentation layer and J2EE for the Business layer. Both the technologies are at the beginning of their life cycle. Currently the product uses .Net Ver 2.0. Efforts are on to migrate to .Net Ver 3.0. The entire system is integrated and resides on a single database. It also has the ability to integrate with other vendor products, databases, operating system, networks and application, and is HL7 compatible. It provides total portability due to its ability to move applications and data across platforms. RCare Magnum has inbuilt Workflow engine, Report designer, Forms Designer, Customization Tool, Define Views tool and other tools for customisation requirements. In addition, an integrated Rules Engine is getting added to RCare Magnum. RCare Magnum is developed in close proximity to International IT and Healthcare Informatics Standards, like ICD-9/10,CPT4, SNOMED, HL7, TCP/IP etc. The modular form of system has the flexibility to add modules as and when required. Every view and document data can be easily exported to XML, HTML, XLS and CSV formats. Also, there are ‘copy from’ and ‘import from’ features available within the system. The system has sufficient intelligence for detecting corrupt data or inconsistent data. All error messages are human readable and does not throw up archaic messages. Based on these messages and the log files, issue logging and fixing is made much easier. A robust PLM (Product Lifecycle Management) in place and based on this process, monthly updates (as necessary), patches (as and when required), and quarterly/half yearly updates are being provided. There is a version upgrade once every 3 years. The system simplifies the maintenance of information by existing staff and has open access for more individuals to information and assists them in organizing and presenting information, thus reducing the need for specialized staff, maintenance overhead and rigid data and reporting structures. The system has 5 levels of security based on which information access can be given to users as per need. The system has a consistent and lucid interface that facilitates use and simplifies complex activities. Care Magnum has been developed using the best of the breed UI guidelines. The supporting documentation (on-line and paper) will be accessible by non-technical users and will facilitate the resolution of problems and the training of users. Documentation is made available as User Guides, Technical and User manuals, Videos and also FAQs via client login through SRIT website. The system is distributable through full effectiveness in a WAN environment. Programming languages used to implement the product are - C#.Net, ASP.net, JSP and JSF, Action Script for Flex and Java(EJBs). The operational features include – Ad-hoc queries, User profile driven function menus, Efficient workflow, Parameterized reporting, Free format text entry and System-wide standard user interface, Easy switching between
functions and invoking associated functions from within one, In-built ethnic language support, Access via web browser, Search facility, Alerts, Reports. Product Component: The functionality of RCare Magnum can be broadly categorized under the following suites of modules – Patient Administration Suite, Patient Care Suite, Clinical Support Suite, Material Suite, Revenue Suite. Technical Specs/Requirements: Database Configuration Operating System: Red Hat Enterprise Linux Advanced Server 3/HP UX/ Windows 2000/2003 Server Database Server: Oracle 9i (9.2.0.4.0) Enterprise Edition/ANSI SQL COMPLIANT RDBMS Minimum: 2GB RAM. 200GB Hard disk Recommended: 4 GB RAM 3*300GB Hard Disk With RAID5 configuration Processor: Dual Application Server Configuration Operating System: Microsoft Windows 2000/2003 Server with latest Service Pack - Java Runtime Environment 1.4, JIntegra for .NET (JA.NET), Oracle9i (9.2.0.4) Client Minimum: 2 GB RAM. 40GB Hard disk Recommended: 4 GB RAM 3*74GB Hard Disk With RAID5 configuration Processor: Dual Client PC Operating System: Windows XP Professional with Service Pack 2, Oracle9i Client: 9i(9.2.0.4), . NET Framework Minimum: 512MB RAM. 40GB Hard disk Recommended: 1GB RAM 80GB Hard Disk Major Clients/Installations: (Partial Client List) Jordan Armed Forces Royal Medical Services, Jordan; As-Salam International Hospital, Egypt; Welcare Hospital L.L.C Dubai; Tropicana Medical Center, Malaysia; DUBAIAL, Dubai; Shell Petroleum & Delivery Cener, Nigeria; Chulaborn Cancer Hospital, Thailand; Kasemrad Hospitals, Thailand; Aditya Birla Memorial Hospital, Pune Contact Details: Sobha Renaissance Information Technology Pvt. Ltd. SRIT House, # 113/1B, ITPL Main Road Kundalahalli, Bangalore – 560037 Tel: +91 08041951999 (Extn: 1523/1529) Email: healthcare@renaissance-it.com Web: www.renaissance-it.com
Indian healthcare IT market is expected to record a CAGR of 18% between 2006-2010 12
www.ehealthonline.org
SYSTEMS PLUS SOLUTIONS Product Name: CARMA (Hospital CARe Management) Year of Release: January 2008 Product Features: Provision to create multiple Divisions/ Strategic Business Units; Division based customization of parameters related to Patient, Stores, and Financial Accounting; Integration of Financial Accounting with HMS; Unique Patient Id; Electronic Medical Records can be viewed and Updated via PDA; Incorporates General, Corporate, TPA, Indigent and Weaker Section types of Patients; Provision to create Packages for In patients; Feature to upgrade and downgrade Patients Financial Class; Provides One-stop Global Request Screen to address all requests for Patients and manage nursing Station; Provides different parameter types such as Templates in case of Pathology module; Provision to specify ICD code during result entry; Addresses four different types of donors: Autologous, Voluntary, Directed, Replacement; Customizable Credit policy for Blood Donors; Covers Patient and Departmental Indent/Issue/Return cycle flow; Covers Purchase cycle flow including Import Purchase Orders; Dietary Services Management: Web based application; Provision to create multiple Divisions/ Strategic Business Units; Division based customization of parameters related to Patient, Stores, and Financial Accounting; Integration of Financial Accounting with HMS; Unique Patient Id; Electronic Medical Records can be viewed and Updated via PDA; Incorporates General, Corporate, TPA, Indigent and Weaker Section types of Patients; Provision to create Packages for In patients; Feature to upgrade and downgrade Patients Financial Class; Provides Onestop Global Request Screen to address all requests for Patients and manage nursing Station; Provides different parameter types such as Templates in case of Pathology module; Provision to specify ICD code during result entry; Addresses four different types of donors: Autologous, Voluntary, Directed, Replacement; Customizable Credit policy for Blood Donors; Covers Patient and Departmental Indent/Issue/Return cycle flow; Covers Purchase cycle flow including Import Purchase Orders; Dietary Services Management: Web based application. Product Components/Modules: (i) Patient Care Management - Out and IN-Patient Management; Operation Theatre Management.; Appointment; Electronic Medical Records; Doctor Accounting
(ii)
Investigations: Pathology – Biochemistry, Hematology, Clinical pathology, Radio-Immuno Assay, Histopathology, Microbiology; Radiology – X-ray, CT, Ultra Sonography, MRI, Densitometry; Nuclear Medicine; Blood Bank (iii) Stores Management - Materials Management; Surgical Stores Management.; Pharmacy; Chemist shop (iv) Specialized Services Management - Food Management; Dietary Services Management; (v) General Administration - Security Management; Application Administration Management. (vi) Financial Accounting - Core Financial Accounting; Integrated with HMS (vii) MIS - For all above modules and Option of Data warehousing and Data mining available. Technical Specs/Requirements: MS SQL Server 2000/2005 & .Net Framework 1.1 and above. Major Clients/Installations: Lilavati Hospital and Research Centre, Mumbai Price Range(min, max): Starting INR 5 lacs and above Contact Details: Mr. Parag Joshi - Principal Consultant Systems Plus Solutions Hiranandani House, Saraswat Lane, Off Linking Road, Santacruz West, Mumbai: 400 054 (M): 09819477110. (T): +91 22 2660 8201-4 (F): +91 22 2660 2706 Web: www.systems-plus.com
TRAKHEALTH Product Name: TrakCare Year of Release: Product Features: TrakCare is a Web-based, patient-centric healthcare information system. It is comprised of a comprehensive portfolio of application modules, including patient administration, clinicals, departmental, and community solutions. At the heart of TrakCare sits the electronic Patient Record (ePR), which captures the continuum of clinical and administrative information about a patient, and the Patient Master Index (PMI). The PMI can be run as a standalone product within a hospital or may be part of a larger state or national
December 2007
system. TrakCare apart from other hospital information systems (HIS) is its unique design, advanced underlying technologies, and “FastTrak to ePR” architecture and methodologies. This combination ensures that TrakCare offers unparalleled flexibility and speed-to-results, with rich ePR benefits available from the very first TrakCare module implemented. TrakCare can effortlessly encompass ePR information from a variety of systems, including legacy systems and non-TrakHealth systems. TrakCare is uniquely built on a powerful integration platform rather than on a traditional. TrakCare is uniquely built on a powerful integration platform rather than on a traditional rigid database and the fixed technologies of the past. As a result, TrakCare modules easily and seamlessly connect to a broad array of patient information
13
COVER STORY
>
HIS VENDOR SURVEY 2007
from across departments, institutions, regions, nations, and the world rigid database and the fixed technologies of the past. The Workflow Manager tool facilitates business process flow in an automatic way and the built-in Layout Editor allows users to configure all screens to suit not only the function being performed, but also the unique needs of individuals and groups performing those functions. Product Components/Modules: TrakCare is based upon the core software components supporting the Electronic Patient Record and the Patient Master Index. In addition, TrakCare provides application functionality to support the needs of the healthcare information system across clinical, administrative, and departmental requirements. TrakCare Core Components: Electronic Patient Record (ePR), Patient Master Index (PMI), Application Integration Platform, Healthcare Application TrakCare Clinicals (CIS): Foundation, Nurses Workbench, Clinicians Workbench, Prescribing, Pharmacy Workbench, Radiology/Departmental Workbench, Active Decision Support TrakCare Patient Administration System (PAS): Inpatients, Outpatients, Medical Record Tracking & Coding, Maternity, OT Management, Patient Billing, Waiting List/Recall TrakCare Community Management
TrakCare Emergrncy Management TrakCare Laboratory (LAB) Major Clients/Installations: India - Escorts Heart Institute & Research Centre, Delhi; Sir Ganga Ram Hospital, Delhi; Fortis HealthCare; Manipal Group of Hospitals International - Trak has more than 200 installations world-wide, in hospitals ranging in size from small clinics through super-specialty hospitals, to being the backbone for regional/state-wide healthcare roll outs. For some case studies please go to http://www.trakhealth.com/casestudies/index.html Price Range (min, max): Actual price will depend on - modules purchased, number of licenses purchased, implementation time/complexity, outright purchase of licenses or annuity model. Contact Details: Anantharaman S Iyer Regional Director (India) TrakHealth Pty. Ltd. Mob: +91 98182 879671 Email: anand.iyer@trakhealth.com Web: www.trakhealth.com
WIPRO HEALTH CARE IT Product Name: Wipro HIS Main and Wipro HIS Lite - Wipro HIS Main is targeted at large public and private sector hospitals and HIS Lite is targeted at mid sized hospitals Year of Release: Wipro HIS Main in 2002 & Wipro HIS Lite in 2007 Product Features: Complete integration of all departments of the hospital including clinical, administrative and supply chain functions of the hospital. Electronic patient folder, clinical data repository, barcode and RFID interface, telemedicine and tele-radiology , transfusion medicine are some of the additional modules which our software offers. Additionally, it has very smart business intelligence and reporting engine as well as a very scalable alert engine Product Components: The product is modular is nature. It is a complete integrated software and runs on a both centralized and decentralized mode and offers patient data and clinical records across multiple locations. Technical Specs/Requirements: It is developed on the latest Microsoft platform
Major Clients/Installations: Wockhardt Group, AMRI-Kolkata, Indraprastha ApolloDelhi, Lotus Hospital-Hyderabad, Rainbow HospitalHyderabad, Apollo Gleneagles-Kolkata, Putra Hospital-Malaysia, Hamadi Hospital-Saudi Arabia, Criticare Hospital-Mumbai, Agadi HospitalBangalore Price Range(min, max): HIS Main is in the price bracket of 35-45 lacs. HIS Lite is in the price bracket of 5-8 lacs Contact Details: Wipro Health Care IT Ltd 6th Floor, Laxmi Building, S P Road, Begumpet, Secunderabad- 500003, AP Tel: 040-39187929 Nagesh Upadhyay Nagesh.upadhyay@wipro.com (Mob: +91-9848035863) Sarbari Ghosh Sarbari.ghosh@wipro.com (Mob: +91-9845690644)
Disclaimer: eHealth does not take the responsibility of validating the accuracy and authenticity of information and data as published in this survey. All details provided herein have been sourced directly from each of the participating vendors. Inconsistency, if any, in the quality of data and level of detail for different vendors is unintentional and depends on the feedback received from company sources. Absence of some vendors in this survey is either due to ‘no response’ till the date of publication or their preference for not participating in this exercise. However, we sincerely apologise to those, if any at all, whom we might not know and failed to invite participation. Such vendors are encouraged to get in touch with us for future engagements. All enquiries relating to product and/or sales should be made directly to the vendors themselves, by referring to contact details as provided. eHealth will not entertain business enquiries on behalf of any vendor or their product.
