ehealth December 2013

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

volume 8 / issue 12 / december 2013 / ` 75 / US $10 / ISSN 0973-8959

Diagnostics the spine of healthcare

GEâ&#x20AC;&#x2122;s Mission Healthier India

Zoya Brar

on CORE

Diagnostics eHealth Magazine

An upstart start-up upsets the applecart

ehealth.eletsonline.com

volume

issue

contents

ISSN 0973-8959

cover story Diagnostics - The Spinal Cord of Healthcare Industry

Special Focus Zoya Brar, Managing Director and Co-Founder, CORE Diagnostics

cover story Prof B B Thukral - Department of Radiology and Imaging, Safdarjung Hospital

Dr Harsh Mahajan, Founder, Mahajan Imaging Centre

Punit Kohli, Business Director, BD Diagnostic System

Sanjeev Vashishta, CEO, SRL Limited

Dr Harsh Rastogi - Sr Consultant, Radiology Department, Apollo Hospitals

Dr Devlina Chakravarty- MD, COO, Artemis Hospital

tech trend

Refurbished Markets-On the Rise

expert speak

Terri Bresenham, President and CEO, South Asia, GE Healthcare

Sachin Chaudhary, CEO, Medical Second Opinion

Dr Nidhi Bhatnagar, MD, Radio Daignosis, Max Hospital

Dr Mona Bhatia - Head of Department, Department of Radiodiagnosis and Imaging, Fortis Hospital

Dr Rakesh Kumar Mathur - Chairman, Radiology and Imaging Radiology, Saket City Hospital

Dr Manoj Chadha, Consultant, Hinduja Healthcare

Dr Manisha Shree, Senior Consultant, Radiologist, Paras Hospital

Dr Risha Nahar, Scientist, Sir Ganga Ram Hospital

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Health Watch

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

issue

december 2013

President: Dr M P Narayanan

Partner publications

Editor-in-Chief: Dr Ravi Gupta group editor: Anoop Verma

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editorial

Diagnostics: The Magic Wand On the other side of the globe, RSNA (Radiological Society of North America) has kicked off in Chicago with a lot of surprises. The opening message for radiologists was to get out of the basement and make sure patients know their name. The RSNA President was talking about accepting more responsibility for patient care. In the era of personalised medicine, the focus was more on fostering better relationship with the patients. Imaging is the buzz word toady. We are racing against time to save lives and even after death imaging plays a role. Now Sheffieldâ&#x20AC;&#x2122;s Medico-Legal Centre has introduced non-invasive Digital Autopsy Facilities that offer a significant humanitarian step forward in establishing the cause of unnatural death using sophisticated visualisation software â&#x20AC;&#x201C; and a scanner rather than a scalpel. The current issue of eHEALTH has integrated all aspects of diagnostics that incorporates multimodality imaging and the coming rise of PET/MR that is destined to rapidly advance radiologyâ&#x20AC;&#x2122;s precision. Besides talking to the key players and stakeholders in various verticals of diagnostics, we have focussed on the most prolific and promising start ups in the industry. It is high time for radiologists to partner with other medical specialities to enhance their approach and visibility. The current diagnostic market in India is pegged at USD 2 billion and it continuous to grow at healthy toll .Until recently the best of diagnostic procedures were confined to top notch hospitals but today many standalone diagnostic centres have changed the rules of the game. Growth of such centres with better services is fast picking up; they add value and competition by way of second opinion, turnaround time and other quality based services. More than 70 percent of treatment decisions come from over 40,000 labs spread across the country. The figure is self explanatory and the intense competition percolates into better service. We talk to some of the leading labs and pathologists to get the whiff of the industry. To promote healthy discussion on healthcare, we are now organising event that will offer a perfect platform to bring together the decision makers and other key players who are pivotal in shaping the healthcare industry. We hope to see you at the grand event that is scheduled to be held in February 2014 at Chennai.

Dr. Ravi Gupta ravi.gupta@elets.in

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news

Saket City Hospital takes Cardiac Care to the Next Level Saket City Hospital (SCH), a wholly owned subsidiary of Dr. B K Modi led Smart Health City, announced the launch of Saket City Heart Institute, which will run two certified centres – Priority One and the Centre for Arrhythmia (heartbeat disorder). Dr. Valavanur A Subramaniam, the father of beating heart surgery, flagged off the launch of the unique facility. The facility was unveiled in the presence of Dr RK Mathur, Medical Director; Dr. Mohan Nair, Chairman, Cardiac Sciences; Dr. G.K Mani, Chairman, CTVS; the Cardiac Sciences team; and the entire clinical faculty. Speaking on the facility, Dr. BK Modi, Chairman, Smart Global, said “The unique model is equipped to tackle unscheduled cardiac emergencies and make cardiac-care services available to the general population, round the clock. SCH has joined forces with Aapka Urgicare Private Limited for ensuring localisation of cardiac-care services.

Core Diagnostics Launches Knowledge Sharing Platform for Oncologists Core Diagnostics launches knowledge sharing platform for oncologists, when in the plan is to connect 1000 oncologists and pathologists within the first six months. Core Diagnostics, the leading high end clinical laboratory in India launched ‘COREconnect’, a live web platform that intends to connect Indian oncology community on a one-of-a-kind knowledge sharing platform, on the eve of the first Indian Cancer Congress (ICC2013) in Delhi. COREconnect will allow doctors to view and browse cases, search for similar cases and review and share cases live on a single knowledge sharing platform.

Healthcare At Home Comes to India

The Burman family, promoters of India’s leading natural health care products maker Dabur India Ltd, has joined hands with Dr Gareth Jones and Charles Walsh, the founder of the UK-based Healthcare At Home, to introduce the concept of managed at-home healthcare services in India. The new joint venture Company – HealthCare At Home India (HCAH) will work with corporate hospitals and doctors to offer critical healthcare services in oncology, pulmonology, post-operative care (orthopedics, cardiac, bariatric etc), critical care and palliative care, to patients in the closed confined and comfortable environment of their own homes.Health Care at Home India will also be adding other services such as maternity and aged care. Its success is founded on providing the highest quality services delivered by well trained and experienced staff (specialist nurses, HCAs and physiotherapists).

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EMRs Provide Systematic Method to Discover New Disease Association

Vanderbilt University Medical Center researchers and co-authors from four other U.S. institutions from the Electronic Medical Records and Genomics (eMERGE) Network are repurposing genetic data and electronic medical records to perform the first largescale phenome-wide association study (PheWAS), released in Nature Biotechnology.Traditional genetic studies start with one phenotype and look at one or many genotypes, PheWAS does the inverse by looking at many diseases for one genetic variant or genotype. “This study broadly shows that we can take decades of off-the-shelf electronic medical record data.

World’s First Digital Autopsy Facility Network Opens in Sheffield UK is set to become the first nation in the world to have a network of stateof-the-art, non-invasive Digital Autopsy Facilities, offering a significant humanitarian step forward in establishing the cause of unnatural death using sophisticated visualisation software – and a scanner rather than a scalpel. The first £3 million Digital Autopsy Facility will be housed at Sheffield’s Medico-Legal Centre and will be opened by the Chief Coroner for England and Wales, His Honour Judge Peter Thornton QC today, November 27th 2013. The revolutionary new technology, created by advanced medical visualization company iGene, part of the Malaysian INFOVALLEY group, uses unique 3D visualisation software and is set to revolutionise the way autopsies are carried out, and the process of examination-investigation, in the future. The new centre in Sheffield is the first facility in the world outside its birthplace in Malaysia, and paves the way for a nationwide network of facilities, signalling a £50 million investment.

A Brain Reward Gene Influences Food Choices In Early Years of Life Research has suggested that a particular gene in the brain’s reward system contributes to overeating and obesity in adults. This same variant has now been linked to childhood obesity and tasty food choices, particularly for girls, according to a new study by Dr. Patricia Silveira and Prof. Michael Meaney of McGill University and Dr. Robert Levitan of the University of Toronto. Contrary to “blaming” obese individuals for making poor food choices, Meaney and his team suggest that obesity lies at the interface of three factors: genetic predispositions, environmental stress and emotional well-being. These findings, published in the journal, Appetite, shed light on why some children may be predisposed to obesity, and could mark a critical step towards prevention and treatment.

FDA Requires Removal of Restrictions on the Avandia The U.S. Food and Drug Administration is requiring the removal of certain restrictions on prescribing and use of the diabetes drug Avandia (rosiglitazone) to reflect new information regarding the cardiovascular risk of the medicine. The actions are consistent with the recommendations of expert advisory committees. Results from the Rosiglitazone Evaluated for Cardiovascular Outcomes and Regulation of Glycemia in Diabetes (RECORD) clinical trial showed no elevated risk of heart attack or death in patients being treated with Avandia when compared to standard-of-care diabetes drugs.

‘Stop selling DNA tests’, FDA to 23andMe.com Google-backed 23andMe, a consumer company that seeks to be the “world’s trusted source of personal genetic information” thanks to its $99 DNA tests, has been slapped with a warning from the FDA that it’s in violation of the Federal Food, Drug and Cosmetic Act. The company, whose founder, Anne Wojcicki, is married to (but separated from) Google co-founder Sergei Brin, markets its Personal Genome Service as a way for consumers to trace their lineage – it can even offer an estimate of someone’s “genome-wide percentage of Neanderthal ancestry” – and also to help clue them into their particular genetic predisposition to diseases such as cancer and Parkinson’s. It’s in that capacity that the product has run afoul of the FDA, according to the agency’s letter, which was sent to Wojcicki on Nov. 22. Regulators have told 23andMe that it must “immediately discontinue marketing” the PGS until it has proven its tests are accurate and received FDA clearance.

