The Monthly Magazine on Healthcare ICT, Medical Technologies & Applications
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DIAGNOSING A BRIGHTER FUTURE Capturing the dynamics of in-vitro diagnostics in India
Health First for Gujarat
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contents
Volume 5 | Issue 12 | december 2010 | ISSN 0973-8959 www.ehealthonline.org
www.facebook.com/ehealthonline
www.twitter.com/ehealthonline Cover story
Diagnosing A Brighter Future Pg. 08
Divya Chawla
cover story
case study
interview
08
Diagnosing A Brighter Future
Operationalising 22 HMIS in Backward
Divya Chawla
column
14
States
Health First for Gujarat Anju Sharma, Mission Director, NRHM Gujarat
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Medica Superspecialty Hospital
Divya Chawla, Sangita Ghosh De
development dimension
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HealthMap: The Online Disease Tracker
Gp Capt (Dr) Sanjeev Sood, Hospital and Healthcare Administrator, SMC, Jodhpur
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Richa Som, HMIS Consultant, JICA/MP RHP
Pharma 28 gives SAP a Thumbs-up
“If prevention becomes a culture in India, the impact will be phenomenal� Amol Naikwadi, Joint Managing Director Indus Health Plus
event report
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event report
Napier India Medical Imaging Informatics Symposium
Telemedicon 2010 32
Regular Columns
column
News review
Standards 36 Redefine
last page
power hospital
40
Divya Chawla
eHealth Sachin Garg, Wg. Cdr. Mudit Mathur, Lt. Col. Salil Garg and Prabhu S. Srivastava
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Healthcare needs 50 surveillance grid
Shubhendu Parth Managing Editor, eHealth
100 95 75
25 5 0
In the Right
Network
magazine reaches to all hospitals in the network of all major health insurers
For advertising opportunities: Arpan DasGupta, 9818644022, arpan@elets.in Rakesh Ranjan, 9953972742, rakesh@elets.in
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> www.ehealthonline.org > December 2010
editorial
Volume 5 | Issue 12 | december 2010 www.ehealthonline.org
Innovations to transformations
President: Dr. M P Narayanan Editor-in-Chief: Dr. Ravi Gupta Managing Editor: Shubhendu Parth VP - Strategy: Pravin Prashant Editorial Team: Dr. Prachi Shirur, Dr. Rajeshree Dutta Kumar, Divya Chawla, Sheena Joseph, Yukti Pahwa, Pratap Vikram Singh Sales & Marketing Team: Arpan Dasgupta (Mobile: +91-9818644022), Bharat Kumar Jaiswal (+91-9971047550), Debabrata Ray, Anuj Agarwal, Fahimul Haque, Priya Saxena, Rakesh Ranjan, Vishal Kumar (sales@elets.in) Subscription & Circulation: Manoj Kumar, Gunjan Singh (subscription@elets.in) Graphic Design Team: Bishwajeet Kumar Singh, Om Prakash Thakur, Shyam Kishore Web Development Team: Zia Salahuddin, Amit Pal, Sandhya Giri, Anil Kumar IT Team: Mukesh Sharma Events: Vicky Kalra Editorial Correspondence: eHEALTH, G-4 Sector 39, NOIDA 201301, India, tel: +91-120-2502180-85, fax: +91-120-2500060, email: info@ehealthonline.org ehealth does not neccesarily subscribe to the views expressed in this publication. All views expressed in the magazine are those of the contributors. The magazine is not responsible or accountable for any loss incurred, directly or indirectly as a result of the information provided. ehealth is published by Elets Technomedia Pvt. Ltd in technical collaboration with Centre for Science, Development and Media Studies (CSDMS)
In-vitro diagnostics (IVD), one of the most crucial segments in the healthcare industry, has created much excitement in the Indian healthcare market, over the past few years. The current IVD market size is estimated to be around US $300-400 million with a phenomenal growth rate of around 15%, which is much higher than the CAGR of the global IVD market. Despite the current dynamics, IVD still remains an underrated segment, not receiving the due attention and credit of various stakeholders including government. However, the market is growing and will continue to grow at a high CAGR. Majority of this growth can be attributed to the rise in number of clinical laboratories, which are the main service providers in the diagnostic segment. Growing at a rate of 30-35%, the number of automated chemistry laboratories, have increased from 700 in 2004 to 1800 in 2010. Major laboratory chains such as SRL Ranbaxy, Dr Lal’s PathLabs, and Metropolis; standalone laboratories; hospital laboratories and independent laboratories, all form a part of this growth. The cover story in this issue highlights the various aspects of in-vitro diagnostics in India. Going further, public health in India has evolved in a big way with many initiatives from the Central as well as State Governments. The Health and Family Welfare Department of the Government of Gujarat, has introduced a mother and child name-based tracking information management system called ‘e-Mamta’ in collaboration with the NIC, Gujarat. A first-of-its kind system, e-Mamta is a web-based software application accessed through www.e-mamta.guj.nic.in. The system covers the entire Gujarat with special emphasis on rural, urban slum and slum-like population. Japan International Cooperation Agency (JICA) ‘Reproductive Health’ project has also been actively involved in improving maternal health in five districts of the Sagar division of Madhya Pradesh, since September 2005. Strategically working in small scale, JICA has accumulated operational knowledge on several maternal health activities for safe motherhood. We are extremely pleased to announce the launch of eHealth’s 50th issue in January 2011. Beginning with the 50th Special Issue in January, the year 2011 will mark a new beginning for eHealth magazine as it moves on to newer dimensions. Happy reading!
Owner, Publisher, Printer - Ravi Gupta, Printed at R P Printers, G-68, Sector-6, Noida, UP, INDIA and published from 710 Vasto Mahagun Manor, F-30, Sector - 50, Noida, UP, Editor: Dr. Ravi Gupta © All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic and mechanical, including photocopy, or any information storage or retrieval system, without publisher’s permission.
Dr. Ravi Gupta Ravi.Gupta@ehealthonline.org
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cover story
Diagnosing A Brighter Future With a CAGR of 19-20%, the in-vitro diagnostics industry is expected to achieve excellence in all aspects By Divya Chawla
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n-vitro diagnostics (IVD) is one of the most vibrant sectors of the healthcare industry. India, in addition to Brazil, Russia and China, offers immense growth opportunities for the IVD industry owing to increasing healthcare budget, coupled with increasing number of private corporate hospitals and stand-alone diagnostic centres, and
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the rising income levels backed by a huge, untapped population bases. As per reports, the combined IVD market in India, Brazil, Russia and China was pegged at US $2.9 billion in 2009. In another five years, this market will grow at a CAGR of 19-20% to US $7.2 billion in 2014. This, considering that the growth rate of the global IVD market is much less, has created much
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excitement among the vendors of IVD instruments and reagents in these countries. Attributing this growth to a variety of factors, Dr. Sushant Agrawal, Director – Laboratory Operations (S&W) and Head - Clinical and Specialised Chemistry at Super Religare Laboratories said that, “Advances in human genomics, proteomics, bioinformatics and microelectronics often
blended with information and computer technology have led to a spurt in the global market for in-vitro diagnostic tests.”
Dynamics in India Various reports state the Indian IVD market size at around US $300-400 million, accounting for only about 2-3% of the entire healthcare market in India. “The industry still struggles with explaining the value that diagnostics can bring to the healthcare system. As we know, 80% of all patient information includes some type of diagnostic testing, yet it only accounts for 3% of the overall healthcare expenses”, said Dr JS Suri, Medical Director, Dr Suri Lab and a well known pathologist in the country. IVD tests used either for the analysis of patient body fluids or tissue samples, are a source of objective information about the body and how it functions. Since this information is vitally important for clinical decision-making, the importance of IVD testing cannot be ignored and in future this fact will be one of the major drivers of growth in this industry. The IVD market comprises of several segments that contribute to the overall growth. According to Dr Agrawal, “In India, IVD instrument and reagents market value is estimated to be around `19 billion. Chemistry and immunochemistry together constitute roughly about 70% of this market, while hematology, coagulation and flow cytometry constitute about 15%. Microbiology, molecular biology
“IVD is an underrated, undervalued industry, unlike pharmaceutical and therapeutic medicaldevices that tend to garner most of the mainstream media’s attention” Dr Jaspal Singh Suri Medical Director Dr Suri Lab
and histopathology contribute 3% each to the market share.” He further adds that, “The market is anticipated to grow at a CAGR of around 15-18% over the next 2 years, against the backdrop of 7-9% CAGR for global IVD market.” Dr OP Manchanda, CEO, Dr Lal PathLabs said that, “The Indian diagnostics market is growing at around 15% CAGR and this trend is likely to continue through the next decade as well, keeping all indices in mind. Molecular diagnostics is growing at an even faster pace of about 25%.” Chemistry and immunology form the biggest segments in the overall IVD market. Other key segments include heamotology and coagulation; while molecular biology is one of the fastest growing and most upcoming segments.