14
www.ehealthonline.org
>
EXPERT CORNER
Innovation in ICT Adoption for Health System - minimising risk and investment Dr. N K Singh, Dr. Ram Kumar, David Yonzan & Dr. Prajeesh, DIHE-A Sobha company
T
he current approach to health care process automation has been predominantly based on a sectoral / enterprise perspective. Each enterprise is limited to one hospital and its own appendages, typically under the governance of a single organizational entity such as a hospital or a clinic or a diagnostic lab. The interoperability, re-configurability, upgradeability and affordability in automating their collaboration with other entities has been so grossly underestimated as a linear extension of their current processes, that such agencies are reeling under heavy spends to understand and keep pace with an ever changing landscape of technologies and products. Piece-meal, monolithic software solutions customized to only their current needs pose interfacing problems when the systems have to scale up and adapt readily to address newer health care delivery models and services. Not only the governance of health systems differ in various demographics / states / countries, even within chosen governance unit, from a health system view point, there are only a few enterprises that host everything; from labs to operation theaters, pharmacy to transcriptions to insurance agents and lawyers within its campus. The majority are smaller enterprises that provide sub-specialties such as diagnostic labs, pharmacies, primary care centers, etc that cannot afford significant investments in IT infrastructure and are very willing to collaborate with other sub-specialties to provide comprehensive care to the citizen. From a payer’s perspective it is even worse, since the inefficiency in the whole system adds up in the bills either directly or indirectly, and that has to be reimbursed to keep the system going. From a patient’s perspective, the system often looks more like a spaghetti of Silos in processes, entities, functions, faculty, products, standards, codes, practices, policies, etc, through which they have to pass in order to address their health problem. While the IT champions are proposing ubiquity, mobility, countrywide networks, citizen centric services, integrated disease surveillance, proactive care, etc, one does not see a single solution that addresses the payer, provider and consumer points of view together. Digital Integrated Health Exchange (DIHE) considers care from a patient centric infrastructure extending across providers, payers and beneficiaries, collaborating electronically under strict medical, commercial and legal protocols in diverse settings. DIHE enables shielding away unnecessary clutter of information from the patient into separable, inter-operable, non-redundant modular units 16
that can get reused and integrated in different ways and run concurrently to cater to the needs of various health care programs. This enables aggregation and distribution of resources, knowledge, skill and consumers to help amortize the cost over a larger population while improving access to care. However, there is significant legacy automation already lying inside individual entities which is hard to replace given the investments that are already made by the providers. And yet, there are geographies where hardly any automation has happened; which will provide a leap frog opportunity for sustainable adoption of ICT in the new paradigm. DIHE aims to interface legacy systems onto a standards based platform, brining them to a homogenous interaction pattern so that they can collaborate beyond their own campuses with other entities, faculty and patients. The underlying problem in current health automation systems is very much due to the approach being employed of developing monolithic solutions separately for each problem, with limited flexibility to alter / scale the system rapidly commensurate with advances in knowledge, best practices and technology. Nature, on the other hand, has shown a different path in designing of very complex organisms such as ourselves; by employing a Fractal based approach. We see a hierarchical organization, wherein some basic components (such as the cells) which are replicated to form groups (tissues) which are then replicated and grouped to form organs, which together form a whole living organism. This process repeats as higher organizations are built, in a “Fractal” pattern of replication, grouping, connecting in different patterns and orchestration of different workflows between them, to produce seemingly very different functionalities from the same building blocks, un-folding a whole new organism from the same elementary blocks. The integrated health care exchange (DIHE) adopts such an approach in constructing diverse health care programs out of common building blocks. While in many other industry segments, the process of setting up “factories” to manufacture different products of a certain “class” by applying model based design and automated production, is an accepted process (such as in manufacturing cars, drugs or electronic chips), the concept is still in infancy when it comes to establishing “software factories” for health care segment that can manufacture different application from basic components. In the health segment today, most of software industry is busy employing scores of s/w programmers in building monolithic solutions for each www.ehealthonline.org
problem, just like what it would be in developing a formula and manufacturing specific medicine separately for each patient!. The approach should be to visualize the underlying commonalities and aggregate them into functional blocks and then produce the heterogeneities through combination of such functional blocks. The question therefore is how do we break down a health system into its fundamental components and reassemble them rapidly in different ways to address the diverse needs of the market with minimal investment? A very important first step is to first unwind the current spaghetti into interdependent layers focusing on discrete aspects of health system, with each layer consisting of a stack of reusable automation components. Following a “fractal” approach, a discrete workflow implemented at a given layer itself becomes a component for the layer that consumes its service. Following a “Service Oriented Architecture” model, each component provides specific “Services” according to a published set of SLAs using specific protocols, to other components. By dissecting the inherent hierarchy in composition of a health care program, it will become easy to address challenges and design issues at each layer independently to a large extent and allows the modeling and simulation to be done at each layer without having to dwelling into functionalities of the layers beneath.
feasible yet, optimal manner, while plans for scaling need to be inbuilt. This necessarily will have to be “managed” under an existing, plus future roadmap and hence a “hybrid” mode of adoption needs to be implemented. While acknowledging the certain – uncertainty leaves room for dynamic adoption, planning and scaling under an optimal shared costing model. Software landscape
Software engineering evolved from building basic automation application packages to Enterprise wide Life Cycle Products. Today in the post internet world, software applications are a conglomerate of various “open source and non open source technology frameworks”. The Health Care system today, in any part of the world is grappling with the word “integrated” and struggling to come out of “legacies”. With no software intensive resources within its faculty, the adoption path of software’s needed to be planned in a way which is primarily need driven and flexible. While Health IT standards like HL7 v 3.0, and DICOM 3.0 are intersecting and coming together as IHE to enable seamless flow of care data, the current stage is full of turbulence. The PPP model therefore provides for dynamic capacity, capabilities, educative adoption of software, implementation and above all, meaningful assimilation. Biomedical devices landscape
THE RAPIDLY EVOLVING TECHNOLOGY LANDSCAPE Hardware landscape
As with any IT intensive program, Health Information and Communication Technology programs consumes a lot of (proprietary) hardware devices, like servers, desktops etc. Given the fact that none of the hardwares are specifically built for the Health Care system; they have their own “constraints” around their usage. The total cost associated with ownership of such “general purpose” computing platforms is hardly reflected in its MRP, which is the only vector visible to the owner. The ownership costs is intimately linked with the users own ability to do preventive and long term technical servicing and maintenance. Optimizing “purpose” with platform, is in itself a complicated exercise because there is no common bridge between the knowledge of hardware intelligence and clinical services. The cost optimization model under the long term sustenance plan will fill in this gap by bringing in, “buy as you need”, and “integrate as you scale” health services.
The wonder days of “standalone” clinical devices is giving rapid way to the connected devices paradigm. More and more clinical devices are being connected to a network of computing platforms and access from distant locations reliably. Not only the costs associated is exorbitant when Bio Medical interfaces are rigidly tied to a network or a computing platform, but its economic usage is also limited. The emerging group of connected devices provides the ability to have its cost amortized over a large user group population and enables cost of Health Care services to decrease. In conclusion, DIHE believes that in the “personalization of care” and “management of disease & wellness”, the ability to “rapidly reconfigure” the value driven integration of these diverse knowledge pieces will help optimize cost and therefore maximize bottom line for all “collaborating stakeholders”. This “transparent interdependence” on “shared value drivers” will ultimately drive long term sustainability of health system ICT adoption and transformation programs of the “appropriate kind” across societies struggling with more solutions than problems!
Network landscape
The evolution of network from Local Area Networks (LAN) to Wide Area Network (WAN) to State Wide Area Network (SWAN) to Global Networks is not a linear adoption of technology. While standards in the broadband fire optic continue to penetrate deeper into societies ,the broadband wireless standards like WIMAX is rapidly settling down as a convenient method of building reliable networks, not to mention the G3 and the G4. In this dynamic landscape, the cost amortization plan needs to be carefully worked out in a December 2007
Dr. N K Singh Head of e-Health business DIHE
Dr. P.S. Ramkumar Executive Director DIHE
17
>
NEWS REVIEW
INDIA
First health institute in Nagaland inaugurated The first health institute to be set up in the North-eastern state of India, Christian Institute of Health Sciences & Research (CISHR) is a collaboration between the Christian Medical College, Vellore and the Emmanuel Hospital Association, in Nagaland. The hospital it is hoped, would soon be upgraded to a 300-bedded one in the near future making it eligible for the status of a medical college. Governor, K. Sankaranarayanan congratulated the government and the people at the inaugural and said the institution would provide both opportunities and challenges. He also called upon the institute
to promote community health care, rural hygiene and educate people in order to prevent the menace of HIV/ AIDS in the state. The project for a 500-bedded referral hospital was sanctioned by the government of India in 1985, for which the work commenced in 1989; the project could not be completed because of various reasons, including cost escalation. However now the people of Nagaland can look forward to various other up-coming projects including a nursing college, a medical college and a school for the children in future.
MedRC provides e-Learning opportunities in health sciences
Cisco to network with hospitals for healthcare solutions
An e-Learning program for health science graduate and post graduate aspirants has been launched at the Dr. NTR University of Health Sciences Digital Library at Vijayawada. NTRUHS provides various courses in Health Sciences to more than 60,000 students through its 300 affiliated colleges. The Medical Education Research Centre for Education technologies (MEdRC EduTech) is converting the entire MBBS curriculum (as prescribed by the MCI) into a series of over 7500 multimedia enhanced digital lectures. The lectures are delivered by Professors who are invited from various medical colleges across India, captured on video and subsequently enhanced by a team of doctors and multimedia professionals by adding multimedia elements in the form of slides, graphics, illustrations, 2D and 3D animation, etc. In addition MEdRC is developing e-Learning courses for Pharmacy, Dental, Nursing, Paramedical, Hospital Staff Training, and for Village Health Workers in various Indian languages. MEdRC also captures and delivers modules for Continuing Medical Education through tie ups with various medical teaching organizations.
Cisco Systems, the networking multinational, is reportedly in talks with companies such as Reliance, Apollo Hospitals and Wockhardt to roll out their healthcare networking solutions in the form of Medical Grade Networks (MGN) to these hospital chains. Cisco’s Internet Business Solution Group, a global consultancy team inside the company had started its India operations about six months back, and aims to provide customised solutions to such hospitals, that are already on the path to major expansion spree planning to expand the number of speciality and superspeciality hospitals three-to five fold in the coming years. This would mean that the Indian hospital industry is in for a major consolidation, which is good news for companies such as Cisco. Through an MGN, doctors and
Needle-free insulin in India soon India, predicted to become the diabetes capital of the world, is home to around 40 million diabetic patients and the number is growing significantly every year. Biotechnology company Shreya Lifesciences has entered into an in-licensing agreement with US-based Generex Biotechnology Corp to market Oral-lyn, the country’s first needle-free insulin. The new version is delivered into the mouth using Generex’s proprietary device branded RapidMist. It has been emphasised that Oral-lyn is not a new drug, but only a new delivery form. Generex Biotechnology recently got the government’s approval to import and register the drug in India. Since insulin is a drug under government price control, the company, it is said would seek a price approval from the national pharmaceutical pricing authority (NPPA). Imported drugs are given up to 35% margin to cover post manufacturing expenses, while locally made ones get 100%. Shreya Lifesciences is expected to launch the drug in a couple of months after meeting regulatory requirements. The price of the drug is expected to be much higher compared to the injectable version. The market size of insulin in the country, now available in the form of injectables and cartridges, is around INR 300 crore. Novo Nordisk, Eli Lilly, Wockhardt, Biocon and Shreya Lifesciences dominate the market.
18
specialists can keep track of their patients on their wireless PDA. Nurses can keep an eye on instruments connected to patients and networks, and insurance companies can track payments. The technology can also enable patients remotely contact their hospitals and send test reports or samples. However, cost remains an issue, which would mean the technology, when rolled out, would be available only in cities and large hospitals. According to Cisco’s internal estimates India’s healthcare delivery market is worth USD 55 billion, and is currently just around 5 per cent of India’s GDP, far behind the spend in developed economies. A further reason for the interest in MGNs is the increase in patients coming into India for medical tourism.
