eHealth December 2012

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

volume 7 / issue 12 / december 2012 / ` 75 / US $10 / ISSN 0973-8959

Web Clinic A New Platform

inside Dr Samit Sharma Managing Director, Rajasthan Medical Services Corporation, Government of Rajasthan p-8

Aravind Sitaraman President Inclusive Growth, Cisco p-22

Special Coverage eINDIA 2012 Report p-24

Special Feature Indian Diagnostics: A Leap in the Dark p-50

Shivinder Mohan Singh MD, Fortis Healthcare

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eHealth Magazine

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volume

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contents

ISSN 0973-8959

cover story

Web Clinic: A New Platform By Shally Makin, Elets News Network (ENN)

Managing Director, Rajasthan Medical Services Corporation, Government of Rajasthan

Day 2: Session 2 - Quality, Standards and Patient Safety

Day 2: Session 3 - Rural Health: Serving bottom-of-the-Pyramid Population through Effective use of Technology Inovations

Dr Tejinder Kataria, Chairperson, Division of Radiation Oncology, Medanta-The Medicity

Day 2: Session 4 - IT for Healthcare Delivery

in conversation

Day 2: Session 5 - Adopting Technology to Redefine Medical Education

tech trends Monitoring Sugar in Type 2 Diabetes

zoom in CyberKnife Redefines Cancer Treatment

Aravind Sitaraman, President Inclusive Growth, Cisco

eINDIA report eINDIA 2012 Nurtures a Health IT Platform

Day 1: Session 1 - Emerging Paradigms in Healthcare

Day 1: Session 2 - eHealth & mHealth Expanding the Healthcare Horizon

Day 1: Session 3 - The Untapped Market

Day 2: Session 1 - Emerging Trends in Health Insurance

Dr Samit Sharma

december / 2012 ehealth.eletsonline.com

eINDIA Awards - Hall of Fame

special feature

Indian Diagnostics: A Leap in the Dark

expert speak

Tapan Kumar, ACP (Deputy Director), Dept of IT & Communication, Govt of Rajasthan

leader speak

Shivinder Mohan Singh, MD, Fortis Healthcare

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

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December 2012

President: Dr M P Narayanan

Partner publications

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ehealth does not neccesarily subscribe to the views expressed in this publication. All views expressed in the magazine are those of the contributors. The magazine is not responsible or accountable for any loss incurred, directly or indirectly as a result of the information provided. ehealth is published by Elets Technomedia Pvt. Ltd in technical collaboration with Centre for Science, Development and Media Studies (CSDMS) Owner, Publisher, Printer - Ravi Gupta, Printed at Vinayak Print Media, D-320, Sector-10, Noida, UP, INDIA & published from 710 Vasto Mahagun Manor, F-30, Sector - 50, Noida, UP, Editor: Dr. Ravi Gupta © All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic and mechanical, including photocopy, or any information storage or retrieval system, without publisher’s permission.

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editorial

New drug pricing policy: a pill to cure all ill? India’s approval for a new drug pricing policy, designed to increase the number of essential drugs from 76 to 348 with price caps, is a welcome move. But will it really serve the purpose or deliver the goods for the masses? An analysis of the policy makes it clear that it will benefit a specific segment of society who can afford to buy medicines. They will now get it under a regulated price mechanism at lower rates. But the policy is not going to ensure availability of drugs to the large suffering masses, who can’t afford to buy medicines even after a price cap. While the Government’s efforts to bring more drugs under price control are aimed at making medicines affordable for the poor, local and foreign drug producers argue that there is enough competition to ensure that medicines sold in India are among the cheapest in the world. When generic drugs in the country are available at the cheapest prices in the whole world, the new policy of the Government will not cut much ice as price regulation makes sense in case of drugs where there is a monopoly or a duopoly. One of the striking aspects of the policy is that patented drugs are not covered under it, though India is considering a mechanism to regulate prices of medicines which are covered by patent protection. Under the new policy, the ceiling price of a particular drug would be calculated by taking the arithmetic mean of the prices of all the brands that have more than one percent market share. According to industry reports, the new policy is expected to cover up to 30 percent of the total drugs sold in the country. However, speaking about the current issue of eHealth magazine, the magazine has tried to bring about some of the very recent updates of Indian healthcare. For example, the present trend of online healthcare, market dynamics of In-Vitro-Diagnostics (IVD) in India and about the Self Monitoring Blood Glucose system. Additionally, the magazine has special reports around the discussions that had taken place at the eINDIA Health Summit, 2012 conference held last month. The conference witnessed eminent speakers, delegate participation, students, hospital CEOs, CXOs, doctors etc. The report will give you a glimpse of the healthcare stakeholders’ views and opinions. Then the December issue has special interviews of Shivinder Mohan Singh, MD, Fortis Healthcare, Aravind Sitaraman, President Inclusive Growth, Cisco and many more. Hope you will all like the edition. Happy reading!

Dr. Ravi Gupta ravi.gupta@elets.in

december / 2012 ehealth.eletsonline.com

volume

issue 12

december 2012

asia’s first monthly magazine on The Enterprise of Healthcare

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inbox Readers Speak As usual, the eHEALTH portal has been flooded with a range of comments from our distinguished readers. Few of these reader comments have been selected by our editorial team to be published in the magazine. Read onApollo DKV health insu says, “That is really fascinating, you are a very professional blogger. I’ve subscribed your RSS feed and always look for some extra stuff in your magnificent posts. Additionally, I’ve shared your site in my social networking sites too. Arista5567@yahoo.co.uk says on Private Equity investments in pharma touch USD 400 million, Thanks like your story.

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Beams Hospital @Beams Hospital We are India’s foremost laparoscopy specialty hospital. Stay connected. We’d love to interact with you! You can also visit us on http://BeamsHospitals. com IndiaQBank@IndiaQBank IndiaQBank is an online test preparation service for the medical and engineering exams of India. AIPGMEE/AIIMS-PG, FMGE and JEE MAIN. EU_Health@EU_Health A part of the EU Commission’s DG Health and Consumers (SANCO), we are working to protect people from health threats and disease. RT ≠ endorsement. Facebook Like of the Month Anita Gupta, Management Information System Officer at Population Services International – India, Working on Zinc+ ORS project funded by UNICEF

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Brandon McBride, stevenhenager@hotmail.com says on leading the Way in Indian Healthcare, “Technology is a blessing in every industry. I’ve seen it in hospitals, especially during my all-too-frequent trips to the Europe. I’ve been stuck waiting in hospitals that had old, outdated systems. These slow and cumbersome systems had everyone waiting longer than necessary. Once, I took a friend to a hospital there that had a large screen that was constantly updating itself with the latest statuses of all the patients and whether or not certain rooms were occupied. One glance was all it took for a nurse to know exactly where he or she needed to take the patient and what needed to be done. We were out of there in no time”.

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policy

A Freeway To

‘Healthy’ Rajasthan

“When it comes to basic healthcare we have removed the distinction between BPL and non-BPL patients. Earlier only BPL patients were entitled to free drugs. Now we are saying that any human being is eligible to get free drugs,” says Dr Samit Sharma, Managing Director, Rajasthan Medical Services Corporation, Government of Rajasthan

Give us an overview of the work that is being done by the Rajasthan Medical Services Corporation in the state of Rajasthan. The Rajasthan Medical Services Corporation (RMSC) has been created to implement the Chief Minister’s scheme of providing free medicines to all patients under “Mukhya Mantri Nishulk Dawa Yojana”. The scheme was launched by the Government of Rajasthan on October 2nd, 2011, and it has been implemented in all 33 districts of the state. e-Aushadhi was implemented to provide a complete supply chain management solution for the drugs under the scheme. It provides drug management service to various district drug warehouses (DDWs) of Rajasthan, medical colleges, hospitals, community health centres (CHCs), primary health centres (PHCs), and drug distribution centres (DDCs) from where drugs are issued to patients, the final consumers in the chain. What is the main idea behind the creation of Rajasthan Medical Services Corporation? RMSC has been created by the Government of Rajasthan with the idea of making healthcare affordable, especially for the poor. Currently drug prices are very high and healthcare is not afford-

december / 2012 ehealth.eletsonline.com

able. About 40 percent of the admitted patients have to either borrow money or sell their assets to undergo treatment. Twenty-three percent of the sick never go to a doctor or hospital because they are not having money in their pockets to spend on healthcare. This is a grave situation, one that leads to thousands of deaths every day. This is a real tragedy. However, this is a preventable tragedy. The situation can be improved through an organisation like RMSC, which provides most commonly used essential drugs free-of-cost to all patients who visit government hospitals. In your opinion what are the major achievements of the scheme? After starting this scheme, the number of patients has increased tremendously. Currently we are able to provide drugs to 2,30,000 patients a day, which is a huge number. Out of this, 80,000 pa-

e-Aushadhi

Scalability of the Application • This software is capable of being extended not only to district level but also at state or national level • This software tracks drugs from procurement stage till patients consuming the medicines • Further it can also be enhanced to the level of monitoring consumption record of individual patients

tients have been added after starting this scheme. These are not just patients from Rajasthan. Patients are also coming from bordering states of Madhya Pradesh, Haryana and Gujarat who don’t have access to some specific drugs in their respective states. The central idea of the scheme is that no patient in need should be deprived of essential drugs. How did you expand the scope of the scheme over the years? Initially we started with 200 drugs, which subsequently increased to 400. Now the Hon’ble Chief Minister has announced that the number shall further be increased to 500-600. We have already started working on that. Quality healthcare is not only about availability of drugs, but also about doctors. What can be done to ensure that all parts of the state have access to good doctors? In my opinion there are four components in healthcare – infrastructure, healthcare manpower, drugs and investigations. In Rajasthan, the infrastructure is well developed and in most places good infrastructure is already in place. As for the health manpower, at PHC and CHC levels, the infrastructure is currently under-

policy

Dr Samit Sharma Managing Director, Rajasthan Medical Services Corporation, Government of Rajasthan december / 2012 ehealth.eletsonline.com

policy

utilised, as in the number of patients is not adequate despite the fact that these places have qualified doctors and wellequipped staff. For instance, in a PHC the average number of staff was ten and the average number of patients visiting the PHC per day was also ten. It is the district hospitals and medical college hospitals that have always been overburdened. So the state government has started a new drive to recruit doctors. Last week itself, we recruited over 500 doctors. Recruitment of more nursing staff and pharmacists is on the way. So far we have inducted 1,400 pharmacists after the inception of this scheme.

e-Aushadhi Technical Specification • Application Server: IBM Websphere 8.0.0.4 64 Bit (2 servers) that support beyond 3 GB heap size • Database Server: Oracle 11g R2 64 bit along with standby database server using Oracle data guard • Load Balancing: Phyiscal load balancer is used for managing the load • H/w Used: IBM X3650 M4 with 16 GB RAM for Application servers and Dell PowerEdge 410 for primary database server with 12 GB RAM

This scheme must be having some focus on rural areas, especially for patients belonging to below poverty level (BPL) families. So how are you managing that? Our sub-centres are essentially meant to serve the rural population. One subcentre is meant to serve a rural population of about 3,000 people. PHCs are also meant to serve the rural population with one PHC serving about 30,000 people, and most CHCs are located in rural areas too. Most of the drug distribution centres are located in rural areas only. RMSC must be involved in procurement and distribution of large amount of drugs. What methodologies are being used to manage such large quantities? The complete procurement and supplies management is handled by the headquarter office in Jaipur. We have 34 DDWs, one in each district and two for Jaipur. The warehouses are incorporated with technologies to store the drugs at the right temperature. The drugs are divided into three categories. The first category comprises drugs that are highly temperature-sensitive. They are stored in walk-in coolers (WICs), which are huge cold storage places. the second category comprises drugs

which need to be stored in “cool places,” where we maintain a certain temperature by air-conditioning. The third category of drugs belongs to those that can be stored at room temperature. From these drug warehouses, the drugs are issued to the sub-stores of various government hospitals. Essentially these sub-stores are the exclusive drug stores for each hospital. From these sub-stores, drugs are finally issued to the free DDCs. Currently we have 14,500 DDCs. The supply chain has been developed keeping in mind that the entire population of Rajasthan should have access to essential drugs in all government institutions. If all CHCs, PHCs and DDCs are located in rural areas, then what about the BPL patients living in urban areas? As I already pointed out, when it comes to basic healthcare we have removed the distinction between BPL and nonBPL patients. Earlier only BPL patients were entitled to free drugs. Now we are saying that any human being is eligible to get free drugs. He need not show any ration card, voter ID card or any other identity proof. He need not necessarily be a domicile of Rajasthan to avail the facility. Talking about the free drugs that have been made available across all government hospitals, how did you come up with the list of drugs? The list of drugs that we are providing for free to everyone is based on the guidelines of the World Health Organisation (WHO) and the National List of Essential Medicines (NLEM). We also have a state-level technical advisory committee comprising doctors, vicechancellors, principals, superintendents, and subject experts. This committee has studied the WHO list and NLEM list and also the disease pattern prevalent in Rajasthan. All these considerations have been deliberated upon to come up with this list of essential drugs.

The team behind e-Aushadhi

december / 2012 ehealth.eletsonline.com

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cover story

Web Clinic A New Platform From new testing techniques to surgical equipment, todayâ&#x20AC;&#x2122;s medicine is very different from a decade ago. Healthcare information is available on the touch of a button thus reducing the number of trips to the doctorâ&#x20AC;&#x2122;s clinic. Here is a sneak peak on the various tools available in the online arena By Shally Makin, Elets News Network (ENN)

december / 2012 ehealth.eletsonline.com

cover story

he trend started with e-tickets, graduating to paying bills and managing bank accounts, and finally fashion. Today healthcare reigns on the Internet with a plethora of information available. You may procrastinate over making that trip to your doctor, but a service that’s available on your phone or tablet on the touch of a button will keep you gripped even while you’re onthe-go. Intuitive features are especially programmed to follow the same series of symptom checking and analysing that health experts follow to understand what the problem is. Each person has unique health needs, but once the problem is outlined, the cure is customised and relayed using interactive online tools like simulators and feedback forms that provide a personalised experience. The Internet is here to transform the way healthcare is delivered to the masses. Technology has had a significant impact in the healthcare arena. Now, with the rapid proliferation of the Internet, technology may actually be serving to alter the traditional relationship between doctors and their patients. As more and more people use the Internet to gather information, many are relying on this developing technology to address their health needs and questions as well. “Online healthcare is certainly the most imminent revolutionary reform waiting to happen in medical world. For many in medicine, that’s an unconventional perspective. Yet, convention can’t

Shyam Znwar

MD, InQvent Holding Pvt Ltd

“Alacurity provides nurses, physiotherapists, translators, medical equipments, service apartments, corporate wellness plans, preventive health check-up packages and follow-up consultations, health concierge services and online medical record for quick retrieval”

hold back the Internet from masses who seek not only reputable health information, but also a dynamic user experience and Web-based dialogue about their respective conditions and questions”, says Dr Sanjay Gupta, Consultant, Moolchand Orthopaedics Hospital, New Delhi. The shortage of physicians across a range of medical specialities is a problem that’s expected to worsen. Retail clinics and urgent care centres grew from the difficulty many people encounter in getting appointments with primary care doctors.