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health watch

Diabetes Mellitus

Lessons from Recent Trials By Dr Manoj Chadha, Consultant Endocrinologist Hinduja Healthcare Surgical, Khar(W) Mumbai

iabetes mellitus is a metabolic disorder, characterised by chronic hyperglycemia, which is associated with absolute or relative deficiency of insulin. It is diagnosed by a fasting plasma glucose (FPG) of > 126 mg percent, random plasma glucose (RPG)> 200 mg percent or a postprandial plasma glucose (PPPG)> 200 mg percent on two different occasions. In normal persons the FPGis < 100 mg percent and a PPPG is <140 mg percent. So there is an intermediate category where the FPG is 100-125 mg percent and/ or PPPG is between 140 and 199 mg percent. This category has been given various names in the past (IFG, IGT etc) but is now recognized as â&#x20AC;&#x153;pre-diabeticâ&#x20AC;?. It is estimated by the IDF (International Diabetes Federation)that the number of diabetic patients in the world is 300 million and the number is growing exponentially every year. Nearly 20 percent of this diabetic population lives in India! A very conservative estimate thus puts the number of diabetics inIndia to be around 60 (to 80) million (6 to 8 crores). Studies from different States of India have estimated that 10-15 percent of population above the age of 20 years is suffering from Diabetes mellitus. These figures do not take into account an equal number of pre-diabetics who are waiting in the wings to be diagnosed. Thus nearly 25 percent of our

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Dr Manoj Chadha,

Consultant Endocrinologist Hinduja Healthcare Surgical

health watch

population has either Diabetes or is pre-diabetic. It is important to pick up these pre-diabetics. They are at equal risk as Diabetics to develop heart disease, stroke or other atherosclerotic complications. If left untreated they are very likely to progress to Diabetes mellitus. The positive side of the story is that they can reverse back to normal with a change in their life style! Diabetes mellitus is a progressive disorder. By the time a patient is confirmed to have Diabetes mellitus, he has already lost 50 percent of his insulin producing cells (beta cells). The only way to prevent this relentless destruction or at the least delay the progression of this disease is to control the plasma glucose values to as near as possible. In spite of all the advances in management of Diabetes, we do not have a therapy to regenerate the dead beta cell. Thus an important point to remember is that that eventually all diabetics would end requiring insulin. This may happen within 15 or 20 or 25 or 30 years or even longer after diagnosis of the disease. Inspite of the various presentations of this disease that we read about (polyuria, polydypsia, polyphagia, easy fatigability, weight loss, delayed wound healing, excessive itching, visual disturbances etcetc), more than half the patients are asymptomatic. They are picked up on either routine health check ups, pre-operative investigations, pre-employment or pre-insurance check ups. Diabetics are likely to develop complications as the duration of disease progresses. Quite a few of them (10 percent) have evidence of complications at the time of diagnosis. Certain complications like micro vascular complications (nephropathy – kidney, retinopathy – eye, neuropathy – nerves and vasculopathy – small vessels) are typical of Diabetes mellitus. The macro vascular complications (heart disease, stroke, peripheral vascular disease

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etc) are commoner than that seen in non-diabetics. In addition macro vascular complications occur at an earlier age and tend to be more serious than non-diabetics. Early in the course of the disease these complications tend to remain silent and hence these patients are asymptomatic. If diagnosed early enough, these complications can be reversed. However once they have crossed a point of no-return, then we can only hope to treat the patient and slow down the progression of the complications. Nearly three decades ago the UKPDS (United Kingdom Prospective Diabetes Study) was conceived and carried out in multiple centers across UK. The study recruited nearly 5300 newly diagnosed diabetic.

coin, three very large studies ACCORD, ADVANCE and VADT picked up nearly 25,000 elderly diabetics (65 yrs) who had been having the disease for more than 10 years. These patients had evidence of underlying heart or cerebrovasculardisease. An attempt was made to control HbA1c < 6.5 percent by any treatment, the physician chose. The ACCORD was terminated prematurely as the mortality in the intensively treated group was more than that seen in the conventionally treated patients. ADVANCE and VADT also did not showany advantage in the intensively treated group over the conventionally treated group.On analysis of the ACCORD data, it was seen that those patients who already had an underlying heart disease and poorly con-

By the time a patient is confirmed to have Diabetes mellitus, he has already lost 50 percent of his insulin producing cells (beta cells) These patients were randomized to receive intensive standard of care or conventional care. At the end of the study period (7-10 years of follow up), the intensively treated patients had a better control and outcome in terms of reduction in mortality due to Diabetes, all-cause mortality, micro vascular complications, stroke and heart attacks. When all these patients were followed for another decade on conventional treatment, the original group of intensively treated patients continued to do better than the original conventionally treated group. The moral of this study was that patients who were intensively treated in the early stages of the disease do well even over the following decade. This phenomenon has been called as the “Legacy Effect”. Looking at the other side of the

trolled diabetes were the ones likely to have poor outcomes with intensive treatment. It is thus recommended that every diabetic patient (Type 2) should have the following consultations/ investigations at least once every year. The frequency could be increased as necessary if there was evidence of any underlying complication. F Ophthalmology consultation F Dental consultation F Lipid profile F Urinary albumin for renal function F Glycosylated hemoglobin (HbA1c) Most of our patients have to pay for their medical expenses from their own pocket. Hence it makes a lot of sense to go for preventive health checks. The old proverb “An ounce of prevention is better than a pound of cure” is apt for this malady!

special focus

Zoya’s

Saga of Success Combining her vision with the tenacity and skill to realize her dreams, Zoya Brar, Managing Director & Co-Founder, CORE DIAGNOSTICS, has forayed into diagnostics and has demonstrated her ability to steer CORE’s meteoric rise. In conversation with Shahid Akhter, ENN, she shares her views, vision and the journey so far

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ith your background in sociology, how did you end up bonding with pathology? My dormant DNA of entrepreneurship finally expressed itself, and restlessness set in. While I was having fun at Google, I felt I was adding value, but not creating. At that point, doing a start-up was only a matter of time. The question was not ‘if’, but ‘what’ (the ‘when’ would simply follow). Serendipity played an important part in diagnostics ending up as my calling. What started out as just another social dinner with a family friend from the Silicon Valley went on late into the wee hours of the morning. One thing led to the other and it culminated in path lab idea.

With so many path labs already there, why did you think of another lab? While there are many path labs, there is not a single lab in India that is focussed on Esoteric testing. Diagnostics makes up for only 3% of the Healthcare expense, but impacts 70% of the cost downstream, and 100% of the outcome. So, while “high end testing” might sound like a cost burden, it is exactly the opposite. It improves the clinical outcome, and might in fact, reduce the downstream cost of treatment. Seeing such a clear “white space”, or a gap in the Healthcare Delivery chain, my start-up was right there, staring at me. It was time to build a lab whose Raison d’être was

high-end esoteric testing – based on molecular diagnostics, genomics, proteomics, etc.

How has been the journey and experience so far ? How do you feel when you look back? In many ways, the phrase, “the journey itself is the destination” is best exemplified as I look back at the past 12 months. Every single day, every single event, has been, well…. “eventful.” Each of these milestones - completing an A+ architecture and look and feel with perfect attention to detail. A high-end lab, must, among other things, look and feel high-end, for various reasons. First and foremost, I knew I would have to compete with the large established labs, multi-specialty hospitals, and technology firms, for talent. As a start-up, that’s nearly impossible. Culturally, working for a start-up is not foremost in the Indian psyche. I knew that the quality of the physical workspace will play a very critical role. Second, I am a firm believer that the quality of workflow is a direct function of the quality of the physical space. I was looking to create a zero-tolerance culture when it came to process errors. A world-class work environment was central to that theme. Looking back, investing in a clean-cut, glass and chrome facility was a great decision. It also symbolizes a very open, very transparent culture (we have no offices… we have just one very large, open commu-

nal work area). It is clutter free (there is very minimal storage space, and that too is made of glass… you can’t hide your clutter), and squeaky clean (you can see your reflection on the floor, all day long). I have personally interviewed nearly 300 people to hire just over 30 members of my team. Well, first, we were looking for absolutely world class people. They are simply hard to find. More importantly, I was solving for not just functional knowhow, but additionally, for two very important traits – listening skills, and an unconditional commitment to full transparency – both of facts and of intentions. That was a Herculean task. I did make some hiring mistakes. For those, I resorted to the Silicon Valley mantra, “You are sometimes going to fail. So, fail fast. Or at least recover from failures quickly.” Net gain: I have enjoyed this short but exhilarating journey, playing in turns, the role of a pilot, and that of an inflight psychologist.

Please give an overview of diagnostic tests that you offer and how does it differ from others ? Our portfolio can best be summed up as one third x 3. The first third comprises of tests that no one else is offering in India. Examples of this are amnio CORE, a non-invasive pre-natal test that is a substitute for the very invasive and risky procedure of amniocentesis, as well as the cad CORE, which is a non-invasive test for Coronary Artery Disease. The second one third is made up of tests that others can offer, but they have to send the samples abroad, resulting in very long turnaround times and high costs. We do these tests locally, here in India. The last one third is a portfolio of tests that others are also doing, but our quality and the second opinion from the panel of US pathologists, with the shortest turn-around time in the industry, makes us unique. Next, we of-

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special focus

fer tests that are not only diagnostic – but also prognostic and predictive. That’s what makes a difference.

High end esoteric testing is the key at CORE Diagnostics

How about the high end fee charged by CORE? Are you doing anything to bring this down? Despite our better quality, faster turnaround time, and second opinion on every test, we are very competitively priced. We are further trying to bring down costs by developing new assays in our lab in Palo Alto in the United States. This is very unique. In most US-India operations, especially in information technology, R&D is done in India, and the commercial operations are in the US. We do the exact opposite. While R&D is very expensive to do in the US,

The second opinion from the panel of US pathologists, with the shortest turn-around time in the industry, makes us unique” we firmly believe that the outcome (in form of newer, lower cost assays) will make up for it. To make such bets, one needs the instinct of an entrepreneur.

Is second opinion a part of every report? Correct. We believe this is essential. Cancer, for example, is a very complex disease, where the diagnosis, prognosis, and prediction is not simply a set of rules. It often requires a gestalt, where cumulative experience, access to most current knowledge, and above all, collaboration, makes a big difference. Let me give you an example. Just two weeks ago we received a sample from a patient who had undergone a mastectomy and two rounds of chemotherapy, following a diagnosis of invasive breast cancer. We analysed her sample and also sent it digitally to our experts in the US for a second opinion. Turns out, the tumor was benign and not cancerous. Our diagnosis changed the entire direction of her treatment.