“IVD products business in India is estimated to be less than US $300 million. I think a populous country like India should focus more on prevention and diagnostics” Dr GSK Velu Managing Director Trivitron
Growth propellants Growth in Indian healthcare market is coming from all possible sources. “Increasing urbanisation with its related stress levels, unhealthy diets and growing sedentary lifestyle has led to rapidly increasing prevalence of lifestyle-related diseases like diabetes and cardiovascular diseases in the country,” says Dr Agrawal. He further adds that, “There is a positive movement towards a proactive interest in health by way of growth in employer driven healthcare initiative, increase in paying capacity of families, active media promotion, insurance companies conducting pre-insurance policy check and awareness of prevention with early intervention.” Attributing growth in the IVD market to various factors, Dr Manchanda said that, “At present, one major driving force in this respect is the basic demographic change in India, the migration to urban cities, with more and more people having access to modern healthcare. The rising level of awareness along with rising per capita income is driving the demand for healthcare. The impetus is provided by the increasing investments in hospitals and clinical laboratories. But this scenario is all set for a change with the medical fraternity looking toward development of the rural sector as well.” Talking about the growth opportunities in India, Dr GSK Velu, Managing Director of Trivitron and Metropolis Healthcare, said that “Both through
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cover story Trivitron and Metropolis we are finding ways to make quality and reliable laboratory diagnosis more affordable and accessible to larger section of the population in India. India also has the potential to become a large global R&D base and manufacturing destination due to its inherent vibrant pharma industry and has the potential to become a large scale global hub for clinical trials central lab testing segment. These opportunities will propel growth opportunities in excess of 25% CAGR for both services and product segment for the next five years.” He further added, “The opportunities in government segment will grow as the government is investing in diagnosis beyond Infectious diseases focusing on cardiovascular diseases, cancer and diabetes. Hence IVD is one of the largest growth opportunity within the healthcare segment in India.” Reports predict consistent growth in the Indian IVD market in the coming years. Growing awareness among people about better healthcare services may be one of the reasons. Moreover, there is an increase in the urban population, as more and more people are moving from rural to urban areas. Availability of better healthcare services in the urban areas allows these people to opt for the best healthcare services—in-vitro diagnostic testing being one of them. The constant rise in India’s population is only creating more demand for diagnostics. The boom in India’s economy is another major factor driving growth. An average growth
of 8-9% has been maintained in India, all through the 2000s, which has for obvious reasons had a positive effect on market growth. Even a couple of years back, while on one hand, major industries across the globe were facing rough times because of the global meltdown, growth in the healthcare industry on the other hand, remained unaffected by the recessionary trends. This was a positive sign for the entire healthcare market including IVD. Another recent trend in India has been the growth in medical tourism. There has been a spur in the number of world-class corporate hospitals in India, in recent years. These hospitals are offering the best-in-class quality healthcare at much affordable costs. As a result of this, patients from all across the world travel
“With 90% of market share, the unorganised laboratories are growing at the rate of 10-15%, while the organised corporate chains are growing at a much faster rate of 25-30%” Ameera Patel CEO Metropolis Health Services
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to India to avail healthcare services at these centres of excellence. This has only added up to the market growth in recent years, with all major hospitals becoming healthcare delivery centres for many international patients. Indian patients, on the other hand, are turning to healthcare insurance for securing their healthcare expenses. As private health insurance coverage expands rapidly, there will be a fair rise in IVD testing as empanelled hospitals and healthcare delivery centres would be compelled to provide the best quality healthcare, for which IVD testing is extremely crucial. There has been a steep rise in the number of clinical and diagnostic laboratories over the past few years in the country. These laboratories, being the main service providers in the diagnostic segment, are fuelling growth in a big way. For instance, the number of automated chemistry laboratories, have 700 in 2004, to 1800 in 2010. And this is just one small segment of the complete spectrum. Laboratories across the country are growing at a phenomenal rate of 30-35%. Big laboratory chains such as SRL Ranbaxy, Dr Lal’s PathLabs, and Metropolis; stand-alone laboratories; hospital laboratories and independent laboratories, all form a part of this growth. The growth in laboratory and IVD market being interrelated, the
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cover story growth in IVD is happening as a result of the growth in the laboratory market.
Defining trends Talking about the recent trends in the industry, Dr Suri said that, “Some of the major developments within this very important industry during the past 15 years include increased automation, enhanced workflow, better product quality, and the discovery and commercialisation of PCR.” He added, “At the same time, market fragmentation and clinical utility of lab tests continue to pose challenges.” The IVD industry has adopted automation in a big way over the last decade. Sharing his views on the evolving trend of lab automation, Dr Manchanda said, “As lab automation continues to evolve, the drive or thrust for smaller, faster, and more-accessible devices is increasing. Emerging markets have different needs with respect to the test menus, technologies used, and operating procedures. Thus, made to order solutions need to be developed for these markets.” He further added that, “Lab automation has also taken on a new level of importance in the ability to actually get instruments interfaced to various laboratory information systems. Information technology has taken a giant leap in the IVD industry.” Sharing his thoughts on automation, Dr Suri said that, “One of the most notable changes in the recent years has been in
“Delivering the right data in a timely and cost effective manner while improving the sensitivity and specificity of the test is the need of the hour and the industry needs to gear up for single workstations that can carry multiple workloads” Dr OP Manchanda CEO Dr Lal PathLabs
automation. Who would have thought robotics, sample prep, and sample in/result out would be standard instrumentation in most laboratories?” Talking about its benefits, he added that, “Its commonplace to see chemistry, immunoassay, and hematology instrument lines in the laboratory. Automation has increased efficiencies, reduced human error, and helped to revolutionise laboratory medicine. Given the aging population and scarce laboratory resources, it will continue to play an important role in years to come.” With the rapid increase in the amount of workflow in the past few years, automation has helped immensely in maintaining efficient workflows. According to Dr Suri, “Given that laboratories see volume increases of
“Super Religare Laboratories, initiated the concept of having wellness centers along with traditional pathology labs in India. We now have more than 105 laboratories across India” Dr. Sushant Agrawal Director – Laboratory Operations (S&W) and Head - Clinical and Specialised Chemistry Super Religare Laboratories
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10-15% every year, automation has proved to be the most important thing; because without automation and improv ment in workflow, physicians would become very frustrated, especially in this country, where the volumes are increasing the most.” He also believes that lab tests have been able to expand in such a big way because of automation, as the problem of manpower shortage has been overcome with the help of improved automated solutions. In addition to automation, another trend that has caught up recently is pointof-care testing (POCT). Research suggests that introduction or POCT decreases the turnaround time in a laboratory by as much as 87%. Though the industry has struggled to develop POCT instruments, yet, the benefits achieved have been phenomenal. Throwing light on this aspect, Dr Agrawal said that, “Last 2-3 years have seen major consolidation happening among global IVD players in India. For example Siemens bought Dade Behring, DPC and Bayer Diagnostics tied up, Beckman Coulter bought Olympus Diagnostic division and Roche bought AVL.” The global players have become increasingly aggressive in this industry, which is an indicator of the hoard of opportunities IVD presents in India. The future, as obvious, has much in store for the various members of this industry. The positive trend and growth is likely to continue making IVD, a crucial segment, both in terms of volume and value.
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Column
Health First for Gujarat e-Mamta: Government of Gujarat’s initiative to reduce maternal and child mortality By Anju Sharma
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ith the goal of improving the Human Development Index, the Government of Gujarat is celebrating the current year as its Golden/Swarnim year. The Millennium Development Goals 4 and 5 of reducing maternal and child mortality are the Swarnim Gujarat goals. Reduction in child mortality includes under five mortality, infant mortality and proportion of children immunised against measles, whereas maternal mortality reduction is possible through an enhanced emphasis on institutionalisation of deliveries. The focus of the Health and Family Welfare Department is to bring down the infant mortality and maternal mortality rates as envisioned by the National Rural Health Mission (NRHM).
e-Mamta – Mother and child tracking application As a major initiative in this regard, the Health and Family Welfare Department of the Government of Gujarat, has introduced a mother and child name-based tracking information management system called ‘e-Mamta’ in collaboration with the NIC, Gujarat. This is the first-of-its-kind system, that has been conceptualised and developed by Gujarat and the Government of India has adopted it for replication in all other states. A web-based software application accessed through www.e-mamta.guj.nic.in, the system covers the entire population of Gujarat with special emphasis on rural,
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Health details of about 85 lakh families in the entire state covering more than 80 percent of the population have been entered so far in the software’s database and system generated unique Health IDs have been provided to all urban slum and slum-like population. Health details of about 85 lakh families in the entire state consisting of about 4.30 crore individuals covering more than 80
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percent of the population have thus been entered so far in the software’s database and system generated unique Health IDs have been provided to all.
The system provides a management tool to the service providers at the grassroot level to determine the potential recipients of the services along with their details, through comprehensive work plans The system aims at registering individual pregnant mothers and children in the age group of 0-6 and adolescents along with their full details to ensure complete service delivery of antenatal care (ANC), child birth, post natal care (PNC), immunisation, nutrition and adolescent services and to track the left outs, if any. It also provides a management tool to the service providers at the grassroot level to determine the potential recipients of the services along with their details, through comprehensive work plans. Finally, the services are aggregated to generate reports that are reliable and valid. The approach is therefore to plan, deliver and monitor, which is proactive rather than reactive.
What makes e-Mamta unique? Certain salient features of the e-Mamta application include: • Generation of work plans for the health workers for comprehensive health service delivery • Real-time reports of the due and delivered services to mothers and children
• Instant analysis of the data through dashborad • SMS alerts to beneficiaries and service providers for better service delivery, improved coverage and follow up • Details of various incentives paid to all cadres of health workers individual records for the benefits of JSY, BSY and CY schemes • Online health record/immunisation card of all individuals of Gujarat will be available in the software and will be generated from any DH/CHC/PHC or e-Gram center • The programme is integrated with the HMIS and various reports (Form No 6, 7, 8, 9, etc.) and registers (Register No. 2 , etc.) will automatically get generated from it • UID compatibility • Interdepartmental coordination – ICDS, Education Department, RSBY, etc. will be integrated in this programme • All other National Health Programmes to be integrated with e-Mamta The application is already in place in 26 districts (including private healthcare
providers) of Gujarat and announced for National Rollout in June 2010 at the NRHM Review meeting in Bhopal.
Future plans Future plans involve completely covering the gamut to provide comprehensive healthcare delivery to the rural population, mainly including the following: • Use of Mobile-based technology for more efficient implementation • Integration with National Programmes • Complete Health Record • Integration with e-Sewa and e-Gram • Basis for ICDs, primary education, school health programme.
About the Author
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Anju Sharma Mission Director NRHM, Gujarat
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Power Hospital
Medica Superspecialty Hospital East India’s largest superspecialty hospital with state-of-the-art facilities By Divya Chawla and Sangita Ghosh De
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ased in Kolkata, Medica Superspcialty Hospital is one of the largest superspecialty hospitals in Eastern India and also the first green hospital in Kolkata, having applied for LEED (Leadership in Energy and Environmental Design) Certification developed by the US Green Building Council. The hospital is a 100 percent subsidiary of Medica Synergie Ltd, which is a group of healthcare professionals providing integrated healthcare solutions along various verticals including hospital architectural planning and building, managing hospitals, public health, quality accreditations and retail pharmacy. Medica is a tertiary care hospital with bed strength of 500 and state-of the art facilities in all specialties. The Rs 100 crore Medica Superspecialty Hospital is all set to offer advanced yet affordable healthcare by way of dedicated institutes in the domains of cardiac sciences, neuro-sciences, kidney diseases, orthopaedics (including spine and joints) and gastroenterology. The hospital will also have an advanced emergency unit with the resources to provide 100% pre-hospital trauma and cardiac care to patients. In addition to this, the rooftop healing garden, use of heliography, the study of the sun’s movement on the site, while positioning the hospital building
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and a pneumatic chute system for quick and efficient movement of path lab samples, are among the many firsts that Medica Superspecialty Hospital offers to the city.
The Environment All material that has been chosen in the construction of this hospital is green compliant and selected from various parts of the globe for the quality and ease of fixing. ABS hospital beds with Linac motor system have been selected for smooth up-down movement. There is an eight feet high FDU doors have aluminum beading for easy cleaning. The furniture
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is modular in nature, in keeping with global trends.
The Infrastructure Medica Superspecialty Hospital has been built keeping the current trend of modular buildings in mind. Currently the building has 3 blocks—Block A, B and C. Block C is attached to Block B in the middle with corridor space. Two more blocks, similar to Block C, can easily be connected to Block B later by simply cutting in through the corridor wall. The dust and disturbance of construction will not affect the already functioning areas of the hospital.