Tools A new online tool takes the guesswork out of developing individualised catch-up immunisation schedules by allowing parents and healthcare providers to easily create a schedule that ensures missed vaccines and future vaccines are administered according to approved guidelines. Government plans to increase online access to medical records and e-consultations which will push up demands on clinicians and increase costs. “Online healthcare is a tool that gives patients the ability to follow-ups with their doctor without travelling or waiting in clinics. This enables doctors with a platform to provide better disease management support for their patients,” says Anita Shet, Chief Executive Officer , Pink Whale Healthcare Instead of relying on a directory of physicians to grab the attention of busy patients looking for a cardiac surgeon, the online healthcare offers video spots of doctors explaining various procedures. Expensive medical treatment in metros and inaccessibility in small towns are paving the way for several start-ups such as Alacurity, Healthkart and HealthCare Magic to fill in the existing gaps in the healthcare system. They focus on preventive healthcare services such as post-treatment check-up, follow-up visits and better referrals. Alacurity, promoted by seed fund InQvent Holding, offers patient assistance, medical equipment and preventive care. Besides, it provides nurses, physiotherapists and medical products including respiratory inhalers, drug devices and medicines to patients at prices ranging from `10,000-2 lakh — which is 25 per december / 2012 ehealth.eletsonline.com

cover story

cent cheaper than the treatment at most hospitals. They are offering these services through prequalified service providers. Shyam Znwar, MD, InQvent Holding Pvt Ltd says, “So far pre and post hospitalisation facilities are not organised. There are good doctors, equipments and hospitals. However when somebody comes to India, they need many more things than just hospitals. They need to stay over for long time. They need proper accommodation, food, translator, nurses, physiotherapist, need to buy or rent equipments. It does not only cost a lot of money, but also requires lot of efforts.” Sumit Chauhan, Vice President & General Manager, Embedded & Telecom Business Unit, Symphony Teleca Corp believes, “Proper treatment of patients suffering from diseases is a critical need for every society. Emerging online and mHealth services are a key opportunity to improve the treatment of patients and also realise better cost efficiencies in the healthcare system.” Bangalore-based Healthcaremagic. com offers specialised packages related to blood pressure, pregnancy, diabetes, cancer and other ailments. It connects patients with registered doctors and specialists online, thus saving time from frequent hospital visits. Started four years ago, it started gaining momentum in the last couple of years, given the boom in online ventures. HealthKart sells over 13,000 fitness, health and personal care products. The products are categorised under eight parts - Nutrition, Sports & Fitness, Diabetes, Home Devices, Eye, Personal Care, Beauty and Parenting. Additionally, HealthKart also sells various healthcare services, such as preventive health packages, diagnostic tests, and gym memberships, etc, to provide one-stop shop for all consumer healthcare needs. Prashant Tandon, CEO, HealthKart mentions, “The expenditure and focus on healthcare is increasing – both public and private. We intend to be a shaping force through providing quality authentic healthcare products, useful information to make this space more understandable and transparent to the consumer and leveraging technology

december / 2012 ehealth.eletsonline.com

Prashant Tandon CEO, Healthkart

Consumer awareness is rising and people are getting more involved in their healthcare. Consumers have access to transparent information to address concerns of authenticity, efficacy, price, etc. to ensure proper healthcare can be accessed from every part of the country”.

Pros and cons The surge of health information on the Internet has one of two effects on the doctor-patient relationship. For physicians who are comfortable with the Internet and with patients declaring their autonomy, and for patients who have explored sites with trustworthy information, the patient-physician relationship is enhanced and improved. But for those patients who access flawed information and then bring it to their physicians, and those physicians who prefer to practice in a more paternalistic mode or who are not up-to-date with the Internet, there will be harmful consequences on the re-

lationship. Dr Sanjay Gupta adds, “For patients as well as doctors, it opens up options from a vast selection of geographical boundaries and across a spectrum of available expertise. Nevertheless, one has to be cautious as online healthcare can be a very useful complimentary tool but not a substitute for traditional medicine”. Consumer advocates argue that the disclosure of performance data will help consumers to choose high-quality providers. While there is a plethora of health-related information on the Internet, currently there is no way to authenticate it. Indeed, there is an immense amount of misinformation available on the web. This unfortunate reality creates situations in which physicians may have to un-teach what their patients have learned. Dr S B Bhattacharya, HeadHealthcare Informatics, TCS highlighted that, “Privacy and secrecy issues, requirements of high levels of system availability and efficient data exchange using well accepted standards continue to be areas of concern”. Sona R, Marketing Executive, Trivitron Healthcare shares, “The sheer convenience of a specialist being just a phone call away can drive users to an online

cover story

Dr S B Bhattacharyya

Head- Healthcare Informatics, TCS

model. Online medical services offer patients a unique opportunity to rate hospitals, doctors and compare the outcome of treatments. It offers a transparency that is beneficial to the patient.” She adds, that the traditional system of meeting the doctor face to face and getting ourselves tested is the most convenient and accurate diagnosis we can ever get, though being a click away from getting diagnosed is easier.” There have been many scenarios where individuals hailing from an urban

Amit Mohan

Director – Marketing, Zimmer India

“Right from seeking information for problems to being reminded regarding next steps, including taking medications, online care is all set to transform healthcare” background find it a very time-consuming and energy grueling activity to first avail a doctor’s appointment and then drive down to the hospital for even a medical necessity that is as small as a general

“Online healthcare is an efficient, cost effective, collaborative approach offering seamless integration. The patients need to learn about illness or ordering prescription medications.This is definitely not a 100 percent replacement for the office visit to a doctor for consultation”

medical check-up. Extending this point, the scale of time and energy that is wasted for other ailments that are a little more serious than general checkups would be even higher. There also lives a certain set of people who are so busy in their daily work routine, that they can’t afford to take time off and visit doctors or hospitals located far from their homes or offices. Patients who use the Internet are becoming more educated about their medical decisions. They no longer go to their physicians for medical information, but rather to seek medical advice to confirm their own suspicions. The availability of information on the Internet is certainly a wonderful thing to have at one’s fingertips. However, if the patient-physician relationship is to maintain its integrity, using such online information must be part of a cooperative effort. Internet medicine is not a substitute for hands-on, face-toface care between a real live doctor and a real live patient. Amit Bansal, Director, HepingDoc.in says, “With corporatisation of healthcare, absence of stronger regulation to reduce malpractices, and without clear visibility of the medical diagnosis and treatments, there is an increasing trust deficit on healthcare providers. This has led to a growing traction for a service that improves visibility and provides structure to the unstructured healthcare.” There is an abundance of fraudulent websites. The only way you can tell an original from a fake one is by painstaking research and cross-questioning the experts before they recommend any treatment. Online healthcare won’t work well for injuries which require immediate care and also may not make sense for persistent problems.

Range of services People who are tired of queuing up and victim of inaccurate advices, logging onto medical health services for consultations, appointment scheduling, recommendations on healthcare providers and treatments serve the purpose. From childcare to fitness, the online healthcare model is offering patients reliable and multiple solutions at the first click. Online medical services offer patients a unique opportudecember / 2012 ehealth.eletsonline.com

cover story

Jayadeep Reddy

CEO and Founder, eHealth Access Pvt Ltd

nity to rate hospitals, doctors and compare the outcome of treatments. Most experts see online portals as complementary to traditional modes of consultation rather than a replacement. For practical reasons, health workers are often unable to talk to home-based patients with chronic conditions on a daily basis; but they could keep an eye on an online medical record that is automatically updated whenever the patient measures their own blood pressure, checks their weight, or takes their medication. Such technology could help medical workers ensure remote patients are healthy, and detect any problems at an early stage before they become serious. “People have surrendered fully in front of Internet which delivers massive information about everything from minor to major. Systematisation and expansion of healthcare sector are few reasons for enlargement of online healthcare.” says Dr Vasvi Mathur, Dental Surgeon, Private Practitioner. While no one counts the number of interactive web projects run by those in the healthcare field, the figure may be in hundreds. The array of content includes education tools, information kiosks, videos and virtual renderings of healthcare facilities. Dr M P Sharma, HOD, Internal Medicine & Gastroentrology, Rockland Hospital talks about the issue related to self medication. He says, ”Self medication can prove to be highly fatal to one’s health. It might lead to complications like: allergy, bleeding, etc. WHO suggests that

december / 2012 ehealth.eletsonline.com

“By using technology as an enabler and accelerator, we are leveraging the massive penetration of mobile and Internet usage with technology innovations in connected devices and helping doctors reach out to more patients”

while providing information online the emphasis should be on prevention of the disease rather than on curative medication” The Second Life-based Ann Myers Medical Center in UK is run by real-life nurses and physicians and demonstrates how women can perform their own breast exams. It also allows a selfselected computer character to receive a virtual mammogram in order to familiarise patients with the procedure. As with anything in social media, the user’s experience is what they make it. But patients can benefit from such content in very specific ways. A social-networking website functions as a support group, users share intimate details of their diagnosis and treatment, including information about specific symptoms and medications.

Perception As online applications become more widespread, healthcare delivery systems will need to develop methodologies that effectively integrate health information technologies with in-person care. It’s a massive revolution. It altogether shifts what goes on when a patient comes in with pages of downloaded stuff and half the time the doctor looking at it has never seen it before. There’s a whole new set of emotions present. Indeed, by providing access to medical information, medical advice, and online support groups, the Internet is making it possible for patients to assume much greater responsibility for their healthcare.

Sumit Chauhan

VP & GM, Embedded & Telecom Business Unit, Symphony Teleca Corp

“Ubiquitous connectivity enabled the remote interaction between doctors and patients and modern mHealth solutions even facilitate remote monitoring of critical health parameters. Technology handles sensitive personal data and requires properly architected systems to assure a trusted patient/ doctor relationship” It is conceivable that cyber doctors will one day provide detailed assessments to Internet users who grant them access to their personal medical records. It is also believed that cyber doctors could actually be brought into the treatment loop and used as a type of consultant to the user’s attending physician. Moreover, audio and visual computer technology may move Internet medicine closer to telemedicine, further merging the distinctions between user and patient. Economists believe that the healthcare system of the future will be completely consumer-centric and consumer-focused, a revolution triggered in part by unfettered consumer access to information via the Internet.

tech trends

Monitoring Sugar

in Type 2 Diabetes

Self-monitoring of Blood Glucose or SMBG is considered to be an important part in diabetes management. While its utility in insulin-requiring diabetes is proven, the role of monitoring in non-insulin-requiring type 2 diabetes is highly debated. Nikita Apraj, ENN explores the subject

DF Diabetes Atlas (Fifth Edition), 2011 estimates that India has more than 60 million people diagnosed with diabetes. The number is expected to grow more than double by 2030. With 63 million people diagnosed with diabetes and around 32 million with undiagnosed diabetes, India is a country with the largest diabetic population, second only to China. Effective management of the disease forms an integral part in diabetes care.

Self-monitoring helps Self-monitoring of blood glucose allows patients to track the levels of blood glucose in their body, what particular foods affect them, and what happens after physical activity or taking medication. Self-monitoring is even more helpful if done in a structured way - by monitoring at the right times and in the right situations and right frequency. Structured self-monitoring can help patients see a

pattern that they themselves as well as their healthcare professional can effectively use as a part of ongoing diabetes management. Dr Roshani Sanghani, Consultant Endocrinologist at P D Hinduja National Hospital says, â&#x20AC;&#x153;Monitoring at home is very important. Every diabetic needs to know their control on sugar frequently. It also helps doctors to adjust medications accordingly. Most importantly, it december / 2012 ehealth.eletsonline.com

tech trends

helps patients understand their own disease better. The best patient is the one who understands his disease.” “SMBG gives a real-time record of blood sugars and tells you about excursions or variability in blood sugars. Patients and physician can better understand about the blood sugar control and undertake Titrate Therapy accordingly to avoid hyperglycaemia and hypoglycaemic episodes,” says Dr Vimal Pahuja, Consultant General Medicine at Dr L H Hiranandani Hospital. “The 12-month data of the Structured Testing Protocol (STeP) Study shows that the use of a new diabetes management concept including structured SMBG, data visualisation, pattern analysis and derived therapy adjustments can significantly contribute to a reduction of HbA1c values and improved glycemic control,” Sidhartha Roy, Business Unit Head, Roche Diabetes Care explains.

Dr Vimal Pahuja

Consultant General Medicine, Dr L H Hiranandani Hospital

“We still don’t have the culture of specific diabetic health educators who will spread awareness”

december / 2012 ehealth.eletsonline.com

Dr Roshani Sanghani

Consultant Endocrinologist, P D Hinduja National Hosptial

“We would like the blood glucose monitoring devices to directly send the numbers to doctor’s mobile device”

SMBG is for all Roy says people with diabetes need to monitor at regular intervals as suggested by their physicians. The monitoring throws out data points of hyperglycaemia and hypoglycaemia at different times like fasting, postprandial, before sleep. This data becomes useful for his physicians. “There were school of thoughts about using SMBG in type 2 diabetes but studies are in strong favour of SMBG. There are recommendations from bodies like ADA (American Diabetes Association) and AACE (American Association of Clinical Endocrinology) in patients of type 2 diabetes for SMBG,” he adds further. Dr Pahuja asserts that frequent diabetes monitoring is not necessary for the individuals who are generally wellcontrolled and maintain HbA1C below 7 percent without any evidence of macrovascular or microvascular complications. However, people with longstanding type 2 diabetes and with uncontrolled type 2 diabetes who are not on insulin and show evidence of some macrovascular or microvascular complications should monitor blood sugar at home. “The frequency of SMBG can be reduced for type 2 diabetes patients and still would generate enough data points for interventions for better quality of life,” says Dr Pahuja. “It’s mainly because individuals not on insulin are not as much prone to sugar dropping as those who are on

insulin are. Their (individuals not on insulin) sugar tends to be more stable through the day. However, if they are taking tablets for sugar-control and sugar goes out of control, they need to check. Monitoring gives a rough but fair estimate about whether sugar is going low or high,” explains Dr Roshani Sanghani.

Awareness level Doctors and vendors agree that the level of SMBG awareness among patients is quite low. Sidhartha Roy attributes this to the fact that India being a self–pay market that also results in lower percentage of usage. Dr Sanghani and Dr Pahuja both feel people are hesitant to pricking. Dr Sanghani says patients are very reluctant to prick themselves. They prefer their healthcare providers to perform tests. They are also afraid of results. “Importance of SMBG is being still underplayed by physician. We still don’t have the culture of specific diabetic health educators who will spread the awareness”, says Dr Pahuja. Can SMBG Replace Diagnostic Tests? Sidhartha Roy refuses any such possibility. “SMBG is a structured way of monitoring your blood glucose. It will never replace laboratory diagnostics”, says Roy. “I don’t think they will and should replace diagnostic tests which we have now. Any test which is used for diagnosis should give consistent results and

tech trends

SMBG devices are still inconsistent in that sense”, says Dr Pahuja. SMBG devices cannot replace HBA1C or fructosamine. “There are chances of errors which are either operator-dependant or instrument-dependant. It can under-estimate or over-estimate when sugars are extremely low or high”, adds Dr Pahuja. Dr Roshani Sanghani too rules out the idea, “Both have different purposes. Diagnostic tests are for more precise testing. SMBG devices readings may show slight variations but these devices are very helpful to check sugar at home. A patient cannot every time rush to pathology to check his blood sugar. It’s also helpful in monitoring sugar levels while travelling and at workplace.” “We would like the blood glucose monitoring devices directly send the numbers to doctor’s mobile device. It will help us to plot graphs, find trends and learn more about diabetes,” says Dr Sanghani while talking about the future development she wants to see in SMBG devices. The decision of recommending SMBG for individuals in type 2 group may largely be determined by personal preferences, cost and individual and healthcare sys-

Sidhartha Roy

Business Unit Head, Roche Diabetes Care

tem resources. Priority lists may be needed to decide which individuals should be offered SMBG. These might include people recently diagnosed with diabetes, those with more erratic lifestyles, people having problems of hypoglycaemia and those particularly keen to tighten their blood glucose control.