Cellworks Group Inc. forays into India through R&D centre in Bangalore Cellworks Group Inc, a California based company, has set up its R&D centre in Bangalore, India. Cellworks Research India Limited (CRIL), the R&D centre, would develop and provide technology based solutions that hasten drug discovery research and development. The new facility is STPI approved and has the necessary infrastructure to house 110 scientists. It intends to focus on innovative approach that enables new paradigm in drug discovery. Research focus would be in the areas of oncology, inflammation, metabolic disorders, CNS and Skin. This research based on the Systems Biology approach involves development of in silico platforms of disease physiology at the metabolic and bio-chemical pathway level. This approach enables drug discovery teams to use these platforms as a virtual experimental system. Thus the drug discovery teams would have the benefit of using the in silico system in conjunction with currently used in vitro and in vivo techniques.
www.ehealthonline.org
AHS on the way to expansion, to offload 15% of equity
India’s Manipal AcuNova acquires German firm Ecron
Apollo Health Street (AHS), the healthcare business process outsourcing subsidiary of Apollo Group that runs India’s largest hospital chain, plans to raise USD 70 million from the capital market by offloading 15 per cent of its equity. The Hyderabadbased company has been valued at nearly USD 470 million. AHS is also looking to get outsourcing contracts worth several millions of dollars from private equity player Apax Partners, which runs 45 hospitals in Europe. Apax Partners had earlier picked 11% stake in parent company Apollo Hospital Enterprises for USD 100 million. The company wants to reportedly pay off 50% of its
Clinical research firm Manipal AcuNova Ltd recently announced it has completed the acquisition of ECRON GmbH, Europe. The new entity ECRON AcuNova will provide end-to-end services for Phase I - IV clinical trials including project management, clinical data management, biostatistics, medical writing, central lab and bioavailability/bio equivalence (BA/BE) studies to pharma, biotech, device and diagnostic companies. The combined strength of the new venture will be 265 employees and the company will increase headcount every year. Frankfurt will be the European HQ, Princeton for the US and Bangalore for Asia.
debt through the money raised from the capital market by early next year. They are looking at inorganic growth and the financial backlog might hinder the growth. AHS had recently acquired US-based BPO Zavata for USD 170 million. It had raised USD 120 million as debt to part finance the acquisition. Post acquisition, AHS will have a turnover of around USD 100 million. It will come out with its Initial Public Offer in the first quarter of 2008. In a bid to further expand, AHS is also looking at tapping the European market. They are also looking at doing the back office work for Apax Partners, which runs around 40-45 hospitals.
Wockhardt plans 14 new hospitals; to invest up to INR 600 cr Mumbai-based Wockhardt Hospitals is planning to set up 14 super-speciality hospitals across the country over the next two years, which could entail an investment of up to INR 600 crore. They intend to almost double their hospitals by 2009 and add more than 1,000 beds to the current 1,100 beds. They’re also planning to fund the expansion through the proceeds of its proposed Initial Public Offering (IPO). The company is also focusing on tier II and tier III cities such as Goa, Bhopal, Nagpur among others for expansion besides metros like Delhi. Wockhardt Hospitals Ltd has already filed its Draft Red Herring Prospectus (DRHP) with SEBI for its IPO. The company is issuing 30,000,000 equity shares of INR 10 each through a book building process, which will constitute 28.77 per cent of the post issue paid-up capital of the company.
CII launches ‘Experience Indian Healthcare’ initiative Medical value travel, more popularly termed ‘Medical Tourism’, was discussed at lenght as the next big window of opportunity at a recent conference organized by the Confederation of Indian Industries (CII) in association with Indian Healthcare Federation(IHCF) from the 13th - 14th November 07 in New Delhi. At the conference was released a new campaign ‘Experience Indian Healthcare,’ geared toward facilitating India to compete in the global heathcare market. Union Ministers Smt. Ambika Soni, of Ministry of Tourism and Sh. Anbumani Ramadoss, of Ministry of Health & Family Welfare expressed their support to the initiative at the conference. India’s medical tourism business is growing at 30% per year and is forecast to generate at least USD 2.2 billion (INR 8700 crore) a year by 2012, according to a department of tourism estimate in India.
December 2007
GE Health’s new mantra:‘In India, for India’ GE Healthcare’s Indian arm, a joint venture between Wipro Ltd and General Electric Co., is planning to make a range of high-end technology products locally with support from its Japan unit, reducing the costs by about 40 percent, helping rural India market. Its development centre in Bangalore has been working on digital X-rays and computed tomography devices. These, and other products including portable ultrasounds, maternal-infant care and medical equipment components are also under development; most of them targeted at rural dwellers. GE hopes to use the core technology and build around it so as to drastically reduce cost. This could mean fabricating or sourcing a lot of the components locally. This is especially relevant keeping in mind that the statistics reveal a gaping urban-rural divide in health-care access with resources highly skewed towards urban India. About 88% of towns have a health-care facility, compared with 24% in rural areas, 90% of which are manned by sole practitioners. Only 20% of the country’s total hospital beds are in rural areas, serving 70% of the population. A person in a village needs to travel more than 2km to reach the first health post to get a paracetamol tablet, more than 6km for a blood test and nearly 20km for hospital care.
Five big hospitals to come up in Health City, Visakhapatnam Plots have been allotted to four big hospital groups including Apollo and CARE in the Health City project coming up at Adarshnagar in Visakhapatnam. Aimed at making Visakhapatnam a hub for medical tourism for NRIs, the Health City with world-class facilities is expected to attract massive investment. The Visakhapatnam Institute of Medical Sciences (VIMS), a superspecialty hospital promoted by the Andhra Pradesh state government, is also part of the Health City project. It will have facilities like resorts, leisure tourism, and helipad on an area of 100 acres. Of 65 acres earmarked for allotment to private groups adjoining VIMS, the Andhra Pradesh Industrial Infrastructure Corporation has as of now allotted 10 acres to Apollo, five acres to Indian Institute of Cancer and Research, and two acres to Rockdale Hospital for Women and Children. These projects will involve an investment of INR 370 crore. The plots are sold at the rate of INR 3 crore per acre.
19
TELEMEDICINE
‘Space’ For Telemedicine As the health care system continues to change and adapt to the new realities associated with finance and management restructuring, the technological side of patient care also has changed. Telemedicine is the new buzz word in the constantly changing vocabulary of the health care system the world over. Dolly Ahuja, eHEALTH SPACE TELEMEDICINE
Space Telemedicine Network specializes in the areas of clientserver, component bases models, web enabled applications and object oriented technologies. It links multiple hospitals with videoconferencing, telepathology and teleradiology facilities, to enable multidisciplinary diagnosis to be carried out with greater equality of access and to save traveling time for patients. Their objective is also to network rural, semi urban hospitals to provide specialist care and tertiary health care, enable low cost, 24x7x365 health care through telemedicine. Space has already networked with 57 leading hospitals in India, with seven in Tamil Nadu. And now intends on bringing more mobile V-Sats to service the under-served.
A ‘hub’ where the specialists from various areas of medicine are available works round the clock in a typical 24 x 7 model. Thus participating hospitals need not worry about the time of receiving the patients since help is always available. All the telemedicine equipment are installed by the company itself, therefore, the participating hospitals/nursing homes incur no extra cost.
http://www.spacehospitals.com/services/services.htm
> >
CHALLENGES
According to an NCAER study, 620 million people live in rural India and the bed-population ratio is today at 1:1333 as against an ideal of 1:500. Also, as against a two million hospital bed requirement, the availability is just 0.7 million. The following are some of the criteria for success of telemedicine in Indian conditions according to Space: • It should benefit a larger community; especially the under-served • Medical data transfer be error-free and reliable • Medial technology should be user-friendly • There should be a complete system in place • There should be proper storage and retrieval system for the medical data • The medico-legal provisions should be thoroughly thought through • Its economic sustainability should be looked into from the beginning • Maintenance aspects are important but often neglected at the planning stage. This can lead early death of the project after birth
CUSTOMISED TURNKEY SOLUTIONS
Space would depute its own technical staff for the operation of the telemedicine equipment in the participating hospitals, and the specialists in the hub interact with doctors of the participating hospitals directly, thus substantially reducing the medico-legal risks, in case of a difficult situation. Hospital staff too would be trained by Space for using the telemedicine equipment and familiarizing with the connectivity procedures with the central hub for a nominal fee. The connectivity would be as simple as making a phone call. The hub would be situated in the heart of the city enabling easy access for the specialists. The hub would have top of the class connectivity infrastructure for video conferencing, image transmission etc.
BUSINESS MODEL SYSTEM ARCHITECTURE
The business model envisaged would neither fleece the end patient nor be fully charitable, thus maintaining the quality of healthcare. 20
Server End Operation: The central server stores all information like patient records, images and waveforms, electronically www.ehealthonline.org
Software Specifications Software (Remote end)
• • • • • • • • •
Supports on any Windows environment. Desktop or Laptop Plug n play of medical devices. Operates on internet explorer (IE 5 or above) browser. Supports thru RS232, USB, SCSI, Parallel, PCMCIA, Firewire, Infrared, Mic, SVHS, Video etc., Minimal downloads, installation and distribution of software upgrades. Proper Login security Integrated Video Conferencing system on international systems. Easy to use Graphic User Interface ( GUI )
in the EHR system. The server also supports multiple access of remote ends to the speciality nodes. Software plug-ins like Cardiology, Radiology, ENT etc. are all integrated into server software, depending on the requirements. Remote End Operation: Remote locations here mean small hospital & diagnostic centers. The systems here are designed to be simple and requiring low maintenance. A standard IBM compatible PC is installed with the necessary operating system (windows or equivalent) along with a browser. The medical devices and the video conferencing system are integrated into one simple system via the PC to the server software. The Dial up, ISDN or DSL connectivity is used to connect the remote systems with the centralized server. The doctor / technician at the remote center registers the patient into the system and appends all medical data pertaining to the patient to the server, which gets stored in the central server and through the Space Hospitals streamer, the same data is available for browsing / viewing by a specialist instantaneously. Specialist End Operation: The specialist terminal, is an IBM compatible PC with a simple (Windows or equivalent OS software.) The medical data from the remote locations online or stored on the server is available to only specialists who have a secured login and password access. When a new patient is referred from remote to a specialist, alerts in the form of SMS, e mail or paging can be sent. Once the specialist logs in, a user-friendly scheduler tells of the pending cases. The specialist can then call upon the relevant records in the form of waveforms or images and type in his/her observations. The referring doctor can access the specialist observations via the server.
UNIQUE FEATURES
Video Conferencing System: Generally a super specialty hospital would use a stand-alone box which has high quality but requires good bandwidth and includes camera, December 2007
microphone etc., and the remote nodes would use PC add on card, which uses the PC technology and software. The standards that are used in video conferencing systems are ITU, H.320/. 323. The frame rate has to be anything between 15/30 frames per second. Reporting: The report format is standardized and can be customized based on the inputs from the customer and will contain all the details pertaining to the EHR, like patient demographics, review of system, symptoms, treatment plan, medication etc. The system is provided with a complete administration module with which the system administrator of the telemedicine network can perform certain tasks such as add new specialists to the network, or new remote nodes, schedule consultations, or edit/modify/delete nodes specialists, appointments etc.
“The initiative by Space Telemedicine to launch 600 mobile V-Sat units, to connect the smallest towns with major super speciality hospitals across India is waiting for funds anticipated to be available by March 2008. The western world is quite willing to invest in Indian telemedicine; in fact we hope to rope in a few associates shortly. So far there has been no Government contribution, but we are trying to get entries into Government CSC programmes. We have also successfully completed pilot projects of ONGC, Bombay and SAIL, Calcutta, and are now waiting for their orders, anticipated by February 2008.” Ganesan Annaswamy, Executive Director, Space Telemedicine
Security: This is the fundamental requirement for telemedicine applications. Security strategies, designed to protect the privacy, authenticate, authorize, and maintain integrity. These are necessary to protect against the threats of manipulation, impersonation and unauthorized access to health care information of individuals. A username and ID is given to the doctors in the remote node and the specialists in the network. Security elements include storage security, network security, data encryption, audit trails etc. Networks should be reliable and secured to ensure user confidence, system and data integrity, and robust system operation. Alerts: The specialist can be alerted through SMS or e-mail the moment a patient is referred. A message can also be sent to him/her when the ECG is being streamed so that the specialist can go online to see the ECG of the patient in Real time. Dolly Ahuja eHEALTH , dolly@ehealthonline.org 21
> >
IN CONVERSATION
The challenge is to create an architecture that allows seamless information ow What has been your vision and approach in building up the IT strategy of Fortis? The healthcare industry requires standardisation of data, system and protocol to happen soon so that information can be carried and exchanged.
For a start, at Fortis, we want to create a centralized system which will take care of patient management, billing and clinical processes. We are hoping to achieve our target by the end of 2008. It has to be a cost effective MIS system, where the Head Office should have all the data. The system should also allow us to scale up. For instance, Chennai Malar already has a system running. It would be great if it can be aligned with our existing system. Here again comes the need for standardisation, where we need the same parameters for feeding information, for example, surgery names. Even the slightest deviation in following standard disease names can lead to different diagnosis and hence treatment. We are currently working on developing a collaborative portal for intra-organizational requirements. It will help employees share documents, medical records, and scan records. The portal also proposes to make many Fortis processes paperless. Time spent on administrative processes can be reduced and knowledge can be captured using the portal.