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What exactly constitutes ‘Global Panel of Pathologists’ that you are associated with? There are 27,000 histopathologists in the world. 17,000 of them are in the US with nearly half of them with a superspeciality training in either one kind of cancer, say, prostate cancer, or one kind of technique, for instance, molecular testing. India, unfortunately, has less than 1000 histopathologists, with very few of them super specialized. With our growing understanding of the complexity of disease, it is not enough just to have a second opinion. The second opinion often must come from a super-speciality trained pathologist.

How do you compare India with the US in diagnostics? How good are our histopathologists and how well are we comfortable with the technology? Let’s start with the good news: We recognize that India has not kept pace with the US, when it comes to diag-

nostics, and efforts to close this gap are underway. I believe with conviction that we, at CORE Diagnostics are the torch bearers of this transformation. We do have good histopathologists in our country. We just don’t have enough of them. And we don’t have nearly the extent of continuing medical education required to keep current with the ever increasing pool of relevant knowledge. We, at CORE Diagnostics are not only ensuring that we have access to an expert in the US to supplement our own histopathologists, we are also investing heavily in education of pathologists in our country.

What is your approach to innovation (you claim that it is your primary brand identity)? Innovation pervades everything we do. Almost literally, it seeps in our marrow and DNA. Our work environment fosters innovation. We believe that innovation is not only a structured process. A lot of creativity and innovation happens when there is free flowing, agenda free dialog. Our open work culture reeks of creativity. The fact that we do our R&D in the US is another great example.

are proximate issues, penultimate issues, and ultimate issues. While one can point to issues like awareness amongst the clinicians – regarding the value of diagnostic, prognostics, and predictive tests, price sensitivity, poor infrastructure, etc, they are all proximate in nature. The ultimate issue really is access to good talent.

How do you foresee and visualise the evolving diagnostics?

Glass symbolises the transparent culture at CORE Diagnostics

How do you connect with the Silicon Valley? What Silicon Valley is to man-made innovation, the Islands of Galapagos are to nature’s innovation - the ultimate citadel of creativity. I travel to Bay Area once a month to stay in constant contact – both with my colleagues at our lab in Palo Alto, but also to remain ingrained in the ecosystem – of other entrepreneurs as well as our partners.

Why did you think of Stanford, Cedar-Sinai, etc. as your partners? We triangulated back from facts like – who wrote that seminal book, who published that landmark peer-reviewed paper, who provides second opinions to the best reference labs in the US, etc. And a pattern began to emerge – with institutions like Cedars, Stanford, Genentech right at the centre of gravity.

With the recently concluded Indian Cancer Congress, what prompted you to be Platinum Sponsor? We saw that ICC was trying to achieve something very bold, very unique – bringing five different Oncology societies

While R&D is very expensive to do in the US, we firmly believe that the outcome will make up for it. To make such bets, one needs the instinct of an entrepreneur” in India together under one umbrella for the first time. Bold moves need bold partners. We felt it was imperative to put our money where our mouth is. And we did this very early on, when there were very few believers in ICC, or whether it could be pulled off. Our signing up as the exclusive platinum sponsor – especially as a start-up – was catalytic. It helped ICC sign up other sponsors.

What are the major challenges you see in Indian path labs? Talent, Talent, Talent. It’s like they say in real estate – Location, Location, Location. Enough said. There

I believe diagnostics will emerge as the core around which the rest of the healthcare delivery system operates. You see, as I said, diagnostics makes up for only 3% of the healthcare expense, but impacts 70% of the downstream cost of delivery of healthcare, and 100% of the outcome. Nowhere in any other industry is the leverage so stark, of a single lever. In healthcare, that lever is diagnostics. India has a handful of national players, and over 50,000 small labs. Hence, some consolidation is bound to happen. Informatics, not just IT, will play a central role in diagnostics. The issue is not one of managing data, but delivering knowledge – relevant knowledge at the right place at the right time. This is bigdata analytics at its best. We have built a system from scratch, called iCORE to serve as our informatics platform. We chose to build it bespoke, because there is absolutely ‘nothing’ on the open market that meets the specs – for an informatics platform for the future.

What are your future plans of action and expansion? We visualize our expansion along three fairly independent dimensions – geography, clinical specialities, and technology. We are growing along each of these three axes.

Your suggestion to budding Start up entrepreneurs in India? Think big. And don’t sweat the small stuff. You can always do it later.

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Cover Story

Diagnostics Diagnostics

Diagnostics

The Spinal Cord of Healthcare Industry From personalised medicine to disease monitoring, the role of the diagnostic industry will be crucial in managing healthcare spending By Ankush Kumar, Elets News Network

t is believed that the history of medical diagnosis began from the days of Imhotep in ancient Egypt and Hippocrates in ancient Greece. The Traditional Chinese Medicine is one of the oldest and have four diagnostic methods; inspection, auscultation-olfaction, interrogation, and palpation. Currently, most of the diagnoses are done through physical examination and assessment of the symptoms exhibited by a patient. The range of diagnostic procedures used supports the physicianâ&#x20AC;&#x2122;s exami-

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nation, and were largely developed throughout the last century. Diagnostic techniques have evolved from the assessment of the symptoms, the physiology of the patient and some basic chemical tests. Continued development of these various methods has led to both technology drive and patient demands bringing some aspects closer together. â&#x20AC;&#x153;The current market size of diagnostic market in India is USD 2 billion which is growing at 20 percent CAGR. The market in India is highly

fragmented with over 40,000 labs where organised sector constitutes less than 10 percent of the market,â&#x20AC;? says, Dr Rana Mehta, Leader Healthcare, PwC India. This growth will be driven by healthcare facilities, private-public projects, medical diagnostic, pathological laboratories, and the health insurance sector. 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

demand. They are 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. According to Sanjeev Vashishta, CEO, SRL Limited “Majority in the organised sector is family driven business.” The organised segment can explore the opportunities of expanding to semi-urban and rural areas and mergers and acquisitions would likely be a route for expansion.

Drivers of Growth Growth has been pursued via a combination of the organic and inorganic route. A majority of growth in the organised sector has occurred through acquisitions and Brownfield projects, rather than setting up green field laboratories. Complex Disease and availability of complex testing has been one of the major reasons of the growth in Diagnostics. There are diseases that are highly complex to be diagnosed through the basic tests therefore the importance of intensive diagnosis and complex testing arises. The other contributor of this growth is the rise of chronic diseases which requires frequent testing. In this case the patient needs to visit the diagnostic center or the healthcare clinic on regular basis. Increase in preventive medicine and wellness care is the other major factor that has lead to this growth. Now the doctors are focusing a great deal on wellness care and preventive medicine in the best interest of the patients and their families. Increasing medical liability on doctors has also contributed to the growth of diagnostic industry. This is one of the reasons why doctors in some of the critical cases prescribe different kinds of tests and exami-

nations. Statistics reveals that each year thousands of people die in most of the developing countries because of medical errors. Medical malpractice is professional negligence by act or omission by a health care provider in which the treatment provided falls below the accepted standard of practice in the medical community and causes injury or death to the patient, with most cases involving medical error.

Future trends Diagnostics is not simply being a way to identify which patients have a specific disease, it is now used to support clinical development of drugs, predict disease before symptoms begin, forecast the progress of a disorder, and identify patients who are most likely to respond (or not respond) to specific treatments. “In the last few years there has been lots of focus on Molecular Imaging and Molecular Diagnostics,” said Dr Harsh Mahajan Founder, Mahajan Imaging Centre, New Delhi and

gene based testing for various medical studies. Convergence of Labs and Radio diagnostics - Diagnostic centers across the world are now expanding their services, they are now looking to provide all the medical facilities under one roof. Mergers and acquisitions of smaller players - Since a major portion of the Indian diagnostic industry is unorganised comprising of small centers and clinics therefore to meet the patient demand and stay competitive these smaller centers will see a lot of mergers and acquisitions. Brand awareness to facilitate growth - As the competition among the diagnostic centers will become stiffer; they will start spending more money so as to build awareness of their brand. Outsourcing of Hospital Labs Hospital Labs face huge challenge to speed & quality in diagnostic service, lack of trained technician and ensur-

“In the last few years there has been lots of focus on Molecular Imaging and Molecular Diagnostics,” Dr Harsh

Mahajan Founder, Mahajan Imaging Centre, New Delhi and Former President, Indian Radiological and Imaging Association (IRIA) Former President, Indian Radiological and Imaging Association (IRIA). Some of the future trends that can be seen in diagnostics are : Rise in Esoteric and Gene based testing - Genetic testing, also known as DNA testing, allows the genetic diagnosis of vulnerabilities to inherited diseases, and can also be used to determine a child’s parentage (genetic mother and father) or in general a person’s ancestry. Companies can be seen investing huge in esoteric and

ing presence. Like Nurse, these staffs can quit abruptly and bring the lab function to halt. Regular monitoring of lab operation to ensure equalitymost hospital leaves the lab under the concerned technician without adequate supervision.

Diagnostic Radiology Diagnostic radiology is concerned with the use of various imaging modalities to aid in the diagnosis of disease. Diagnostic radiology can be

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Diagnostics

“People are working today in Radiology for Tumor Angiogenesis and understand that what causes the Tumor to grow faster than the normal cells and then to find out an affectivity of a drug once it is given to a certain person”

Dr Devlina Chakravarty, Chief Operating Officer, Artemis Hospitals

further divided into multiple sub-specialty areas. Interventional radiology, one of these sub-specialty areas, uses the imaging modalities of diagnostic radiology to guide minimally invasive surgical procedures. Therapeutic radiology—or, as it is now called, radiation oncology uses radiation to treat diseases such as cancer using a form of treatment called radiation therapy. Imaging Modalities - commonly used imaging modalities include plain radiography, computed tomography (CT), magnetic resonance imaging (MRI), ultrasound, and nuclear imaging techniques. Each of these modalities has strengths and limitations which dictate its use in diagnosis. Radiology has a very important role in diagnostics, starting with Xrays, which are essential for diagnosis of fractures, as well, play an important part in the initial investigation of chest diseases, and abdominal disorders, particularly calculus disease. Mam-

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Color Portable Ultrasound Systems, Installed Base by City Type, 2008

mography is another example. Ultrasound is now essential in the field of obstetrics, as well as important in various abdominal disorders, and in conditions of the breast (as a supplement to mammography), thyroid, scrotum and joints. “Radiology is also one of the primary investigative modalities in gynecology CT and MRI is also extremely important, particularly in conditions of the brain and spine, which are poorly evaluated by other techniques,” said Dr Preeti Vaid, Radiologist. They are also use-

ful in conditions of chest, abdomen, bones and joints as well as soft tissues. She further added that Imaging is extremely important in planning treatment for both surgery and radiation. It is one way to gauge the extent of a disease, and so it is also important in the follow up after treatment. “Now, we can know through MRI that whether the Cancer is limited to the liver, intestine or it has spread to the lungs or to the brain,” said Dr Harsh Rastogi, Sr Consultant & Clinical Co-ordinator, Radiology Department, Indraprastha Apollo Hospitals. Research and Development has been termed as the base of Radiology as it provides better ways of treating a particular disease. “To strengthen the economy and keep the money home, we need to be our own bosses and strengthen our in-house R&D”, said Dr Nidhi Bhatnagar, specialist consultant, MSKUGS, Max Panchsheel. “There is now a shift towards molecular imaging which goes beyond morphology and addresses function.