What studies say

“There are recommendations from bodies like ADA and AACE in patients of type 2 diabetes for SMBG”

As published in IDF Guideline for type 2 diabetes 2012, studies performed among insulin-treated individuals with type 2 diabetes suggest that SMBG is required to titrate the insulin dose while avoiding hypoglycaemia. SMBG may help type 2 diabetes patients who are on insulin or sulphonylurea drugs because the information about a patient’s glucose level is useful to refine and adjust insulin dosages, resulting in an improved glycemic control, says a study published in ADA Diabetes Care. The impact of monitoring on patient wellbeing must also be considered as some studies suggest adverse psychological effects. Given the large increase in the prevalence of type 2 diabetes, it will be important to define the role of SMBG so that resources can be used appropriately. december / 2012 ehealth.eletsonline.com

zoom in

CyberKnife Redefines Cancer Treatment

CyberKnife has a huge role to play when cancer incidence is on the rise worldwide as per the estimates released by the International Agency for Research on Cancer (IARC) By Dr Tejinder Kataria, Chairperson, Division of Radiation Oncology, Medanta-The Medicity

ung cancer has the highest incidence in both the developing and developed countries accounting for 12.7 percent of all cancer cases followed by breast cancer at 10 percent and colorectal cancer at 9.7 percent. The research and advances in screening, surgery, chemotherapy and radiation have changed the overall survival in breast cancer for early stages reaching more than 80 percent. Lung cancer is difficult to treat as compared to other cancers with 75 percent of all patients losing their battle to the disease for

december / 2012 ehealth.eletsonline.com

want of adequate treatment modalities. According to the National Cancer Registry Project, India, more than 60 percent of patients are diagnosed with cancer at the late stages due to poor awareness of symptoms. Curative surgery is possible in only 20 percent of lung cancer cases as the tumour spreads to the lymph nodes and distant organs before being detected. Most of the lung cancer patients have co-existing conditions like chronic pulmonary disease or cardiac disease due to smoking and age-related changes and are not able to undergo either anaesthesia or surgery.

zoom in

In fact lungs infected with cancer are home to distant metastases from colorectal, kidney, breast, pancreas, sarcomas and cervical cancers. The possibility of cure in patients with less than three cancer deposits in brain, lung, liver or bone i.e. oligometastatic cancer has remarkably improved due to availability of focussed radiation by way of stereotactic radiation in the last decade. Cyberknife is a Robotic Radiosurgery device that has the capability of treating tumours anywhere in the body without the need for anaesthesia. Approved by US-FDA in 2001 and CE-marked for cancer and noncancer treatments, it is a new hope for cancer patients and can treat all kinds of cancers at different stages. Though its name may conjure images of scalpels and surgery, the Cyberknife treatment involves no cuts. It provides a pain-free, non-surgical option for patients who have inoperable or surgically complex tumours, or who may be looking for an alternative to surgery. Treatment time with CyberKnife is limited to 30-45 minutes for channelising 100-120 radiation beams from 1,200 areas to the targeted tumour. The patient is completely conscious during the procedure. Also it needs only 3-5 fractions with little or no recovery period allowing patients to almost immediately return to normal activities. With CyberKnife, localised treatment of cancer is possible by singling out the tumour and sparing normal tissues. Differential radiation is possible by increasing radiation dose for tumour while lowering dose for surrounding normal tissues. The flexibility and ease with which the CyberKnife is able to

reach even the deep seated tumours is unmatched. Treating certain tumours like in the lung is challenging because those tumours move as you breathe, making it difficult to target them accurately with radiation. The CyberKnife can track, detect and treat tumours that move with respiration in organs like the lungs and liver with extreme accuracy. It has the capability of reaching targets as small as five millimetres and as large as 10 centimetres with negligible risk to the organs surrounding the target. This enables Cyberknife to deliver radio-surgical doses to cancerous and non-cancerous tumours in delicate organs like the brain and spinal cord. In fact the treatment results are matched or at times better than open surgery.

CyberKnife offerings There is no head- frame required to be fixed on the patient, breath holding which is difficult for some patients has also been dispensed with. The combination of image guidance cameras, robotics, and the latest computer technology ensures that the CyberKnife System is able to overcome the limitations of frame-based radiosurgery systems such as the Gamma knife and Linac based such as X-knife. Unlike some radiosurgery systems, which can only treat tumours in the head, the CyberKnife System has unlimited reach to treat a broad range of tumors throughout the body, including the prostate, lung, brain, spine, liver, pancreas, and kidney. More than 100,000 patients have been treated so far with 250 installations worldwide.

december / 2012 ehealth.eletsonline.com

in conversation

Technology Shapes Future

Aravind Sitaraman, President Inclusive Growth, Cisco gives holistic vision of telemedicine in the country. In conversation with Sharmila Das, ENN

december / 2012 ehealth.eletsonline.com

in conversation

Kindly tell us about the telemedicine solutions you have designed for Indian healthcare? On an average, India has one doctor for 1700 citizens while the optimal average should be one doctor for 600 citizens. In some cases, the ratio is up to 25,000 citizens to a doctor. The United States has one doctor for 350 citizens. If India aspires to be a superpower like the United States, we need to increase the number of doctors, among other things, by six times. This is impossible as no country can organically grow their medical population six times and meet quality. In Ciscoâ&#x20AC;&#x2122;s view, India needs to embrace technology not only to treat the medical imbalances, but also to leapfrog into the future. Our solution virtually delivers a doctor, specialist, or a super-specialist in remote areas through networking technology. The interaction between them is through video and vernacular language. The doctor can read and see all vital tests that are done on a patient. The patient can interact with the doctor conveniently. Finally, the doctor can dispense a prescription or recommend a course of treatment that can be taken by the patient just as he would in a real-life situation. This fundamentally balances out the doctor-citizen imbalance we see in India as well as the urban-rural divide in terms of resource availability. How do you think telemedicine is crucial for Indian healthcare? How the Indian healthcare is making full use of it? The doctor patient imbalance is a definite disabler for the growth of the nation. Further, urban areas house 30 percent of the countryâ&#x20AC;&#x2122;s population whereas they have 80 percent of doctor population. Instead of trying to force the doctor population to work in rural areas even through giving incentives, the easier alternative is to deliver the population medical practitioners over the network so the citizen can get at least basic consultation. This approach will immediately address the medical imbalance as well as the urban-rural divide of resource availability. When the nation grows with economic and infrastructure reaching the rural population causing a reverse exodus of trained medical population to rural areas, telemedicine infrastructure will morph to virtual specialty

and super-specialty treatments only. In the interim 1520 years, telemedicine is the only way for Governments to deliver their medical security obligation to their people.

Instead of trying to force the doctor population to work in rural areas even through giving incentives, the easier alternative is to deliver the population medical practitioners over the network

What is your take on Indian telemedicine market? How organised is it? Currently, there is no telemedicine market. Over the past decade, the country had inaugurated over 60 pilots and none of them survive today. This is primarily because we chose to adopt satellite-based delivery of these services when the whole world was gravitating towards fiber-based delivery of network. Of course, India has to contend with tele-density and other fundamental issues of telecommunications first before it embarked on fiber. So in one sense, satellite based communications, especially when most technology was denied to India, was the only alternative. However, this is like wanting to race an Ambassador car in a grand-prix racing circuit. Not that we as a country is beyond technology denial phase and have over a million route-kilometer of fiber. Going back to satellite based delivery of telemedicine is akin to listening to music on gramophone records when digital music is where everyone is at. However, this situation presents a country like India an excellent opportunity where it can innovate, choose the latest technology to advance its healthcare needs, and create large number of jobs in rural areas. This will not only address the healthcare needs of the country but also inject money into rural areas in a responsible and scalable manner.

What are the top five challenges that a telemedicine player like you face in Indian market? The major issue that we need to overcome in this country is a mindset that we need to use only those technologies that we have created. During the Cold War era, this mindset is valid but that era died about 15 years ago and the world has moved on. Secondly, we need to adopt technologies that will not infuse complexity in the

edge because that would make maintenance and scaling a major challenge. Thirdly, there is basic infrastructure issue like power, networking availability, etc. Fourthly, we need to normalise the telecommunication rates that resonate with the rest of the world. This is especially true for humanitarian applications. Fifth, we need to create an incentive system for Government and private doctors to participate in telemedicine as they can view this as a direct challenge to their livelihood. How the CISCO telemedicine is different from other telemedicine products? Our solution is significantly different from other offerings in this space. For one, we provide a very scalable video-based architecture delivered securely from a cloud using our latest collaboration technologies at the cost of USD 1 per consultation for technology. For another, we offer an end-to-end project management, reporting, and technology support for our customers. We do not believe in selling our equipment and disappearing. Where do you see the future of telemedicine in India is heading? India has no option but to embrace telemedicine to provide medical care services to its citizens. If the country wants to safeguard the health of its citizens and bring them into the economic mainstream as productivity constituents, we have to embrace telemedicine. If we do it right, I see that telemedicine centres will be ubiquitously present in India in the next five years which will not only result in a dramatic improvement in our Human Development Index scores but also a great prosperity for the rural areas. december / 2012 ehealth.eletsonline.com

eINDIA Health Summit Special Report, 2012

eINDIA 2012 Nurtures a Health IT Platform

Sri N Kiran Kumar Reddy, Hon’ble Chief Minister of Andhra Pradesh and hon’ble chief guest, during the inauguration of the eighth edition of eIndia 2012

“T

echnology is of no use unless it comes to the reach and affordability of the common man,” said Sri N Kiran Kumar Reddy, Hon’ble Chief Minister of Andhra Pradesh and hon’ble chief guest, during the inauguration of the eighth edition of eIndia 2012. India’s largest ICT event – comprising conferences, expo and awards – was held at the Hyderabad International Convention Centre on 15-16 November, 2012. Jointly organised by Elets Technomedia Pvt Ltd; CSDMS; and the AICTE and hosted by the Andhra Pradesh Government and Mee Seva, the two-day event witnessed 30 panel discussions on ICT usage in governance, health and education. Apart from the seminal tracks, eINDIA Awards turned out to be the real showstopper of the event. Fifty-four awards were given for ICT initiatives across governance, health and education under 24 separate categories. Moreover, the ICT expo with 110 exhibitors was a major attraction of eINDIA 2012. For exhibitors in healthcare, the target audience was medical institutes and medical professionals. The aim was to showcase how an IT initiative could help in reducing the paperwork and hence the workload of hospital staff.

december / 2012 ehealth.eletsonline.com

Dr (Smt) Killi Kruparani, Minister of State for Communication & IT, Government of India; Dr Raghuveera Reddy N, Minister of Revenue, Relief and Rehabilitation, Government of Andhra Pradesh; and Sri Ponnala Lakshmaiah, Minister for IT & Communication, Government

“If we focus on taking benefit of public information infrastructure, we will be able to redesign the nation for the future generations”, says Sam Pitroda, Advisor to the Prime Minister of India on Public Information Infrastructure & Innovations

The recently held eINDIA 2012 at HICC, Hyderabad, witnessed key decision makers & experts, administrators & policy makers, leaders & stakeholders, service providers & IT-telecom vendors, consulting firms, ICT entrepreneurs & development agencies – all converging on one platform

of Andhra Pradesh also graced the occasion with their presence as Guests of Honour. Besides, J Satyanarayana, IAS, Secretary Government of India; and Sanjay Jaju, IAS, Secretary, IT & Communication, Government of Andhra Pradesh & eINDIA Programme Chair; Dr M P Narayanan, President, Elets Technomedia Pvt Ltd; and Ravi Gupta, CEO, Elets Technomedia Pvt Ltd and Convener of eINDIA 2012, were among the other dignitaries present at the eINDIA 2012 inaugural session. In the two days, eINDIA witnessed eight sessions on health and telemedicine. While aiming to provide a platform for dialogue on the health systems in India and beyond, the eINDIA Health Summit track was able to associate with various departments and representatives of state government departments, bodies like NABH and others. The event speakers and attendees were from reputed hospitals, diagnostic laboratories, doctors, policy makers, researchers, health experts and industry members from Andhra Pradesh, across India and abroad. The following pages gives a detailed report on the proceedings of the event and the knowledge exchanged at this platform.

eINDIA Health Summit Special Report, 2012

Day 1: Session 1

Emerging Paradigms in Healthcare

From Left to Right - Veerabhadraiah Narumanchi, Sanjeev Gupta, Srikant Nagulapalli and Dr B K Murli

Technology progression in medical sector would be the next big move in India. Country with large population needs low cost medical services, thus costing need to be tamed through technology induction in healthcare. Hospital services market in India is likely to reach USD 18 billion by 2020 and thus technology segment can play a pivotal role in the healthcare industry, hereâ&#x20AC;&#x2122;s a report december / 2012 ehealth.eletsonline.com

eINDIA Health Summit Special Report, 2012

Data should be in one format

Sanjeev Gupta Marketing Head, Accenture

The overall healthcare expenditure is around four percent of GDP including private and public both, but public expenditure is something around 1.3 percent of GDP. The industry is also expecting to see an increase of at least three percent of public healthcare expenditure overall to eight percent. If you see rural and urban India, you will find that the lifestyle diseases are also changing the shape where the largest number of patient coming forward are those suffering from diabetes, cardiac arrest and various infectious diseases. The shift in disease pattern all together defines the urban healthcare phenomena totally different and a rural healthcare phenomenon is totally different. The primary healthcare is required at the grass -root level but you will find the lifestyle born diseases are at a different level of prevention and cure methodologies both for urban and rural areas. The 80 percent of expenditure is out of pocket but actually there is only three percent insurance cover. Today the way inflation has entered, the way ex-

pansion has taken place and the way we look forward in the industry, three percent seems to be too less to survive. This is the one number which reflects huge amount of potential between both the private sector and public enterprises. We find three important pillars to describe right to health 1) the affordability of healthcare 2) the accessibility of healthcare and 3) the quality of healthcare. If these three things are collapsed together, some sort of healthcare is ensured to the common man in India but how to achieve it. The healthcare providers are huge in number and we need to bring them into a big network to create a larger pool of providers. This enables them to explore the knowledge, share the knowledge and also sharpen the knowledge. The public private partnership enables right to health. Huge amount of investment is going forward in terms of IT application and systems as you see HL7 standard adoption across the country. To help run HMIS all across the country, the plugged-in data should be in a single format.

Healthcare evolves with technology During the recent times the way healthcare is delivered has undergone a lot of changes. If you compare with the last ten years on date programmes, like mass community health insurance, programmes like Arogyasri RSBY, and many other programmes from other states as well, they have changed the way people have been receiving healthcare. Around ten years ago, the majority of people were getting treated in mostly Government hospitals and with the way the healthcare sector has evolved in India from the last ten years, there is a large private healthcare industry which has developed across most part of the state as well as the country. The result is that most of the below poverty line people who were unable to access healthcare in the private healthcare facilities. This was the major reason why the Government has come up with largely massbased community health insurance programmes. Based on the experience with Arogyasri, I can surely say that one of the major contributors for the success of this programme is NITbased platform, where we can process the various cases in on evidence--based manner.

december / 2012 ehealth.eletsonline.com

Srikant Nagulapalli CEO, Arogyasri Health Care Trust

eINDIA Health Summit Special Report, 2012

System of the doctors, by the doctors, for the doctors

Dr B K Murli Founder & Director, Dr Hope Hospital SaaS (Software as a Service) is the newest and the cheapest approach to healthcare IT. A few decades back, technology in Indian healthcare was a rare phenomenon. Thanks to the advancement that has happened in the space over a period, healthcare IT is now a game changer. Patient safety is defined as the prevention of harm caused by errors of commis-

sion and omission. Errors of commission are the most commonly happened errors. For example, wrong dose of medication given at a wrong time. Errors of omission are less commonly reported or referenced; they are the errors that occur when a necessary therapy is not carried out. Healthcare is expanding in almost all the countries, but by 2015 it will get doubled. We need a system which is cost-effective. In case of public insurance, we need to share the electronic medical records, to share the billing process at the least cost. Now IT has a role of catalyst, it addresses a patient by telemedicine, virtual monitoring tools, and patient education programmes and IT addresses quality. Two years back, we introduced â&#x20AC;&#x2DC;one patient one identificationâ&#x20AC;&#x2122;, which is unique electronic health records system allowing every patient to store their medical information online. A SaaS system is used on the telemedicine platform. The benefit of Saas is that, it works in a small clinic in a remote vil-

lage and also in a 500-bedded corporate hospital. According to the future of cloud computing, more number of applications will be inclined towards the SaaS business services. In future, there might even be a mixture of applications which can be accessed when the Internet is connected or even when it is not connected, be it online and offline. It is a system of the doctors, by the doctors, for the doctors, Medical professionals can easily customise application to changing processes. Cloud computing companies have entirely changed this scenario and have come up with services which do not even make it a requirement for the desktop computer during work. They can work remotely from any other location that saves huge amounts of money and time which can be put as investment for other works. mHope is a product of Hope Hospitals. It is an innovative concept that has already been implemented in our group of hospitals and has led to huge benefits.

Expanding coverage of Mother and Child Tracking System (MCTS) Currently there are various systems running in the Health department of Andhra Pradesh for increasing efficiency of physical and financial management system like 108 emergency response management and 104 health advice and counselling. We are looking forward to integrate the Mother and Child Tracking System (MCTS) and Hospital Management Information System (HMIS) model and expand the coverage of MCTS beyond mothers and children. This will further help in tracking and transaction processes linked with computerisation of hospitals. The entire transaction of the facilities will be covered through the HMIS which can help in monitoring the programmes. The comprehensive Human Resource Management (HRM)

covers all aspects of HR and the entire performance monitoring at the state or district level. The government is looking towards developing a GIS-based model, even of sub centre with performance gaps and we can see that the performance gaps are increasing. The IT Secretary of the Government of India has also mentioned that they are going to connect all level of Panchayat Villages in the country and deliver all IT related facilities in the departments. The number of facilities will have the optic fibre connectivity, so that the facility can help and explore the PPP. We can then better use the Mee Seva for improving our system and supporting our monitoring system along with other PPP options which are available.