Manish Gupta CIO, Fortis Healthcare
Fortis Healthcare is considered to have one of the best IT infrastructure among healthcare providers in India and is proud of being the pioneer in deploying Web-based HIS system. 22
What according to you are potential improvement areas in your existing systems and how do you plan to take the IT capacity in Fortis to the next level? Scalability matters. The challenge is to create an architecture that allows seamless information flow. The system will be truly scalable when it can adapt to the growth in the business. Another challenge is providing standard treatment across all our facilities. Apart from that, we are of the opinion that a patients records should be available to a specialist upon request so as to treat the patient with complete knowledge of their medical history. There should be portability of data and information. This model is followed by most healthcare facilities in advanced countries like www.ehealthonline.org
the US. Perhaps Storage Area Network (SAN) can be used in this regard. Small hospitals can come in hosted model. At present, there are not many hospitals on Centralized Business Network. The administrative formalities while admitting and discharging the patient and clinical care are the two dimensions of the healthcare business. When a doctor prescribes a particular drug, the system should be able to tell him if there is a problem with his prescription with regard to the characteristics of the drug and the history of the patient. Another common challenge is providing information to the patients’ relatives and friends. This information can be published online. A unique code identifies each patient and online data is updated hourly. Currently, things are distributed and isolated. They service only a limited audience. As we expand our network, our network architecture will have to be more sophisticated. One issue that we are currently addressing is having 99.9% uptime for the network. We have to have a backup for this, especially if I want to have a centralized system which is going to run all my hospitals. Therefore, I need to have an always-up, always backedup network. What are the various backend, front-end, integration platforms and technologies that are in use in Fortis? We are using Microsoft Office and Exchange applications, Sharepoint, VistA (Veterans Health Information Systems and Technology Architecture), Office Communications and TrakClinic. Earlier we used an in-house product, since January 2007, we are using a web-based medical system from Trak Health for inventory, administration, patient management and billing etc. It is yet to be used for clinical processes, in India. Currently the systems used are episode centric not patient centric. Every two months, we show our doctors the benefit of using Trak. This centralized system is hosted on intranet. Doctors can also access this system from their homes using a VPN (Virtual Private Network). Since the system is browser based, it is machine independent. Two of December 2007
telephone or videophone. This facility is available at our hospitals in Noida and Mohali. Our Jaipur facility is also interested in going there. ISRO (Indian Space Research Organization) provides infrastructure support such as VSATs, ground telemedicine setups and mobile vans.
“Regulation of standards for information exchange is most important, as it will result in a lot of saving.” our hospitals, in Jaipur and Mohali are powered by this system. We are currently working on the design for a SAP core ERP rollout of a single centralized system for all our hospitals. The new system will manage our accounting (financial, profit & loss, etc) and stocks (aspects like purchasing). The SAP system will interface with the existing Trak system. What is the practice at Fortis in terms of EMR & PACS? Currently we use EMR through Trak. The usage of PACS is not full fledged as yet. The idea is to first introduce PACS, then have a centralised system. Right now our Noida facility is using PACSlater all our hospitals will use it. We are looking at sharing it. Fortis has also ventured into Telemedicine initiative for rural areas. What is the level of success in this initiative? Currently Telemedicine is not fully focused. It is like an add-on and simple web based programme. Remote telemedicine setups are usually based in villages from where the patient and his doctor consult Fortis’ doctor over
Equitable sharing of medical, clinical and patient-specific data / information is crucial for seamless patient care. Yet there is no standard regulation on health information exchange and privacy issues. How much need is there for this in the industry? Insurance people want hospitals to share data to generate maximum revenue. Although regulation exists on paper, it is not so much in action. Then there are gaps in whatever regulation exists. As far as the industry is concerned, regulation of standards for information exchange is most important, as it will result in a lot of saving. As is the case now, day to day IT expenditure is more than a crore of rupees per year per hospital. Then there is the cost of Voice Communication also. All this is predictable recurring cost. This cost needs leveraging. We need to upgrade in quality but at lower prices. Once we have a standardised and centralised system in place 30 - 40% of the cost will be reduced. What is your opinion on Mobile and Wireless use in healthcare? There is a lot of potential in mobile and wireless technology. Windows can definitely be used for employees. Trak can be used for Doctors. It is even available on mobile today. There is SAP for backend. What is required is an application to allow pushing back data through perhaps a wristband like gadget. So the data can be passed from the patient to the nurses and the pharmacy. Bluetooth is another important tool which may be used for communication in providing healthcare. So, one way is to go directly to Trak, and the other is to use Mobile. Bar coding can be used, where the cell phone itself can identify data instead of Bar code reader. Web portal can be very helpful, provided the patients and local doctors are IT savvy. 23
>
POWER HOSPITAL This section features Hospitals & Healthcare Institutions providing top class healthcare services and infrastructure in their endeavour to provide international standards in comprehensive patient care. To have your facilities featured, write to dolly@ehealthonline.org
Escorts Heart Institute and Research Centre, New Delhi
A
leading provider of highest quality healthcare in North India, Escorts Heart Institute and Research Centre (EHIRC) has more than 30 companies in hand. Located in South Delhi, off Mathura Road, it is accessible easily by road. The hospital was founded by Late H. P. Nanda, a heart surgeon from Manhattan. After having practiced in New York for twenty years he returned home to India to establish this state-of-the-art facility offering high-technology health care solutions. Primary Care
Secondary Care
Tertiary Care
family medicine
internal medicine
cardiology
maternity and child care
general surgery
neurology
immunisation
obstetrics & gynaecology nephrology
nutrition
paediatrics
gastroenterology
ophthalmology
endocrinology
orthopaedics
neonatology
dermatology
neurosurgery
dentistry
plastic surgery
psychiatry
urology
24
In September 2005, EHIRC sold 90 per cent of its equity to Ranbaxy - backed Fortis Healthcare Limited. Escorts operates through three large hospitals in New Delhi, Faridabad and Amritsar. Together with 11 heart command centres and associate hospitals, The hospital manages nearly 900 beds. EHIRC New Delhi, has been ranked as the best cardiac hospital in India by an Outlook-Cfore survey and has been given the highest grade by CRISIL - an acknowledgement of the quality of delivered patient care. A leader in the fields of cardiac surgery, interventional cardiology and cardiac diagnostics, the Institute has introduced innovative techniques of minimally invasive and robotic surgery. The Institute’s latest addition of Cardiac Scan Centre provides a combined power of CV-MRI and Smart Score CT Scanner to diagnose coronary artery disease at very early stage. This facility is the first of its kind outside America. State-of-the-art infrastructure and equipment has made this set-up technically the largest and the best dedicated cardiac hospital in the world. The 332-bed Institute has 9 operating rooms and carries out nearly 15,000 procedures every year. The hospital offers robotic surgery procedures at very reasonable prices. www.ehealthonline.org
It is a common practice for International clients to fly in for open-heart surgery, vacation in India for a week after the procedure, and then fly back home. Generally, open-heart surgery at Escorts would usually fall in the range of USD 5000. Escorts is accredited by the British Standards Institute and is working toward JCI accreditation. An extensive local area network (LAN) ensures computerised inter-face between patients’ data and investigations. Besides, Internet and Medler facilities enable doctors to access the latest medical information from anywhere in the world. EHIRC sports an informative and interactive website. The site also provides a ‘Library of Animations’ on various surgical procedures to clear doubts and prepare patients and their family beforehand.
affected heart muscles, thereby increasing the blood supply. With the introduction of this new LASER therapy, patients with small coronary artery disease, otherwise not treatable either by angioplasty or bypass surgery can also be treated.
SERVICES OFFERED INTERNATIONAL PATIENTS:
Diagnostic Services, Treatment Services, Preventive Cardiology and Rehabilitation Services, Pediatric Heart Care, Emergency Services, Community Services, Corporate Services.
EHIRC INTRODUCES YAG LASER IN INDIA FOR TREATING CAD
The HOLIMUM: YAG LASER has been introduced for treating coronary artery disease. Laser treatment for CAD can be done either in combination with coronary artery bypass surgery or as an isolated procedure. It is usually recommended for those who have very severe coronary artery disease of small sized vessels where a conventional bypass grafting is not feasible. The laser treatment involves using a fiber optic laser delivery system to make multiple laser driven holes in the heart muscle. The laser treatment stimulates formation of micro vessels in
Departments • • • • • •
Cardiac Surgery Interventional Cardiology Anesthesiology Pediatric Cardiac Care Radio Diagnosis & Imaging Nuclear Medicine November 2007
A single window assistance cell has been set-up to streamline the arrival and stay of overseas patients and their attendants at EHIRC, New Delhi. This cell provides visa assistance; attends to all medical needs, lodging/boarding arrangements, information needs, travel/other arrangements as well as finance assistance.
EMERGENCY SERVICES:
A fleet of five well-equipped MCCU (Mobile Coronary Care Unit) is available 24 hours a day. Each ambulance is a minicoronary care unit in itself, with on-board ventilation, a defibrillator, a cardiac monitor, and an IABP (Intra Aortic Balloon Pump).
AIR AMBULANCE SERVICE:
• • • • • •
Haematology Medical Consultation Pulmonology Microbiology Clinical Biochemistry Clinical Biochemistry and Emergency.
EHIRC has a dedicated team trained in aero-medical transport of critically ill cardiac patients. For evacuation, a fully trained team, comprising a cardiologist, an anesthetist, a nurse, a cardiac surgeon (if required), with all the essential life saving equipments like the ventilator, defibrillator, monitor, IABP and so on, is dispatched to the destination in a 6 - 8 seater aircraft/ helicopter of Deccan Aviation. 25
>
NEWS REVIEW
WORLD
Thailand: Microsoft’s new healthcare research hub Following Microsoft Corp’s purchase of software and assets to streamline administrative and medical record-keeping at Bangkok’s Bumrungrad Hospital, Thailand has become Microsoft’s worldwide healthcare research centre. This is the third acquisition for Microsoft’s healthcare group but its first outside of the United States. It gives a push to the company’s plan to enter the hospital-software market. It has bought a software called Hospital 2000 and its intellectual-property rights from Luxembourgbased software company Global Care Solutions. Global Care has worked with hospitals in this country for seven years. Its 71 Thai staff will also move with the deal. Microsoft (Thailand)
would establish a healthcare research centre in Bangkok and work with Microsoft centres in China and India. The Bangkok centre will work exclusively on healthcare software for worldwide sales. The healthcare industry spends USD 30 billion each year on hardware and software worldwide. Global Care’s Hospital 2000 is an electronic-record system. Its integrated document imaging and delivery allows instantaneous scanning, storage and retrieval of both electronically generated and handwritten material. It serves both front and back office operations, including radiology, laboratories, pharmacies, discharges and transfers, registration administration and clinics and wards.
Over 25 yrs of biomedical & pharmacological records now acessible in electronic format
Orange (France) launches healthcare e-solutions
Thomson Scientific, part of Thomson Corporation and leading provider of information solutions to the worldwide research and business communities, announced that it has added EMBASE Classic to the Dialog (File 772) and DataStar (EM73, EMXX) platforms, providing access to more than 25 years of archived life sciences data available for the first time in electronic format. The fully digitized database is drawn from approximately 3,400 international journal titles, with a focus on European and North American published literature including non-English language articles. EMBASE Classic contains more than 1.8 million records from the biomedical and pharmacological literature. The historical data in it, combined with up-to-date records in the EMBASE database, gives researchers approximately 60 years of information regarding medical and drugrelated subjects. Researchers can now review advancements made during an extremely fertile period for the sciences, particularly in the areas of molecular biology, marine sciences, vaccines and other drug therapies.
Orange Telecom (France), a long-established operator in the field of telecommunications, will present medical practitioners in France an advanced communications platform. This operation will be powered by Orange Healthcare. Orange Healthcare is launching its first e-healthcare offering designed to improve patient comfort and care quality. Known as Connected Hospital, this “solution” comprises a number of facilities for both patients and staff. For patients there is a multimedia terminal above the bed which allows them to make phone calls, access the internet and various games, check their email and videos on demand or television, and access information about the facility and the facility’s medical staff. For healthcare professionals there are mobile terminals for “voice-data” exchange, interactive terminals, geolocalisation patient wristbands and devices that make it possible to monitor or even assist healthcare workers in isolated situations.
IBM and Beacon Equity Partners bring telemedicine to most remote island The world’s most remote inhabited island can now access advanced telemedical care, thanks to pro-bono services and support from a team led by IBM and Beacon Equity Partners (BEP). Tristan da Cunha is located over 1,665 miles west of Cape Town, South Africa, and is accessible only by a boat trip lasting over a week. Some 270 British citizens call the island home. IBM and BEP joined Medweb, the University of Pittsburgh Medical Center (UPMC) and the Government of Tristan da Cunha in announcing the successful implementation of “Project Tristan.” The tested and proven remote medical solution combines medical equipment, satellite communications and remotely supported electronic health-record (EHR) technology, allowing medical experts from anywhere in the world to assist island clinicians in their daily practices with medical diagnoses and emergency support. Until recently, the island’s only physician, Dr. Carel Van der Merwe, has had to rely upon minimal technology and limited medical support. Working from a hospital without so much as its own telephone to provide care for patients Project Tristan,which is based on open standards and runs on the Linux Operating System, is expected to greatly enhance the island’s level of medical care and standard of living. The island’s physician is now able to electronically capture and share medical data and information, including X-Rays and ECGs as well as pulmonary function evaluations and video camera examinations with physician consultants. Satellite communications will enable clinicians to provide real-time diagnostic advice and suggested treatments to the attending physician.