Global medical equipment market

by category 2011 6%

Others

13%

Patient Aids

30%

Woundcare Syringes, Needles & Catheters

Other Consumables

Electrodiagnostic X-Ray Apparalus

10%

15% 9%

Imaging Accessories Orthopaedic & Prosthetic

Dental

2% Source: Espicom Business Itelligence 2011

interpreted and reported by a competent radiologist, so that the patient may be treated accordingly. According to B B Thukral, consultant and HOD, Dept. of Radiology and Imaging Safdurjung Hospital and VMMC “Teleradiology is good and bad. On one hand it provides expertise at places where Radiologists are not available. On the other hand it reduces interaction with the clinician which is not good and can cause harm to the patient.”

Offshoring Radiology In an era of escalating healthcare costs, rising salaries for one of the highest paid physician specialties makes offshoring of radiology to countries with lower wage structures an attractive proposition: one healthcare firm in Bangalore India pays its radiologists who work for US clients $30,000 – $100,000, well above the average Indian salary for radiologists but still

“Teleradiology is good and bad. On one hand it provides expertise at places where Radiologists are not available. On the other hand it reduces interaction with the clinician which is not good and can cause harm to the patient.” B B Thukral, Consultant and HOD, Dept. of Radiology and Imaging Safdarjung Hospital and VMMC It is likely that in the foreseeable future the pace of innovation in diagnostic imaging will continue to accelerate to meet the increasing demands of the medical fraternity,” said Rakesh Kumar Mathur, Chairman-Radiology & Imaging Radiology, Saket City Hospital. He further added that the equipment will become smarter, faster and more patient-friendly. According to Dr Devlina Chakravarty, Chief Operating Officer, Artemis Hospitals, “People are working today in Radiology for Tumor Angiogenesis and understand that what causes the Tumor to grow faster than the normal cells and then to find out an affectivity of a drug once it is given to a certain person”.

She further added that Radiology is moving from high-end Imaging to Physiology and Pathology of disease which is value adding to the Healthcare Industry.

Teleradiology As technology has progressed, methods of imaging have increased and existing methods have improved. Speed of performance, quality of images, visualization of structures, reconstructions etcall these have been possible with advance technology. Teleradiology, definitely has a big role to play in the future especially in a country where there are less radiologists. Images can be transmitted from remote areas and

low enough for the firm to charge about half what radiology groups in the US charge. The CEO of other India based Teleradiology company notes that highly qualified Indian radiologists earn between USD 20,000-30,000. Using a median US radiology salary of USD 350,000-400,000, it appears that most highly qualified Indian radiologists can be retained for salaries at somewhere between one-tenth to one-twelfth the prevailing US rate. The vast gap between what qualified radiologists earn in the US and emerging market countries such as India make offshoring of radiology financially attractive.

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Diagnostics

ith the introduction of new technologies and precision techniques, how do you see the developments in Diagnostics in next five years? Advanced technology is helping the clinicians to reach correct diagnosis faster and thereby initiation of treatment is early. However it is at some cost to the individual and society, which at present is exorbitant in Indian context. Many a time’s unnecessary and costly investigations are being done without any additional benefit to the patient. Clinicians are now treating disease rather than the patient as a whole. Treatment is not only of the disease but also of the patient and his family which requires proper counseling and consolations. I am sorry to say this is grossly lacking in today’s’ over busy clinicians. I do see a lot of development over next five years particularly in molecular imaging and organ/ site specific targeted therapy as a result of further improvement in imaging and human of biological processes.

Please name few guidelines you would offer the radiology professional just entering the field? Younger generation of radiologists is running towards newer technologies like CT, MR, PET CT and PET MR, forgetting conventional radiology. Many diagnosis which can be confirmed on simple ski grams, are being investigated by costlier modalities like CT & MR unnecessarily. A lot of it is market driven and to some extent malpractice driven which needs to be checked. Sometimes patients having half knowledge from the internet also leads to unnecessary investigations.

Where do the Indian Diagnostic market stand as compared to Global standard? Population of India is second largest

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Incentivise Doctors to visit

Peripheral Areas

“When diagnostic services will improve in the smaller towns then only the doctors will prefer to go to these areas”. Says B B Thukral Consultant and HOD, Dept. of Radiology and Imaging Safdarjung Hospital and VMMC, New Delhi. In conversation with Ankush Kumar, ENN

Clinicians are now treating disease rather than the patient as a whole. Treatment is not only of the disease but also of the patient and his family which requires proper counseling and consolations costs. Strict control and supervision of clinical trials is mandatory.

What are the newer laboratory investigation and current epidemiological trends?

in the world after the population of China. With the current rate of growth of population we are likely to surpass China in the near future. Health services, as they are, grossly lack in reaching out to all parts of the country. With private sector and private money coming in it is likely to push the demand of diagnostic imaging equipment. However I foresee huge demand for diagnostics in the country in tier two and tier three cities.

What do you think about Clinical trials, are they worth doing on human or is it a kind of malpractice? Clinical trials are an essential part of progress to be made in medical field particularly in therapeutics; hence they cannot be avoided. However one has to abide by the laws of the country without harming any individual. Malpractice in clinical trials has to be avoided at all

Newer investigations in the field of diagnostic imaging are PT CT, PET MR, MR HIFU etc. Newer epidemiological trends suggest that we need to take note of non communicable diseases like Diabetes, Hypertension, Cancer etc as life expectancy of the people has increased over the years. Population of aged is on the rise.

What are some of the challenges that Diagnostics Imaging Departments are facing in the Government Hospitals? Challenges in the Government hospitals in diagnostic imaging department are many. This is more so because of the dependence of the clinicians on the diagnostic tests before taking up the patient for surgery or any other treatment. More over these diagnostic tests are done at relatively cheaper rates or are free of cost. This increases the load on the department thereby increasing the waiting time for these investigations. Remedy lies in increasing the technical man power in addition to replacing old equipment with newer equipment and simultaneously increasing the number of radiologists.

There is dearth of quality Radiologist in India. How do you think the demand for Radiologists can be met? To meet the ever increasing demand of radiologists we have to train more doctors in the field of radiology by increasing the number of admissions/ seats in post-graduate courses in the field of radiology. Only when more radiologists are produced they will be available in peripheral towns which will improve health services tremendously. When diagnostic services will improve in the smaller towns then only the doctors will prefer to go these areas. Opening of new hospitals with adequate infrastructure and man power in areas where there are no hospitals will also reduce the load on hospitals in bigger towns.

What kind of Government support is needed in bridging this gap? Some steps have already been taken by the Government of India in this regard by enhancing the number of seats in Government and private medical colleges. In addition Government of India is giving financial aid under PMSSY program to Government medical colleges to upgrade their training infrastructure for post graduate teaching and training for increased number of seats in post graduate courses. If sufficient financial incentives are also provided to doctors to go to peripheral areas things are likely to improve further. Medical council of India can also be approached to amend its rules to accommodate more post graduate students per teacher for training and modifying the infrastructure criteria for the department of diagnostic radiology. Government funding for improvement of health services under NRHM and URHM is also being taken up aggressively. This will also improve the health service in smaller towns.

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Diagnostics

Attracting Foreign Patients through

High Intensity Focused Ultrasound â&#x20AC;&#x153;Now we have competition where least invasive and least harmful technique would be used to treat patients.â&#x20AC;? Says Dr Harsh Rastogi, Sr Consultant & Clinical Co-ordinator, Radiology Department, Indraprastha Apollo Hospitals. In conversation with Ankush Kumar, ENN

ow do you see the evolution of Indian Diagnostic Industry over the years?

When you look back to those times when CT, Ultrasound and MRI were not available, there was a clinical art of diagnosing patients by palpitating or putting the hands on the effected body part and then it used to be confirmed by the open surgery. We have grown not only in Diagnostics but we have started treatment in the department of Radiology. So now we are treating patients by Angiography or DSA techniques or giving a diagnosis by putting in a needle or even Non-Invasive treatment such as High Intensity Focused Ultrasound. We are now dependent on diagnostic and imaging to diagnose the disease and when the diagnosis is done then we can use the least invasive way of treatment in Radiology department. Radiology has to contribute much more in coming years. One of the examples is of LIVER Cancer, which is very difficult to treat but now we can do the diagnosis of LIVER cancer, decides whether surgery is possible or not. If surgery is not possible then we can treat it with Chemotherapy which is given locally

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Diagnostics

into the tumor by Angiography or by Radioembolisation. Therefore I believe that Radiology has completely revolutionised the healthcare sector.

How do you think Technology can bring more efficiency to the doctors in the Healthcare sector? With improvement in technology, improvement in the computer graphics, processing speed, software availability and computer technology. We can now see very minute problems which can be diagnosed. Technologies like 64 slice, 128 slides, 256 slice and 320 slice CT scans can pick up even a very small lesion which was not being picked up earlier, also the resolution of Imaging has improved tremendously. Then what has happened is the imaging quality has changed, we are not dependent on one image, today we also talk in terms of physiology and pathological changes that have occurred. Once you have this information in digital form you can use the networks that are available, the softwareâ&#x20AC;&#x2122;s that are available. You can send these images across states or even other countries for second opinion and this is very fast and accurate process.