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Power Hospital Major Services Offered l
Endocrinology
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Key Hole Surgery
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General Medicine
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Head & Neck Surgery
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Bariatric Surgery
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Maxillofacial Surgery
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Cancer Medicine
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Gynaecology & Obstetrics
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Paediatrics
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Rheumatology
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Laboratory Medicine
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Blood Bank
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Psychiatry
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Transfusion Medicine
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Respiratory Medicine
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Plastic Surgery
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Emergency Services
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Trauma Surgery
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Intensive Care
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ENT
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Dentistry
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Rehabilitation Services
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Nutrition and Dietetics
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Telemedicine
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Pharmacy
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Gift-cum-Book Shop
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Cafeteria
The CSSD is also located here, handling the sterilisation requirements of hospital linen and instruments. The 3rd Floor and above of Block B are patient ward areas. Block C comprises the service areas like the kitchen, laundry, stores, mortuary along with physiotherapy, pathology laboratory and blood bank.
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The Pneumatic Chutes Technology The sample collection room is connected to the pathology laboratory by pneumatic chutes, a first in the city of Kolkata. The pneumatic chute system has been installed for quick and efficient movement of documents and pharma products to different parts of the hospital, and path lab samples from the out patient sample collection area, blood bank and wards to the path lab saving time and ensuring greater accuracy in test results.
Faster Response in Emergency Situation The emergency room is on the Block B ground floor with direct access to the ambulance bay outside. Dedicated lifts connect the emergency room to the OT complex on the 2nd floor. The imaging department is also located on the same wing as the ER for easy access of patients there. This department offers high resolution x-rays, ultrasound, CT- a second installation of its kind in the world, 1.5 tesla MRI, mammography and bone densitometer. All images taken will be captured and stored and can be seen by any consultant in the hospital in his/her own computer by using PACs (picture archiving and communication system).
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Modern Operation Theatres Medica Superspecialty Hospital has several features for modern OTs including regular air changes, HEPA filters of 0.5 microns, pendants so that there are no wires on the floor accumulating dirt, shamphored negative corners to avoid collection of dirt, laminar flow, seamless floors with no joints to avoid accumulation of dirt and use of epoxy paints.
Innovative Critical care Units The hospital has come up with a 120-bed CCU, which is the largest in Eastern India. It has designated ICUs like cardiothoracic, neuro etc., to provide specialised care. Further, the OT and Cath Lab floors also have designated ICUs. The units are equipped with the best and updated technology. The critical care units have a nurseâ&#x20AC;&#x201C;patient ratio 1:1 and doctorâ&#x20AC;&#x201C;patient ratio 5:1. Skilled social workers are present to counsel patients and their family members. There are no hidden costs in charges for treatment and diagnostics and the rates are reasonable with the best possible treatment. With these and more, Medical superspacialty hospital offers various state-ofthe-art services that put it on the roadmap for the becoming a leading superspecialty hospital in India.
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>Development Dimension
HealthMap: The Online Disease Tracker Tracking emerging health threats through online database on HealthMap By Dr Sanjeev Sood
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Health is more than just application of information and communication technologies in healthcare. eHealth should be envisaged as a new way of working which integrates complex networks of people, processes and technologies to provide a more consumer-centric and user friendly healthcare system where information is accessible, relevant and reliable. As the commercial world continues to push the boundaries of innovation with ubiquitous technologies, health informaticians also explore new ways to achieve the vision of universal healthcare. The growing digital economy has seen innovative technologies such as digital marketplaces, mobile communication, health 2.0, cloud computing, next generation games consoles and social networking becoming more ubiquitous in our everyday lives. The ‘mashing up’ of data across the World Wide Web through web services has given healthcare providers greater edge over all kinds of information.
What is HealthMap? Information travels fast—especially online—and a group of scientists from US are putting this fact to good use by monitoring and trying to prevent infectious diseases in their tracks. HealthMap is one such innovation that is a freely accessible, automated electronic data-mining project for monitoring, organising, and visualising reports of global disease outbreaks according to
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Innovative technologies such as digital marketplaces, health 2.0 and cloud computing are becoming more ubiquitous in our everyday lives geography, time, and infectious disease agent. In operation since September 2006, and created by John Brownstein, PhD and Clark Freifeld of Children’s Hospital
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Boston and Harvard Medical School, HealthMap acquires data from a variety of freely available electronic media sources such as ProMED-mail, Euro surveillance,
Wildlife Disease Information Node, to obtain a comprehensive view of the current global state of infectious diseases. Thus, HealthMap is a public website bringing together disparate data sources to achieve a unified view of the current global state of infectious diseases. Users of HealthMap come from various organisations including state and local public health agencies, the WHO, the US Centers for Disease Control and Prevention (CDC), and the European Centre for Disease Prevention and Control. HealthMap is used both as an early detection system and supports situational awareness by providing real time, regional information about outbreaks, even from areas relatively invisible to traditional global public health efforts. Currently, HealthMap monitors information sources in English, Chinese, Spanish, Russian, and French and reports not only infectious diseases affecting mankind, but also animals and plants. By doing so, HealthMap provides an overview of potential disease outbreaks in local pockets, often before government and other health agencies such as the WHO and the CDC realise they are threats. The program is tracking in over 200 countries currently, and this helps to monitor the global impact of infectious diseases. Once the news is in, HealthMap tracks and compiles all the latest reports, from government warnings to blogosphere buzz, and makes them available on its site free of charge. HealthMap uses a colour-coded reference system overlaid on a world map to highlight where disease news is being generated. For instance, ‘red’ or ‘hot’ icons designate areas in which there are multiple reports of illness. The programme continues to scan progress once public health agencies declare an outbreak or epidemic to keep both researchers and consumerism the loop and on top of the latest news about any particular event. Another such initiative is the Bio Sense Real-Time Clinical Connections Program developed by the US Federal Centers for Disease control and prevention. The Bio
The HealthMap website
HealthMap uses a colour-coded reference system to highlight where disease news is being generated. ‘Red’ or ‘hot’ icons designate areas in which there are multiple reports of illness Sense program, initiated in 2004, is an innovative biosurveillance programme designed to increase the nation’s emergency preparedness through the development of a national network for real time disease detection, monitoring, and health situational awareness. Bio Sense sits atop a hospital’s existing information systems, continually gathering and analyzing their data in real time. It is a Federal Program that monitors the outbreaks from early stages, while HealthMap is an informal reporting and early warning information system available on public domain.
The underlying technology HealthMap uses a number of different algorithms to sort through all the information online. This automated system scours news services and online discussion forums and data warehouses pooling information about emerging health threats worldwide. This allows rooting out duplicative reports and determining where and when something is happening. Thus, HealthMap
is essentially a disease mining information system. Data mining is the process of extracting patterns from data and to transform these data into meaningful information. According to Clark Freifeld, co-founder of the HealthMap, the website is continuously updated on the front as well as backend. HealthMap is now tracking 50,000 websites. It offers customized data viewing, is interactive and physicians can upload information on any outbreaks in real-time. A recent example of HealthMap’s abilities is the salmonella outbreak generating headlines and concern across the US and the cholera outbreak in Haiti. By clicking on the red, square-topped icon over the US (indicating a countrywide threat), a site visitor is linked to recent news reports, government estimates of sickened individuals, and so forth. HealthMap founders informed author that they spotted the emerging outbreak days before the CDC by homing in on reports of salmonella-related gastrointestinal distress in New Mexico.
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>Development Dimension free telephone no 1075 accessible from BSNL/MTNL telephone from all states is in operation since February 2008. This receives disease alerts from anywhere in the country and diverges the information to the respective state/district surveillance units for verification and initiating appropriate actions wherever required. IDSP is supporting activities related to H1N1 virus under IDSP with total outlay of `20.85 crores for three years (2006-09) for Human Component.
Conclusion
Indian initiative The Indiaâ&#x20AC;&#x2122;s answer to HealthMap and BioSense Programme is Integrated Disease Surveillance Project (IDSP), launched by MoHFW in 2004. It is a decentralised, state-based surveillance pogramme in the country, intended to detect early warning signals of impending outbreaks and help initiate an effective response in a timely manner. Major components of the project include integrating and decentralising surveillance activities; strengthening of public health laboratories; human resource development and training of state surveillance officers, district surveil-
lance officers, rapid response team, other medical and paramedical staff; and using IT collection, collation, compilation, analysis and dissemination of data. Currently linkages are being established with all state head quarters, district head quarters and all government medical colleges on a satellite broadband hybrid network. The network on completion will enable 800 sites on a broadband network. This network enables enhanced speedy data transfer, video conferencing, discussions, training, communication and in future e-learning for outbreaks and programme monitoring under IDSP. A 24X7 call center with toll
HealthMap affords excellent example of application of informatics to strengthen public health system to effectively monitor and respond better to a public health crisis situation like one being currently faced by India in face dengue epidemic by collating and integrating all data from diverse sources. Effective surveillance shall enable keeping track of all cases, avoid panic, encourage knowledge sharing and mount coordinated response to public health crisis.
About the Author
Gp Capt (Dr) Sanjeev Sood Hospital and Healthcare Administrator SMC, Jodhpur
CATCH UP WITH latest news, articles, interviews and case studies at
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case study
Operationalising HMIS in Backward States
The Health Management Information System (HMIS) needs to be unpacked and viewed with the perspective of multi layer approach
By Richa Som
J
apan International Cooperation Agency (JICA) Reproductive Health Project has been active in five districts of the Sagar division of Madhya Pradesh since September 2005. Through implementation in these districts, JICA has been contributing to the State Department of Health & Family Welfare (DoH&FW) on improvement of the quality of services for maternal health. JICA has kept the stance of technical cooperation with the DoH&FW, and has conducted operations within the framework of NRHM/ RCH-II. Strategically working in small scale, JICA has accumulated operational knowledge on several maternal health activities for safe motherhood. The project has four major components, namely, hu-
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man resource management (HRM), total quality management (TQM), HMIS and IEC/BCC and activities are addressed to various layers of the health system, including state, division, district, block, sector, SHC and village. In contrast to the usual approach, JICA/MP Reproductive Health Project adopted a bottom up approach (focused on data recording, inputting and upward flow), concentrated on the human element of the HMIS and started working towards generation of authentic data with validation mechanism.