26
www.ehealthonline.org
Fast forwarding cancer research using IBM World Community Grid Canadian researchers expect to accelerate their cancer research by tapping into a global network of hundreds of thousands of people who volunteer their idle computer time to tackle some of the world’s most complex problems. The research team at the Ontario Cancer Institute (OCI), and scientists at Princess Margaret Hospital and University Health Network, are the first from Canada to use the World Community Grid, a network of PCs and laptops with the power equivalent to one of the globe’s top five fastest supercomputers. The team will use World Community Grid to analyze the results of experiments on proteins using data collected by scientists which would take conventional computer systems 162 years to complete. However, using World Community Grid, the analysis could be finished in one to two years, and will provide researchers with a better way to study how proteins function, and could lead to the development of more effective cancer-fighting drugs.
Telemedicine in Space AMD Telemdicine is helping to improve health care delivery in Nigeria through a nation wide telemedicine program that is using a Nigerian satellite to relay medical data and images. Nigeria’s telemedicine project is a nine-site program, funded by the country’s National Space Research and Development Agency (NASRDA) for the Ministry of health. NASRDA has installed telemedicine equipment in two Nigerian hospitals, as well as some additional federal clinics throughout the country. Additionally, NASRDA has provided a working telemedicine clinic in a bus that will travel to the remote parts of Nigeria to provide primary healthcare services. Furnishing connectivity for the program, Nigcomsat-1, Nigeria’s advanced communication satellite, links the medical data sent from the bus to the in-country hospitals, giving patients and doctors in remote areas access to expert care. The Nigerian telemedicine project is equipped with AMD Telemedicine’s state-of-the-art stethoscopes (for heart and lungs), opthalmosopes (for eyes) , dermascopes (for skin), otoscopes (for ear/ nose/throat), and general examination cameras, making it possible for remote patients to be examined for a wide range of conditions. .
DRE, releases updated medical equipment catalog website DRE designed the updated site www.dremed.com to allow medical professionals quickly locate the equipment they need. New features include, more prominent and effective search tool; additional product listings and updated product information; downloadable sales literature on products to provide valuable information to the buyers; fully printable catalog available for download; process of requesting product information and pricing has also been greatly simplified; using a quote cart system, customers can request pricing on entire lists of equipment at once. New and returning customers alike will find the site much more helpful in their buying and research experience.
New device launched in France to screen breast cancer is time efficient Anoto Digital Pen & Paper technology has helped reduce waiting lists for breast cancer screening in France by significantly shortening the time it takes to analyse mammograms. Normal turnaround times of up to 3 hrs were reduced to less than 30 minutes. This means that breast cancer screening centres using the digital pen will be ready for the second stage of France’s national ‘Plan Cancer’ programme, set to start early in 2008, under which, all French women between the age of 50 and 75 are offered mammography every two years. This procedure used to be performed by administrative staff without any medical training, and was prone to errors - a risk that has been virtually eliminated by the use of Digital Pen & Paper (DPP). A visual check of the digital forms is now only required in less than five per cent of cases, giving the DPP-based solution an accuracy of more than 95%. On average, each Department runs 30,000 breast cancer scans every year. The long-term objective is to equip the 45 Departments who perform most scans with DPP technology.
December 2007
USD1 billion from India for Pan-African eNetwork project India will invest USD 1 billion in the Pan-African e-Network satellite project, a joint initiative with the Africa Union aimed at developing the region’s ICT infrastructure. The Indian government will finance the project over a period of five years through a grant to the African Union. Ethiopia for example, has been given a grant of USD 2.13 million from India for the project. In order to participate in the e-network project, African countries must sign agreements with Telecommunications Consultants India, a government enterprise. So far, 27 African countries have signed the agreement some among them are Zambia, Gambia, Ghana, Burkina. The project will include installation of Very Small Aperture Technologies (VSATs) to carry VoIP (voice over Internet protocol) communication. The VSATs will be used for online education and telemedicine programs expected to extend ICT infrastructure to rural areas and other underserved communities. The telemedicine network will be used to share knowledge from Indian doctors with their African counterparts through an online training program. India hopes the investment will help it sell more telecommunications equipment to Africa, including VSATs, as well as services for telemedicine and other social applications. India also wants to make inroads into Africa’s ICT market before China steps up investments on the continent. The Pan-African e-Network project was first announced by former Indian president Abdul Kalam in South Africa in 2004 and in October 2005, the Indian government and the African Union signed a MoU to formalize the project. 27
>
BUSINESS
NEWS REVIEW
Trivitron to set up INR 2.5 billion medical tech park
Chennai-based medical technology company Trivitron Medical Systems Pvt. Ltd. will get a funding of USD 11 million (INR 433 million) from ePlanet, a venture capital and private equity firm and a wholly owned subsidiary of the HSBC Asian Ventures Fund 2 Ltd., in exchange for a minority stake in Trivitron. The funds raised will be used for developing Trivitron’s forthcoming medical technology park, set to come up in a total area of 25 acres in Sriperumpudur in Chennai. The park, slated to be a first of its kind, will promote indigenisation of medical technology in India. By October 2008, the first batch of products is expected to be manufactured from the plant. Apart from the INR 433 million from private funding, the
company has raised over INR 900 million from internal accruals and bank borrowing. Trivitron’s technology partners too have pooled in another about INR 900 million for the INR 2.5 billion technology park project. Though Trinitron is the largest company of Indian origin to produce medical equipment, Dr. Velu feels that people were sceptical about buying made in India equipment, suspecting the quality. Trivitron hopes to clock a revenue of Rs 1000 crore by 2012. With an existing portfolio of more than 15 companies in the Healthcare and Life Sciences arena, coupled with a dedicated team, ePlanet, has special interests in this sector, and believes Trivitron will provide a platform for their global partners for entry into India, to set up manufacturing facilities and distribution centres for medical equipment to serve both the local and global markets.
Cryobanks plans INR 500 cr (US$ 125m) investment Quest Diagnostics has chosen HCL as a technology partner to accelerate the launch of its India operations. HCL will work with Quest to establish and manage their IT infrastructure. Quest Diagnostics India is a wholly owned subsidiary of USD 7 billion worth Quest Diagnostics Incorporated, which is into medical diagnostic testing, information and services. HCL will host Quest Diagnostics’ India data centre and provide network and IT support services from its centre at Noida. In addition, it has collaborated with Quest Diagnostics to develop a patient health record product currently in pilot.
Cisco, Satyam in global collaboration for integrated health solutions Fundamental changes are taking place in the way in which the healthcare services are provided to citizens across the world. Many countries have a compelling need for a single-point-healthcare service. Satyam has deep expertise in Integrated Health Solutions and has developed a health IT framework -- “Distress to Discharge” (D2D™) and has proven implementation methodologies. Now Cisco and Satyam Computer Services Limited have announced that they will collaborate to explore a new venture that will optimize, deploy and manage solutions for handling medical distress situations and health management solutions for global markets. The venture, in which Cisco has expressed a strategic intent to make a minority investment, is being pursued as part of Cisco’s extended USD 100 million venture program targeting Indian innovation. The Integrated Health Solution provides individuals with access to first response, professional healthcare advice and support, with rapid access to trained medical experts either at designated local health centers or over a fixed/mobile phone infrastructure. In this servicesled solutions-oriented architecture, Cisco’s technologies will work in an integrated way with Satyam’s processes and Software Application to support this.
India’s Pharma Industry to grow at 16%: KPMG A report from research firm KPMG, released at the recent CII Pharma Summit in Mumbai predicts that the domestic pharmaceutical industry is projected to grow by 16% annually for the next five years, three percentage points more than the current growth rate. The report ‘Indian Pharma Inc: a continuing success story’, projects the growth as being mainly driven by an increasing spend on healthcare on account of rising disposable incomes, increased penetration of health insurance and changing disease profile, coupled with regulatory changes. The report also says that organised pharmacy chains, which currently holds just 2 per cent of the domestic market share, would capture an increasing percentage of the total market and expand the market with value-added services and enhanced offerings. The focus of the therapeutic mix will also shift from acute diseases to chronic diseases in the medium to long run with about 75%, driven by the increasing prevalence of the chronic diseases, life style changes and ageing population, the report said. .
ICICI Venture, keen on part of healthcare pie invests USD 10 million in hospital chain Private equity firm ICICI Venture has invested USD 10 million to pick a minority stake in urology hospital chain RG Stone Urological Research Institute. RG Stone, which is owned by Delhi-based Bansal family, will use the fund to set up 20 new hospitals across the country by 2008. RG Stone currently has six hospitals spread across India. In the first phase, the institute plans to set up its own super-speciality hospital in Goa primarily to cater to foreign patients. In addition, RG Stone will set up speciality urology divisions in collaborations with some existing hospitals. These would include S K Soni Hospital (Jaipur), Kamyani Hospital (Agra), Saguna Hospital (Bangalore) and Ivy Hospital (Mohali). These projects are expected to be completed by the end of this year. In the second phase, the company plans to add 15 new hospitals by September, 2008.
28
www.ehealthonline.org
USIBC launches healthcare mission to India Seeking to expand Indo-U.S. healthcare cooperation, the U.S.-India Business Council’s (USIBC) ‘Coalition for Healthy India’ launched its inaugural executive mission to India recently. The mission is comprised of executives from the most prominent players in healthcare, including Emergent BioSolutions, Johnson & Johnson, Abbott, Pfizer, IBM, Avesthagen, Excel Life Sciences, Cognizant, Stryker, BD, Yes Bank, Patton Boggs, Ernst & Young, the Association of State and Territorial Health Officials (ASTHO), and the National Association of County and City Health Officials (NACCHO), among others.
The highlight of the mission was USIBC’s participation in the 4th Annual CII Healthcare Conference in New Delhi on November 13-14. The USIBC also took part in a series of high-level meetings with industry and government officials throughout the course of the mission. The Coalition for Healthy India (CHI) is a USIBC initiative dedicated to improving healthcare outcomes for Indian patients by ensuring affordable access to the latest and best treatments and cures. CHI brings together like-minded members of the U.S. and Indian business communities, non-governmental organizations, patient advocacy organizations and health professionals to coordinate and support improved access to healthcare in India.
MarketRx with Cognizant for USD 135 mn IT major Cognizant Technology Solutions has acquired New Jerseybased MarketRx, provider of analytics and related software services to global life sciences companies. The company had earlier signed a definitive agreement with MarketRx to acquire it for USD 135 million in cash, to be funded through its cash reserves. The acquisition would provide Cognizant access to MarketRx’s 75 customers. It will strengthen Cognizant’s full suite of offerings across all areas of the life sciences value chain - from research and development and manufacturing to sales and marketing operations. This acquisition expands their capabilities in the analytics segment and broadens their service offerings for the life sciences industry, while providing strong synergies with the existing Business intelligence/data warehousing and CRM services.
Omega Healthcare’s USD 14 million expansion plans in India Omega Healthcare, provider of healthcare BPO and KPO services, has announced growth plans for its Indian operations over the next 18-24 months. Omega intends to put in over USD 14 million to expand its Bangalore and Chennai facilities and will more than double its employee base to 3,000. Omega is among the top BPO/KPO providers in the healthcare segment, offering medical coding and compliance, accounts receivables analysis and management, and reconciliation services. The company presently employs 1,200 associates at its two facilities. Several of its clients are Fortune 100 companies. The recently inaugurated state-of-the-art facility in Bangalore houses 750 Omega associates, and the rest are located in Chennai. They have over 50 US-based clients, 6 of which are top 20 medical billing companies and many of which are publicly traded.
Dr Reddy`s plans to ramp up R&D spend Indian pharmaceutical major Dr Reddy’s Laboratories Ltd. (DRL) aims to increase the R&D spend on its three major research programmes, including the reverse cholesterol transport (RCT), in a bid to come out with pathbreaking molecules in the next 7-10 years. The company’s half-yearly expenditure on drug research ending September 2007 stood at USD 44 million and an equal amount is expected to be spent in the next half year. The company’s inclination to raise more resources for drug research comes at a time when the company has started seeing the early signs of success at all the three tracks of drug research currently under way at its four laboratories, including the one at Atlanta in the US.
Max New York Life to invest USD 609 million in India Max New York Life Insurance has disclosed plans to invest INR 24 billion (USD 609 million) in the country over the next four years. They have reportedly drawn up a blueprint to invest INR 24 billion in expanding their base and network across the country over the next four years. The new scheme follows the company’s success with selling over 1.9 million policies across the country through its 29,000 agents, with more than INR 54 billion in sum assured.
IBA Health acquires iSOFT plc Australia’s IBA Health Ltd, recently acquired iSOFT. The new entity IBA Health Group, will be the 4th largest healthcare IT company in the world and the largest outside the US. India will become the hub for the product and R&D initiatives for the group. The new entity will be one of the largest Australian employer in India with a strength of more than 2500 IT professionals with offices in Bangalore, Chennai and Hyderabad. IBA and iSOFT’s products are currently being implemented by leading healthcare providers in over 35 countries. The combined Group will have the financial strength, international scope and enhanced skills to deliver major growth opportunities and value to shareholders, customers and employees.