What kind of state-of-the art facility we have in the Apollo Diagnostic Center as compared to some of the other superspecialty hospital across the country? Apollo as a group has always been the first in a lot of things, we were one of the first few to acquire multi-slide CT scanner like 64 slice Toshiba scanner that we have. In Chennai we installed the first CT scanner, which was 320 slice, very few centers have that capability. Moreover the first 3 Tesla MRI scanners were installed at Apollo and we were the one to start this trend, a revolution in North India. We know that technology is very helpful in mak-

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We are now dependent on diagnostic and imaging to diagnose the disease and when the diagnosis is done then we can use the least invasive way of treatment in Radiology department ing the critical diagnosis which is required for appropriate treatment. We were the first few to start Neuro intervention work in North India in 1996. We have the first PET MR ie the MR image and nuclear medicine (PET scanner) is fused together is very useful for Cancer patients. This was the third or fourth in the world when it was brought.

Do you think that every Superspecialty Hospital should have an in-house Radiology department? In-house Radiology Department is a must in any tertiary care or secondary care hospital because then the hospital does things the way they want to do. For instance a study for liver in our hospital is done in three phases the arterial phase, the capillary phase and the venous phase whereas at other places it is a single phase. You can get a lot of information from a triplephase scan than a single-phase study. We have the first HIFU (High Intensity Focused Ultrasound) machine, which also uses MRI for treatment of uterine fibroids. The scan which is done for a HIFU patient is very different from any scan which is done outside. So we have developed our own protocols and these are the ways we attract a lot of foreign patients. HIFU treatment is so popular that we get patient from Africa and Middle East for the treatment of fibroids.

What are some of the new trends and techniques that are picking up in the Diagnostic Industry?

There are some of the new techniques that are coming up in MRI. In MRI there is a potential of whole body imaging, itâ&#x20AC;&#x2122;s been practiced but at very few centers. There are some new sequences that have recently evolved which can give you a lot of information about the extent of disease for example cancer. Now, we can know through MRI that whether the Cancer is limited to the liver, intestine or it has spread to the lungs or to the brain. The other is, today a number of cancers are treated, by Gamma knife or X-Knife or Cyber Knife, they encounter problems because of radiation. I think in the next few years much less harmful radiation such as HIFU would be used to treat a lot of cancers and diseases. I am sure there will be competition where least invasive and least harmful technique would be used to treat patients.

A recent survey has revealed that India has acute shortage of Radiologists. So what can be the role of Tele-Radiology in fulfilling the demand for Radiologists? In Tele-Radiology you do not require a Radiologist to be stationed at every primary health centers or at every nook and corner. If the healthcare center have the proper information about the disease then they only need the technician who can do X-ray or an Ultrasound. And if they think that this is something where we need an expert advice then there are so many ways of transmitting information to a central hub station which can be manned by doctors 24 hours, seven days a week and 365 days a year.

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Ensuring Quality

Healthcare Services

“Radiology is moving from high-end Imaging to Physiology and Pathology of diseases which is value adding to the Healthcare Industry.” Says Dr Devlina Chakravarty, Chief Operating Officer, Artemis Hospitals. In conversation with Ankush Kumar, ENN

lease tell us about your roles, responsibilities and your association with Artemis so far?

Please tell us about Artemis modernisation and expansion plans?

I joined Artemis in the year 2007, as Director of the Radiology program and from there I moved on to become the medical Director of the company whereas currently I am the chief operating officer of the hospital.

At present we have two hospitals one in Gurgaon and the other in Dwarka. We also have two other smaller centers, one is in Riwadi and the other is in Bhiwadi. Artemis is already a 300 plus bedded hospital and we are going to start another 300 bedded tower, making the bed strength to 600 in total. Moreover in smaller cities we are looking to start hospitals between 100-150 bed and then connecting all this to the central hub. Therefore it will be a hub and spoke kind of model for which we have already identified certain states.

Hospitals across the world are competing to provide best State-of-the-Art facility to their patients. What are your views on this? I think more than having the best State-of-the-Art facility what really matters is the service that hospital delivers. Our main focus is on patient’s medical outcomes coupled with service excellence. I think providing an infrastructure if you do not have good doctors or having good technology if you are not efficient in handling that technology is not going to take you far. So it is a combination of having the best infrastructure, the top line technology and most importantly the medical outcomes and the service that the patient gets.

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As an experienced professional in the radiology profession, what role do you feel advanced technology is playing and what other advances do you foresee? Radiology is a very Technology intensive field and Artemis is proud to have latest Technology in Radiology. We were the first to have 3-tesla MRI in this part of the town, we were the first to start the PET-CT scan in Gurgaon

Artemis is already a 300 plus bedded hospital and we are going to start another 300 bedded tower, making the bed strength to 600 in total and we were also the first to start the multi-slice CT. At present, Radiology is moving from just anatomical diagnosis to physiology of the disease and certain software have also been developed in Radiology by which you just don’t look at the anatomy and identify disease but the disease itself shines out because of its different physiology as compared to the normal tissues and cells. For Instance in our MRI center we have software called the DWIBS (Diffusion

Weighted Imaging with background suppression). When we apply DWIBS while doing the whole body scan, we can detect Cancers in any part of the body because the cancer cells have the diffusion restriction and it shines out differently as compared to the normal cells. So basically Radiology is moving from high-end Imaging to Physiology and Pathology of diseases which is value adding to the Healthcare Industry.

Do you think that every Hospital should have in-house Radiology department? Radiology is the spinal cord of the healthcare system. It is a crucial requirement for healthcare but one has to be smart in investing in the new technology so that you know what you are paying for. One should not be blindly paying for a technology without understanding the tangible benefit of the

technology. Moreover, when you have bought a technology, optimum utilisation of the technology is essential therefore you have to understand the profile of patients that you are going to cater in your hospital. It basically depends on the size and the specialty of the hospital. We are a super-specialty hospital and one cannot do without an in-house Radiology because we are dealing with a spectrum of cases and you cannot outsource the department. In certain smaller hospitals, one could have either a small scale Radiology or outsource it to another bigger hospital. It is good to share the resource because Radiology is a very expensive and technology intensive department. Now if every other hospital starts replicating and putting the machine then it will lead to resource underutilisation. So every hospital needs to understand what is the type of the patients they are servicing and ac-

cordingly they should install their Radiology equipment.

Knowing the fact that India has shortage of Radiologist, what could be the role of Teleradiology in this scenario? There is a big shortage of quality Radiologist not in our country but in other countries as well so we have a dedicated room for Teleradiology where we are not only reporting for our offside centers but we are also reporting to off-shore. So Teleradiology is a great boon. Also, hospitals like us are training Radiologist, we have a DNB program in Radiology where currently we have four students and every year we will keep on adding four students. So the Government allows private hospitals, depending upon their infrastructure, their volume and quality of work to start a DNB programme.

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Cover Story

Diagnostics

Dr Nidhi Bhatnagar, Specialist Consultant, MSK USG, Max Medcare, Panchsheel, talks to Ankush Kumar, ENN, about how companies in the West are targeting lucrative markets like India with technologies that are obsolete in their own country

Quality Diagnosis

A Must for Rural Healthcare H

ow do you see the Indian Diagnostic Market? What kind of Imaging & Diagnostic setup you have at Max Hospital?

Market depends upon a triangle-like association between the producer, provider and the consumer. A balance has to be struck between the three viz a viz need based productivity, cost efficacy and reasonable degree of flexibility to

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accommodate the changes as and when they are encountered. In India due to continued inflation the prices of latest diagnostic modalities are steadily on the rise , hence market remains restricted only to the bigger cities. In general, masses remain deprived of the usefulness of technological advancements. Max Panchsheel has Colour Doppler scan and routine / HF Ultrasound

facility, conventional Radiography, Mammography and Dexa scanning. Apart from this it has state of the art Laboratory facilities for all routine and specialised investigations. The range of cross-sectional investigative modalities at Max Saket are extensive and offers services related to every specialised unit that can be , at a leading Institution.

Specialists should be available round the clock. The patients should be under close observation, preferably as in-patients. Informed consent should be mandatory from the patients undergoing such trials and should be in detail appraised of the consequences.

“a forum needs to be created on the lines of FDA, to approve / disprove B-grade technology infiltrating our markets” Dr Nidhi Bhatnagar Specialist Consultant, MSKUGS, Max Panchsheel

There are lots of cases of Clinical trial, where we call them guinea pigs. What you think about such practices, are they worth doing on human or it is a kind of malpractice? Clinical trials form the basis of the ultimate technically safe treatment , to reduce morbidity and mortality pertaining to diseases which challenge the Medical fraternity. To transform a killer disese into a treatable one takes years of perseverance and cannot be interpreted only by the results of studies conducted on animal models. Human trials are imperative to the growth of medicine but, should have strict codes of conduct. They have to be properly monitored, controlled and have a monitoring committee to regulate such trials . The most challenging issue is to be able to manage and provide appropriate treatment in the event of complications. Very close quality monitoring by

Long back, R&D is mainly done abroad but today India is emerging as new hub for the researches. What is your viewpoint on this? This change is so very welcome. We have the man-power and intellect both, for such ventures. It will keep the resources within the country and strengthen the economy. Our dependency on foreign companies would reduce. We certainly need to strengthen in-house R&D. We need to convince the Government and strong Financial houses of this concept so that Gross under-funding towards this field can be eliminated. Mis-appropriation of funds in bane plaguing research projects strips the country of credibility and results. Pseudo-researches flood medical conferences and clinical trials, there - by mitigating the efforts by honest scientists. Plagiarism has to be kept in check by strong committees from Premier Institutes with heavy penalties.The bottom line is that one cannot keep re-discovering the wheel in the name of originality and claiming it to be in-house R&D.

With emergence of new technologies and equipments, people have started doing test in homes only. How much do you think it is reliable and acceptable? Every in-house investigation kit should be backed by proper information leaflet and perhaps a small word of caution / counseling by the Pharmacist dispensing them. An in-depth training of the Pharmacists, preferably through the companies manufacturing such kits, would lessen the hazards through rampant use of such investigations and patients getting entrapped with the re-

sults they are not equipped to deal with. The up side of this is strengthening a common man’s power to enable him to monitor his illness more closely than offered through the Hospitals. Of course the down side is false negative or positive results which if left unaddressed for too long can result in increased morbidity. Also, the Pharmaceutical companies that are providing such facilities should manufacture these kits for diseases which seriously warrant close patient monitoring eg blood sugar levels, Pregnancy tests, occult blood in stools or urine.