Situation analysis A situation analysis was done and the findings of the situation analysis presented
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a plethora of issues which bore reflections on each level. Each level had a different set of problems, which could be identified as factors weakening the HMIS as a whole. At the SHC level, it was found that there is a high information overload. On an average, there are about 30 registers, 4 records, 7 lists and some other reports being maintained by the ANMs. The anatomy of source of information for the various parameters being reported was also not clear. Proper orientation and guidelines for any format were conspicuous in their absence. Non-uniformity and ambiguity about the mandated set of recording and reporting formats was found to be a unanimous feature for all levels. Interestingly, new formats kept
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case study on being introduced without the older formats being withdrawn. This had led to the same data element being reported in different formats and at times with different values. Form 6 seemed to be the most accepted reporting format and the ANMs were very comfortable using it. However, since the forms were out of print, the MPW were making manual forms which led to non-standardised reporting format. A Time Use Analysis was done in Hatta block of Damoh district. The findings of the time use analysis revealed that on an average, one day per week is given in filling the record books (rough to fair); for each service delivery day, around half to two hours is given in filling the rough records. This depends on the efficiency of the worker in filling records and the target load; on an average, two days are given in preparing the monthly report. Therefore, total time allotted monthly is around six days which is around 25 percent of the time allotted for service delivery per month (taking that 24 days in a month are days of service delivery). Taking the average of 75 minutes for rough recording, out of the remaining 18 days of service delivery, around one full day (approx. 23 hrs) equivalent to percent of the available time (18 days) is lost in rough record keeping. Therefore total time lost in reporting is seven days out of 24 working days which amounts to 29 percent. At the block level, there was no uniformity in the formats being sent from the block to the district level. The number of formats being sent vary in number from anywhere from 15-25. The numbers vary within blocks. Computerisation of information was almost absent. NRHM provided the opportunity to recruit DEOs who had no clarity about their roles. Proper orientation (each entry) on the MIES (NRHM) format was required for the block level data managers. There was no clarity on the source of information for each data element leading to compromise in data quality. At the district level, the situation analysis revealed too many loop holes. For example, the NRHM MIES was a new
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Activities undertaken during the Transition phase l
Detailed analysis and consultation with ANMs
l
Advocacy at state and national level with NHSRC
l At the district level, constant discussions with DPM led to finalisation of modified Form 6 l ANMs trained during ANC trainings on the correct way for data recording, implications of data and how to use data for progress monitoring, etc., for the Maternal Health cards. l Attempting to bring about behavioural change and encouraging honest reporting through repeated reminders and field monitoring visits l
Introduction of MH cards at the SHC level
l
Revised Form 6 to meet the state level reporting requirement developed
l This revised Form 6 promoted for all ANMs in two districts; the DEOs were asked to give computer print outs of these forms to the ANMs l
Use of Form 7 encouraged and printouts given
l
Good LHVs given on the job coaching on data validation and team building
l
The data elements required by NRHM incorporated in Form 6
l
Both DEO and BEE called for training on information management
l
DEOs oriented on the vital health indices, NHPs and their role in NRHM
l
The MIES format was circulated in a bilingual format
l
The Excel commands, which make data consolidation easy were taught
l Comments specifying the source of information for all data elements inserted to ensure uniformity in data collection l
Initiation of computerisation with the help of DEOs at the CHC level
Timeline from SHC to District level sealed with the consultation and consensus of the District Health authorities
l
format and required caste disaggregation of data which was not being generated at the lower levels. The reporting format for block and district were not in similar formats for many parameters. Therefore compilation at district level became a very time taking process since it required data transfer and compilation from one format to another. Several reports were being sent from the district to the state and by different people. There was no data standardisation and the same data elements had different values quoted in different reports.
Interventions undertaken The findings from the situation analysis clearly revealed that it was essential to first streamline the reporting system at
> www.ehealthonline.org > December 2010
all levels and standardise it. However, it was also clear that not much could be done for standardisation of reporting formats as the formats are sent from either the national or state level. The strategy therefore adopted was to create systems for coping up with the transition period- till the reporting formats were finalised from national level. Another key input area was capacity building of data managers of all levels, familiarising the newly recruited computer operators with programmatic issues.
National level advocacy during the designing of the NRHM reporting formats The field level scenario revealed that there is a limitation up to which a
One of the new interventions in the project area has been the usage of GIS for evidence-based planning and management at the district level meaningful dent can be made to reduce the information overload at the district level. It was therefore strategically decided to start advocacy at the state and national level to reduce the reporting and recording burden of the frontline workers. Field implementation had enabled to gain an in-depth understanding about the prerequisites for a functional HMIS at the field level. Some basic design principals for reporting formats always need to be borne in mind. The design principals were that the data elements should be such that they feed into national indicators, have usability by the worker herself, feasibility of data collection and avoiding data duplication. Meetings at national level for advocating the need to streamline the hardware (reporting and recording formats) were periodically held. The HMIS Consultant was invited by NHSRC in for a national workshop on finalising the data elements for reporting format at each level. The main inputs at the national level were to fine tune the reporting data elements according to the capacity of the ANMs. The formats were field tested in Pathariya block of Damoh district. Later the NHSRC HMIS team came to JICA/MP RHP Project Office to have a detailed discussion on each data element from the point of feasibility of data collection by the front line health workers. The new NRHM reporting formats were finally rolled out to the states from Ministry of Health and Family Welfare (MoHFW).
Rolling out the new NRHM reporting formats in Madhya Pradesh At the state level, MP had taken the initiative to take these reporting formats to the district level and JICA/MP RHP
has been constantly providing Technical Assistance for this purpose. JICA/MP RHP team was invited by the state to take the session on orientation on the new NRHM reporting formats in March 2009. This training was done for all the 50 districts and the participants included the DPM / ASO and DDA from each district. The participants were oriented on each data element. During the orientation, many issues came up which required state specific decisions. At the state level, the Project team also facilitated to initiate a discussion and come to a consensus amongst the various program heads on the new reporting formats. JICA team met the Joint Director (RCH) to chalk out the plan for rolling out the NRHM formats at all levels in the state. The main decisions reached, with the Technical Assistance of JICA, were to allow the districts to print the formats at their level for the first three months since large scale printing from state would have some procedural delays. Considering that this was a transition phase for HMIS reforms, the state also decided to retain the old reporting formats till the new system is perfect. Meanwhile, divisional level trainings started rolling out in the state. A level wise capacity building plan for the new NRHM reporting formats was devised by the JICA/MP RHP and is now being followed in the state.
HMIS implementation in Bundelkhand
the main design principal of the formats. For years the frontline workers have been used to filling reports on area basis and not service basis. This mammoth change is the main message delivered during the block level orientation. Building new systems for information flow have been devised so that manual compilation (one of the main reasons for bad quality data) gets minimal. Computerisation from SHC level onwards has already been initiated and roles and responsibilities of various levels of data managers been clearly demarcated. One of the new interventions in the project area has been the usage of GIS for evidence-based planning and management at the district level. The Project has also constantly been providing assistance to plot state level indicators on GIS and is in the process of encouraging the usage of GIS as a planning tool by policy makers at the state level.
Challenges With the new system in place, operationalising it involves hand holding and constant support in the initial months. This might not be possible for the Project team alone to take it forward. There are scalar implications and mechanisms for ensuring data quality and streamlining information flow needs to be created for the whole state. Much as it may seem, but reforming HMIS has to have a bottom up approach and not limited to software. Capacity building, data standardisation, building linkage between program and data and computerisation are the bigger challenges facing our country.
About the Author
Apart from the advocacy efforts at state level to roll out the NRHM reporting formats, district and block level orientations on the reporting formats are presently going on in Sagar division of the state. There are several challenges like changing the mindset of workers on
December 2010 < www.ehealthonline.org <
Richa Som HMIS Consultant JICA/MP RHP, Bhopal
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case study
Project SAP implementation for Panera Biotech Cost Project Cost: `40 lakhs Miscellaneous Cost: `10 lakhs Timeframe Three months Key People R Babu, Founder and CEO, Enteg; Sanjeev Pant, Chief Information Officer, Panacea Technology Platform: SAP ERP 4.7 version OS: Windows Server 2007 Modules l Materials Management (MM) l Production Planning (PP) l QA & QC l Plant Maintenance (PM) l Sales & Distribution (SD) l Customer Service (CS) l Human Resources (HR) l Financials & Controlling (FICO) l Product Life Cycle l Management (PLM) Benefits l Fully integrated system l Capture cost and compute profitability l Improving production cycle l Streamlining business processes.
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> www.ehealthonline.org > December 2010
Pharma gives SAP a Thumbs-up SAP implementation at Panera Biotec provided a fully integrated system with access to readily available information at any time By Divya Chawla
T
he Indian pharmaceutical industry, exhibiting dynamic growth patterns, is on a constant lookout for new technologies and intelligent business strategies. IT solutions that improve business efficiency, enhance knowledge integration and meet all regulatory standards are currently creating much excitement in this market. Following the current trend, Panacea Biotec, one of the leading pharmaceutical and life sciences organisations in India used Enteg’s SAP solution for its affiliate company—000Panera Biotec.
Client Background Panacea Biotec is a leading vendor of vaccines and pharma products in the Indian market. Providing a brief background of the company, Sanjeev Pant, said “Some of the vaccines, manufactured by us include polio vaccine, hexagonal and pentagonal vaccines, and so on. Recently, Panacea has also launched swine flu vaccine in India. In the pharma sector, the company is all over India and with an established presence in the international market, as well. The company has five R&D units and five plants in India. Certain very famous products in the pharma sector, such as Nimesulide, have been developed by Panacea. The organisation also has a presence in oncology, diabetology, cardiac areas, nephrology and kidney transplant areas. In vaccines, the company produces around 17 different products and around 70-75% of the revenues in this sector are coming from the international market. In pharma, around 25% revenue is coming from the international market. In the pharma sector, as you know, a product can only be exported to a particular country if it is approved by the pharma regulatory authority of that country. So the process of getting approvals takes somewhere around two and a half years. Therefore, the revenue from international market in this sector is limited.” “Panera, an affiliate company of Panacea, is into bulk drug manufacturing. Panera will be supplying these products to Panacea as well as the Indian market. As of now, Panera
Rajagopalan Babu Founder and CEO, Enteg
Sanjiv Pant Chief Information Officer, Panacea Biotec
December 2010 < www.ehealthonline.org <
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case study is only supplying products to Panacea, fulfilling around 60 percent of the need of the company and a very few products are being exported, as of now”, he added.
Project Outline The implementation, which took only about three months to get completed, is now providing immense benefit to Panera, which mainly carries out bulk drug manufacturing. Panacea’s instant decision to implement SAP in the current fiscal year left the organisation with only over three months to complete the entire process, starting from vendor selection to end-user training. “Earlier we had decided to roll out the SAP implementation project for Panera in the fiscal year 2010-11. However, due to certain reasons, we decided to roll it out this year and by the time the decision was taken, there were only 3 and a half months left for us to complete the project”, said Sanjeev Pant, CEO, Panacea Biotech. After the decision to implement SAP was finalised, Panacea started with the vendor selection process. The organisation based its decision on various criteria, which mainly included the expertise of vendor in the pharmaceutical sector, their commitment towards the set timeframe, their comfort level while working on such projects and mutual cost consent. “Panacea had a requirement of implementing SAP in their new plant, because of which we approached them. “There was an evaluation process, during which we demonstrated our application, post which we were selected. One of the major advantages we had was our expertise in the healthcare domain as we have worked with and a few other companies in this domain”, shares R Babu from Enteg. “We took around 15 days for selecting the most suitable vendor, after which considering all criteria we shortlisted Enteg for the implementation”, adds Sanjeev Pant.