Veerabhadraiah Narumanchi CIO, Commissioner of Health and Family Welfare, Government of Andhra Pradesh december / 2012 ehealth.eletsonline.com

eINDIA Health Summit Special Report, 2012

Day 1: Session 2

eHealth & mHealth Expanding the Healthcare Horizon India has emerged as the leader in telemedicine with 400 plus telemedicine centres operating across the country which extend clinical healthcare to remote areas. But less than 50 percent of these facilities are active now. Irregular or no power supply, paucity of technicians to maintain and train the users, inadequate computers and internet bandwidth are few of the issues which plague telemedicine

From Left to Right - PK Taneja, Shefali Dash, Partha Dey, Dr Pankaj Gupta and Andy David

Customised Mobile Solutions

Andy David Director â&#x20AC;&#x201C; Healthcare, SAP Asia Pacific Japan

december / 2012 ehealth.eletsonline.com

I am primarily responsible for SAPâ&#x20AC;&#x2122;s Healthcare Go-to-Market strategy across the region which covers market analysis, business development, customer reference and building SAP brand in these segments. SAP healthcare covers private and public hospitals and associated healthcare organisations across the region. Currently SAP has joined hands with hospitals in Hong Kong, Singapore, Malaysia, India, China, Indonesia and Australia. With over14 years in IT applications to Government, health and manufacturing sectors, we are now working towards developing SAP mobile solutions. The Computer on Wheels (COWs) is a new trend in hospitals and doctors today look for an iPAD rather than using a pen and a paper. Today in a hospital environment, IT is part of varied functions available from providing

security to providing stability to the various enterprise solutions. The customisation of proven mobile solutions within all the deployment is readily available. They can link with any device and any software such as PACS, RIS, ERP and finance along with SAP solutions. You could use all the systems in one view with easy user interface. SAP enables a winning mobile EMR strategy where they concentrate on patient security, a secure robust platform, scalable and readily deployable, packaged apps that are customisable, link to any clinical application, single source truth reaching all stakeholders, improving patient outcomes and patient satisfaction. Such mobility solutions can collaborate anytime, anywhere with instant information access thus enhancing treatment quality and patient satisfaction.

eINDIA Health Summit Special Report, 2012

Aim to develop an ICT vision document Gujarat is considered as one of the developed states and it’s moving reasonably fast when it comes to health. In Gujarat we are trying to develop a vision document. It’s the beginning and we are trying to develop to enhance the department, organisation, knowledge about IT and I think we are improving accessibility, affordability and quality of healthcare. We are in the process of strengthening the governance, increase overall accountability and efficiency of the system , and ensuring citizen centering and family friendly health systems. Over the last decade or so we have developed a large number of applications. One of them is known as Mukhyamantri Amrutham Yojana which we have launched about 3 to 4 months ago. We are developing the Gujarat Hospital Management Information Systems, particularly for big hospitals, teaching hospitals, district hospitals and sub district hospitals. We are developing a kiosk, which will help educate the citizens about

the availability of doctors at various centres. In 2006, we were also part of the Drug Logistics Information and Management systems programme at primary healthcare centre level. This helps in some kind of decisions, where it provides a network and access to the suppliers along with online information about the stocks. Today we have about 513 direct demanding officers connected to the systems and it helps us to ensure reasonably better healthcare facilities. e-Mamta is a Mother and Child Tracking System developed by Gujarat in the year 2010. Now e-Mamta is much bigger, perhaps having 180 parameters and having about 100 different health indicators. Another good application which we have done for the last two to three years is GPS Mobile Health Unit. We have about 118 of them in rural area and underserved area, and now we are able to locate them, track them and monitor their performance through GPRS Technology.

PK Taneja Principal Secretary, Health & Family Welfare, Gujarat

Technology that trades along with healthcare

Partha Dey Healthcare Practice, IBM

The healthcare industry in India has a lot of challenges- 30 percent of Indians don’t have access to primary healthcare facilities. Forty percent Indians fall below the poverty line each year because of healthcare expenses. Approximately, 30 percent people living in rural India don’t visit hospitals because they are afraid of healthcare expenses. The healthcare needs of 47 percent of rural India and 31 percent of urban India are financed by loan or sale of assets. There are various possible solutions leveraging technology models where doctors / caregivers are available on phone. This facility can address lot of challenges of remote patient care, pre and post operation consultation, etc. However, key challenge is the payment mechanism. Rural health centres/ Panchayat office can have Skype-type video call facilities to connect to the district head quartered hospital. The sensor devices in rural health centres can provide patient data to the doctors / caregivers in district hospitals. e-Tickets availability for government hospital can address long queues and wasting of time and electronic patient records, leveraging Aadhaar number, can address lot of challenges including the government immunisation drive. Integration of all challenge is very important and we should have a common platform for integration. IT requires the investment without which nothing is going to work. The implementation of eHealth and mHealth initiative is not seeing the light of the day because of adoption issues. You have to handle it professionally as a change management. Choice of appropriate technology is important. We have to define this old map clearly to articulate, implement and adopt technology in phases. december / 2012 ehealth.eletsonline.com

eINDIA Health Summit Special Report, 2012

NIC goes hand in hand with technology

Shefali Dash Dy Director General, ICT Sector, NIC A centralised web-based application for improving delivery of healthcare services to pregnant women and children up to five years of age was introduced by MoHFW, GOI in

technical collaboration with NIC in December 2009. It has been declared as a Mission Mode Project under the National e-Governance Plan (NeGP) in July 2011 with the objective that all pregnant women should receive Ante Natal Care (ANCs) services and Post Natal Care (PNCs) services. The society should encourage institutional delivery and all children should receive their full immunisation. NIC has developed e-Hospital which is now being implemented in about 19 hospitals across the country. Major ones are RML Hospital in Delhi, AIIMS in Delhi and many others. e-Hospital is a generic application, which addresses all the major functional areas of a hospital. This deals with complete treatment cycle of OPD/IPD patients and integrates various functions in the areas of clinical, administrative, and billing/insurance. It is an integrated

HMIS Suite consisting of HIS, LIS, RIS, PACS, Blood Bank and Telemedicine Suite. It confirms to HL7 standard so the data between hospitals is interoperable so that is one of the way to bridge some of the gaps. Mother & Child Tracking System (MCTS), derived from eMAMTA, which was started by the Government of Gujarat. So this is a total G2G portal used by the health officials at various levels like the primary healthcare, the block or state level, the district level or even the national level. They can also monitor the scheme like how many patients are there and there has been a unique mapping of all the health facilities, institutions, healthcare service providersi.e the ASHA workers through sms or workplan. We have recorded 99 lakh pregnant women who have been registered for taking the benefits from the government.

A systemetised approach to manage health information

Dr Pankaj Gupta Consultant, Healthcare ICT, National Health Systems Resource Centre, Government of India

december / 2012 ehealth.eletsonline.com

I am a health IT consultant and work with both public and private sector. We have done a study with the National Health Resource Centre (NHRC). This report has been published and converted into an international paper. Recently, we studied healthcare IT system at the national and state level and Rural Child Health system and we found most of the systems work in silos; they do not talk to each other. Each of the system is created as an application not as a product and if you have to look at any data across these systems it is impossible to do that. Technology being used was outdated, capacity development was not done. So change management was not done so what happened was adoption dropped after the initial spike. As a result the usage of most of the system was pretty low and the data was coming in different format. So it was difficult to make sense out of those data and it became data

collection-system rather than decisionhelping system. For that we have painted a vision document for the Central Government. We said that you need to have the national eHealth authority that lays down the architecture for all IT systems that are out there. So letâ&#x20AC;&#x2122;s compare this with a town planner. Town planner basically lays down standards for the roads for the water inlets, for the common areas etc. The town planner does into the floor planning for each building, each society and so and so. This is exactly what eHealth authority needs to do - lay down the standards for integrating all the different applications as long as each application, each system is able to give outputs and take the needed inputs from the others. There is some challenges around that which need to be managed. So national eHealth authority needs to have thought so that it can make sure that people donâ&#x20AC;&#x2122;t fly off to different directions.

eINDIA Health Summit Special Report, 2012

Day 1: Session 3

Diagnostics, Point-of-Care Technologies & Chronic Disease Management

The Untapped Market Though the challenges of providing high quality healthcare in developing countries are different than those in developed countries, there is a common goal to provide access to health monitoring and assessment technologies to people with limited or no healthcare facilities. Here Diagnostics, Pointof- Care Technologies & Chronic Disease Management play an important role. From Left to Right - Sanjeev Vashishta, Dr N Eshwar Chand and Reena Nakra

Technological advancement in laboratory mediicine Primary objective towards which we strive is to make a patient painless whenever he comes for treatment. It may not be incorrect to state that lab medicine is the nerve centre of all medicine. About 70 to 80 percent of the medical decisions are based on lab medicine results and outcomes. The three aspects I have mentioned earlier i, e. timely care, good quality care are something we are striving for. These three aspects have to be covered not just for giving quality care to the people but also to keep the competition at bay. One more aspect is rapidity or quick turnaround. So the idea is to get the test done at the first point of contact and the logistics build around in a manner that you are able to turnaround the test results in an early time and second is the accuracy. The accuracy is depended over multiple factors, one is what the processes you have laid down, what kind of team you have, skill set you have what kind of technology you are using so these are four things which will enable you to get the accuracy in the outcome of the test results and lastly is the value for money which is very individualistic in the mind of user and value of money is something which has to be given.

Sanjeev Vashishta CEO, SRL Ltd december / 2012 ehealth.eletsonline.com

eINDIA Health Summit Special Report, 2012

Mobile MIM is the first FDA cleared application Pocket ultrasound is the new addition for diagnostics of particular disease. Previously all radiologists used to work on workstations but now hand-held devices; smart phones and the tablets have dominated the market. Mobile MIM is the first FDA-cleared app for diagnostic interpretation of medical images on mobile devices. Mobile MIM supports the viewing of CT, MRI and nuclear medicine scans. Here, public private partnership can help us in providing point-ofcare to remote and underserved areas. Point-of-care technology and wireless networks are fit like hand in glove in healthcare and use of the network is poised for growth. Wireless technologies also have added to the ease. Instead of clinicians going where data is, data is now going where the clinician is. There are a few disadvantages of point-of-care testing. Sometimes its inferior to central testing; the cost can sometime be more than what is done in the central laboratory. The satisfaction levels could be less for the patients as well as for the trading physician and not all devices or all tests are validated universally. So in conclusion it can be said that the point of care testing is way to go.

Dr N Eshwar Chand Chief Radiologist, Kamineni Hospitals, Hyderabad, General Secretary, IRIA, Andhra Pradesh

Diagnostics is at the threshold of endless possibilities

Reena Nakra Head M&A, Dr Lal Path Labs Pvt Ltd

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By 2015, we believe chronic patients will be empowered to take control of their diseases through IT-enabled disease management programmes that improve outcomes and lower costs. Their treatment will center on their location, thanks to connected home monitoring devices, which will automatically evaluate data and when needed, generate alerts and action recommendations to patients and providers. IT will enable us to leverage the scarce or specialised clinical resources through telemedicine. Home monitoring devices, such as scales, glucometers, and blood pressure cuffs, will automatically transfer daily values to electronic personal health records (PHRs). The combination of the PHR, where patients record information, the electronic health record (EHR), where providers record information, and their linkage to clinical knowledge bases and rules engines, which will automatically evaluate data and generate alerts and action recommendations to the patient and appropriate providers, will transform chronic care management and reduce the need for acute interventions. Point-of-Care Test (POCT) reduces Thematic Apperception Test (TAT), makes it possible for physicians to receive test results of critically ill patients in real time. Decentralisation of diagnostic testing, from the lab to the immediate vicinity of the patient, is facilitated through point of care diagnostics. They have significantly impacted diagnosis of diseases such as Malaria and HIV. However, Remote Diagnostic Technologies (RDT) still have limitations of sensitivity and specificity for many conditions and hence, further refinement is required in this technology.

eINDIA Health Summit Special Report, 2012

Day 2: Session 1

Emerging Trends in Health Insurance

From Left to Right - Vimal Wakhlu, R S Sharma, Bishwajit Nayak, Dr T S Selvevinayagam

The health insurance sector continues to record good growth and as per the statistics released by the Insurance Regulatory and Development Authority (IRDA), the industry recorded 17.5 percent growth in gross premiums written during the period between April to December FY2011-12, as compared to the same period in the previous financial year

december / 2012 ehealth.eletsonline.com

eINDIA Health Summit Special Report, 2012

A medical prototype for rural India In health sector we need to focus on real India, that is rural India. We need to have some sort of a model for the real India. Here’s that how we involve some models which are in the public private partnership domain and some of the models are working in some of the states on pilot basis where the local villager would be playing a major role ensuring proper health services. As we are all aware that 70 percent of India lives in villages and there are 6,37,000 villages in India and it’s not possible to have one doctor per village in the conventional way. You need to have buildings; you need to have equipments so the model suggested was that we have a local village boy who has done 10th or12th and he can be trained as a paramedical staff. He has medical kit which has all the instruments like blood pressure monitor, glucose meter, ECG

machine along with a laptop with multimedia features and a mobile phone. So anybody falling sick in the village can call on toll free number. The person goes to the villager who is sick, he establishes link with main city, call centers those work round the clock and operated by the doctors and the doctor can actually give him patient advice. The paramedical person learns how to go ahead with patient’s treatment and perform some test and since he has got all these instruments and hence the doctor would be able to see images directly on his screen. Now if the doctor feels that the patient needs some extra investigation and he is not sure whether the line of treatment he has in mind should be the same, so he can take a specialist along and the specialist can see the patient and in case they feel the patient cannot be treated remotely they know the location of the patient by

Vimal Wakhlu Chairman & MD, Telecommunications Consultants India Limited (TCIL) virtue of GPRS phone of the paramedical person and they can send an ambulance. That is how proper medical service can be provided to villagers of India.

Health Insurance reduces acquisition cost Health insurance regulates a lot of activities in terms of number of committees that have been formed to standardise health insurance parameters, health insurance format and also standardise guidelines in health insurance policies. Importing models for health insurance from other countries have managed to get healthcare suitable for certain kinds of demography in another country. That may not be suitable for our country and for hospitals obviously which are introducing higher medical technology. But if you look at the ground reality we still have large population of consumers who are not clear on what are the rights under healthcare or in health insurances. If you look at the health insurance market, last financial year the general insurance premium overall was around `58,344 crore. The private sector obviously contributing little more than the public sector. If we look at the health insurance premium, presently the growth has been at almost 19 percent. The pri-

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vate sector is obviously growing at a higher rate because you have a dictate from the government for the public sector that reduces the loss ratio. The challenge in health insurance is that when we discuss health insurance, we always speak about loss ratio it’s never about making profit in it. Obviously this has created an investment opportunity for hospitals. Health insurance is now moving towards reducing acquisition cost to direct marketing web sales a lot of health insurance are now trying to approach customers by passing the traditional agencies methods. There was a Third Party Administrator Model which came up in 2001 when the insurance industry got privatised. The TPA model obviously was aimed at reducing cost bringing in more strict control in system. But what it ended up as in, probably in five years till 2006 was that increase leakages. Now entire public sector is moving towards in-house servicing they have setup joint venture

Bishwajeet Nayak Head, Health Claims and Networking, Future Generali along with LIC where the public sector will have its own company to service its policies. To make the market stable health insurance we need to have product development linked to the customer based and what service level expected.

eINDIA Health Summit Special Report, 2012

Better delivery of healthcare

Dr T S Selvavinayagam Joint Director, Chief Minsiter’s Comprehensive Health Insurance Scheme Hospital based provision of care may not be a reliable option in the long run. It is not that the government hospitals may not be able to compete with the private hospitals for various reasons - it could be the policies, it

could be the leadership, it could be the institutional arrangements even they may not be able to adopt the changing situation. However, this is not a permanent phase and there are always possibilities to change. The idea is that you will not be paying unnecessarily, unwanted and list qualified services. The important thing which we do on cost containment is provision of ambulatory care or OP services that are shifting from in-patient to the outpatient. Now we are linking it to the grades of the hospitals so we are very sure that we are paying to the near normal level. When we come on quality issues as we have online empanelment, monitoring and all but need is regular assessment recertification on a regular basis. If we talk about IT we are using IT, at almost all the levels like online empanelment, biometric enrolment,

smart card, de- duplication, electronic pre-authorisation, claims approval & payment, call centres, electronic patient records, cloud computing, and monitoring field functionaries through video surveillance etc. All these things are there but we have further scope to move in where we can use IT for developing a protocol. The main purpose is that necessary message reaches the public. They should know where to get treatment, when to get treatment and how to get treatment. Finally I want to say insurance is here. It’s going to expand but what we should remember is that it is not a replacement to the existing system, it is only supplementary to the system and if you keep it in the concept, develop the Government hospital, develop the insurance , definitely we will be in a position to deliver the better cap.