With technologies at its peak, where do you see Medical Diagnostic in India in near future? Companies in the West are looking for lucrative fertile markets and I believe India stands out as the most receptive ground. However, their reality check on India’s payment parity to their expectant pricing of the product is not in complete sync with the current market trends governing medical practice in India. To gain foot hold, International companies are pushing in outdated technology which may have lost their purpose back in the West but may still hold a purpose in technologically parched peripheral regions of India. Outdated technology gets touted as the latest “new” concept and floods the market, further weakening the economy through financial drain. This is the price we are paying for not addressing our own R&D more vigorously. In fact a forum needs to be created on the lines of FDA, to approve / disprove Bgrade technology infiltrating our markets. Each such equipment should be routed through a panel of experts and be assigned a rating on its functionality, applicability to the current medical practice, price structure and comparative analysis with other existing equipment. B-grade technology should not find its way into Indian market. Consumer awareness has also to be addressed on lines of “Date of expiry.”

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Diagnostics

ow do you see the future of Radiology in India? What is so Unique about the Fortis Escorts Radiology Department?

Single centralised reporting system is the only way today by which radiology can function. Because to have superspecialised reporting at different centers, 24/7, all 365 days round the year, is only possible when you have got a centralised system in place. As I don’t think any single smaller center can’t actually afford a Radiologist of a certain caliber all the time. Therefore to run that kind of system you need to have it centralised as we have DICOM images which are transferrable. When I came to Fortis Escorts about three years ago, Teleradiology was the first thing that I actually suggested as I believed that it was the way forward for Fortis. And hence that was what I started doing in 2010, there was PACS (Picture Archiving Communication System) that was in place and I got all working and we started the Teleradiology system. Through PACS the moment the X-ray is done, it comes online in our system, we don’t have to wait for it to be processed and hence it saves a lot of time. The turn-around time is less than 15 minutes or so, the moment its online we can get that reported immediately. We have completely stopped the process of cassette moving, the X-ray being developed then the film being dried and taken to the doctor and even the quality check. Therefore if somebody is sitting in an OPD and he wants to see the X-ray being done in the XRay room, he can see it right-away. This has been our biggest efficiency as it can also be used at the Mobile and various other platforms.

What kind of MRI setup you have in Fortis Escorts? How it is different from some of the other hospitals? As far as MRI is concerned, we have 1.5 tesla MRI fillers, which is consid-

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ered as the best cardiac package, FDA approved one, for various stents and hardware that has been installed in their vessels. We also have the filler system which has the full cardiac package so we can evaluate cardiomyopathy and myocardiac infusion. So possibly we are one of very few centers in India which are capable of evaluating the above mentioned ailments along with other cardiac diseases which nobody else can take a note. For instance there have been patients for whom nobody can say why

there heart is diluting and why they are in this condition. But now when we are able to do the MRI, we actually can see that they have some infection which is actually curable. For instance there has been cases of children of six months age to two years of age having cardiac involvement because of viruses, so we have to treat them within 24 hours and make sure that they are up and running so that they don’t have long term boundation. We have got Emergency MRI in our hospitals, those who have gone to various hospi-

Redefining Healthcare through Teleradiology “When I came to Fortis Escorts about three years ago, Tele-Radiology was the first thing that I actually suggested as I believed that it was the way forward for Fortis. ”Dr Mona Bhatia, HOD, Dept of Radiodiagnosis and Imaging, Fortis Escorts. In conversation with Ankush Kumar, ENN

tals and cities having cardiomyopathy and being directed to our hospital, we take the charge of getting them diagnosed as there is no one who has got the full cardiac package to do this.

A recent survey has revealed that there is a shortage of Radiologists in India. So how is the healthcare industry/ government going to address this issue? Long time ago, UK had done a research as to how many number of ra-

diologists you require per number of patients, as there is a major growth in the number of diagnostics being done. The reason for this is, that the Patients are all the more aware, as to what all is possible and secondly we need a very high precision diagnostic study, high precision diagnostics before somebody goes for treatment. To convey the patient that this is the actual treatment, the curable chances are this much and the cost of the treatment is this much, there has to be a high precision study behind it. Now it

is for the Government authorities to actually evaluate how many Radiologists would they require in a particular state. When I completed my MD, Radiology in 1991 from Delhi we had only 6-8 seats in a state of this volume. The corporates must have vision, to give Teleradiology access in tier-2 and tier-3 cities, which is what we are aiming at. For instance if we can cover the centers online, 24/7, by this way weâ&#x20AC;&#x2122;l be able to cover lot of patients. We shall use Technology to the best of the need of the population.

Can you throw some light on the process and procedures in Radiology, what are the diseases that can be diagnosed through Radiology? Radiology is one central tool under which everything, for instance is diagnosed ie Medical, Surgical, Cardiovascular, Cardiothoracic, Neurosurgeon, Orthopedic, Gynecology, and Obstetrics. Everything comes to the sphere of Radiology, each of these sub-specialties will have trauma, infection, inflammation, oncology, so be it pre-surgical or post surgical, emergency patient or inactive patient, whether its pre, intra or post surgical evaluation. Radiology is one of the central specialties which is important in all clinical fields.

How important will be the role of Radiologist in the coming years? I believe that particularly in the field of cardio vascular disease, the scope of Radiology is still untouched. Because the chance of CT coronary angiography, it aids to evaluate on the coronary disease. Radiologists, Cardiologists and I work together to able to evaluate coronary disease and dig out cases which can be solved with the due action. Also, Radiologists play a big role in rooting and mapping coronary for the Cardiologists. So there is a big role of Radiology played in Cardiology. Technology plays an indispensable role in Teleradiology.

december / 2013 ehealth.eletsonline.com

Cover Story

Diagnostics

Expansion through

Mordenisation â&#x20AC;&#x153;A close interaction between the clinician and the radiologists in planning treatment is becoming vitally important to ensure the most optimum utilisation of resources keeping economies in mindâ&#x20AC;?. Says Rakesh Kumar Mathur, Chairman-Radiology & Imaging Radiology, Saket City Hospital. In conversation with Ankush Kumar, ENN

eing the newest hospital in the Indian healthcare ecosystem. What kind of latest machines have been installed at your Radiology and Imaging Department?

Saket City Hospital has a Radiology and Imaging Center which is equipped with ultra-modern technology and delivers exceptional quality images of all parts of the body. The unit is endowed with first of its kind machines like wide bore 3 Tesla MRI scanner providing a wide range of diagnostic options in a patient friendly setting. The 256 slice per second CT scanner (iCT Philips) which forms the mainstay for high quality body imaging, including Angiographies of all

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Diagnostics

parts of the body especially state of art CT coronary angiography (CTA). This is now a well-established screening procedure for a segment of population at high risk of coronary artery disease (CAD) at one-fourth the radiation dose as compared to other scanners. Other services include digital X-ray, 3D, 4D Ultrasound, Color Doppler, Mammography and Dexa for bone densitometry. A highly qualified and experienced team of radiologists are available 24x7 to support these services.

Where do you think the Indian Imaging and Diagnostics market stand as compared to Global standard? The Imaging & Diagnostics segment in India generated revenues of USD 645.1 million in 2012. It is projected to reach USD 1000 million by 2018. This compares to worldwide radiology imaging market size of USD 25.43 billion in 2012 which is expected to reach USD 39 billion by 2018. Indiaâ&#x20AC;&#x2122;s growth of this market is projected

the radiologist plays a central role in patient care & diagnosis. Practically no patient treatment plan can be complete without some aspect of radiology coming into play. This is amply clear when one sees the interest the specialty of radiology is drawing from the young doctors seeking to enter the profession. The radiologist plays an important role in ensuring that medical resources are utilised appropriately and efficiently. A close interaction between the clinician and the radiologists in planning treatment is becoming vitally important to ensure the most optimum utilisation of resources keeping economies in mind. While the primary care physician may be the patientâ&#x20AC;&#x2122;s first point of contact, the radiologist is now involved in more ways then one as a link in the health care delivery process by advising the physician the best course of action. It is not uncommon for radiology to reveal completely unsuspected disease entities there by completely altering the course of management.

Current MRI scanners can provide 3D images to the surgeon helping plan the approach to complex tumor surgeries especially in the brain to be at 8 percent per annum for the same period which is almost twice the annual growth rate of 4.2 percent in 2012. The increasing growth rate in India can be attributed to the awareness of radiology services playing an integral part in the health care delivery process.

What is the role of radiology in diagnostics? Over the last decades there have been radical changes in the field of medicine, largely driven by technology. The healthcare delivery process has undergone a change with radiology taking center stage. Accordingly

december / 2013 ehealth.eletsonline.com

How important is the role of imaging in planning treatment both for surgery and radiation? Ultrasound, CT and MRI play a vital role in providing the surgeon information prior to any operative procedure. With the availability of these imaging modalities, the surprise element is completely eliminated. It also helps the surgeon in planning the surgery. The impact is seen directly on the time taken for the surgical procedure thereby reducing morbidity and time spent in the hospital. Current MRI scanners can provide 3D images to the surgeon helping plan the approach to complex tumor surgeries especially in the

brain. With the quality of CT Coronary Angiography under going constant refinement it is a very good procedure for guiding the interventional cardiologist and cardiac surgeon about the extent of disease in the arteries. The planning of revascularisation procedures becomes much simpler. The role of imaging does not end at making a diagnosis. Imaging is also widely used for functional study of different organs with PET-CT. Radiation planning software is now an integral part of CT and MRI scanners helping plan accurate delivery of radiation dose. CT and MRI are also routinely used for monitoring of response to treatment by chemotherapy and radiation therapy at appropriate intervals.