The Technology The technology chosen for implementation was SAP ERP, version 4.7. The
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technology was already implemented in Panacea’s Corporate Office and the company wanted to replicate the implementation in their Panacea plant also. Panacea’s main objective for implementing SAP was to streamline the production plan and HR activities of Panera. Talking about the change in scenario after SAP implementation, Sanjeev said, “We saw a major improvement in the production cycle such as the logs are now maintained properly and actual costs can be calculated. This helped in streamlining the business processes and getting the right costs and investment.” Bringing forth his point of view, Babu said that, “Before SAP implementation, all business information—be it production, quality management, profitability, was scattered and rested with different departments and sources. Because of this, it was not possible for Panera to get live updates. After SAP implementation, you can get the complete visibility of an organisation at any point in time. All information is fully integrated and readily available. It helps the company to increase its market. An integrated system is what they have got after implementing SAP.”
Working through Challenges Although, the implementation process got completed within the set timeframe, yet there were certain initial hiccups. Talking about the challenges faced by Enteg, Babu said that, “Panacea is into the business of vaccination, while Panera manufactures
> www.ehealthonline.org > December 2010
these vaccines. The main challenge was that for a given batch or product, the material had to be collected from various vendors. So we had to effectively compute and arrange the cost of the correct product so that the right profitability can be acquired. In large organisations that have multiple sources of raw material from different places, especially different vendors, the raw material costs will vary dynamically. Hence the costs need to be allocated appropriately to different batches. Modelling was another challenge. We had an initial interaction with the end-users to get a better understanding of the work. We also went to the factory and studied the actual manufacturing process. After the actual manufacturing process, we started capturing the cost. This manufacturing process is put into the SAP system.” The roadblocks however, did not affect the benefit quotient for Panera. Sharing his perspective on Panera’s benefits, Babu said that,“Panera had never had a single system that was fully integrated. For a manufacturing unit, capturing the cost is the most important thing. The ability to capture this cost and compute the profitability is actually an immediate process. However, looking at an RoI perspective, it might take a longer period of time to realise actual benefits. As far as the basic benefits are concerned, Panera will start realising them immediately. The major benefit of an ERP system is the availability of an integrated system.”
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event report
Telemedicon 2010 6th International Conference of the Telemedicine Society of India 14-16 November 2010 By Divya Chawla
T
he Telemedicine Society of India organised the 6th edition of its annual conference, Telemedicon from 14-16 November 2010 in Bhubaneswar, Orissa. The conference was organised in association with SCB Medical College, Cuttack and under the aegis of Department of Health & Family Welfare, Government of Orissa. The focus of this year’s conference was—Distance Education in Health Sciences. Experts in the field of Health IT, telemedicine and education participated in the event and deliberated on the various issues in this sector.
Day I The first day of the conference comprised of basic and advanced tutorial sessions, technology sessions and round-table forums with renowned experts that discussed key issues in telemedicine. The basic and advanced courses on telemedicine and ehealth on the first day were targetted at participants with little or no knowledge of the subject and participants having basic knowledge of the subject, respectively. Students and professionals from various disciplines such as health sciences, life sciences, engineering and ICT applications attended these sessions and
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had a lot to learn from them. The sessions deliberated on technical aspects; standards and guidelines; clinical and educational practices; legal, ethical and social issues; elements for successful practice; ICT infrastructure for 21st century healthcare; telemedicine applications in surgery; evaluation; advanced technologies and mhealth. National and international experts participated in a session on tele-epidemiology. A special session on ICT and advanced technology in education, training and skill development for healthcare professionals was organised for students and professionals of health sciences; researchers in medical education technology; and policy makers in health sciences education such as MCI, NCI, DCI, AICTE, UGC and others. Chaired by Dr Georgi Graschew, Wissenschaftlicher Kkordinator, Robert RÖssle Klinic and Max DelbrÜck Centrum for Molekulare Medizin, the session comprised of a mix of speakers ranging from medical professionals to industry experts, who covered a wide range of topics such as global trends in medical education, changing paradigms, digital libraries and knowledge management. Other key sessions of the day comprised of Telemedicine Society of India – Industry Round Table Forum, which was con-
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“Frank Lievens gave an overall view of the current ehealth situation of various countries across the globe. He said that India has the required expertise to adopt telemedicine and ehealth in a big way”
vened by Prof K Ganapathy, renowned expert in the field of telemedicine, who was also been appointed as the new President of the TSI and Dr LS Satyamurthy from Bangalore. Another round table discussion was organised on the first day, which was participated by several national and overseas experts.
Day II Day II of Telemedicon 2010 began with a keynote lecture by Dr. Georgi Graschew on IT-enabled medical education and research. Dr. Graschew touched various aspects of the role and benefits of IT in medical education during his presentation. The keynote address was followed by a session on distance medical education that covered presentations on several key topics including concepts and relevance of distance medical education in resource crunch countries, technology and systems for medical learning in a collaborative way, need for a national knowledge network and India’s promise for futuristic learning infrastructure, collaborative learning in surgical science and cancer education over national onconet network. Various national and international clinical experts participated in this session and deliberated on several key aspects of distance medical education. Frank Lievens, International Coordinator of the International eHealth, Telemedicine and Health ICT Forum
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(ISfTeH) spoke in length about the global aspects of eHealth in the post tea session on Day II. Frank gave an overall view of the current ehealth situation of various countries across the globe. He said that India has the required expertise to adopt telemedicine and ehealth in a big way. Following Frank Lieven’s talk, a session on telemedicine applications in India – the Ministry of Health initiatives was organised. Frank Lievens and Pramod K Gaur, Vice President, TeleHealth UnitedHealth Group, USA spoke on HR issues in ehealth around the world and the business and economic case for large scale telehealth adoption globally, respectively. The third session of the day focussed on policy, security, privacy, legal, ethical and social issues in telemedicine. This session was chaired by BS Bedi, Advisor – Health Informatics, CDAC and Vice President for TSI. Talks in this session focussed on telemedicine and ehealth law in USA, broadband/telecomregulatory policy for health, telemedicine policy for India, security and privacy issues and how to frame telemedicine/ehealth law for India. A grand Inaugural Ceremony was organised in the evening of Day II, and Mr Naveen Patnaik, Chief Minister of Orissa inaugurated the event.
Day III Day III began with a plenary lecture on A Decade of ISRO’s Community Service
> www.ehealthonline.org > December 2010
– taking IT enabled healthcare from nowhere to everywhere by A Bhaskaranarayana, President, Telemedicine Society of India. This was followed by lectures on eHealth Managed Services, Patent Issues in Telemedicine and Department of IT, Government of India’s initiatives in Telemedicine in the first decase. The day also has a session on telemedicine applications based on case studies from low resource countries and states. Certain key topics discussed during this session were teleophthalmology in India, government funded state telemedicine networks, SAARC and pan African project report and national telemedicine programme of Maldives. Dedicated industry sessions were organised on day III, during which several key solution providers showcased their products and spoke about the latest technologies in ehealth in India. Short paper sessions were also included in day III’s agenda. The highlights of day III of the conference were a TSI Special Session: First Decade of Telemedicine in Indian Sub-Continent and meeting of SAARC Telemedicine Forum. Telemedicon 2010 ended with a positive note leaving the participants with much hope for the future of telemedicine and ehealth in India and the role and benefits of these technologies in distance education and health sciences in India.
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Column
Standards Redefine eHealth Growth in the area of health information technology must happen on a foundation of open standards and formats By Sachin Garg, Wg. Cdr. Mudit Mathur, Lt. Col. Salil Garg and Prabhu S. Srivastava
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nformation technology is becoming pervasive and ubiquitous in the world around us. In healthcare, it is increasingly being used for both diagnosis and therapy. Further, eHealth and telemedicine in their various avatars are starting to be used in providing medical services to a large chunk of people in Indiaâ&#x20AC;&#x2122;s rural and remote areas. It is hoped that this will ultimately improve the quality of medical care and bring down, costs as well. For this to happen, it is inevitable that open standards are leveraged. It will also be necessary to build systems that are simple to use by those who are not techni-
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cally savvy. Another area of importance will be the need to prevent data lock-in. The US Congress has already decreed that patients have a right to see their health records and is starting to ensure that such records are portable, which means that all electronic records should be kept in open, documented formats. These measures will allow users of an eHealth network to call other practitioners or connect with patients on their audio/video-conferencing systems to collaborate or consult, thus making medical care just a phone call away. Continuing in the same vein it implies that the medical
> www.ehealthonline.org > December 2010
attendants should be able to transmit images and other medical data in the simplest gadgets, such as a mobile, fax. The importance of open standards in eHealth is all about protecting the future of healthcare technology and safeguarding the investments made.
Open standards in eHealth The promise of open formats and open standards is especially relevant in the area of eHealth because ICT solutions in this area are heavily data-driven, and these will be the key to providing quality healthcare. As noted by Garg and Mathur, open standards
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Government has an important role to play in the proliferation of standards like the United States Federal Government which will be giving upto US $27 billion in incentive payments to those doctors, hospitals, and other providers that adopt and make meaningful use of standardised EHRs help to consolidate competing standards, increasing the aggregate pool of resources available for using them without the cost inefficiencies of a single vendor de facto. For suppliers, this helps to consolidate a larger customer base. Instead of picking the portion of customers using the proprietary standards you are equipped to support, you can instead offer products and services to a larger consolidated base of users. This also means that since in a networked system, interconnection, interoperability, scalability, security and privacy all depend on widely accepted, open standards and guidelines, and future equipment needs to retain compatibility with its forerunners, it is imperative that the data be stored in open and documented formats. According to Cerri and Fuggetta, the technology supplier cannot claim any right on the customersâ&#x20AC;&#x2122; data and information or impose limitations and constraints on their manipulation. The customer must have the true possibility to switch to another supplier and to access its own information without being anyhow limited. If a programme stores user data in a proprietary format (e.g. for performance reasons), it must anyway be possible to export that complete data in an open format. Without such safeguards it may be difficult to create large local consortia or regional, provincial, national or international teleHealth systems. It is also important to understand the impact of any Intellectual Property Rights claims on the proposed standards. Health Standards
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need to be truly open and not subject to being held hostage by any interested parties by way of IPR.