Only 1.08% Indians have medical insurance According to a recent study released by National Insurance Academy (NIA) of India, the health insurance sector in the country has recorded a healthy 38% growth during 2006-07. However, only 1.08% of the one billion Indians have secured medical insurance cover since 1986 when health insurance was first introduced in the country. Shortage of hospitals and insurance providers, poverty, lack of co-ordination between hospitals and insurance firms and people’s belief in destiny have been cited as some of the reasons for the poor response. The potential market for health insurance is about INR 30,000 crore, but, at present, it is just limited to INR 1,400 crore. Also the health insurance sector stands at just 3% of the insurance sector. The study was collected from 16 insurance companies providing medical insurance.
December 2007
29
> >
CASE STUDY
Global Alliance of IT Giants Powers Cancer Research Melbourne Branch of the Ludwig Institute for Cancer Research had researchers working across several labs using isolated computing systems that struggled to process the huge amounts of raw data generated. Microsoft worked with partners Dell and Intel, significantly reducing data processing times and simplifying and centralising management of the Institute’s computing environment. Susan Thomas, eHEALTH SITUATION
The Ludwig Institute for Cancer Research (LICR) founded in 1971 is made up of a worldwide network of nine branches in seven countries dedicated to basic and clinical research. Each branch of LICR has its own area of specialization. The Melbourne Branch in Victoria, Australia, concentrates on tumor biology; specifically, for colon cancer. “LICR researchers are working to understand the biology of tumors within the gut and how protein markers secreted by tumors can be used as an early detection mechanism for colon cancer,” says Dr Robert Moritz, Manager of the Proteomics Facility at LICR and Director of the Australian Proteomics Computational Facility. “Being able to detect tumors before they become life threatening would significantly increase survival rates for those with this type of cancer.” Currently, common tests for colon cancer, such as the colonoscopy, are invasive and expensive and have their own inherent health risks, making them unsuitable for populationbased screening. In contrast, if LICR researchers develop a test for the early detection of colon cancer using protein markers, future tests for this type of cancer could be as simple as having a blood test. The Melbourne Branch has more than 20 proteomics researchers in various laboratories, each working on different aspects of proteomics. They use mass spectrometers to generate the data used to identify protein markers. These instruments can generate between 10,000 and 15,000 mass spectra per hour, which then needs to be converted into protein identifications. Smaller lab-based computers found it hard to keep up with the large amounts of dataflow.
SOLUTION
In 2005, LICR asked Microsoft Global Alliance Partner, Dell, to propose a solution that would deliver greater computing power to researchers working on multiple projects. The solution needed to meet the following criteria: • Increased processing power of all computers in the cluster. • Easy-to-use interface for researchers. 30
Simple, centralized management of a large cluster system. • Compatibility with algorithms used for proteomics research. • Scalability for future growth • Cost competitiveness. • Ability to integrate with existing technology infrastructure. • Ability for researchers to share results throughout LICR’s global network. Dell suggested building a high-performance computing cluster (HPCC) that would pool each laboratory’s resources to create a system with far greater processing power that could be accessed remotely by all researchers. Following which, Dell joined forces with Microsoft and Global Alliance Partner, Intel, to carry out the project. LICR joined the Microsoft® Windows® Compute Cluster Server 2003 Rapid Deployment Program, and Microsoft gave them access to the Beta 2 version of the software, which was released in November 2005. LICR’s proteomics staff visited •
“It’s quite common for this sort of computing facility to be isolated from the rest of the technology environment... but with Microsoft, the computing cluster can be incorporated into the existing environment.” Chris Green Technical Specialist, Microsoft www.ehealthonline.org
Microsoft headquarters in Redmond, USA, to contribute to discussions about the product. The project began as a proof of concept, funded jointly by Dell and Intel. The proof of concept was completed in late 2005 and comprised a 16-node computing cluster. “Combining Dell and Intel’s deep pool of technical resources and expertise to build the proof of concept helped the Ludwig Institute quickly identify the benefits and challenges of this project, ensuring hardware and software work harmoniously to deliver the best result for the customer.” Ivan Chan, Intel’s Dell Regional Account Manager for Asia Pacific. The ease of use of Microsoft Windows Compute Cluster Server 2003 made it the obvious choice for the Ludwig Institute. LICR was also impressed with the power of Dell’s hardware. The powerful dual-core technology in Intel Xeon processors enabled LICR to process more data within a shorter period. LICR soon discovered that researchers in other laboratories at different institutions in Australia were faced with the same problems as the LICR team. Thus, in 2005, it formed a consortium with 21 other Australian proteomics research centers to discuss the creation of the Australian Proteomics Computational Facility (APCF). The idea was to take the knowledge gained from the LICR project and expand this on a national scale. Acting as a national test bed, LICR rolled out the solution, using a configuration with one head node to provide a cluster for production and the other head node for testing and development. The cluster connects researchers from at least 20 different locations across Australia, from Perth to Brisbane and beyond, through a single administrative interface. In January 2006, the APCF was awarded an enabling research grant of Aus$ 2 million by the National Health and Medical Research Council to create a high-performance computing platform to assist other research centers with highthroughput proteomic analysis. The APCF will process the raw mass spectrometry data using algorithms such as Mascot from Matrix Science, Phenyx from GeneBio, Sequest from Thermo and many other open source programs. These algorithms transform raw molecular data into a form that biologists can understand. LICR is also developing its own algorithms using Microsoft® Visual Studio® .NET. “As my experience is in biology, not computers, a good compiler and an intuitive development environment are important to me.” says Eugene Kapp, a computational biologist at the Proteomics Laboratory, LICR.
BENEFITS
Faster Processing Times: The processing power of the highperformance computing cluster is at least 20 times faster than December 2007
Software and Services Products • Microsoft Windows Compute Cluster Server 2003 (Beta 2 version) • Microsoft Windows Server System • Microsoft Visual Studio .NET 2003 Technologies • Microsoft Active Directory • Microsoft Terminal Services (part of Windows Compute Cluster Server 2003)
Hardware • 2 Dell PowerEdge 2850 Servers • 16 Dell 1855 Blade Servers • Dell PowerConnect networking switches • 36 Intel dualcore 64-bit Xeon processors Partners • Dell • Intel
that available when researchers worked on isolated systems. This has increased the productivity and output of researchers. The servers in the HPCC can work on several individual tasks or combine to complete one large job. Integrates with Existing Infrastructure: Microsoft Windows Compute Cluster Server 2003 integrates with the Melbourne Branch’s existing IT environment, including Microsoft Active Directory and Terminal Services for remote access. Cost-Effective Computing: The solution is based on a pay-as-yougrow pricing structure, enabling LICR to expand the solution as it needs and as funds become available. “The solution had a fairly small learning curve, so we didn’t need to increase staff numbers or conduct extensive training to manage the system,” says Moritz. “We have also reduced our support and maintenance costs.” Centralized Management: Microsoft Windows Compute Cluster Server 2003 features a centralized management interface that allows the entire HPCC to be managed from one location, increasing ease of implementation and simplifying ongoing management, communication and monitoring of the progress of the research.
FUTURE PLANS
LICR is now working towards expanding the solution to give proteomics researchers across Australia access to the HPCC at the APCF. This would involve growing the computing cluster to 128 nodes (with 256 dual-core processors), making a total of 135 servers including the head nodes. Susan Thomas eHEALTH, susan@ehealthonline.org
31
>
PRODUCT PROFILE: HARDWARE eHEALTH gives you an overview of the latest medical equipments in the global market. This service is brought to you absolutely FREE. To have your new products featured, send us the details at dolly@ehealthonline.org
TRIVITRON’S BREM DR 50 X-RAY GENERATOR
Trivitron, the largest Indian Medical Technology company for the first time launched home products in the Imaging division under its new brand name Brem. Brem, stands for the well known method of X-Ray generation called Bremsstrahlung. • Compact in nature • The new-age high frequency (40KHz) X Ray generator, with POD technology reduces X Ray dose to almost half for the patients, without any quality compromise • Eliminates the soft radiation, which can cause skin cancer over prolonged exposure • power saver- requires only a single phase power source and operable from a 5 amp power point- max. Output Power 50 KW • Automatic input voltage compensation • Automatic Exposure Control (AEC) • Vertical Movement : 350 -1850mm (Center of the detector)
• • • •
Detector Rotation : 0 -270° Pixel Matrix : 4K X 4K, 16 Million Pixels Digital Image Control Interface: Custom design is available Main functions of workstation: Position Indicator, Tissue Equalization, Filter Correction, Grayscale Transform, Window/ Level Adjustment, Gamma correction, ROI Equalization, Black/White Reversion, Image segmentation, Mark, Enhancement etc.
For Details Contact: Trivitron Group of Companies 15, IVth Street, Abhiramapuram, Chennai - 600 018 Ph : +91 - 44 - 2498 5050 (6 lines) Fax : +91 - 44 - 2498 5757 / 2467 2782 Website: www. triviron.com Email: corporate@trivitron.com
DIGITAL 3-CHANNEL ECG MACHINE WITH INTERPRETATION “XCLUSIV” (1103G)
G-SCAN DEDICATED MRI
LUNAR DPX-IQ BONE DENSITOMETER
•
•
•
• • •
• • • • • • • • • • •
Simultaneous acquisition of 12-lead ECG data Leads Manual: single channel or three Auto I: standard three channel Auto II: standard single channel plus rhythm lead Auto III: European three channel Measurement/interpretation and distinguish point printing function under automode operation Real-time clock, real-time measurement and presenting of ECG parameter High-efficiency lithium battery, at least 2 hours’ working time Function of heart rate detection and protection against pulse shock while pacemaker applied Storage of 8 patients’ ECG data USB interface and RS232 Option: ECG Software for networking
For Details Contact: Medical Point Update Medical Equipment 13-B, 1st Floor, N.S. Marg, Darya Ganj, New Delhi-10002 Ph: +91-11-23289201 Telfax: +91-11-23289200 Email: sales@medicalpointindia.com Website: www.medicalpointindia.com
32
• •
• •
“One Room” MRI system Real-Time MR Dedicated shielding available Instant positioning: Pressing the button of the joint under investigation, automatically moves the patient and coil in the isocentre. Musculo skekeletal MRI system guarantees very high sensitivity and patient friendliness. Simple user interface yet allows all scanning parameters to be personalized and the custom sequences can be stored and integrated in the normal menu structure for subsequent use. Unique tilting design: the gantry can be rotated to move the patient in a true weight-bearing position. Based on a 0,25 T permanent magnet so no cryogens and no complicated cooling systems are required.
For Details Contact: Esaote India (NS) Limited B-604/704, Oxford Tower Gurukul Road Ahmedabad - 38005 Tel. : +91-79-27433140/27449440 Fax : +91-79-27490245 E-mail : info@esaoteindia.com Website : www.esaoteindia.com
•
•
•
World’s most popular densitometer, delivering excellent clinical utility at a reasonable price. Image quality is second only to the near-radiographic images of the LUNAR EXPERT-XL with dose levels 2-3X lower than other DEXA densitometers (total body dose is over 50X lower) The 1-minute AP spine, 2-minute femur, and 4-minute total body scans provide high patient throughput yet ensure excellent precision (0.5% spine, 1.0% femur, 0.5% total body). DPX-IQ sets the performance standard for fast, precise measurements, low patient dose, and high-resolution imaging. The 1-minute AP spine, 2-minute femur, and 4-minute total body scans provide high patient throughput yet ensure excellent precision (0.5% spine, 1.0% femur, 0.5% total body) Available in either a full (240 cm) or compact (180 cm) length. Only the scanner arm moves during examinations - not the table.
For Details Contact: 329, LIG, Vasant Enclave, New Delhi - 110057 Tel: 011-26144746, 26153613 Cell: 9810204615 Email: salesindia@perfectmedicalsystems.com Website: www.perfectmedicalsystems.com
www.ehealthonline.org
>
PRODUCT PROFILE: SOFTWARE SOLUTIONS
eCLINICIAN: DIAGNOSIS @ MOUSE CLICK OVERVIEW
New Steth Diagnostics is launching “eClinician”, after successful sales of “Clinician” with over 3000 customers in the last 12 months. This is the only product of its kind in the world. The differential diagnosis model is unique and patent application pending. eClinician has an updated database and features 4560 disease reference, differential diagnosis from signs and symptoms, clinic management system, systemic examination and patient record management. “eClinician” is a user friendly, simple and effective software to reach diagnosis. The clinic management system is based on windows platform.
The differential diagnosis model brings up uncommon conditions to physicians’ notice. New Steth offers online data updates for eClinician, providing users with up to date information on diseases and treatments. eClinician is highly affordable for the medical practitioners and students.