What has been the role of Technology in diagnostics? The primary role of new technology is to improve quality of patient care. Over the past 20 years, there has been rapid growth in the use of innovative diagnostic technologies, such as digital radiography, 3D & 4D ultrasound, MDCT, and high field strength MRI. Information technology including data manipulation storage and transfer between different teams of care givers has improved the speed and efficiency in the decision making process. Instant availability of data and images at multiple stations through out the health care facility eliminates the need for paper and hard copy transfer of information. Patient safety is an important aspect driven by technology especially new systems which are designed to achieve the same or better results at lower radiation doses. There is now a shift towards molecular imaging which goes beyond morphology and addresses function. It is likely that in the foreseeable future the pace of innovation in diagnostic imaging will continue to accelerate to meet the increasing demands of the medical fraternity. The equipment will become smarter, faster and more patient-friendly.

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Diagnosis-

Mainstay for any Treatment Dr Manisha Shree, Senior Consultant Radiologist, Paras Hospital, Gurgaon, believes that diagnosis is the mainstay for the treatment of major deadly diseases. In an interaction with Ekta Srivastava, ENN

december / 2013 ehealth.eletsonline.com

ow does the introduction of the newer technologies change the face of Radiology?

Do you think that every hospital should have their own diagnostic centers?

Radiology has come in a very big way in the last 10-15 years. With the advent of computers and the sophisticated electronic mediums now the diagnosis has become the click away facility. Initially if you have brain hemorrhage then you can just presume it by watching the symptoms and signs of the patient but today you just get an MRI and thatâ&#x20AC;&#x2122;s how the patients are improving because you are treating them with exact pathology. So it has tremendously changed. We have amalgamated the imaging and the computerize version in a way that now we can sit anywhere and advice accordingly. With these PACS system, today we can give the diagnosis in depth over the phone itself.

Yes, it should be mandatory. In case of a critical patient or in an emergency patient, the diagnosis is extremely important. In extreme trauma cases, diagnosis plays a very major role and you cannot wait for the reports from the other centers to reach you. So, availability like basic radiology should be there. Now even the causality medical officers are being trained in the basic radiological modalities like ultrasound and same training is given to the emergency department also. Now, its like other field are more dependent on radiology then radiology being penetrating in the other fields.

Today Radiologist also starts working as a clinician. What is your intake on this? Hospital is always a team work. Today radiologists have to update themselves with emerging technologies. This is the one aspect where radiologist needs to work up, radiologists are always the part of the diagnostic team but their involvement now more because of the expansion of the modalities and a number of things that you can do now, which you cannot do initially and then there is a branch called Interventional radiology where radiologists are working as the clinicians also.

Where does India stands in global standards in terms of using the recent technologies? Well, at par with rest of the world, these facilities are limited to the bigger cities; still people from the smaller cities have to travel in the big cities to avail these facilities. While in the west they got all the facilities in the peripheries so thatâ&#x20AC;&#x2122;s the difference. Nevertheless, this is a different story but in the quality level what is happening there we have here.

Patients using medical devices which can be used at home, what do you think about this? Any decision should not be taken up on the part of the patient it should be un-

an antipyretic and lower down your fever but nothing beyond that. People are just pepping up pills like pain killers and lots of things without knowing how it is harming them or how it can harm them in the long run. So, I am not in much favor of uploading the symptoms and treating yourself. In fact what I am more in favor of how like NHS and all work in England, there are more of family clinics coming up ,that is also how the government can as well help you, so rather then everybody rushing in the bigger hospital to get the care , they can access them in the smaller areas as well.

What according to you are the pros and cons in the Healthcare sector? I think websites that are asking to upload the symptoms and prescriptions and then helping you out with the treatment and people taking advantage of this, it should not be done to the radi-

The number of the Radiologist that comes out every year and the requirement ratio that we need has a big disparity der the medical supervision of the medical person. It has both pros and cons, it cannot be like that I can check my sugar level and treat myself, it is wrong. But if the doctor advises you like ok this is the time when you have to check your sugar level, this is the time after your medicine and if there is any kind of disparity then doctors should be informed, patients are not the one to take the decision.

Websites coming up, where you have to upload your prescription and get the medicine or treatment being done, Are you in favor of such things? Doctors, they are not in favor of this. Like you have fever, and you cannot drive down to the doctor then you take

ology. Today as the technology being used as the prime focus, I think they are like the technologies but they have to learn the technologies. Numbers of people who are trained in those kinds of technologies are less there are not too many to work in those places and there is disparity between the number of trained people to work on such things and number of patients. The ratio is not very ideal in the country. The number of the Radiologist that comes out every year as this is a specialized branch and the requirement ratio that we need has a big disparity. But we can take advantage of the Tele-radiology, a lot of work from the periphery or the remote areas can be done or reported can be advised through the bigger centers.

december / 2013 ehealth.eletsonline.com

Cover Story

Diagnostics

Shifting Gears From Radiology to Pathology â&#x20AC;&#x153;Till now we were only concentrating on Radiology and Imaging but there have been lots of demand for Pathology services from patients who come to us.â&#x20AC;? Says Dr Harsh Mahajan, Founder, Mahajan Imaging Centre, New Delhi and Former President, Indian Radiological and Imaging Association (IRIA). In conversation with Ankush Kumar, ENN

lease tell us about your journey in the Healthcare Industry? I did my MBBS from Maulana Azad Medical College and secured first position in Radiology. After passing out from PGIMER, Chandigarh, I worked as a senior resident in AIIMS. That was the time when old scenarios were changing, and radiology techniques such as ultrasound and CT were emerging. In 1987, I was awarded a Rotary Foundation International Scholarship and went to M.D Anderson Cancer Hospital at Houston, Texas, USA for a super specialist fellowship in Magnetic Resonance Imaging. MRI was at that time very new, even in the US. I did primary research in cancer imaging using MRI and joined as a faculty of this hospital. After one year, despite a lot of allurements to stay back i decided to come back to India with a dream of bringing the latest technology in India. Gradually in partnership i opened a centre at Green Park with first ever 1.5 Tesla MRI machine by GE. Unfortunately, our partner expired in 1998 and then we stood alone in the market, we

December / 2013 ehealth.eletsonline.com

worked harder and opened around seven new centers. We also started nuclear medicine and Bone Densitometry Centre at Sir Ganga Ram Hospital, New Delhi. In July 2001, we started another MRI centre in Dehradun. In keeping with the same vision we got into a public private partnership with the Uttarakhand Government to run the MRI centre at Doon Hospital, Dehradun which is the largest government hospital in Uttarakhand.

What are your expansion and modernisation plans in India? Do you see any major roadblock in the Healthcare industry? We currently oprate eight centers, six of them in Delhi and two in Uttarakhand, and Dehradun. We plan to expand in North India and we will do that in the next 5-8 years. We are looking to increase the total tally of centers to 28 in the next five years. Moreover in our expansion plans we are genuinely focusing on the training and development of the new Radiologists that are coming up. We also want to delve into the research which is at the nascent stage in the country. We have tie-up for reserch with MIT Boston for the last six years, IIT Delhi, AIIMS but we want to do it in more formal and proper manner. If you look at the medical industry the payback takes a long time, for many of us its labor of love because we want to be doctors thatâ&#x20AC;&#x2122;s why we are in this profession. The corporate may have a different ideology or different take whereas for us profit making is not the only motive behind this business.

Radiology has evolved rapidly in the past couple of years. What are some of the key focused areas within Radiology and what will be the future trend? In the last few years there had been lots of focus on Molecular Imaging

I feel that Molecular Imaging from Radiology at Nuclear Medicine side and In-Vetro Molecular Diagnostics from Pathology at Genomic side are going to merge and become a very powerful tool for prevention of diseases and Molecular Diagnostics. This is where we have taken the lead; first with the Gama camera and then by establishing the nuclear medicine centers in 2000. And in 2007 we were among the first to set up a PET CT center in Gangaram Hospital. So basically I feel that Molecular Imaging from the Radiology at Nuclear Medicine side and In-Vetro Molecular Diagnostics from the Pathology at Genomic side are going to meet and become a very powerful tool for prevention of diseases. This will be helpful in finding out who is at more risk, specially heart disease, cancer and then also help in sub typing of cancer, spread of cancer.

You have recently announced to start a new center in Delhi. What is so unique about this center? This center is at a very prominent location at Ring road and Defence colony which is easily approachable from all places of Delhi and NCR. This center has everything under one roof; we have 3Tesla MRI white-bore open system and also a silent system. We have a high end CT scanner which will do all kinds of CT examinations including CT Coronary Angiography.

Then we have a 4D high end ultrasound system, there is a CT scan for Dental and Maxillofacial application which is called the CBCT, we have the highest level dual energy X-Ray where it takes X-Ray imaging to a very-very low radiation doze with much higher levels of resolutions, very expensive machines but itâ&#x20AC;&#x2122;s the best. There is bone densitometry the Dexa-scan, then there is the highest end full field mammography which is a fifty micron system (it can go down to fifty micron radiation at very low radiation doze). Moreover for the first time we have the non-invasive cardiac lab where the highest end echo machine available in the world is installed (we will do Echo, Stress Echo, TMT, Holter ECG as well as the high end pulmonary test).

Are there any other services that you are planning to provide at this center? We are going to tie up with one of the Pathology players to provide Pathology facilities, blood testing facilities, all under one roof. Till now we were only concentrating on Radiology and Imaging but there have been lot of demand for Pathology services from patients who come to us, from friends and Physicians who say that you must have Pathology. There are 5-7 large Pathology players in the market that we have identified and we will tie with one of them. With opening up of this center, for the first time we plan to do health checks, that was a need which we have not addressed before. Earliar we were very focused on disease but with the kind of facilities that we have here we are going to start health checkup as well. We will not only start just the basic health checks that we wanted to do but will take it to the next level whether itâ&#x20AC;&#x2122;s Genomics or CT angiography. So there will be different Health packages right from the basics to the top.

December / 2013 ehealth.eletsonline.com

Cover Story

Diagnostics

Punit Kohli, Business Director, BD DiagnosticsBD Diagnostic Systems in India, is a heathcare veteran with infection prevention portfolio. In conversation with Shahid Akhter, ENN, he shares his experience in automated blood culturing and diagnostic solutions that help in better patient management

Changing Clinical Practice and Improving Patient Care T

echnological advances have given rise to innumerable diagnostic tools. Please tell us about BDâ&#x20AC;&#x2122;s role in diagnostics?