Standards proliferation Twin concerns relating to standards includeâ&#x20AC;&#x201D;who sets them and who uses them. Obviously a standard that is open but used by none is of no consequence. It is important that any standards setting be done in consultation with the endusers, which includes the private sector also. Else, Kesanâ&#x20AC;&#x2122;s worries about a real danger that the government might step in unquestioned and prematurely pick winning technologies (and in the process, losers) may become reality, leading to a divergence between the private and public providers, resulting in losses for all. The best approach to achieve and ensure eHealth interoperability is by developing a holistic partnership between the public and private sectors. The government has vested interest in providing medical care in the remotest areas as well as to all citizens of the country irrespective of their financial status. On the other hand, the private sector is more interested in the returnson-investment, which means that they will invest in technologies and standards that increase efficiency as well as expand the addressable market. We may thus be able to incorporate the technological and the medical finesse of these institutes with the holistic aim of providing reasonable medical care for all. Another point that becomes extremely important for standards in a nascent area
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like eHealth is continuous evolution. As Krechmer has pointed out, standards should be supported till user interest ceases. This means that all standards must be continuously benchmarked against current technologies and upgraded or deprecated as the case may be. Government has another important role to play in the proliferation of standards. It can incentivise standards adoption like the United States Federal Government which will be giving upto US $27 billion in incentive payments to those doctors, hospitals, and other providers that adopt and make meaningful use of standardised Electronic Health Records (EHRs).
Role of standards Two widely used standards in the health industry are discussed here. One is used for image transmission and storage and the other for electronic health records.
DICOM DICOM (Digital Imaging and Communications in Medicine) is the industry standard for transfer of radiologic images and other medical information between computers. Patterned after the open system interconnection of the international standards organisation, DICOM enables digital communication between diagnostic and therapeutic equipment and systems from various manufacturers. Such interpretable standards are important to cost-effectiveness in healthcare. DICOM users can provide radiology services within facilities and across geographic regions, gain maximum benefit from existing resources, and keep costs down through compatibility of new equipment and systems.
HL7 Health Level 7 is an all-volunteer, nonprofit organisation involved in development of international healthcare standards. HL7 and its members provide a framework (and related standards) for the exchange, integration, sharing, and retrieval of electronic health information. HL7 is also used to refer to some of the specific standards created by the organisation (e.g., HL7 v2.x,
v3.0, HL7 RIM). v2.x of the standards, which support clinical practice and the management, delivery, and evaluation of health services, are the most commonly used in the world. HL7 is an ANSI accredited SDO and is also accredited by ISO for the mutual issuing of standards. HL7 focusses on application layer protocols for the healthcare domain, independent of lower layers. It specifies a number of ďŹ&#x201A;exible standards, guidelines, and methodologies by which various healthcare systems can communicate with each other. Such guidelines or data standards are a set of rules that allow information to be shared and processed in a uniform and consistent manner. These data standards are meant to allow healthcare organisations to easily share clinical information. For example, the HL7 Clinical Document Architecture (CDA) is an XML-based markup standard intended to specify the encoding, structure and semantics of clinical documents for exchange.
Remote cardiac telemetry Remote cardiac telemetry was developed to allow home ECG monitoring of patients with suspected cardiac arrhythmias. The clinical need to monitor outpatients has resulted in advances in technology that now allow us to monitor heart rhythms remotely through a wide variety of devices, including ambulatory external monitors, implantable event recorders, pacemakers, and cardioverter-defibrillators. Traditionally, ambulatory monitoring has been used to determine the cause of palpitations and syncope and, to a lesser degree, to identify ventricular ectopy or nonsustained ventricular tachycardia in patients at potential risk for sudden cardiac death. The rapid expansion of ambulatory monitoring technologies affords the clinician the obvious diagnostic advantage of more comprehensive and real-time data. Devices can record cardiac rhythm continuously or intermittently and can be worn externally or implanted subcutaneously. The new devices transmit recordings
to a centralised monitoring station via telephone by converting an ECG signal into an audio signal and then uploaded to a personal computer for analysis. There is an intrinsic appeal to real-time access to potentially serious arrhythmias. This is particularly true for patients those are being monitored for syncope or while starting an antiarrhythmic drug. In these instances, rapid access to data could result in clinically significant management decisions, and devices with real-time data access are preferred. The problems are faced on compatibility to analyse the data from older machines, thereby ensuring that each time money and effort is invested in acquiring newer and expensive software. Moreover, data transmitted by one machine cannot be analysed by a machine of another company resulting in many a times deaths due to non availability of standards. eHealth and telemedicine are an ever evolving field and as technology improves, so will its ambit. Today, we are looking at universal medical care for all and also good medical care, in which telemedicine will be at the forefront. However, it will require
that newer technology is able to make medical care simpler and more accessible. To ensure that the mission of health for all is not subverted by interested parties, it is imperative that the technologies and data formats used are standardised. We should ensure that future standards are built on a foundation of existing open standards like TCP/IP, XML etc. and are well documented. For standards to be truly useful, they should be widely used and privategovernmental partnership may play a very important role in the proliferation of such open standards.
About the Authors Sachin Garg Architect Yahoo! India R & D Wg. Cdr. Mudit Mathur Commissioned Officer Indian Air Force Lt. Col. Salil Garg Cardiologist â&#x20AC;&#x201C; Army Medical Corps Prabhu S. Srivastava Architect Navankur IT
Note: This work provides the overview of the field of Telemedicine practices done by various experts and institutes. Author(s) take no claim in either designing the models or its concepts, however, direct integration of isolated works in the field of Telemedicine practices has been done in this article. Suitable cross references can be provided on request by eHealth.
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in conversation interview
The Indian healthcare industry is gradually moving towards preventive rather than curative healthcare. Amol Naikwadi, Joint Managing Director of Indus Health Plus, an organisation that specialises in preventive health check-ups, spoke to Divya Chawla, about the preventive healthcare industry trends, technologies, and more
â&#x20AC;&#x153;If prevention becomes a culture in India, the impact will be phenomenalâ&#x20AC;? 40
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How has the Indian healthcare industry evolved to adapt preventive health check-ups? In India, as 4 fellow Indians are succumbing to heart diseases every minute and 30-40% of people who suffer a first stroke, die even before medical help can reach them, the need for preventive healthcare is indeed becoming crucial. Research indicates that the incidence of breast cancer in women is at an alarming rate of 16% and every year cancer claims approximately 8 lakh Indian lives. In such an alarming scenario, preventive healthcare becomes extremely important and definitely the need of the hour. Preventive healthcare means detection of diseases at an early stage in an individual through various check-ups which ascertain whether the various organs in the body are functioning properly. This helps the individual to know well in advance if he/she is suffering from any disease. This helps them to take preventive treatment, where in if the disease is at the nascent stage, it will get cured promptly. Preventive healthcare detects asymptomatic diseases. In case of curative healthcare, the individual comes to know only when the disease has reached a stage where the symptoms may show and corrective remedial treatment is undertaken. It may become difficult to cure certain diseases at this stage. In a developing economy like India (which has a huge middle class population), with Indians more prone to lifestyle diseases; with less than 0.1% of population doing preventive checkups, the scope for preventive healthcare is beyond imagination. Preventive health checkups are something that is needed every year. However, as such Indians have a very fatalistic approach towards healthcare. ‘Prevention is better than cure’, is something that we all have all heard since our school days but seldom do we actually implement this principle. We forget to put it to practice and take chances with something that’s most precious, our health. The same person, who
“In a developing economy like India (which has a huge middle class population), with Indians more prone to lifestyle diseases; with less than 0.1% of population doing preventive checkups, the scope for preventive healthcare is beyond imagination” would spend money and time to get his vehicle quarterly serviced, will think it is a waste to go for his annual BP checkup! A recent CII report indicates that 8% of households are pushed below the poverty line each year due to health expenditure. Technopak reports indicate that 40% of the low and middle income population borrow money or sell assets to pay for hospitalisation. Most of these unexpected expenses are medical expenses, which leave many a person bankrupt. Hence, it is time for one and all to wakeup to the concept of preventive healthcare. What is the current trend in India vis-a-vis the global trends for preventive health check-ups? There has been a double digit growth charted globally for the healthcare industry. Preventive healthcare forms a part of the wellness industry, which is growing at a very healthy rate. According to WHO, it is indicated that India is increasingly becoming the capital for various diseases like cancer, heart and various other stress related (lifestyle) diseases. Hence there is a definite increase in the need for preventive health check-ups in India. What is your perspective on the preventive healthcare check-ups market in India? The Indian healthcare industry, unlike other industries, stands untouched by recession. There had been a steady growth in this sector, revenues from the healthcare sector accounts for 5.2% of the GDP, making it the third largest growing sector in India, and further the healthcare sector is projected to grow to nearly 1,80,000 crores by year 2012 and a compounded
annual growth rate (CAGR) of 15-17% for at least the next 7-10 years. The preventive healthcare market is growing at a 25% growth rate. Provide a background of Indus Health Plus and the services offered by the company? Pioneering in affordable, comprehensive and qualitative preventive health checkups and diagnostics for a-symptomatic Indians, Indus Health Plus was established in the year 2000 by a team of likeminded professionals. Primarily started to propagate the inherent benefits of preventive diagnostics, the aim is to create awareness on how preventive health check-ups can reduce mortality and risks related with modern day diseases. The mission is to create a health revolution, safeguard health care and promote ethics and honesty in healthcare. An ISO-9001-2000 certified company; it has alliances with well-equipped and renowned delivery partners across the country. Currently, Indus has a presence in Maharashtra, Goa, Chattisgarh, Karnataka and Delhi. Indus Health Plus has been expanding its network of delivery centers across the country and aims to eventually achieve a pan-Indian footprint in the preventive health care segment. Indus currently operates in 15 cities across 26 delivery partners. The strength at Indus Health Plus is the fact that it has reached out to ‘more than 2 lakh’ clients. As an organisation, Indus provides its clients with customized preventive healthcare packages and ‘loyalty cards’ which offer huge discounts on medical tests and services at the delivery partners. Indus emphasizes on
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interview to access quality medical treatment at highly discounted rates. This card gives attractive discounts across a spectrum of services that are normally not covered by health insurance.