SALIENT FEATURES
eClinician has two sections: My Patient and References. ‘My patient’ is a clinic management system with a unique model for differential diagnosis from clinical presentations. One can register a patient, save examination details including systemic examinations, notes on patients, view various reports, issue medical certificates, prescribe and print the prescription by using the My Patient module. ‘References’ has comprehensive reference on 4560 diseases and a wide database on various topics including Lab investigations, HIV and AIDS, Drug and Food interactions, Essential notes etc. eClinician aids medical practitioners with quick reference on diseases, treatments, medications with contra indications. It can practically replace the bulk of medical text books from the doctors table. The data is summarized by the Newsteth panel of specialists and provided in bullet points for easy access.
34
For further information on eClinician, log on to www.alldiagnosis.com or www.newsteth.com
www.ehealthonline.org
>
PRODUCT PROFILE: SOFTWARE SOLUTIONS
CORTEX : Hospital Management Information System OVERVIEW
•
HospIT HMS was released in 1996 and upgraded as “Cortex” in 2007 with a complete web based solution, with Internet/ intranet access. Cortex is a complete product for single and multiple hospitals. It helps manage Administration, Finance, Inventory, Patient records, Lab, Pharmacy, General Stores, 4652 Disease reference, differential diagnosis from signs and symptoms, and systemic examination. A team comprising of Doctors, Management and Software experts ensures best in class solution in hospital management. A tried and tested product for over 11 years, Cortex is a web based ERP solution, functional in any internet browser. It is developed in ASP.NET platform with SQL Server database. Cortex has been created with the vision to address needs of healthcare in future. It incorporates the latest software developments and disease reference. It is an innovative tool with online telemedicine capabilities.
• • •
Streamlines administration - evaluation of performance and rewarding Inventory and finance management Central control and management through efficient reports on various subjects: patient profile/ diagnosis/ prescriptions/ procedures/ employee work patterns etc. Advantages for Patients: Photo registration card: smart
Cortex Architecture
•
SALIENT FEATURES
• • • • •
Complete flexibility for customizations Easy to learn and user friendly Efficient and improved patient care Reduces paperwork / manpower deployment •
Tech Specs of Cortex HMIS Front End HTML, ASP.NET, Telerik RAD Ajax controls (Web Browser) Middleware VB.NET, .NET frame work 2.0 Backend MS SQL Server 2005 Integrated Development Microsoft Visual Studio 2005 Environment (IDE) Operating system Microsoft Windows 2003 Server Application server Microsoft Internet Information Server (IIS)
December 2007
• • • • •
card / bar code tracking; online appointments and payments; Insurance documentations made easy, Digitized patient records Advantages for Doctors: Treatments, indications and medications; can view similar cases from database – DD solutions; patient data readily available including complete history of Reference on 4500+ diseases, lab tests etc. Advantages for Management: complete records available in one location; reports can be viewed any time: performance of each department or individual, procedures, cash flow, balance sheet etc.; inventory management, better understanding of cost centers Online updated reference database for doctors on diseases / epidemics Major Clients/Installations: 17 Hospitals of various sizes New Steth provides training; supports customers with warranty and services Free installation/ upgardation/ no amc Pay per patient model: first time in hms sector Allows hospitals to have up-to-date technology always
New Steth Diagnostics Pvt. Ltd. is an ISO 9001:2000 certified company focusing on healthcare solutions for Patient Care, Hospital Management and Doctors’ Reference. Websites: www.alldiagnosis.com, www.newsteth.com.
35
> >
TECHNOLOGY TRENDS
Sound with a Sight - Ultrasound in Medical Imaging Dipanjan Banerjee, eHEALTH
Sound is not always heard..it is seen as well’ - at least docs would agree ! A cyclic sound pressure with a frequency greater than the upper limit of human hearing (above 20 Kilohertz/20,000 hertz) can be used to image the anatomy of human body – and that’s ‘ultrasound’. Being one of the most widely used diagnostic tools in modern medicine, ultrasound-based electronic devices are increasingly used to harmlessly reveal the inner structure of human body. The technique, widely known as ‘ultrasonography’ provides high quality visualisation of muscles, tendons, and internal organs, their size, structure and any pathological lesions with real time tomographic images. It is also used to visualize a fetus during routine and emergency prenatal care. The biggest advantage is that the technology is relatively inexpensive and portable, especially when compared with modalities such as magnetic resonance imaging(MRI) and computed tomography (CT). As currently considered in the medical environment, ultrasound poses no known risks to the patient. Ultrasound is generally described as a ‘safe’, as it does not use ionizing radiation, which imposes hazards, such as cancer production and chromosome breakage. However, ultrasound energy has two potential physiological effects -
it enhances inflammatory response and it can heat up soft tissue. However, current studies indicate that benefits to patients far outweigh the risks. Ultrasound finds application in a wide variety of medical diagnostics, and is especially useful for obstetrics. It can be used to date the pregnancy (gestational age); confirm fetal viability; determine location of fetus; check the location of the placenta in relation to the cervix; check for the number of fetuses (multiple pregnancy); check for major physical abnormalities; assess fetal growth (for evidence of IUGR); Major Manufacturers: and check for fetal movement Aloka • and heartbeat. Agilent Other scans routinely • Cypress Plus conducted are cardiac, • GE renal, liver and gallbladder • Philips (hepatic). Other applications • Siemens include musculo-skeletal • Sonosite imaging of muscles, ligaments • Toshiba and tendons, ophthalmic • Trivitron ultrasound (eye) scans and • superficial structures such as testicle, thyroid, salivary glands and lymph nodes. Due to the real time nature of ultrasound, it
We believe that the performance, size, durability, ease of use and costeffectiveness of our products are the prime advantages of our ultrasound devices in medical diagnostics. There are five biggest advantages of our devices: (I) Bringing ultrasound to the patient - Our systems’ mobility eliminates delays, which are associated with the outpatient referral process or moving heavy, cart-based systems across hospital departments to scan patients. (2) Quicker diagnosis and treatment - By providing ultrasound at the primary point-of-care, our systems can eliminate delays associated with the outpatient referral process or moving heavy, cart-based systems across hospital departments to scan patients. This increased accessibility is changing clinical practice, improving patient care and safety and has the potential to reduce healthcare costs through earlier and more rapid diagnosis of diseases and conditions. (3) Reducing Risk and complications – The systems allows to see the unseen and, where previously physicians relied on their knowledge of morbid anatomy, now, with real-time ultrasound imaging, they can perform procedures and see inside the body
(4) Increasing Clinical Productivity – The image resolution of the SonoSite systems is so high that physicians rarely need to subject patients to additional exams involving larger systems. Because the results are available much more quickly, it greatly improves the overall patient care. (5) Creating the future of ultrasound – Hand carried ultrasound is an extension of the physician’s Pavan Behl Country Manager, SonoSite India eyes, ears and fingertips. The systems are increasingly being used for procedures where physicians need cost-effective, nonradiating imaging in such diverse applications such as real-time trauma assessment in emergency situations, guiding interventional procedures such as biopsies, nerve blocks and surgery, and in the imaging lab for full diagnostic examinations. It is the future of ultrasound.
36
www.ehealthonline.org
What are the advantages of ultrasound devices? Ultrasound is a non-invasive imaging technique using high frequency sound waves developed to visualize internal organs, their size, structure and the pathology. It is one of the most widely used diagnostic tools in modern medicine. It is portable, relatively inexpensive with no risk to the patient as well as the operator. Applications A.B.Sivasankar, Directorof ultrasound include cardiology, Imaging Division, Trivitron obstetrics, gynaecology, Vascular, musceloskeletal, urology, neurosurgery etc. Ultrasound especially plays a major role in women welfare through prenatal ultrasound examination. What is Market Opportunity of Ultrasound Devices? India is one of the fastest growing market in the world for ultrasound medical devices. The current market size of the medical ultrasound device in India is approx 3 billion rupees and is growing at an average CAGR of 20% per annum. Presently 90% of the demand being met through imports. Further, if we look into the healthcare expenditure, 70% is spent for treatment and only 30% for diagnosis. For a better healthcare administration this ratio should be inverse i.e. 70 % should be for early diagnosis, which will actually result in reduction in actual treatment cost. Shortly with insurance expected to play a major role in healthcare and with increase in the middle income group capacity
is often used to guide interventional procedures such as fine needle aspiration (FNA) or biopsy of masses for cytology or histology testing in the breast, thyroid, liver, kidney, lymph nodes, muscles and joints. Ultrasound scanners using pulsed wave and colour Doppler are used to visualize arteries and veins.
ADVANCES IN ULTRASOUND TECHNOLOGY
Traditionally, ultrasound imaging was possible only in 2D. However, latest technological advances have made 3D and even 4D imaging a reality. 3D ultrasound works similarly to the traditional 2D ultrasound, except that the ultrasound waves are directed from multiple angles. These waves are reflected back and captured and together to provide enough information to construct a 3D image - in much the same way as multi directional cameras are used to create 3D movies. However, 4D ultrasound system is set to provide a ‘next generation’ integrated solution for medical imaging
to pay for better treatment we can witness a significant demand for ultrasound. What is the leading edge of Trivitron devices? We market the ultrasound from the pioneers who were the first to introduce ultrasound to medical diagnostics internationally and who have manufactured more than 220,000 units - namely Aloka Japan. Recently Trivitron have signed a JV with Aloka for manufacturing the ultrasound units in India. This fifty year old company has the experience and expertise in developing unique technologies in ultrasound diagnosis and recent ones being ‘e-tracking’ and ‘e-flow’. Aloka’s eTRACKING (Echo Tracking) is a new, more accurate way to evaluate vessel wall stiffness before the onset of changes such as thickening or plaque formation. eTRACKING allows you to detect atherosclerosis much earlier than commonly used Intima Medial Thickness (IMT). By estimating a patient’s “blood vessel age”, a healthcare provider can advise the patient to alter his or her lifestyle through diet and exercise to prevent atherosclerosis. eTRACKING also supports accurate tracking of treatment at 0.01mm accuracy. eTRACKING also enables FMD, a non-invasive way to assess endothelial function, which is considered the first indicator of atherosclerosis. FMD measures minute vasodilatation with 0.01mm accuracy. Broadband Harmonics also enhances a high-definition blood flow imaging mode used primarily for vascular imaging - Directional eFLOW. This can be used for both low-velocity and high-velocity flow, delivering greater spatial and temporal resolution. Very Recently Trivitron has launched the first compact, light-weight Windows based Laptop Color Doppler in India. This unit offers high image quality, networking and work flow benefits not previously possible in a small system.
applications, allowing practitioners to provide faster treatment and improve therapeutic success rates. When rapid succession 3D images are processed real-time, creating a three-dimensional motion video - it gives a 4D ultrasound. This is achieved through 30 frame per second volumetric imaging. 4D uses the same frequency of sound waves as a normal ultrasound, but the sound waves are directed from many more angles, producing a ‘real-time’ video of the anatomy. An important factor in ultrasound image processing is the beam-former - the part of the system that provides the focusing for the ultrasound beam. Even today’s most advanced stateof- the-art medical ultrasound imaging systems suffer from very poor image resolution. This is due to the very small size of deployed arrays of sensors and the distortion effects by the influence of the human body’s non-linear propagation characteristics. The solution lies in the latest adaptive beamformer that significantly improves image resolution at very low cost and results in better diagnosis. Dipanjan Banerjee, eHEALTH , dipanjan@ehealthonline.org
Read articles online at www.ehealthonline.org December 2007
37
Your monthly magazine on healthcare ICTs, technologies and applications
Read, Update and Stay Ahead... SUBSCRIBE NOW!
Subscription Order Card Duration (Year)
Issues
Subscription USD
Newsstand Price INR
Subscription Price INR
Savings
1 2 3
12 24 36
100 150 250
900 1800 2700
900 1500 2000
-Rs. 300 Rs. 700
*Please make cheque/dd in favour of Elets Technomedia Pvt. Ltd., payable at New Delhi
Three easy ways to subscribe:
www.ehealthonline.org
Web : Log on to http://www.ehealthonline.org/publication.asp and submit the subscription form online. Fax : Complete the information on the card and fax it to +91-120-2500060 Post : Mail the form along with the cheque to : eHealth magazine Elets Technomedia Pvt. Ltd. G-4 Sector-39, Noida 201 301, U.P. India Tel +91-120-250 2180 to 85 Fax +91-120-2500060 e-mail : manoj@elets.in, Web : www.ehealthonline.org
I/We would like to subscribe to monthly eHealth
magazine!