UIDAI enables better functioning The UIDAI’s mandate is to issue every resident a unique identification number linked to the resident’s demographic and biometric information, which he can use as his identity them anywhere in India, and to access a host of benefits and services. Aadhaar’s guarantee of uniqueness and centralised, online identity verification would be the basis for building these multiple services and applications, and facilitating greater connectivity to markets. It would also give any resident the ability to access these services and resources, anytime, anywhere in the country. The Aadhaar can help poor residents easily establish their identity to banks. As a result, banks will be able to scale up their branch-less banking deployments and reach out to a wider population at lower cost. For example, provide the identity infrastructure for ensuring financial inclusion across the countrybanks can link the unique number to a

bank account for every resident, and use the online identity authentication to allow residents to access the account from anywhere in the country. An efficient, cost-effective payment solution is a dire necessity for promoting financial inclusion. The Aadhaar and the accompanying authentication mechanism coupled with rudimentary technology application can provide the desired micropayment solution. This can bring low-cost access to financial services to everyone, a short distance from their homes. Aadhaar would also be the foundation for the effective enforcement of individual rights. A clear registration and recognition of the individual’s identity with the state is necessary to implement their rights – to employment, education, food, etc. The number, by ensuring such registration and recognition of individuals, would help the state deliver these rights. The Unique Identification Number (Aadhaar), which

RS Sharma Director General & Mission Director, Unique Identification Authority of India (UIDAI) identifies individuals uniquely on the basis of their demographic information and biometrics will give individuals the means to clearly establish their identity to public and private agencies across the country. It will also create an opportunity to address the existing limitations in financial inclusion. december / 2012 ehealth.eletsonline.com

eINDIA Health Summit Special Report, 2012

Day 2: Session 2

Quality, Standards and Patient Safety How India is rising up to the challenge?

“Patient safety is improving the system by learning where people fail and not by holding people accountable for failure”-John R Clarke

From Left to Right - U K Ananthpadmanabhan, Dr Girdhar J Gyani, Dr Pervez Ahmed, Dr G V Ramana Rao and Dr Annie Stanley Thakore

Patient safety in the operating room has long been a concern for hospitals. Numerous initiatives to improve OR care have had some impact, but problems persist. Wrong-site surgery, for example, has received a great deal of focus. A closer look!

Patient safety lacks system

Dr Annie Stanley Hospital Administrator, CARE Hospitals

december / 2012 ehealth.eletsonline.com

When we talk about patient safety and quality, we mean prevention of harm to patients while receiving healthcare. It is about eliminating preventable medical mistakes, guarding against the impact of human errors, establishing systems to safeguard patients. Quality means continuous improvement. NABH accreditation plays a major role in healthcare delivery systems in India. World Alliance for Patient Safety (WAPS) was formed in 2004 and it’s a great initiative. Momentum to this movement came only after initiative was taken to include Patient Safety in July 2007. Jakarta Declaration was made for our Southeast Asia Region, which high-

lighted the role of involvement of Patient for Patient Safety. The Foundation urges member states to “engage patients, consumer associations, healthcare workers, and professional associations, hospital associations, healthcare accreditation bodies and policy makers in building safer healthcare systems and creating a culture of safety within the healthcare institutions. Our challenges in patient safety is lack of systems in our hospitals and other healthcare institutions, lack of awareness/ realisation of its importance even among the healthcare providers, no scientific data base is available and lack of dedicating funding for promoting patient safety.

eINDIA Health Summit Special Report, 2012

Demand for accreditation has created awareness Quality in healthcare has been very recent phenomenon in our country. I always kept saying that when I was involved in the development of the accreditation programme for the NABL, for medical laboratories, I knew that the quality in healthcare was very different. The quality in healthcare means saving life of the patient. Today we have got NABH which is internationally acclaimed society for quality in healthcare and both the aspects, one is the standard and another is an organisation that means the hospital accredited by NABH today have got the global acceptance. I will say accreditation relies on establishing technical competence of healthcare organisations in terms of accreditation standards in delivering services with respect to its scope. It focuses on learning, self-development, improved performance and

reducing risk. Accreditation is based on optimum standards, professional accountability and encourages healthcare organisation to pursue continual excellence. Why quality in healthcare is still a farfetched concept, because the demand supply ratio controls the quality. Demand still is huge and supply is very limited and with these circumstances you canâ&#x20AC;&#x2122;t build quality. This is a very simple market phenomena but I think todayâ&#x20AC;&#x2122;s 83 percent expenditure in healthcare is coming from the private sector. So hopefully in the next five years the demand and supply issue should be appropriate when supply of quality healthcare will increase. NABH has done something wonderful. A framework is available from NABH but see in five years only 160 hospitals got accredited. It is to see if the de-

Dr Girdhar J Gyani Member Governing Board, NABH and Member Governing Body, ISQua mand for accreditation gets increase in the years to come so that more and more healthcare providers go for accreditation.

Corporatisation of hospitals is the trend

U K Ananthapadmanabhan President (Operations and Projects), Kauvery Hospitals Group, Trichy

India needs a healthcare system that can meet the demand of over a billion people. Each year 39 million people are pushed into poverty because of their inability to meet healthcare costs. India leads the world in terms of maternal deaths.5,70,00 maternal deaths in 2010, MMR 212 as against 109 of MDG in 2015. Dearth of qualified medical professionals in rural areas is observed. Health insurance covers only about a fifth of the population. Unorganised private sector accounts for almost 80 percent of outpatient healthcare. This is the canvas on which we are talking about the quality standards, patient safety and improvement. There has been a paradigm shift in healthcare delivery mecha-

nism. Today from large public sector hospitals, we have corporatisation happening with a chain of clinics, day care centres and primary health centres coming up in places such as Podukota, Trichhy and Madhurai. In Trichy hospital qualified pharmacists are working, which I feel is good improvement has happened. When you say a particular hospital is approved or recognised by any insurance company, they also look for some standards requirement and that is indeed very basic requirement. Insurance company, whether it is private or public, also introduces some kind of standardisation and quality parameters. I have seen some standard developed by NABH and I feel NABH standard should be more precise.

december / 2012 ehealth.eletsonline.com

eINDIA Health Summit Special Report, 2012

Need to redesign the safety mechanism ‘Quality’ is an attitude, if you don’t have that attitude you will never have ‘Quality’. Accreditation is very important, It’s like passing a test; you get to have a degree but that is only a degree, it does not give you a stamp of high quality. We have 1.2 billion people’s views taken on that. There should be quality healthcare for all. We heard about health infrastructure which is improving, we heard about quality accreditation which provides NABH, NABL, etc. We have a lot of data that needs to be transferred to intelligence which then is useded for all quality standard, etc. Indian hospitals are gaining reputation as ‘high quality’ service providers, several new projects with world-class infrastructure, quality driven organisations are investing in latest equipment, IT, SOPs and patient-centric delivery systems. Medical service excellence is achieved to ensure best patient experience and clinical outcomes. There is a programme in the US which is called WINGS. It is supported by an insurance company, which creates the same concept which is used in plane. As

per the initiative, when you get into the plane whether the pilots have flown the aircraft 50,000 times or one time, they all need to go through the check-list. That check list is regardless of who the person is. The checklist is verified by five or ten people before the plane flies. Same thing needs to be replicated in healthcare. Issues that lead to medical errors are majorly due to four most important things. These are-communication, orientation/ training, patient assessment and staffing ratios. If you address just four of these, you’ll actually take care of very significant reduction of lots of these events which happen. So there are a lot of factors which need to be addressed when we talk about quality and standard. I particularly like occupational safety. People don’t talk about occupational safety. I am very particular about the people who work in healthcare organisation and in nursing jobs. Nursing job environment is the most dangerous job. We have problem about exposures to blood-borne pathogens which is very significant for

Dr Pervez Ahmad Vice Chairman & Lead Director, General Manager, Modi Hospital & Research Center people who work in healthcare environment. At the end I can say that patient and staff safety is a global concern. All our efforts need to be made to reduce the risks of error, not devising quickfix solutions. The mantra is: redesign, transform and innovate.

Emergency medical services This particular discussion on quality standard and patient safety are very important and I am sure my experience will also add value. Vision of GVK EMRI is to respond to 30 million emergencies and save 1 million lives annually, to deliver services at global standards through leadership, innovation, technology and research and training. And for that these factors of safety are very important. Quality care is very important standard. The organisation thought that we need to be proactive by creating a leadership liverish technology. Do not be complacent about yesterday’s glory but ensure that there is a significance innovation & refinements on continuous spaces and capacity building research so that the efficiency and effectiveness can also be enhanced. This organisation has attempted in the pre-hospital care by an am-

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bulance based emergency response services. Developed detailed process understanding and well-defined responsibilities throughout the organisation. We have started very unique process where the patient use three digit numbers-‘108’. We have established an emergency response centre; only with a focus that we can quickly identify the exact location. We also realised that the medical emergency should also have in addition to that, police and medical emergency should have the integration. The technology is being provided by Mahindra Satyam. The technology solution takes care of the person who is free to take the calls and unique Id comes easily, safety gets ensured and goes to the next process, the voice process can also be transferred to a place where a dispatch decision of ambulances can also be taken. PPP is a very useful learn-

Dr Ramana Rao GV Executive Partner, Emergency Medicine Learning Center (EMLC) & Research ing for us, where we understood the priority of the government that we need to bring a lot of process, performances measures and the right kind of people, so it would become a good PPP model.

eINDIA Health Summit Special Report, 2012

Day 2: Session 3

Rural Health Serving bottom-of-the-Pyramid Population through Effective use of Technology Inovations

From Left to Right - Balaji Utla, Ajay Sawhney, Bhudeb Chakravarti and Girish Babu

Over the years development planning in India has focused on reducing the burden of illness and mortality among women and children. A large number of development and public health programmes such as the Integrated Child Development Services (ICDS) have been geared towards this, since a long time. Yet the status of Rural Health in India is at very negligible condition, a closer look!

ICT optimises efficiency Equity is an important thing; everybody should have equal opportunity that provides accessibility, availability and affordability. In Andhra Pradesh, a citizen, if he/she is unwell can access emergency care even at midnight. So care centers are 24x7x365 toll free. One needs to dial â&#x20AC;&#x153;104â&#x20AC;? and it is operated only by healthcare providers in the field. It provides algorithm driven health advice. We also have data about the national health programme, integrated with Janani Suraksha Yojana. It reduces MMR and IMR, reduce mortality, reduce morbidity and it assist with implementation of national health schemes. These are the services that are rendered specialised call centres, which work beyond the citizens help line. The call centers reduce the load on the Public Health System. In Andhra Pradesh, government registered close to 1.2 million pregnant women; no other state probably in country has such a record. Similarly, close to 1.2 million hypertensives and diabetes are referred and those records are available. We also have telemedicine centers in Araku in Hyderabad to offer health services to 140 villages.

Balaji Utla, CEO, HMRI december / 2012 ehealth.eletsonline.com

eINDIA Health Summit Special Report, 2012

Healthcare is all about better patient experience Most of the healthcare facilities are not effective and efficient enough. Government is providing much facilities but the requirement is much- much higher. Doctor and patient ratio is five times lower in rural areas than the cities. In cities, patient has number of options, whereas in villages it is very less because there are less number of doctors. In rural areas, the facilities are not effective and available, distribution of medicine are not available. We have done projects in Andhra Pradesh for distribution of medicine to various places. The important factors that we should focus are medicine, skill detector and health workers, long queue etc. All the hospitals in a state or country start working at the same time (8:30 am) as if all the people will get sick at morning 8:30 am. Why they canâ&#x20AC;&#x2122;t expand the time or why the people not follow the rotational shift? Itâ&#x20AC;&#x2122;s all because of lack of strategic vision. The reporting of health information needs to be collected in one format. For that, we need to provide efficient care irrespective of shortage of care professionals. Technologies such as mHealth, e-referral, EMR etc. We also need to reduce duplication and adverse drug events like online availability of Critical Care Data (CCD), EMR,Clinical Decision Support System at point of care. There is a better patient experience with online access to information.

Bhudeb Chakravarti Senior General Manager & Region Head, National Institute for Smart Governance (NISG)

Achieving the Millennium Development Goal is all crucial ICT never works well if you simply apply it to the existing practices. At present, our analysis of the situation and the kind of the system where we are trying to place the ICT will get actually contracted. On top of this convergence of delivery of health and nutrition services at the same time is more difficult to bring about behavioral change in the community which we are trying to serve with the given current trajectory of achievement. Currently our MMR is at 134 per lakh, live births and goal for 2015 is 100 per lakh whereas the current rate of MMR will be left somewhere in between. Malnutrition in Andhra Pradesh is high and in fact that is the underline problem which also feed in to IMR and MMR. With 56 percent of pregnant women being anemic, children being born with low birth rate, the number of children and children less than three years who are underweight is around 37 to 40 percent. There are large numbers of parameters prevalent in health system.

Ajay Sawhney Principal Secretary, Public Health & Family Welfare Department, Andhra Pradesh

Train health workers for primary prevention

Girish Babu Bammakanti Chief, Care Rural Health Mission, Care foundation Scheme

december / 2012 ehealth.eletsonline.com

We train village women and accommodate them in our health centres as health workers and in this way community participation in terms of reaching healthcare to rural places is ensured. One can solve 70 percent of primary health problems and most of the common problems are like cold, cough, fever, malaria. 70 percent of all diseases could be treated then and there itself by just having one remote doctor with health workers. We are doing with 50 of Maharashtra programmes so effectively that you will be able to reach lakh of population with only a group of health workers and one or two remote doctors. The other 30 percent of the cases go to

the primary health center (PHC) based on town level. This is a very cost-effective process with the model processed into four parts, the first thing is the training and capacity building of the health worker. We spend 80 percent of our time only in training programme of health workers to define areas of virtual trainings even when they visit primary centers scheduled monthly in a clinical rotation. The second part is supply chain management of your primary health centers and integrating this data with IT. The third vertical and the fourth one is health financing. If you offer primary care you can reduce your burden of hospitalisation.

eINDIA Health Summit Special Report, 2012

Day 2: Session 4

IT for Healthcare Delivery

From Left to Right - Pankaj Kumar Bansal, Pradeep Balachandran, Dr Ayanthi Jayawardena, Parvez Ahmad, Charles J Antony and Fr Ferdinand Peter

When the Prime Minister announced, in his Independence Day address of 2011, that health would be among the foremost priorities of the 12th Five-Year Plan (2012-17), it was both an admission that health has been hitherto an area of great neglect and a promise that policy would now accord it the priority it deserved. Are we now on that path? And how technology can come handy in taking us on that path, hereâ&#x20AC;&#x2122;s a report!