“Thanks to today’s advanced technology, chances of a problem escaping unnoticed, is almost negligible. Prevention, not just early detection becomes the mantra” detailed comprehensive tests that are normally not conducted by most centers due to its increased expenditure. Nonetheless, Indus offers these tests at substantially lower costs than any diagnostic center in the country. The unique aspect at Indus Health Plus is that all the medical tests under any package (that are undertaken at any of the delivery partners), are conducted in a SINGLE day followed by reports and counselling- All in ONE Day. Since its inception, Indus has enabled the highest number of CT Coronary Angiograms (non-invasive) in the world in a single day. Thanks to today’s advanced technology, chances of a problem escaping unnoticed, is almost negligible. Prevention, not just early detection becomes the mantra. Hence, the focus of Indus Health Plus is to create awareness on how preventive health check-ups can reduce mortality and risks. Our products are preventive health-
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care packages and Healthfriend card. Some of the packages offered include: Essential Care Health Checkup Package (EsCP), which has basic tests for those on a budget; Early Care Health Checkup Package (ECP), which includes a list of 12 essential tests beneficial to all; Cardiac Care Health Checkup Package (CCP), which focuses on cardiac care; and Exclusive and Comprehensive Health Checkup Package (ECHC) for everyone above 35 years of age. There is an additional exclusive package for Delhi. The full checkup followed by reports and expert doctor’s counseling is completed in a single day. Healthfriend Cards is a revolutionary healthcare product introduced by Indus in 2005. In India, close to 70% of health expenditure is out of pocket and we understand this. A part of our drive to make quality healthcare ‘accessible, available and affordable’ to all, the Healthfriend cards enable Indusites and their families
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What are the key equipment and technologies installed at your centres? According to a published article, cardiac CT scan is the most comprehensive scan available for the heart. We have evolved from the basic preventive health packages to the high-end packages. This scan involves a huge sum of money but Indus offers this service along with a bouquet of other services at a very nominal rate. Indus believes in adding value to their services for their consumers, as they know that in India almost 80% healthcare expenses are paid out of pocket. We have invested and developed an in-house ERP software in order to give a better experience to our clients. At Indus, we work in close conjunction with our delivery partners in order to provide our clients with the packages they have opted for. We believe in creating an experience for our clients and it is this experience that our technology helps us to achieve. How do you foresee the transformation in healthcare delivery through preventive health checks? A recent ICRA report emphasises on the role of prevention especially to battle chronic diseases rampant in India, and so there is immense scope for work here. There is a need for an awakening in the thought process of Indians. As prevention becomes a culture in India, the impact will be phenomenal. Planned surgeries can be undertaken instead of last minute critical operations. The mortality rate due to lifestyle diseases can also be minimised. Overall the losses can be reduced and it would help in the effective use of India’s GDP. Hence preventive healthcare is the need of the hour and there is tremendous scope of the same in India and at the global level.
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event report
Napier India Medical Imaging Informatics Symposium December 4, 2010 Bridging the technological and medical divide in imaging informatics By Divya Chawla
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apier Healthcare, formerly Karishma Healthcare, organised the Napier India Medical Imaging Informatics Symposium on December 4, 2010 in New Delhi. The symposium was supported by Redington, Oracle and Barco, who provided their support as the Technology Partners. The symposium focussed on bridging the technological and medical divide in imaging informatics. The objective of the symposium was to help healthcare professionals choose the right single solution for enterprise-wide imaging informatics. The seminar began with a talk on ‘PACS Challenge for the Indian Radiologist’ by Dr Avinash Nanivadekar, Chief Radiologist, Ruby Hall Clinic, Pune. Dr Nanivadekar called PACS a disruptive technology as its advent completely destroys the comfort of the existing technology. He said that though initially hospitals did not understand their need of PACS, radiologists are now getting aggressive with the use of technology. He said that the worst a hospital could do was choose a bad PACS vendor. He stated several reasons that justify the need of PACS in a particular hospital including lost films, data not archived, need for repeated examinations, transfer and storage issues, difficulty in identification, and so on. The next presentation was on ‘Selecting Right PACS for Right Clinical Discipline; Vendor Neutral Archive’ by Dr Adam Chee, Chief Advocate (Director), Binary Healthcare. Dr Adam focussed his presentation on four critical aspects—imaging informatics essentials, health informatics ecosystem, tips on
selecting right PACS and vendor neutral archive. He said that there is no standard core body of knowledge in medical imaging, which is a major drawback. Further, though everybody thinks that medical imaging informatics is limited to radiology, it is not. Also, PACS is not just limited to images—it is offers much more than that. He also spoke about the various types of PACS including—Mini PACS, Departmental PACS, Hospital PACS and Enterprise PACS. Going further, Dr Balaji Ramachandran, Principal – Healthcare, Napier Healthcare, spoke on ‘EMR+PACS (1+1>2) and CDSS Value’. He said that lack of integration between EMR and PACS is a major challenge. Further there is a lack of clinical workflow support in EMR, automation, comprehensive textual metadata in medical images and image mining tools. He said that factors for success in any PACS related project include professional buy-in, innovative CIS, standardisation of quality of care, optimisation of quality vs cost ad integrated healthcare services. Kulbhushan Chand, Director – Partner Solutions Centre, Oracle India made the final presentation of the day. He spoke about the worldwide presence of Oracle in the healthcare sector. Oracle’s solutions improve quality through health information exchange, business intelligence and security, access and identity management. The day ended with video presentations from Barco and the launch of Dr Adam Chee’s book—‘So you want to be a PACS administrator’ in the last segment.
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news analysis
MBBS Seats Increased in AP Uday Krishnan, a class twelfth student and medical aspirant, has better chances of becoming a doctor now. The new guideline of Medical Council of India allows medical colleges, of 1100 beds strength or above, to increase their intakes in medical courses up to 250. This new regulation of MCI will allow several top colleges in the state to increase their seats by twenty percent to even fifty percent at some places. Approximately thirty percent more medical aspirants will be benefitted in Andhra Pradesh from the coming academic year. The competition for getting seats in medical colleges is very high. As per the stats, every year around thirteen students compete for one seat. The competition is likely come down from the coming year. On an average 60,000 students qualify EAMCET, state entrance exam for getting into engineering, agriculture and medical colleges. Allocations of medical colleges’ seats are just restricted to some of the top rankers. Any increase in the number of seats will bring ease to thousands of students every year. Osmania Medical College, with bed strength of 6,000, currently has 200 seats. They would be able to add fifty more seats in the wake of MCI’s new guideline. Similarly, Gandhi Medical College and Warangal Medical College, with 1100 beds and 1200 beds respectively, can increase their intakes by fifty to hundred, depending upon their faculty strength. However, the new guideline has not brought any good news to private medical colleges and hospitals. Most of the private colleges don’t have required infrastructure supporting 1100 beds. So they have to continue with the existing number of seats. A private college management said that even students with the rank of 6,000 will stand a fair chance of getting medical admission now. However, there is apprehension existing among the senior doctors about in-
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The new MCI guidelines will allow a number of colleges in the state to increase their intakes by thirty percent on an average. Students bliss eHealth Bureau
crease in the number of medical seats. The existing ratio in the state, at undergraduate level, is estimated to be around one teacher per nine students. As per the senior doctors, there are multiple factors that should be taken into consideration before increasing the number of seats. Medical equipments, availability of teachers, hostel facilities, classrooms and multiple other infrastructural needs have to be fulfilled before increasing the intakes. The quality concern has been raised against MCI guidelines. This country is already facing the unemployment problems for thousands of trained engineers every year. Hitherto, medical profession has been in the elite group because of the tough competition that students face to get into medical colleges. So far only those students
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are given an opportunity to become doctors, who are capable enough to be trained. The increasing ratio between number of students and teachers will also affect the quality of training. In rural areas we have a number of incompetent doctors creating medical blunders every now and then. But looking at the positive side of the coin, this new guideline can play a significant role in strengthening up the fragile medical condition in India. “The country is still facing a dearth of medical practitioners; we need around 1.8 million doctors to maintain a good medical environment.” Dr Naresh Trehan, Chairman Medanta Medicity said at a recent conference. Post graduate medical seats have also been increased by thirty percent from coming year.
national conference on ict in Public safety & security January 28, 2011 The Claridges, New Delhi
securing citizens through technology e
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• Access Control & Identity Management
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• Senior Officers from Key Government Defence Establishments • Heads of Police Departments & Intelligence Agencies • Security Experts & Defence Analysts • Technology Providers & Suppliers
Organised By
For Sponsorship enquiries: Debabrata Ray, Email: sales@elets.in, Mob: +91-9899650692 For Programme enquiries: events@elets.in
www.secure-IT.in
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news review
Technology
NextGen, ScImage bring universal image integration to EHRs ScImage, an enterprise imaging and informatics company, has partnered with NextGen Healthcare Information Systems to release a universal medical image integration module that provides NextGen users simultaneous access to patient-centric and study-centric images. The NextGen Medical Image Integration Module allows images produced by any imaging modality or commercial PACS to be accessed through a common viewer inside NextGen Ambulatory EHR. It provides a physician and clinician viewing application to NextGen clients with no downloads required. Clients also have access to a broad array of content, including medical images, documents and reports generated
by multiple disparate PACS systems. In addition, this module includes builtin modality work list services, eliminating extraneous costs and complexity for end users. At the core of the new offering is the native ability to capture and transfer discrete procedural data from select modalities directly into NextGen Healthcare’s clinical database. These critical data points can be pre-populated into NextGen Healthcare’s clinical reports or examined for outcomes investigations. The application can also replace or enhance PACS technology currently installed without the need for costly upgrades or data and image migration, while maintaining the current workflow for each clinical area.
The NextGen Medical Image Integration Module aims to address a major challenge for physicians, who find that many PACS vendors only provide a proprietary viewer with their own systems. The technology is valuable in health system environments, where a single patient may see his primary care physician and specialist at separate locations, and then have additional procedures completed in a hospital. In the past, the unfamiliarity of different viewing applications required end-users to be trained on each individual system and to download multiple image viewers. This new application eliminates those downloads and provides access for users on most major operating systems and mobile devices.
Life Sciences
Market
Serum Institute vaccine to help Africa combat meningitis menace
Global dental implants market to reach US $4.2 billion in 2015
An indigenous vaccine will help rid Africa of meningitis, one of the continent’s worst enemies. Less than 10 years after the creation of the Meningitis Vaccine Project, the new vaccine—MenAfricVac is ready to be introduced in Africa for mass immunisation. MenAfriVac, the conjugate single dose vaccine that protects both children and adults, is developed by Serum Institute (SII) in Pune. It was licensed by the drug controller general of India in December 2009, prequalified by the World Health Organisation in June 2010 and registered in Niger, Mali and Burkina Faso earlier this year. Burkina Faso, Mali, and Niger have been selected for the first introduction of the vaccine on the basis of several criteria, including disease burden, the ability to organise mass campaigns and participation in clinical trials to develop the vaccine. Countrywide vaccination campaigns of the population in the 1-29 age group in these three countries will begin in December. More than 25 African nations, stretching from Ethiopia to Senegal, that fall under the region’s infamous meningitis belt, will use the vaccine to combat the life-threatening bacterial disease.