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
1
2
3
Years
6/,5%Ă&#x; Ă&#x;Ă&#x;\Ă&#x;) 335%Ă&#x; Ă&#x;\Ă&#x;*5. %Ă&#x;
I am enclosing a cheque/DD No. ............................ Drawn on ................................. (Specify Bank)
!Ă&#x;-/. 4(,9Ă&#x;!'!:) .%Ă&#x;/. Ă&#x;)#4Ă&#x;!. $Ă&#x;(%! ,4(
2S Ă&#x;
Dated ........................................ in favour of Elets Technomedia Pvt. Ltd., payable at New Delhi. #/6%
For Rs./USD ............................................................................................................................. only Subscription Terms & Conditions: Payments for mailed subscriptions are only accepted via cheque or demand draft • Cash payments may be made in person • Please add Rs. 50 for outstation cheque • Allow four weeks for processing of your subscription • International subscription is inclusive of postal charges
2Ă&#x;34/
"5), 29 #!0!$).' (%! #)49 Ă&#x;).& ,4( Ă&#x;&/2 /2Ă&#x;53Ă&#x;! Ă&#x;"%4 !4)/ ).4%26 .$Ă&#x;" 4%2Ă&#x; .Ă&#x; )%7 '!"% %9/. -)#2 Ă&#x;2)*0$ E (%! /3/&4 !Ă&#x;
0!#)& ,4(# Ă&#x;&!#) )#Ă&#x;2%'!2%Ă&#x;) ,)4!4 )/. .Ă&#x;4(% ).'Ă&#x;Ă&#x;
&/#53
Ă&#x;!3)! Ă&#x;Ă&#x; -%$ ).4%2 % 4%, Ă&#x; 3(/7 .!4)/ Ă&#x;!.Ă&#x; #!3). .!,Ă&#x;0 ).3)'( 'Ă&#x;E ( ,!4&/ %!,4( 2-Ă&#x; 4 !Ă&#x;&2! 0(),) -%7/ 00).% 2+Ă&#x;&/ 3´Ă&#x;0(2 2Ă&#x;4(% 4%#(. Ă&#x; /,/'9 %-%2 3534! ').' ).!" Ă&#x;4%#( ,%Ă&#x;25 ./,/ 30/4, 2!,Ă&#x;E ')%3Ă&#x;& )'(4 (%!, /2Ă&#x; .!4)/ 4( ,%'!, .!,Ă&#x;3 Ă&#x;).&/ %-). 2-!4 !2Ă&#x;/. WWW )#3 Ă&#x;-%$) EHEA #/ LTHON LINE O RG
)#4 ( #,)- EALTH .%7 ").'Ă&#x; Ă&#x;(%)' (43
>
ZOOM IN
HIPAA for Insurance Regulation The provisions of HIPAA have come to dominate nearly all aspects of health care data standards development process in the United States of America. HIPAA is forcing all of the standards developers and many industry sectors to rethink their plans, and, in many cases, to redefine their roles. Susan Thomas, eHealth
“HIPAA” is an acronym for Health Insurance Portability & Accountability Act of 1996, Public Law 104-191 of the United States of America, which amended the Internal Revenue Service Code of 1986. HIPAA was intended to make healthcare delivery more efficient, and to increase the number of Americans with health insurance coverage. These objectives were achieved through three main provisions of the Act: 1) the portability provisions, 2) the tax provisions and 3) the administrative simplification provisions.
BEFORE HIPAA
Prior to the passage of HIPAA, people were afraid to switch jobs or change employers out of fear that a pre-existing medical condition would disqualify them from receiving health insurance coverage from a new employer. Health insurance was also prohibitively expensive and it used to be difficult for individuals to purchase health insurance independent of their employer. Thus the number of self-employed let alone unemployed individuals with health insurance was unacceptably low.
records during the course of a typical hospitalisation. Many of these people have legitimate reasons to access medical records. However, prior to the privacy provision in HIPAA there was no regulation on who could access medical records, what information could be accessed, and how the information found in medical records could be used in the health care system.
HIPAA SIMPLIFIED
Title I: Health Care Access, Portability, and Renewability Title I of HIPAA protects health insurance coverage for workers and their families when they change or lose their jobs. It regulates the availability and breadth of group and individual health insurance plans. It also prohibits any group health plan from creating eligibility rules or assessing premiums for individuals in the plan based on health status, medical history, genetic information, or disability. Though this does not apply to private individual insurance. The clause also limits restrictions that a group health plan can place on benefits for pre-existing conditions.
Administrative Simplification, encouraged the widespread use of electronic data interchange in the US health care system and required improved efficiency in healthcare delivery by standardising electronic data interchange, and protection of confidentiality and security of health data. The use of electronic health information was expanding in the early 1990’s, and the health care industry was unable to standardize the process and use of electronic health information without federal action. On an average some 150 people have access to a patient’s medical December 2007
Group health plans may refuse to provide benefits relating to pre-existing conditions for a period of 12 months after enrollment in the plan or 18 months in the case of late enrollment. However, individuals may reduce this exclusion period if they had health insurance prior to enrolling in the
plan. It allows individuals to reduce the exclusion period by the amount of time that they had “creditable coverage” prior to enrolling in the plan and after any “significant breaks” in coverage. “Creditable coverage” is defined quite broadly and includes nearly all group and individual health plans, Medicare, and Medicaid. A “significant break” in coverage is defined as any 63 day period without any creditable coverage. Title I also forbids individual health plans from denying coverage or imposing preexisting condition exclusions on individuals who have at least 18 months of creditable group coverage without significant breaks and who are not eligible to be covered under any group, state, or federal health plans at the time they seek individual insurance. Title II: Preventing Health Care Fraud and Abuse; Administrative Simplification; Medical Liability Reform Title II of HIPAA defines numerous offenses relating to health care and sets civil and criminal penalties for 39
ZOOM IN
>
them. It also creates several programs to control fraud and abuse within the health care system. However, the most significant provisions of Title II are its Administrative Simplification rules. Title II requires the Department of Health and Human Services (HHS) to draft rules aimed at increasing the efficiency of the health care system by creating standards for the use and dissemination of health care information. These rules apply to “covered entities” as defined by HIPAA and the HHS. Covered entities include health plans, health care clearinghouses, such as billing services and community health information systems, and health care providers that transmit health care data in a way that is regulated by HIPAA. As per the requirements of Title II, the HHS has promulgated five rules regarding Administrative Simplification: the Privacy Rule, the Transactions and Code Sets Rule, the Security Rule, the Unique Identifiers Rule, and the Enforcement Rule. Title II of HIPAA, the Administrative Simplification (AS) provisions, requires the establishment of national standards for electronic health care transactions and national identifiers for providers, health insurance plans, and employers. Administrative Simplification, encouraged the widespread use of electronic data interchange in the US health care system and required improved efficiency in healthcare delivery by standardising electronic data interchange, and protection of confidentiality and security of health data. HHS published the final HIPAA Security Rule in the Federal Register on February 20, 2003. Health plans
and providers were required to be in compliance with these measures by April 21, 2005. The administrative simplification provisions of HIPAA also directed the development of standards for unique health identifiers (or national numbers that are used to identify the individual or organization in standard health transactions) for patients, employers, health plans, and providers.
CRITICISM
While respect for patient privacy was already informally considered a cornerstone of the medical professional, the complex legalities and potentially stiff penalties associated with the Privacy and Security Rules (2003) of HIPAA, as well as the increase in paperwork and the cost of its implementation, were causes for concern among physicians and medical centers. HIPAA restrictions on researchers have affected their ability to perform retrospective, chart-based research as well as their ability to prospectively evaluate patients by contacting them for follow-up. Consent forms for research studies are now required to include extensive detail on how the participant’s protected health information will be kept private. While such information is important, the addition of a lengthy, legalistic section on privacy may make these already complex documents even
more user-unfriendly for patients who are asked to read and sign them. This suggests that the HIPAA privacy rule, as currently implemented, may be having negative impact on the cost and quality of medical research. The complexity of HIPAA, combined with potentially stiff penalties for violators, can lead physicians and medical centers to withhold information from those who may have a right to it. A review of the implementation of the HIPAA Privacy Rule by the U.S. Government Accountability Office found that health care providers were “uncertain about their [legal] privacy responsibilities and often responded with an overly guarded approach to disclosing information...than necessary to ensure compliance with the privacy rule.” Susan Thomas eHEALTH, susan@ehealthonline.org
Surveys show that the American public largely distrusts HIPAA According to a recent survey by Harris Interactive, nearly three of five Americans agree that the privacy of their health information is not well protected by federal and state laws and organizational practices. The nationwide survey of 2,392 adults was commissioned for an Institute of Medicine committee that is considering how the Privacy Rule promulgated under the Health Insurance Portability and Accountability Act of 1996 affects health research. The fear of disclosure of their personal health information is the primary reason Americans decline to take part in clinical trials of new medicines and other health research. When asked under what circumstances they would agree to allow their personal health information be used in a research project, the largest group, 38 percent, said they wanted to know more about the project and would have to give their specific consent for each project. Other surveys too suggest that HIPAA and other privacy rules are slowing down research, adding to its cost, and in some cases, stymieing the projects. HIPAA has made giving consent to research more complicated, with longer and more dense forms for patients to review, human research subjects’ information may be less protected. It also appears that fewer doctors are reporting communicable diseases to state authorities because of privacy concerns. http://www.govhealthit.com/online/news/350058-1.html 40
www.ehealthonline.org
>
EVENTS DIARY
14 - 16 January, 2008
25 - 27 March, 2008
Health GIS 2008 Bangkok, Thailand
IV International Conference “Telemedicine- Experience Prospects” Donetsk, Ukraine
www.telemed.org.ua/Seminar/eng/2008e/index_ e.html
www.telemed.org.ua/Seminar/eng/2008e/index_ e.html
25 - 27 January, 2008
25 - 28 March, 2008
Medical Traveller Business Congress ‘08 Malta, Other
Medical Tourism Asia 2008 Singapore, Singapore
www.gaiaint.com/gaia-international-eventmedical-travel-business-malta-2008.htm
www.medicaltourism-asia.com/ibcsg/ medicaltourismasia/index.jsp
26 - 29 March 2008 28 - 31 January, 2008 30 November - 1 December, 2007 Workshop on Medical Informatics & Biomedical Comm. Wardha, India
ARAB HEALTH 2008 Dubai, United Arab Emirates www.kallman.com/HealthShows/arabhealth2008. htm
www.jbtdrc.org/July%202007/future_event.htm
Indian Society for Medical Statistics Silver Jubilee National Conference Manipal, Karnataka, India
CRITICARE-2008 Madhya Pradesh, India
2 - 5 December, 2007
6th MedTech Investing Europe Conference Lausanne, Switzerland www.campdenconferences.com/default.asp?page= conference&conference.id=18
www.cehr.de/registration.htm
Unite For Sight 5th Annual International Health Conference Connecticut, United States of America uniteforsight.org/conference/2008/registration. php
16 - 18 April, 2008 15 - 17 February 2008
Best Practices in Implementing Chronic Care Programmes (Europe) Amsterdam, Netherlands
http://www.terrapinn.com/2008/rfid/index.stm
12 - 13 April, 2008 14 - 15 February 2008
3 - 4 December, 2007
RFID World Asia 2008 Singapore, Singapore
www.criticare2008.org
www.manipal.edu/ISMSConference-2007/
CeHR: International Conference 2007 Regensburg, Germany
www.worldhealthcongress.org/
9 - 11 April 2008 13 - 17 February 2008
30 November - 2 December, 2007
World Congress of Health Professions Perth, Western Australia, Australia
International Conference on Medical & Community Genetics Chandigarh, India
Med-e-Tel Luxembourg, Germany www.medetel.lu/index.php
www.worldcongress.com/events/HL07080/
www.geneticsandpopulationhealth.com/index. php/Main_Page
6 - 8 December 2007
20 - 22 February, 2008
Second National Bioethics Conference Bangalore, India
Canadian Critical Care Conference Whistler, BC, Canada
ala.ir/iomc2008/
www.canadiancriticalcare.ca
18 - 20 May, 2008
1 - 3 March, 2008
Symposium on Health Informatics and Bioinformatics, HIBIT ‘08
http://nbc.ijme.in/index.php
9 - 11 December, 2007 3rd Annual World Healthcare Innovation & Technology Congress Washington, D.C., United States www.worldcongress.com/events/HT07010/ ?confCode=HT07010
14 - 16 December, 2007
Meditec Clinika 2008 Chennai, India
10 - 11 May, 2008 1st International Online Medical Conference (IOMC 2008) Online, India
Ýstanbul, Turkey fens.sabanciuniv.edu/hibit08/
www.meditec-clinika.com
25 - 28 May, 2008 7 - 9 March, 2008 52nd National Conference of Indian Public Health Association New Delhi, India
Geneva Health Forum: Towards Global Access to Health Geneva, Switzerland www.genevahealthforum.org
BCSB 2007 : “International Conference on Bioinformatics, Computational and Systems Biology” Bangkok, Thailand
www.iphaconference.mamc.ac.in
MEDEXPO East Africa 07 Nairobi, Kenya
Conference on Biomedical Electronics & Informatics (BEBI ‘08) Rhodes (Rodos) Island, Greece
www.waset.org/bcsb07/
www.growexhibitions.com/kenya/medexpo/
www.wseas.org/conferences/2008/rodos/bebi/
42
20 - 22 August 2008 21 - 23 March, 2008
www.ehealthonline.org
INDIA
2008
29 - 31 July 2008 Pragati Maidan, New Delhi
www.eINDIA.net.in/ehealth
Block Your Calender Today!