Vision for all inclusive healthcare If you look at todayâ&#x20AC;&#x2122;s standards, India will equate its healthcare professional ratio to the number of patient in year 2022. Hospitals to fulfill this demand is impossible because the demand is too much than supply. The geographical and rural footprint for healthcare is not adequate. 70 percent of the population in India is rural and there is no way of reaching doctors who are living in urban areas. So a sector of population in India do not get proper healthcare. Technology has to fill this gap especially in large private hospitals. So far, they all have failed due to non capability to capitalise the opportunities, poor quality of healthcare and non-transparent pricing. In last 50 some years, the big private hospitals could not able to rise up the challenges or create some regulations and standards. Nowadays, hospitals are forced to optimise their operations for profitability and customer satisfaction for survival. There are lots of push and pull in the whole landscape where we have to perform like any other corporation. The growth of

Charles J Antony Former MD & CEO, TATA, Council Member & Educator, Gerson & Lehrman Group specialised healthcare facilities, as retail healthcare is booming in India. There are lots of hospitals that are coming up with 100 beds, 200 beds or 75 beds all are specialty centers. So lots of specialised healthcare is coming. Consumer empowerment is now the trend among the masses as everybody has access to a smart phone, ipads for maintaining their health record, blood sugar level, stress level and self monitoring. The Integrated healthcare eco-system

is now cloud based. This is a much untapped green field where the major IT companies are not able to capture big private hospitals. Government is struggling on their own way, so there is a need to open the doors for small players to get into the market and optimise. The biggest challenge is the enormous data that comes from various different sources. People do not want to spend unnecessary money,but they want access to anywhere anytime at optimal cost. There are 3G, broadband, Internet; social media etc which are playing very active role to move forward that something you cannot avoid. So now these elements like cloud computing, social media, smart consumer access are coming together and completely changing the landscape and this brings to us as an interconnected world. In the next few months we will play a very active role how to change the landscape and take it to next level. TATA launched Pan India, mHealth pan for 150 million subscribers also done through 3G telemedicine phone once the need for the pan was generated.

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eINDIA Health Summit Special Report, 2012

Healthcare in Tamil Nadu ICT department in the healthcare sector of Government of Tamil Nadu runs 18 Government colleges with 41 hospitals, 267 secondary care Government hospitals and 1600 plus primary health centre. All these are managed by the different directorate. We are having 32 revenue districts but we have made 42 health districts. We are running 17 verticals in the health department where the different directorates take care of the different departments. If you see the vital statistics of Tamil Nadu as on today we are among the bigger states standing second in all data after Kerala. Our IMR is 22, MMR is 72 and TFR is 1.7 only. We are processing six initiatives taken by the Government of Tamil Nadu. First five are already implemented and 6th is in the process. The other part is Mother and Child Tracking System (MCTS) we started it with name called (PICME) Pregnancy and Infant Cohort Monitoring and Evalu-

ation and it started in 2008 in Tamil Nadu till date we have registered 35 lakh mothers into this system. Just by entering the PICME number you will find all the details available within the system. Monitoring System(MRMBS) under this for each pregnant mother Rs 12000 is provided as a maternity fee and this is totally a paperless system. We have received Rs 660 Crores transaction online during 2011-12 in maternity benefits scheme. The next is Chief Ministerâ&#x20AC;&#x2122;s Comprehensive Health Insurance Scheme and our budget is around 750 crores. It is a smart card based which has 64kb storage capacity and Scostaâ&#x20AC;&#x2122;s specification for the card. If we see today 179000 claims has been processed and Rs 416 crores has been transacted through this system is totally paperless. Finally we are going to establish our State Health Data Resource Center (SHDRC) with the support of ICMR, World Bank, NRHM and state government this system

Pankaj Kumar Bansal Mission Director. State Health Society & Project Direct Reproductive & Child Health Project, Tamil Nadu analyse the data, process the data which will help at state level in policy formulation, policy changer and intervention on day to day basis all details will be available here.

We need to build sensitive healthcare institution

Fr Ferdinand Peter Director, Bishop Benziger Hospital The Benziger Hospital was established in 1948. Our hospital is the very first private hospital in Qulin, Missouri. Today it has grown to become a 600 bedded multi and super-specialty hospital having all the major departments, modern equipments, facilities, eminent doctors and efficient paramedical staff. It is a

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venture aiming at the integral development of the people who live in the neighboring villages. Community radio is the latest of the many innovative initiatives of Bishop Benziger hospital in its constant attempt to reach out to the community around it. It is hoped that this new venture will complete and complement the already existing services rendered by the hospital through its community health centres. A community radio is a platform to voice the common issues of a particular community living in a specified geographical area irrespective of religion, caste, community, colour, age, education, or profession. Bishop Benziger was responsible for introducing professional nursing in the hospitals of Kerala. When opportunities became open for the private sector to start radio stations, Bishop Benziger hospital found a long awaited

opportunity to fill in a lacuna i.e. a communication component in its development projects. Hence community radio became complementary in the efforts of Bishop Benziger Hospital. Radio Benziger was awarded second place at the national level by the ministry of information and broadcasting in the category of community engagementâ&#x20AC;?, In less than two years of broadcasting history, nearly 2,50,00 people have participated in the radio programmes.This is the first radio in India to broadcast marine weather and marine safety tips on a daily basis in association with INCOIS, Hyderabad. The radio programmes succeeded in building awareness among the public about pollution control, waste management, traffic safety, pulse polio, TB Filariasis etc. We feel a healthcare institution is able to be sensitive to the needs of people only through feedbacks.

eINDIA Health Summit Special Report, 2012

A cross sectional descriptive study in District General Hospital Trincomalee in Sri Lanka The Epidemiology Unit in Sri Lanka with the collaboration of WHO initiated Electronic Hospital Information System (EHIS) in 2005 in several Base Hospitals. Under this project, new software and system hardware has been installed but it was complex, was not popular among hospital staff that led to failure of the system. The new software was introduced to the hospitals in Northern and Eastern provinces called Multi Disease Surveillance System (MDS). As the country is aiming towards eHealth and paperless hospital information system it is important to study the system to understand why it has succeeded while others failed. It was completely a paperless system running at

the OPD. This system was password protected. Each member of the staff of the DGH Trincomalee was given a password to enter into the system. After this initial step of registration at the OPD, the hospital Patient Identification (PID) number was automatically generated. This PID number was used in subsequent visits of the patient to retrieve previous records. Medical officers have full access to the system. The OPD computers were directly connected with the main laboratory, therefore prevented duplicating laboratory reports on the same patient. At the pharmacy, a pharmacist/ dispenser issued drugs according to the prescription and automatically stock balance of a particular drug appeared. A

Dr Ayanthi Jayawardena Medical Suprintendent, Base Hospital Deniyaya, Sri Lanka competent doctor who is familiar with the system can enter details of the patient within Â˝-1 minutes. It takes longer for examination of the patient and then doctor can spend the saved time with patient.

Ergonomic technologies for healthcare practices We are trying to leverage the potential of automatic speech recognisation. Here, technology like Voice Interface Systems can act as an alternative input modality to existing system. If we apply the conventional input modality systems like voice Interface, where automatically speech converted to text and get suppose to the database. There are special context where doctors need an area to fit in descriptive text. Core technology is the Automatic Speech Recognition if we skip the technology part, the Auto-

matic Speech Recognition (ASR) is being formulated as a supervise pattern. There are two parameters- Word Accuracy or Word Error Rate and Response Time. So what is the essential ingredient for that? It is the data. So if there is the facility you can plug in to ease the flow of data and given such technologies which can positively play role then it should be appreciated. So the greater goal is to promote wider adoption of electronic health record with the use of ergonomic technologies.

Pradeep Balachandran Health Informatics, C-DAC, Thiruvananthapuram

Implementing IT is very important IT helps a patient before he/she steps in the hospital and when steps out too. For driving better healthcare services, six parameters that include quality, safety, effectiveness, patient-centeredness, timeliness, efficiency, and equity is important. Wide role of IT is implemented in front office, inventory, human resource, application management, finance and budgeting, life science, clinical management and ancillary modules. Now mHealth is coming very aggressively. The top five

mHealth areas of applications are appointment scheduling, patient information, tracking the patient, patient records and patient monitoring. We have designed Centralised Telephone Based Appointment System at Rainbow Hospitals. When a patient schedules the appointment, the system generates an SMS automatically. Video conferencing system plays a major role in medical consultation, treatment, meetings, trainings and demonstration of live surgeries.

Dr Parvez Ahmad Group Medical Director, Rainbow Group of Hospitals, Hyderabad december / 2012 ehealth.eletsonline.com

eINDIA Health Summit Special Report, 2012

Day 2: Session 5

Adopting Technology to Redefine Medical Education

From Left to Right - Prof Rafath Razia, Dr V Balasubramanyam, Pankaj Kumar Bansal and Dr Murlidhar Joshi

The Medical Council of India (MCI) also in their revised regulations has recommended the establishment of medical education technology units in each medical college. The Parliamentary Committee on Subordinate Legislation has also strongly recommended that MCI should make it compulsory for all medical colleges to prescribe for a minimum number of lectures to be imparted using audio-visual techniques in substitution of conventional lectures by teachers/professors in the classrooms. However, is this really happening?

december / 2012 ehealth.eletsonline.com

eINDIA Health Summit Special Report, 2012

Technology enhances medical education We have medical education technology, new frontier, e-books, new gadgets, eclass room, and e-learning process. Around 40, 525 graduates pass out every year from medical colleges. They are able to work, learn and study wherever and whenever they want to. Todayâ&#x20AC;&#x2122;s classrooms have more practical active learning what people looking for. IT supports the clouds to decentralise and here I feel hybrid- learning is a most important factor in medical education not in e-learning. The economic pressures and new modes of education give competition to traditional teaching. In medical colleges, the faculty members should provide the facility of adequate training program. We also need to embrace mobile applications, tablets computing, game based learning and learning analytics, collaboration, creativity and critical thinking.

Dr Murlidhar Joshi Director, Joshiâ&#x20AC;&#x2122;s Institute of Pain

Need for software to collaborate with industry I am working on how technology gets into the system in medical education. If we talk about the e-learning industry its worth in the year of 2007 was 10-12 million dollars, 25 million dollars in 2009 and according to the global industry analysts market, it will reach to 107 million dollars by the year of 2015. To assimilate the information exactly the way a teacher wants, there are certain software developed to assist the teacher. Collaboration of such software within the industry is the need of the hour. This process

of communication is not limited with doctors, nurses and patients and can also be communicated to transmit the information. This can be customised according to the various communities and situations. CME credit points are increasingly the new trend in the industry. We are also approaching towards distance programmes. We have 500 courses, super specialties at St John, hosting digital content to organise the system of distance education and disseminate information among the network hospitals.

Dr V Balasubramanyam Domain Consultant-Medical eLearning, St. Johnâ&#x20AC;&#x2122;s Medical College, Bangalore

A fresh era of nursing education should start The healthcare sector of the nation and nursing are two inseparable fields like two sides of a coin. WHO bulletin says 24 million nurses are required in India. Increasing the numbers of nurses and midwives alone is not sufficient. Improving capacities, nursing services and healthcare delivery require concentrated, strategic interventions to improve the quality of nursing and midwifery education. Nursing education is a very demanding task and situation at present time is that it is a multi factorial and complicated. It is good for nursing and mid wives to learn the teaching methodology that is used in nursing like the theory, lab procedures and actual patient care. In Andhra Pradesh, there are increasing number of institution and the number of seats, multipurpose health worker schools are 301, school of nursing for GNM programme around 400, and the collages of nursing for BSc Nursing programme is 216+ 13 post basic programme and 25 MSc Nursing programme, facilities for nursing education are needed various ways. There should be infrastructure and building, teacher and faculty is a major problem because a nursing teacher should be an expert nurse herself. There is a problem of gender also as in India most of the nurses are women, there is also medical domination in most of the hospital and healthcare setting.

Prof Rafath Razia Deputy Director (Nursing), I/C Registrar, APNMC december / 2012 ehealth.eletsonline.com

eINDIA Health Summit Special Report, 2012

Anniversary Celebrations

Hall of Fame

Chief Ministerâ&#x20AC;&#x2122;s Comprehensive Health Insurance Scheme, Government of Tamil Nadu receives the award for the Best use of technology in Health Insurance (Public Choice)

PARAS by Srishti Software gets the award for the Best ICT in Healthcare by the Private sector (Jury Choice)

GeTNABH by Hope Hospital grabs the award for the Best ICT in Healthcare by the Private sector (Public Choice)

Aapka Urgicare Pvt Ltd receives the award for Best Innovation by a Healthcare Provider (Jury Choice)

Sir Ronald Ross Institute for Tropical and Communicable diseases gets the award for the Best Innovation by a Healthcare Provider (Public Choice)

SRL Ltd grabs the award for Best Innovative Use of Technology by a Diagnostic Service Provider (Jury Choice)

Dr Lal Path Labsreceives the award for Best Innovative Use of Technology by a Diagnostic Service Provider (Public Choice)

Health Management Research Institute receives the award for Best Initiative in Healthcare through PPP (Jury Choice)

Narayana Nethralaya Postgraduate Institute of Ophthalmology gets the award for Best Initiative in Healthcare through PPP (Public Choice)

Centre for Development of Advanced Computing grabs the award for Best use of Technology in Telehealth (Public Choice )

Community Radio Benziger (Hospital Radio) receives the award for Best use of Technology in Telehealth (Jury Choice)

december / 2012 ehealth.eletsonline.com

NEWS

India to set up Nanoscience Institute in Chandigarh

The Government of India has set aside `100 crore to set up the country’s firstever Institute of Nanoscience and Technology at Mohali in Punjab. A similar Institute at a cost of `100 crore has also been cleared for Bengaluru. In addition, the Centre through the Department of Science and Technology (DST) has pumped in `80 crore

to strengthen the nanotechnology infrastructure across the country. For setting up the Centres for Nanotechnology (CN), Karnataka has got `25 crore each for the facility at Indian Institute of Science (IISc) and the Jawaharlal Nehru Centre for Advanced Scientific Research (JNCASR). Similar facilities are also underway at Kolkata and Pune. The CN would focus on the product or device oriented development but not on basic research to speed up technology commercialisation. The country is ranked fifth globally in nanotechnology R&D with a similar ranking in terms of peer review submissions. Bengaluru has been a pivotal point of action in nanotechnology after Mumbai’s Indian Institute of Technology (IIT). For the Institute of Nano Science and Technology, Bengaluru with a Nano Park, the state government has already allocated the land.

The government of India is looking at the Institute of Nano Science and Technology as a specialised centre of excellence to promote the growth of R&D in the areas of nanomaterials, nanometrology, nano-bio pharma, nano-medicine and nano-R&D relevant for food and agriculture. The key objective is to transfer intellectual capital in a bid to maximise the application potential in nanotechnology. Therefore a critical component of the Institute of Nanoscience and Technology is human resource development. In 2007, the Government of India spearheaded the Nano Mission only to develop products which have the potential to benefit the country. The technical programmes of the Nano Mission are carried out by the: Nano Science Advisory Group (NSAG) and the Nano Applications and Technology Advisory Group (NATAG).

Diabetes Therapeutics Market to reach USD 1.49 billion by 2016: Frost & Sullivan

With diabetes in India reaching epidemic proportions, the related therapeutics market is expected to grow at a double digit rate over the next five years. Higher disposable incomes have raised the incidence of this lifestyle disease, turning India into the world’s diabetic capital. Enhanced diagnostics will further broaden the patient base, and pharmaceutical companies that offer drugs with better efficacy and affordability will fare well in the market. New analysis from Frost & Sullivan estimates the market revenues to reach USD 1.49 billion by 2016. Rapid cultural changes, such as increasing urbanisation, modified diet patterns, and sedentary lifestyles among the younger generation, have heightened the prevalence of diabetes in India. With a rapidly expanding segment of aging people, the treatment pool for type two cases in particular is expected to grow, increasing uptake of non-insulin therapies. “The market for new non-insulin and insulin therapies is gaining ground, as treatment outcomes improve,” said the Frost & Sullivan Analyst. “Novel drugs such as incretin mimetics, glucagon-like peptide-1 (GLP-1) agonists, and dipeptidyl peptidase-IV (DPP-IV) inhibitors are also earning acceptance among physicians.” The patent expiries of several existing drugs will actuate the launch of their generic versions. Although consumption volumes of these diabetes medications are expected to rise, their lower costs will not make significant impact on market revenues.