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According to a recent report, dental implants are estimated to have one of the highest growth rates amongst all dental device submarkets. The global dental implants market, which represents 18% of the global dental device market, is expected increase from US $3.2 billion in 2010 to US $4.2 billion in 2015 at a compound annual growth rate (CAGR) of 6%. Europe is currently the largest market for dental implants, with a market share of 42%, and is predicted to have the highest CAGR from 2010 to 2015 at 7%. The growth can be attributed to the rising demand of cosmetic dentistry across all age groups worldwide, and the use of dental implants for the effective treatment for edentulism.
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news review Technology
Philips launches 24/7 pacemaker monitoring Royal Philips Electronics has announced a new service that provides Web-based remote monitoring follow-up services for patients with pacemakers. Pacemakers are a critical part of treatment for patients with a wide range of heart conditions, and they must be checked frequently to ensure proper function. Philips has offered transtelephonic, data transmission via phone, follow-up services for 35 years. Leveraging this experience, Philips is expanding its portfolio to include the latest pacemaker technology. Remote monitoring is becoming standard for surveillance of patients with cardiac implantable electronic devices; scientific data has demonstrated remote monitoring allows earlier detection of patient issues than standard in-clinic follow up. Philips brings unprecedented convenience and patient care quality to cardiology practices by conducting Web-based remote monitoring of their pacemaker patients, ac-
cording to Phillips executives. Philips technicians review, summarise and triage each pacemaker test and provide clinically appropriate, customized notification to support timely and informed patient management for the physicians.
People
K Chandramouli appointed the new Health Secretary K. Chandramouli, IAS (UP:75), Secretary, Department of AIDS Control, Ministry of Health and Family Welfare as Secretary, Department of Health and Family Welfare, Ministry of Health and Family Welfare, Government of India has taken over as the new Secretary of Ministry of Health & Family Welfare. The decision was taken after the retirement of K Sujatha Rao from the post of Secretary on November 30, 2010.
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news review
People
International
Nova Medical Centers appoints Sudhir Bahl as President and COO
Nebraska starts work on US $18 million network to connect rural hospitals The Rural Nebraska Healthcare Network (RNHN), a consortium of nine rural hospitals and related clinics in western Nebraska, has launched a construction of a US $18 million fiber optic medical network that aims at improving care throughout the Nebraska panhandle. The proposed 750-mile fiber network spans 12 counties in western Nebraska, and will connect to national research networks such as National Lambda Rail and Internet 2 in Denver. Officials held a ground breaking ceremony for the network at Regional West Medical Center in Scottsbluff, Neb., one of the members of the non-profit consortium. The project has been made possible with the support of Regional West Foundation and in cooperation with Fiberutilties Group, an Iowa based consulting and technology firm, Louisville, Colo.-based Zayo Group, a provider of bandwidth infrastructure services, and Omaha, Neb.-based Adesta LLC, a of solutions for advanced communication networks and security systems. Using federal funding under the Rural Healthcare Pilot Program of the Federal Communications Commission, in conjunction with funding provided by Zayo Group, the RNHN will connect the primary care hospitals and dozens of affiliated clinics creating one of the most advanced and robust medical technology networks in Nebraska.
Nova Medical Centers, India’s first multi-specialty standalone day care surgical centre, has appointed Sudhir Bahl as its new President and COO. Sudhir has joined Nova Medical Centers as President and Chief Operating Officer to lead the overall operations of the Company, and will be based out of Delhi. He will also be the Head of Max-NOVA SPV and serve on the board of the SPV. Sudhir will be responsible for steering the growth of overall NOVA Operations in India and additionally be engaged directly in managing the doctor empanelment. Sudhir Bahl, a Healthcare Delivery Industry and Domain Specialist, has 18 years of experience in transforming companies – be it start-ups, re-organisations or joint ventures across healthcare sector. His practice spectrum spans General Management, Business Development and Corporate Affairs in both Indian and International Healthcare markets.
Product
Initiatives
Panasonic launches new technology to monitor heart
FDA launches external defibrillator improvement programme
Panasonic has unveiled its new CardioHealth Station, a tool for personalised preventive medicine, at the 2010 American Heart Association Scientific Sessions. Panasonic’s flagship healthcare product, the CardioHealth Station is designed to assist medical professionals in making a quick and valuable assessment of cardiovascular health and is expected to launch in North America pending FDA action. The CardioHealth Station has a built-in portable ultrasound system optimized to perform a non-invasive examination of the carotid arteries. It provides an automated real-time measurement of the intima-media thickness (IMT) and allows the user to search for arterial plaques.
The US Food and Drug Administration (FDA) has launched a programme to facilitate the development of safer and more effective external defibrillators through improved design and manufacturing practices. The Center for Devices and Radiological Health (CDRH) has received more than 28,000 reports associated with failure of external defibrillators in the past five years. Manufacturers have also issued recalls on several occasions. CDRH has identified that many of the problems, including engineering design and manufacturing practices, were preventable and correctable. As a part of the initiative, CRDH is taking steps to work with manufacturers, users and experts to improve the engineering design and manufacturing practices of these devices, and to make way for the development of their next generation.
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news review Market
Product
Siemens launches Fast Care technology platform for CT Fast Care from Siemens Healthcare is the new technology platform for CT (computed tomography) scanners which helps hospital staff to perform CT examinations faster and more efficiently than before, while also keeping the dose as low as possible. The Fast Care applications simplify workflows during scanning and in the preparation of image reconstructions. Patients benefit from lower radiation doses and shorter examination times as the system automates many operating procedures, suggests parameter settings for image quality and dose reduction and standradises processes which makes results more readily reproducible. These enhancements help CT operators and service providers improve their productivity. Fast Care will be available on the Somatom Definition AS scanners in March 2011 and on the Somatom Definition Flash scanners in May 2011. Somatom Definition product family CT scanners that are already on the market can be upgraded to the new platform. Two of the major current needs in computed tomography for which Siemens has developed Fast Care are optimisation of the processes relating to patient diagnostic examinations and reducing the doses necessary for such examinations. The new technology platformâ&#x20AC;&#x2122;s applications therefore focus on two aspects: fully assisting scanner technologies (FAST) support process optimisation and combined applications to reduce exposure (CARE) assist with dose reduction.
Handheld ultrasound market poised for rapid growth The US handheld ultrasound market is expected to exceed US $1.2 billion by 2016 due to technological advances and improvements in three and four-dimensional capabilities by some of the major manufacturers including SonoSite, GE and Siemens, according to a new report by a market research firm. The report includes market analyses and competitor profiles for 11 ultrasound systemsâ&#x20AC;&#x201D;cardiology, radiology, obstetrics, gynaecology, breast, urology, vascular, ophthalmic, emergency medicine, musculoskeletal, trans-cranial and handheld ultrasound imaging devices. Adoption of handheld ultrasound devices and the use of ultrasound in emergency medicine will fuel strong growth in the overall US ultrasound market, which suffered a sharp decrease in sales during the recession, according to the report. The breast ultrasound market is showing strong growth, the report notes, and is on track to double in size by 2016.
Government
Corporate
Himachal Pradesh launches BPL medicine scheme
Fresenius Medical Care brings home haemodialysis to India
A scheme for providing 38 types of medicines free of cost in OPDs of government hospitals of Himachal Pradesh was launched by Chief Minister of Himachal Pradesh, Prem Kumar Dhumal at Nahan recently. The scheme has been named Pandit Deen Dayal Upadhaya BPL Security Yojna. The CM said BPL beneficiaries have already been given insurance cover of `30,000 under the Rashtriya Swasthya Bima Yojana (RSBY). Insurance cover of `1.75 lakh is being provided for critical ailments.
Fresenius Medical Care, the global leaders in dialysis equipments and services has introduced the concept of home haemodialysis for the first time in India. Home haemodialysis concept is already practiced in many countries across the globe and with its introduction in India a new chapter will be unfolded in the Indian Dialysis Society. The technique has many benefits, however, it requires the patient and/ or his relatives to be properly trained in order to carry out the procedure at home. Choosing the right equipment is also crucial for safe and quality dialysis.
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Last Page
Shubhendu Parth Managing Editor, eHealth
Healthcare needs surveillance grid ‘Fixing the sick’ approach should give way to a preventive care and diagnostics system, especially for the rural people
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s a speaker invited to talk on the trends in healthcare sector in an event in Chennai recently, I was pleasantly surprised to hear Dr Mahesh Vakamudi echoing noted futurist Jim Carroll’s forecasts for year 2020. Mahesh is head of Anesthesiology and Critical Care at Chennai’s Sri Ramchandra Hospital. Quoting Carroll, my fellow speaker put forth the proposition that India needs to transform the present healthcare system, which “fixes people after they are sick,” into a more proactive preventative care and diagnostics system. Unfortunately, for India, a decade may not be sufficient to achieve this paradigm shift. And there are too many odds stacked against it. Today, the biggest challenge that the country faces is not that of ‘availability’ of quality healthcare; the country has sufficient number of best-in-breed healthcare facilities to meet needs of urban population segments. Instead, India is grappling with a huge challenge of ensuring ‘accessibility’ of quality healthcare facilities to all, particularly for the rural populace.
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According to the data made available by the Union Ministry of Health, curative services favour the non-poor in India—for every `1 spent on the poorest 20 percent population, `3 is spent on the richest quintile. All this, despite the National Rural Health Mission (NRHM), which has not been able to achieve anything remarkable in improving the state of health facilities in rural hinterlands. Yes, NRHM can claim to have made some impact in neo-natal care and immunisation, but ill health continues to be a major risk factor for the rural poor in the country. And the reasons are clear for anyone to see: lack of adequate healthcare services in rural and remote areas and very high direct and indirect costs of accessing them elsewhere. Non availability of a ‘neighbourhood’ healthcare facility adds to the loss of ill person’s contribution to the household economy and leads to a diversion of time–particularly of women in poor rural households–from productive activities to caring for the ill. And the impact is severe. Over 40 per-
> www.ehealthonline.org > December 2010
cent of hospitalised Indians are believed to borrow heavily or sell assets to cover their healthcare bills, while 25 percent of hospitalised Indians fall below poverty line because of hospital expenses. To transform from a not-so-efficient curative care nation to Carroll’s vision of treating citizens “for the conditions we know they are likely to develop, and re-architecting the system around that reality,” India needs to quickly set up a nationwide disease surveillance grid, something that had been piloted in bits and pieces but never quite rolled out. While the NRHM mission document does talk about strengthening capacities for data collection, assessment and review of evidence based planning and villagelevel disease surveillance system, the government now needs to drive the agenda as part of its integrated Mission Mode Project under the National eGovernance Plan. It should also create a mechanism to fund the initiative as part of the state’s overall budget allocations, and link the disbursal to a time-bound, milestonesbased implementation plan with a fixed project deadline and fund expiry date.
Celebrating Innovations that Transformed Indian Healthcare
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march 04, 2011 The Claridges, New Delhi
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Special Issue January 2011
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