To boost the adoption of new drug classes, educational programmes for both physicians and patients are necessary. Only a small percentage of the Indian population fully understands the disease, and government initiatives, such as the National Program for the Prevention and Control of Diabetes, Cardiovascular Diseases, and Stroke (NPDCS), aim to increase this percentage. “The Indian government has also held mass early detection screening programs in 100 districts and 33 cities,” noted the analyst. “Patient compliance centres are addressing the challenges of expensive treatment, inconvenient modes of administration, and the unpleasant side effects of oral anti-diabetics. These initiatives will result in better diabetes management and increase patient share, fuelling growth in the therapeutics market.” december / 2012 ehealth.eletsonline.com

NEWS

Philips reaches 500 installations mark for its pioneering Ambient Experience Hospital Solutions

Royal Philips Electronics, the parent company of Philips Electronics India Limited, has announced the 500th order of its Ambient Experience Hospital Solution, reaching an important milestone since the beginning of these installations in 2006. The latest order has been placed by San Joaquin Community Hospital (Bakersfield, California, USA) which joins a long list of healthcare providers across 50 countries that have opted for this solution. Ambient Experience solutions feature the imaginative use of dynamic light, images and sound to place patients in a calm, reassuring and relaxing environment. By giving patients personalised control over the theme selection that defines the color and intensity of the ambient lighting as well as the audio-video content in the room, the patients’ involvement and engagement in pro-

Health Minister presents NABH certification to PSRI Hospital Pushpawati Singhania Research Institute (PSRI) Hospital organised NABH accreditation ceremony where the Health Minister of Delhi, Dr Ashok Walia, along with Joint Director NABH, Dr B K Rana, presented the certificate to PSRI Hospital team. Dr Ashok Walia expressed the need for more health institutions with world class standards as there is a huge gap between the patient load and availability of healthcare facilities. Welcome address was delivered by Executive Director, Smt Sunanda Singhania. Dr Dipak Shukla, Director Administration proposed the vote of thanks. The ceremony was attended by the Chairman Executive Committee of PSRI, Dr R P Singhania, NABH Assistant Director Deepti Mohan, Senior members of PSRI faculty and eminent doctors of South Delhi.

december / 2012 ehealth.eletsonline.com

cedures is encouraged. Through skillful architectural and interior design, examination and treatment rooms are de-cluttered so that patients feel less overwhelmed by technologically complex medical equipment and procedures. The benefits not only extend to patients. Philips Ambient Experience environments have been shown to decrease the duration of procedures, while also helping caregivers to work more efficiently and with more satisfaction. “The response from healthcare providers in India has been very encouraging as they work towards ensuring that their patients overcome their fears of traditional hospitals and actively respond to instructions on diagnosis and treatment. Undergoing imaging and radiation therapy can be particularly stressful for patients and this is where the role of a cutting edge solution like Ambient Experience comes in. It not only relaxes the patient, but also lends a sense of control over the situation that he has been placed in,” says A. Krishnakumar, President Healthcare at Philips India. “Achieving a milestone figure of 500 Ambient Experience orders within six years of the concept’s commercial launch is a remarkable achievement, especially when you consider that each one is a customised solution,” adds Greg Sebasky, CEO Customer Services at Philips Healthcare. “We have seen an increased demand for our Ambient Experience solutions in the past year, which is a clear proof of a growing global awareness of the importance of the patient experience. The increased customer demand reflects the reality that patient-friendly comforting environments are not only beneficial for patients, but also for hospitals”.

India to set up 250 trauma centres by 2017 The central government has proposed to build 250 trauma care centres in the country in the next five years to help accident victims, Haryana Chief Minister Bhupinder Singh Hooda said at the fifth annual conference of the Indian Society for Trauma and Acute Care (ISTAC) here. The Haryana Chief Minister warned that accidents on Indian roads were rising at an alarming rate of three percent annually and ever year nearly 1.3 million people in the country die in road accidents. He also admitted the availability of trained human resources was a major challenge for access to quality trauma care services in the country.

“By ensuring that motorcyclists wear helmets while riding can effectively reduce fatal injuries by 30 to 40 percent. Nearly 90 percent of accident victims in India suffer head injuries,” said the All India Institute of Medical Sciences Trauma Centre Chief, M C Misra. “Trauma care is very fragmented and varies from state to state,” Misra said, stressing that “we need trained manpower at all levels for a responsive trauma care system in the country”. “Sometimes patients reach us as late as after 14 hours of fatal injuries,” Misra said, adding that lack of adequate trauma care services was one of the leading causes of accidental deaths in rural India.

NEWS

Smile Foundations Gifts Karnataka Its First Mobile Hospital The Smile Foundation, a national level development organisation, in collaboration with Life Insurance Corporation of India (LIC) and city-based NGO, Karuna Trust, launched Smile on Wheels, the first mobile hospital in Karnataka. Smile on Wheels will operate by taking a well-equipped mobile hospital unit along with specialised doctors, nurses, medical staff, equipment and medicines to villages and slums. Through the initiative, a range of healthcare services will reach inhabitants in Yemalur and Doddakannelli villages. In addition, a series of health camps will be organised to widen the coverage. Speaking on the occasion, LIC Karnataka, Zonal Manager, South Central Zone, A K Sahoo, said, “LIC is financing this mobile medical unit as part of its CSR activity. Smile on Wheels is part of LIC’s efforts to

provide sophisticated medical facilities to remote villages and slum areas.” Speaking on the partnership with Smile Foundation, Karuna Trust Secretary, H Sudarshan said, “We shall cover 58,206 beneficiaries in Yemalur and Doddakanahalli through Smile on Wheels. It

Govt okays 3-year Mini MBBS degree The much awaited MBBS degree in community health aimed to address the paucity of doctors in rural India has got a go ahead from the Indian government. The course will create a special cadre of health workers that will be trained mainly in district hospitals, then placed in sub centres or primary health centers. The Union Health Ministry has decided to launch a three-year medical course with six months of rotational internship from 2013. The course named as the Bachelor of Science (Community Health) has been worked out keeping in mind the nation’s acute shortage of doctors and specialists. The new medical course will create mid-level health professionals with candidates eligible to apply being students who have studied physics, chemistry and biology in the higher secondary (10+2) level. After acquiring the degree, the graduates will be employed as Community Health Officers by state governments at district levels, an official said. “The proposed course is likely to be introduced in the states willing to adopt it from 2013. in order to address the serious concern of shortage of availability of human resources in the health sector in rural areas, the government is committed to introduce the course, with in-built safeguards,” he said. The Medical Council of India (MCI) recently cleared the introduction of the three-and-a halfyear course.

will facilitate diagnosis of diseases as well as treatment of minor injuries and surgeries in villagers” Started in June 2006, about 22 Smile on Wheels vans have been operational in 13 states and 5 lakh people have benefited.

Software for detecting diabetic retinopathy developed IIT-Kharagpur has developed software for early detection of diabetic retinopathy. This is a diabetesrelated problem that could lead to blindness. Patients suffering from diabetes for more than 10 years are susceptible to this disease. Funded by IBM India, the software would also help in risk categorisation of the disease. Titled Computer Vision Approach to Diabetic Retinopathy Screening, the project is now being used on a pilot basis at a hospital in the city with encouraging results, Chandan Chakrabarty of IIT-Kharagpur, who is principal coordinator of the project, said. “The software uses data analytics capabilities to automatically compare and analyse retina images of the patient. It not only detects whether the patient has diabetic retinopathy, but also provides risk categorisation ranging from low to medium and high,” Chakrabarty said. DR is an ocular manifestation of systemic disease, which affects up to 80 percent of all patients who have had diabetes for 10 years or more. The project was initiated March 2011 by the IIT Kharagpur, in association with IBM India and Susrut Eye Foundation and Research Centre (SEFRC), Kolkata. “The solution is being used in our clinic and the results are very encouraging. In fact the accuracy level is as high as 92 percent,” said Anirudh Maity of SEFRC, where the project is being used on a pilot basis. december / 2012 ehealth.eletsonline.com

special feature

Indian Diagnostics

A Leap in the Dark By Sharmila Das, Elets News Network (ENN)

In vitro diagnostics (IVD) has seen much technological advancements that have benefitted the end consumers

ndiaâ&#x20AC;&#x2122;s diagnostic segment is so far dominated by unorganised local players. However, there are no doubts few organised players too like Roche Diagnostics, Abbott, Tulip Group, Transasia Biomedical, Span Diagnostics, etc are making their presence felt in this domain. As per the industry experts, the diagnostics market in India is witnessing a 20 percent growth which is faster than any country in the world. In the financial year 2011-12, revenue earned by the diagnostics sector is USD 600 million as against USD 510 million in 2010-11. The growth factors can be attributed to facts such as improved diagnostics tools, treatment monitoring, faster response times, and increased availability of over-the-counter (OTC) tests, which patients can perform in the comfort and convenience of their homes.

Market facts The global IVD market is forecasted to grow at a Compoundeded Annual Growth Rate (CAGR) of 6.8 percent during 2011-18 to reach a value of ` 3, 61,500 crore (USD 72.3 billion) by 2018. The United States was the largest market for IVD and accounted for 50 percent of the global IVD market in 2011. The Asian region is expected to be ruled by the emerging economies such as China and India, showing the highest CAGR. China is the largest IVD market among emerging countries and Molecular diagnostics segment is gradually emerging as the fastest growing vertical in the diagnostics industry.

december / 2012 ehealth.eletsonline.com

special feature

The pathology industry in India is around `10, 000 crore and about `1,000 crore is managed by organised sector comprising handful of top laboratories. The industry is highly competitive and price-driven with kickbacks and business referral payments in the absence of a regulatory body.

The sub categories The Indian diagnostics market can be broadly divided into equipment and services segmemnts. The service sector is largely unorganised, with a large presence of players located at the regional or city level. Backed by immense potential characteristics including a large population of qualified clinicians, huge number of patients, cost-efficient treatments, and a well-trained medical community, the lab services market, a leading segment of the Indian diagnostics market, is estimated to grow at a CAGR of around 26 percent during 2012–15. John Thomas, Managing Director, Agappe shares, “The current IVD market is shifting gradually towards semi-automated and fully-automated laboratory instrument. The number of tests conducted in the last decade has doubled to over 500 million tests. The major reason is the increase in awareness coupled with increasing middle class income which is leading to the increased IVD tests. Recent advances in the areas of molecularlevel and genetic testing are dramatically changing clinical practice. New testing techniques are more sensitive and specific and allow clinicians to detect, diagnose, and manage disease more effectively than ever before. Technologies that analyse DNA, RNA, and protein composition diagnose disease at initial level, permitting earlier detection and a more personalised approach to patient care”. Rajesh Pandya, Country Manager, Abbott Diagnostics, India feels, “The market will exhibit steady growth in the future considering high patient population growth rate, increasing number of hospitals and diagnostic labs, innovation by pharmaceutical companies, unhealthy lifestyle leading to chronic diseases, demand for cost-effective, faster and sen-

sitive results, increased affluence and increased healthcare awareness”. Chinmoy Sinha, Cheif - Technomarketing Affairs, Diatek Healthcare & Sirus Biocare Pvt Ltd, says, “Indian Diagnostic market is dominated mostly by the traders who import the product either in finished pack or as Original Equipment Manufacturer (OEM) and sell in their brand. Customers prefer better pricing of product and look for technologies which are time tested in advanced countries. So the majority of diagnostic company maintains mix up of product range to meet the customers’ demand of different sectors.”

Local/Organised

Expanding horizon

In India, technological advancements and higher efficiency systems are taking the market to new heights. Use of advanced and cutting-edge technologies in understanding a disease prognosis has further strengthened the sophistication level of participants in the sector. Rapidly rising automation needs along with the rising incidence of diseases are consistently driving the growth of the Indian diagnostics market. The increasing number and complexity of tests, coupled with a shortage in laboratory staff, is leading to a greater level of automation in laboratories. Labour accounts for around 65 percent of operating expenses in a typical laboratory, and automating a laboratory can expand its capabilities while achieving significant savings.

When around 70 percent of the treatment decisions in the country are based on lab results, Indian diagnostics players are too smartly putting their foot forward to meet the demand. They are too expanding their presence not only in India, but also in overseas territories like the Middle East and the United States. The spectrum of their test menu is expanding in the areas of genetics, cancer, endocrinology, infectious diseases, and molecular diagnostics. They are coming up with various business models to penetrate not only in tier-I, but also to tier-II and tier-III cities. The organised segment can explore the opportunities of expanding to semi-urban and rural areas and here mergers and acquisitions would likely be a route for expansion.

John Thomas

Managing Director, Agappe

Research study says multinationals have a larger share of the diagnostics market pie because they have products which cut across all segments whereas local companies choose to focus only on one segment. However, this trend is seeing a change now as several local manufacturers are now adding new capabilities and technologies to match global standards. The key growth products include hematology, reagents, molecular diagnostics, and specialty diagnostics. Molecular diagnostics contributed 30-40 percent of the total market.

Inside the sector

“The current IVD market is shifting gradually towards semiautomated and fullyautomated laboratory instrument. The number of tests conducted in the last decade has doubled to over 500 million tests” december / 2012 ehealth.eletsonline.com

special feature

Dr Suresh Kuruganti, Consultant, Public Health, International Centre for Advancement of Rural Eye Care (ICARE), L V Prasad Eye Institute says, “The potential of IVD in healthcare is immense and its role cannot be over emphasised considering the volume and magnitude of clinical load, the increasing awareness and knowledge of different conditions, and exponential growth in demand for care that is taking place. Many of them are cost-effective and can be replicated easily. All developing countries stand to benefit in general. These developments have brought about many improvements in the healthcare scenario, and have better acceptability”.

Rural connect There is also tremendous growth potential in tier-II and tier-III cities. India is the home to over 100 cities with enough population size to generate demands for diagnostics centres catering to a wide range of requirements. Several healthcare giants are seeking to tap into this market. Lifestyle and communicable diseases are no longer restricted to urban centres and are spreading to rural areas as well. As a large portion of rural areas do not have even the basic healthcare facilities, several cases remain undiagnosed. These changing disease patterns, rising incidence of diseases, higher healthcare spending, and untapped markets create abundant opportunities for IVD manufacturers in rural and semi-urban

Rajesh Pandya

Country Manager, Abbott Diagnostics, India

december / 2012 ehealth.eletsonline.com

areas. Dr B R Das, President- Research & Innovation, Mentor - Molecular Pathology & Clinical Research Services, SRL Limited says, “Over the past decade, patient awareness has increased several fold. Most people in tier-I and tier-II cities are aware of the benefits of frequent check-ups and preventive healthcare, and this has also percolated down even to tier-III cities and rural areas. Moreover as urbanisation has created an erratic lifestyle and shifting demographics, healthcare is on top of everyone’s list. So all this has greatly contributed to individual opting for such diagnostics.”

Dr Suresh Kuruganti

Consultant, L V Prasad Eye Institute

Regulations and IVD Despite the prime significance of this sector, a well-defined regulatory pathway for diagnostics products is awaited. Due to lack of regulatory legislation, there is no clarity on the classification and requirements for approval of diagnostics products and novel medical devices in India. An insider from the industry who requests anonymity, shares “There is need for a change in the way approvals to such products are given by the Drug Controller General of India (DCGI). At the time of approval, diagnostics products and medical devices are categorised into critical and non-critical diagnostics. Any diagnostics tool developed by an indigenous company or academic institution has to go through a validation process conducted by an independent DCGI-approved test-

“The market will exhibit steady growth in the future considering high patient population growth rate, increasing number of hospitals and diagnostic labs, innovation by pharmaceutical companies”

“The potential of IVD in healthcare is immense and its role cannot be over emphasised considering the volume and magnitude of clinical load” ing lab such as National Institute of Biologicals (NIB), apart from in-house validation procedures conducted by the company itself. For other products, it needs to be proven that there are same products approved in India. Despite huge technological differences between the two, diagnostics are still treated as drugs by the DCGI. Currently, the DCGI recognises primarily HIV, Hepatitis B and C blood grouping, and Syphilis kits as these need serious licensing and regulations. Regarding the rest of kits, there are neither guidelines nor any institutes, with known positives and negatives to be tested. This leads to Indian companies innovating new diagnostics to face a great difficulty in catering to overseas market opportunities as the country of origin has no properly laidout procedures. In contrast, products, which are im-

special feature

ported and marketed into the country, do not have to go through these procedures as they have been approved by globally accepted regulatory standards. Owing to India’s diverse population, validation becomes a prerequisite for all companies as the product might be effective on one section of the population while it may not be effective on the other. There is a need for the Government to establish a clear pathway for such evaluation processes. Lack of clear specifications also allows for many products, which are not classified by the DCGI, to get into the market without any approval. At times, new products cannot be introduced in the market as they do not fit in any regulatory classification. Lack of such regulatory frameworks and standards in India brings a large disparity on the quality of products. Many products are available in India without approval. This puts pressure on the buyer to first test the product in-house before using it on patients. In turn, the buyer expects free samples from the seller, which delays the sales cycles and increases costs. The Association of Diagnostic Manufacturers of India (ADMI), an association of Indian IVD manufacturers, has approached the Government with various proposals for reforms.

edges and low utilisation rates resulting in undesired operating margins. Pandya says, “The diagnostics market in India is highly fragmented and some of the challenges to the market include prevalence of laboratories without accreditation, quality control, low penetration of insurance, Rupee depreciation and low priced reagent sales. Abbott introduces significant technological advancements enabling creation of modern and progressive diagnostics laboratories that help diagnose and monitor diseases such as AIDS, Hepatitis, Cancer, Heart ailments, metabolic disorders and important indicators of general health, improving patient care diagnostics”.

Early detection poses a new opportunity Screening technology for early detection of major cancers has not been within the reach of the IVD sector

Chinmoy Sinha

Cheif - Technomarketing Affairs, Diatek Healthcare & Sirus Biocare Pvt Ltd

until now - with the exception of the prostate-specific antigen (PSA) test for prostate cancer. However, for most cancers, early detection and treatment can provide significant improvement in survival prospects when compared with late detection and treatment. A noninvasive IVD-based test that would allow detection of a major cancer, with high accuracy and at an early stage, would be attractive, considering many issues with current, mainly in-vivo-based procedures. A wave of new IVD-based tests has started to reach the market and could offer new hope for early detection of major cancers. If the IVD-based models were validated, drug-like blockbuster revenues could follow some tests. The commercial payback for one such test could surpass the revenues of a companion diagnostics by a multiple of 10. The IVD originators in this market segment will need large commercial partners to help them exploit the opportunity. Major IVD players or clinical laboratories would be the obvious candidates. By 2020, several pharma players are expected to become involved as well, provided clinicians and payers have validated the most promising tests within the next few years.

Roadblocks

End note

The Indian IVD industry is highly fragmented due to low-entry barriers, which has led to an increase in the number of laboratories, and the complete lack of standardisation. Another significant concern for companies is the inadequate insurance coverage. Responding to the demand for quality healthcare, most corporate labs have introduced cost-effective and convenient patient care packages. The cost of equipment contributes to almost 40 percent of the cost in a tertiary setup. The diagnostics equipment are cutting edge at the time of purchase; there is the threat of inevitable obsolescence within five to seven years of the setup. Most of such equipment are imported and very few local reputed manufacturers exist. This leads to apportioning to higher treatment costs and lesser competitive

ICT automates the entire process of testing, starting from the online patient booking to the registration of the sample and then finally getting the report digitally signed after analysis of the sample. ICT is expected to play an important role in data mining in pathology and diagnostics industries, which are growing leaps and bounds. Private companies are striving to increase health awareness among the common man, not only in metro cities but also in tier-II, tier-III, and smaller towns. 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.

“Indian Diagnostic market is dominated mostly by the traders who import the product either in finished pack or as Original Equipment Manufacturer (OEM) and sell in their brand”

december / 2012 ehealth.eletsonline.com

expert Speak

Healing Comes Online The Government of Rajasthan has taken initiatives to automate the hospitals in the state to improve patient care By Tapan Kumar, ACP (Dy Director), Dept of IT & Communication, Govt of Rajasthan

rogya Online is the electronic management of health information to deliver safer, more efficient, better quality healthcare to the citizens of the state. This landmark initiative is facilitating the transition of paper-based clinical record keeping to electronic means for better information exchange.

Hospitals covered under the project The customisation and implementation of the system at Sawai Man Singh Hospital (SMSH), Jaipur, was assigned to C-DAC, Noida. They have developed the software for the system and customised for SMSH, Jaipur over the past two years. Hardware, software and LAN nodes have been set up across five buildings of the hospital for operationalising the first phase of the Health Information Management Systems (HIMS) which consisted of 13 core clinical modules.

december / 2012 ehealth.eletsonline.com

The integrated solution manages Hospitals Central Lab, OPD, IPD, OT’s, Drug Store and Blood Bank as well as the treatment modalities offered by more than 44 clinical and non-clinical departments, 70+ wards with 2500+ beds. The system also manages an average of 5,500-6,000 OPD patients on

daily basis and approximately 15,000 daily investigations with errorless reporting mechanism.

Activity completed so far As of now all the core clinical modules and other modules have been made operational at the SMSH, Jaipur. The

The key benefits of ‘Arogya Online’ system include • Streamlines workflow operations to improve hospital administration • Enhances the quality of patient care • It creates a platform for information exchange • Streamlines resource utilisation and management across hospital departments • Single point solution for optimising productivity and reducing manpower costs • End to end supply chain management within the system • Unique modular design structure of application to enhance operational flexibility • ‘Arogya Online’ is designed to provide the highest level of flexibility and operational efficiency for a hospital. The system performs complex tasks like investigation billing, bed management, admission discharge and transfer procedures, pharmacy management and various other related activities.

expert Speak

Achievements at SMSH – (Benefits to Citizens) • Waiting time for patients has been considerably reduced • Facility of OPD, admission, investigation billing, sample collection, free medicine distribution to BPL at Dhanwantri OPD block • Bed management and display of admitted patients investigation report on ward’s computer • Display of investigation reports of all the patients on internet (www.medicaleducation.rajasthan.gov.in). Report can be viewed on mobile also • Consolidated information to citizens through single portal of medical education department wherein information related to all medical colleges across Rajasthan is available medicaleducation.rajasthan.gov.in • Reduction in processing time due to Common Stationary Concept i.e. operators not need to change the stationary for different works/ printouts • Control over professional blood donors with use of Biometric Donor Registration along with bar coding for identification of blood bags

website (www.medicaleducation.rajasthan.gov.in) has received wide appreciation and acceptance.

Computerisation of 28 blood banks Blood Bank is one of the important departments of the hospital. Its activities include blood donations, blood grouping, antibody screening, antibody identification, cross matching, blood infectious tests, component preparation, issuing compatible blood and blood components, etc. Blood Bank Module provides up-to-date information about total daily blood or component stock, total daily blood requisitions and information regarding donor. Blood bank module constitutes of, registering the donor at the hospital premises or at the camps arranged by

the blood bank itself. Every donor undergoes a physical examination test and the donor examination results are entered into the system. Depending on the examination result the donor’s blood can be accepted or rejected. If a donor is accepted his/her blood is collected and is put in a bag and that bag is given a unique number by the system itself. This bag number is the same unique number given to identify that donor also. After the blood is collected, it undergoes certain tests. Initially the blood has to undergo serology tests the results of which are entered into the system through the result entry screen. After the result entry process an authorised person validates the result on the system. After serology test, blood grouping is done on the blood and results of the same are entered

Achievements at SMSH – (Benefits to Hospital/ Staff) • Better ward management through computerised admission (IPD) process • Hospital central lab and blood bank completely computerised • e-Library facility for medical journals/ books of SMS library • Issuance of free medicines to the patients, with effect from, 2nd October 2011 with stock management of drugs/ medicines. System integrated with drug warehouse module (e-Aushadhi) used by Rajasthan Medical Services Corporation under Arogya Online • Actual statistics provided to hospital to plan budget/ costs/ resources accordingly • Nursing staff engaged in OPD registration activity were freed from their work and given patient care activity • Hospital is able to demand reimbursement on the investigation related groups so as to provide better medicare to patients

into the system. A senior person again validates this blood group detail on the system. After all the tests are performed on the blood, the various blood components are separated. The components are added to the existing stock and are now ready for cross match. The requisition of blood component will come from hospitals. For every requisition, blood is issued depending on the availability of blood at the bank.

eClassroom As per the budget announcement by the hon’ble Chief Minister of Rajasthan, an e-classroom is to be established at all the medical colleges in Rajasthan. In compliance to this Department of Medical Education, Government of Rajasthan has planned to set up a state of art eclassroom at each of the six medical colleges and Rajasthan Health University. This e-classroom will use latest information and communication technologies and facilitate and enhance, share teaching contents and lectures. Objective of the project is to enhance and facilitate the learning process of future doctors and medical professionals through the use of ICT. e-Classroom will provide a platform for doctors to learn from the best in class faculties, share their experiences and hence improve the quality of the education. This technology will also ensure standardisation in the learning process and will help in improving the quality of doctors in Rajasthan. This e-classroom will use latest ICT and facilitate and enhance, share teaching contents and lectures. Reduced cost of computers and Internet has lead to concept of e-learning and e-classrooms. e-classroom is a new concept where student will be present with his professor and fellow learners in a classroom however they will not be present physically in the classroom but connected to the classroom via Internet. The PPR has been approved by State eGovernance Mission Team (SeMT) with an estimated budgetary cost for `433.31 lakhs. Currently funding and transfer of funds to RajCOMP Info Services Ltd (RISL) by respective Medical Colleges is in progress. december / 2012 ehealth.eletsonline.com

leader speak

The Bonafide Visionary Shivinder Mohan Singh, MD, Fortis Healthcare, believes healthcare needs to be standardised, accessible in a cost-effective manner to the masses. In an email interaction with Sharmila Das, ENN What is your take on Universal Healthcare (UHC)? Do you feel after Thailand and Brazil, India would be able to take significant steps towards UHC? If no, where do you see the challenges? Universal Health Care (UHC) is an objective that has continued to challenge India. The Millennium Developmental Goals had set an objective of ‘Health for All’ by the year 2000; even 12 years post that time line, the horizon continues to be a receding one. There are multiple reasons for this slippage, the primary one being the lack of a cogent strategy and a delivery plan to match, at the country level. The journey towards UHC will be a long one, requiring several structural and systemic changes. Yes, India can take progressive steps towards realising its vision of UHC. This will require a significant shift in the priority that has hitherto been accorded to this sector and, hence, will need a long term sustained focus. Experience from many of the countries that have implemented UHC suggests that there are three stages in the development of a country’s healthcare system in its journey towards UHC. The first stage is referred to as ‘Nascent’, characterised by a weak delivery structure, inequitable access, variable quality, inefficient operations and high out of pocket expenditures. The second stage is the ‘Maturing’ stage, characterised by improving access, creating the right delivery structures, improved efficiency, a shift towards quality, and a significant increase in demand. The final stage is referred to as ‘Maturity’, characterised by well-established delivery structures, focusing on efficiency and quality, and managing the shift towards rising aspirations in a society which has got used to UHC; such a system continually re-calibrates itself to meet emergent challenges and expectations. India is in the ‘Nascent stage’ and it could well take between 10-15 years

december / 2012 ehealth.eletsonline.com

of sustained effort to arrive at UHC. Major challenges that will need to be tackled are: • Financing healthcare delivery: will lead to approx. trebling of public share of expenditure as Government’s role shifts from provider to a significant payor • Enhancement of infrastructure: huge capex will need to be deployed to increase the number of hospital beds by approx. 3.5 times; investments will be required to set up educational institutions to produce medical talent; PPP formats will need to be developed and deployed to facilitate delivery of care • Regulation: a strong and unbiased regulatory framework will be required to enforce quality and governance What are your expectations from the 12th Five Year plan for Indian healthcare? How do you feel the increased spending on Indian healthcare should be disseminated? I feel the following need to be done: • Faster progress towards Millennium Development Goals. • Grant of infrastructure status to healthcare • A favourable policy environment to encourage private players to engage in PPPs in the healthcare sector. • Investments in new medical colleges; and opening the field to established and serious private players • Setting up of hospitals for vulnerable sections of society and rural areas • Creation of policies for compulsory health insurance and/ or innovative solutions with similar intent • Favourable policy on clinical talent retention in India as well as ease in the re-entry into India of international medical degree holders. (Encourage reverse brain-drain or brain gain for India) • Positive attitude to look at public and private players as trying to achieve a common goal, rather than being at daggers drawn How do you feel healthcare giant like Fortis can make a difference in collaborating UHC, managed care model in India? We can offer our expertise and experience in managing hospitals in a sustainable manner. For example, we can offer to have deep understanding of efficient operations, clinical quality; control costs (to consumer) inspite of inflation. To have ability to standardise healthcare (McDonalds’ approach). We can help work with the Government on PPP mode to improve the care delivery framework cost-effectively. What is your opinion of the medical training that is available in the country? There is a high variability in the quality of talent emerging from training schools these days. So the healthcare sector has to expend additional resources on re-training and skilling prior to deploying resources for patient care. We need to create transparency and upgrade our health education systems, bringing them to international levels.

leader speak

At times the government hospitals are unable to retain talented healthcare specialists. What steps should be taken to ensure that the government owned healthcare centres, especially in rural areas, are fully manned? The government can consider PPP for such healthcare infrastructure. A key factor will be to incentivise doctors through monetary and non-monetary means to devote time in rural centres. Also government should set up appropriate training infrastructure to utilise locally available talent. What plans do you have for Fortis in near future? We plan to increase our presence in other parts of our country so that more and more people can have access to affordable and high quality healthcare. For that matter, we plan to partner with the State Governments progressively to further the PPP agenda in a sustainable manner. We wish to setup protocols and clinical pathways to standardise delivery of healthcare in line with best practices. We encourage our hospitals to train incoming fresh talent so that we can offer to the citizens of India a first-class private healthcare network spanning secondary and tertiary care on a â&#x20AC;&#x2DC;quality-based valueâ&#x20AC;&#x2122; proposition.

december / 2012 ehealth.eletsonline.com

case study

Robotic Surgery Removed 15 cm-long Tumour The cancerous tumour was removed through a keyhole with the use of new state-of-art da Vinci Si Robotic Surgical System. Nikita Apraj, ENN presents a report

run Kumar (name changed), 51 was feeling relieved when doctors at Asian Heart Institute (AHI), Mumbai, told him that sonography reports of his abdomen have come clean. Just a month ago Kumar was operated in AHI for a complex renal surgery, where doctors removed a cancerous tumour as large as 15 cm from his kidney through a robotic procedure. According to doctors, the case is unique due to the massive size of the cancerous tumour and the fact that it was operated as a robotic procedure with minimal blood loss and pain. The surgery was done by Dr Jagdeesh Kulkarni and Dr Mangesh Patil from Asian Robotic Surgery Institute, a unit of AHI. There are very less literature reports from India but the large renal tumours usually means approximately 10-12 cm in literature, said doctors. Normal size of kidney is 10 x 6x 4 cms. “Robotically a tumour removed in everyday practice is about 4-5 cms long. But in this case the size of the renal tumour was approximately 15 cm and was removed completely by robotic surgery through a key hole size of 3-4 cm and the patient is doing well now,” said Dr Jagdeesh Kulkarni, Onco-Urologist, Panel Robotic Consultant, AHI. Kumar, who also had a thyroid issue, consulted his family doctor when he suddenly started losing weight few months ago. “My doctor suggested me to undergo check up and do my abdominal ultrasonography. I was shocked when the test revealed that I have such a big cancerous tumour growing inside my kidney,” said Kumar. The exact reason for formation of such a huge kidney tumour is not known, said doctors adding that the possible reasons for such tumour growth include genetic causes, smoking, alcoholics, stones or complex cysts.

december / 2012 ehealth.eletsonline.com

Unique features of robotic procedure in this case • • • •

Complete removal of renal tumour without spillage Minimal pain to the patient Highly accurate, so no chance of error 3D vision which gives more precision

The complete surgery was done robotically on September 7th . Doctors removed the tumour through the keyhole as a single complete mass without crushing and spillage to prevent recurrence of cancerous growth. “This is probably the first time in the country that such a huge mass has been removed as a single piece through a keyhole. The surgery was challenging as well because of the size of tumour. Ordinary surgeons would have suggested open surgery, which would have caused a lot of pain and discomfort to the patient,” said Dr Mangesh G Patil, Consultant Urologist and Robotic Surgeon, AHI. Long Hospital stay is a disadvantage of open surgery. It was a high risk procedure from patient’s point of view because cancer-cure is the most important. It was challenging to remove such a big tumour through a keyhole. Patient’s life depends a lot on the intra-operative and post-operative management. The blood loss during this procedure was less than 50 ml. Dr Ramakanta Panda, Vice Chairman & Managing Director AHI, said, “The Asian Robotic Surgery Institute is the first institute in Mumbai to offer robot assisted surgeries. The institute has recently completed more than 100 robotic surgeries with the highest success rates, thereby setting a new benchmark in Indian healthcare.”

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