With the growing incidence of drug resistance, infectious diseases are estimated to be the biggest contributors to the mortality amongst children and young adults. To provide successful treatment, the physicians are looking for diagnostic tools which have quick turnaround time, minimal manual errors and improved recovery rates. Becton, Dickinson (BD), a leading global medical technology company is a pioneer in automated diagnostic solutions and has a history of providing innovative solutions for the better and faster diagnosis and treatment of infectious diseases. The BD BACTEC

december / 2013 ehealth.eletsonline.com

Systems and Phoenix systems are world-class technologies available in Indian laboratories which are meticulously used to support critical diagnostic requirement of the physicians. BD has pioneered development and commercialization of the BD MGIT Liquid Culture Systems, which support end to end effective TB diagnosis, drug susceptibility testing and facilitate treatment follow up support. Liquid Culture Automation has now become a gold standard of TB diagnosis, from sampling, culture to drug susceptibility tests.These systems have turned around conventional way of diagnosis of disease and have sufficiently supported superior patient outcomes through channelizing correct data analytics.

Detecting bloodstream infections is an ongoing challenge for healthcare professionals and hospitals despite improvements in testing methods and best practices. Any significant contribution from BD? Given the prevalence of excessive use of antibiotics in India, most of the patients are already on antibiotics before they show up in a laboratory. This makes detecting bloodstream infections extremely challenging as these antibiotics tend to inhibit true positives or cause delayed diagnosis. This untimely misidentification of the root cause leads to high mortality rates associated with Sepsis. BD has pioneered the use of â&#x20AC;&#x2DC;RESIN TECHNOLOGYâ&#x20AC;&#x2122; and has made significant contributions in

overcoming these challenges in Sepsis management. BD BACTEC system supported by the Resin media enable labs to report out correct results by statistically significantly increasing recovery of pathogen and minimizing turnaround time. In addition to providing world class systems, BD also partners with hospitals and labs in promoting best practices in blood collection for improved treatment outcomes. BD actively engages with microbiologists and clinicians, through workshops and round table meetings, that offer opportunities for these professionals to deliberate on the challenges in correct diagnosis and treatment of infectious diseases.

Tuberculosis is India’s major concern. Its diagnosis and identification of clinically appropriate treatment regimens is essential to effectively treat patients, prevent spread of the disease. BD’s breakthrough in this field? Diagnosis and treatment of TB has become much more challenging today, since the discovery of the resistant forms of the disease - MDR TB and then the more deadly form XDR TB. BD has been making a powerful impact on TB through the introduction of BD BACTEC MGIT Systems, which utilize liquid culture technology. In fact Jasmine Jani, Application Manager at BD Diagnostic Systems was invited to present a paper on rapid drug susceptibility testing of M TB using the MGIT 960 system at the recently held Union meeting in Paris. Liquid culture is faster, more accurate and more comprehensive than conventional solid media or sputa smear approaches. It is particularly valuable in its ability not only to detect MDR/XDR-TB but also in determining which drugs can be used to treat the patient. It is also more effective than conventional approaches in diagnosing TB in patients co-infected with TB

and HIV. WHO in 2007 endorsed liquid culture as a “standard of care” for TB diagnosis and patient management.

Diagnosing and managing sepsis early is very crucial. How diagnostics impact and improve the patient’s outcomes and reducing healthcare system costs? Sepsis is a disease continuum and quickly progresses from SIRS (Systemic Inflammatory Response Syndrome) to Shock causing high mortality and morbidity in healthcare settings. A positive blood culture is crucial and has diagnostic and prognostic relevance. At present, with the current practice most of the patients who are suspected of sepsis are put on empirical treatment wherein the clinicians use

With various technologies available to healthcare settings, it is of utmost importance to meticulously analyze the appropriateness of the system on various parameters before choosing the right solution fit. These parameters would ideally include performance of systems on two major fronts – Time to report and Recovery of various pathogens under challenge conditions such as high concentration of antibiotics in samples. BD BACTEC™ systems are proven over the years to support the most superior antibiotic neutralizing devices called BD Resins, which are capable of neutralizing the strongest of antibiotics at trough, mid or peak level of antibiotics. These systems have far superior performance than other com-

‘We have turned around conventional way of diagnosis of disease and have supported superior patient outcomes through channelizing correct data analytics’ their best judgment and put the patients on antimicrobial treatment. Often broad spectrum antibiotics impose the risk of selecting the resistant strains that may multiply and become problem in treatment. An automated blood culture with capability of recovering organisms in the presence of any level of drugs, plus good clinical sampling practices would be able to achieve true benefit of diagnostic support to patient management. The leadership team at BD Diagnostics (Amit Bhatnagar, Shveta Sharma amongst many) has been involved in shaping educational workshops and programs to ensure the critical care.

What are the benefits of using sensitive and rapid time-to-detect blood culture systems to enable earlier diagnosis of sepsis?

mercially available systems which are easily compromised in recovery rates at mid/peak antibiotic levels. In terms of time to detection, the BD BACTEC system is proven to offer the highest percentage recovery in the first 24 hours as compared to other automated blood culture systems available. BD BACTEC system is capable of recovering 25 percent more positives in day 1 than other automated blood culture systems. This is of great help to clinicians in diagnosis sepsis faster with shortest time to detect positive blood cultures. BD BACTEC FX series of instruments are the only class of instruments supporting Blood Volume Monitoring Capabilities for samples which effectively support surveillance of cultures and highlight timely interventions as required.

december / 2013 ehealth.eletsonline.com

Cover Story

Diagnostics

Quality Plastics for

Precision Diagnostics At times when the same sample is processed by the same instrument there are two different readings or results, at times your plastic consumable may be the cause of the trouble

lastic is a common material used in consumer products, food packaging, and laboratory research. While plastic offer convenience to customers at the same time there are serious risk to human health and environment from its widespread use. Three common and mostly used plastic in domestic purpose have been shown to leach toxic chemicals when heated, worn or put under pressure these include Polycarbonate which leaches bisphenol A (BPA), Polystyrene which leaches styrene, PVC which breaks down into vinyl chloride sometimes leaches phthalates. This leach out implicated in several human health disorders such as reduced fertility & reproductive tract abnormalities, hormonal, brain & behaviour problems, impaired immune functions and various forms of cancer. According to estimates, minimum of 8 billion pounds of BPA are used by manufacturers yearly, this is important information relevant for the laboratory. This is so because, if household plastics could cause damaging effect to us, the plastics that we use in the lab may also do the same to the bioassays.

Chemicals in Plastic The significance of using high quality consumables in biological research is felt by the scientific community than ever before. This change is due to the growing concerns and increasing numbers of authenticated findings published about the consumables spoiling experimental results. Not all consumables are equally created.

December / 2013 ehealth.eletsonline.com

P Babu, National Manager â&#x20AC;&#x201C;

Consumable, Eppendorf India Limited

An insight in to how the manufacturing process of the lab plastic wares can give a better idea on what can affect assay results. Though the tips and tubes are made of polypropylene, the manufacturers add different chemicals during the manufacturing process to achieve desired outcomes, some are unavoidable for production others are avoidable and have been shown to influence assays, thus are critical. Any of these classes of compounds can potentially leach into liquids that come into contact with plastic surface. Especially while working with organic solvents, temperature and time dependant incubation steps, the leachable interact with the biological samples and affect assay results.

Advantage of Accuracy To improve experiments and to get confident on the accuracy of results, one must consider three factors, these

include product specification for consumables, secondly production process should be considered as a certificate from manufactures, there should be no use of plasticisers (softeners) and biocides, all dyes should be free from organic substances and heavy metals. The consumables should ideally be manufactured from virgin plastics and an automated manufacturing under clean-room conditions for most products to eliminate human interaction as source for contamination and ensure highest quality of consumables for diagnostic labs. Lastly, quality control is of utmost importance as critical purity levels of consumables in diagnostic sector. Many consumables can be sterilized by autoclaving, but molecules such as DNA, RNases and endotoxins are very stable and difficult to remove entirely or inactive by this method. Hence, the choosing a consumable which is ready should be free from pyrogen, endotoxins, Human DNA , Bacterial DNA (E. coli), RNase, PCR inhibitor, DNase, ATP and more. We have to understand that not all consumables used in diagnostic labs are created equal. Besides the obvious product features, there are huge differences in quality and purity. Chemicals that some manufacturers use during production can negatively affect the assay. The outcome of assays can strongly depend on the specific consumable used during the experiment. Next time when you experience some errors in your measurements make sure you check the consumables used.

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Diagnostics

Offering Integrated

Diagnostic Services â&#x20AC;&#x153;At present we have an enviable network of around 250 labs and around 4500 collection points. Our focus is to optimally utilise the vast capacities that we have built and consolidated the businessâ&#x20AC;?. Sanjeev Vashishta, CEO, SRL Limited. In conversation with Ankush Kumar, ENN

hat is the size of the Diagnostic Industry in India?

Almost 90 percent of the Diagnostic market is fragmented which comes in the unorganised sector and only about 10-11 percent is in the organised sector. Now out of this 10-11 percent there are certain players who are running like corporates. Majority in the organised sector is family driven business. If you talk about SRL, itâ&#x20AC;&#x2122;s in the organised sector and a professionally managed company. The estimate for the diagnostic industry ranges between USD 2.5 billion to USD 5 billion. However, we believe the size of the Indian diagnostic industry is close to USD 5 billion. One thing is certain that in the next ten years the growth is going to be phenomenal and the estimate by 2022 the size of the industry would be upwards of 30 million dollars.

Please tell us about the state-ofthe- art facility that you have at your center. We offer more than 95 technologies spanning over screening, diagnostic, monitoring and prognostic spectra of lab medicine. Our imaging technologies like the PET scan, MRI (3Tesla), CT (500 slice) are far superior and produce highly defined results. Sanjeev Vashishta

CEO, SRL Limited

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Diagnostics

Similarly, employing state-of-art techniques in pathology has earned us the recognition of GoI’s Department of Scientific and Industrial Research. Today we are the only one in the country to offer complete diagnostic services - Pathology, Radiology, Wellness, Occupational Health and Clinical trials. We have 4 Centers of Excellence (COE) in Histopathology, Molecular Biology & Genomics, Cytogenetic and Haematology that are headed by renowned specialists in the respective sub-specialty. The COE provide technological and professional leadership in the organisation and act as the nerve centers for advancements in these areas. They are fully equipped to carry out the latest and the best available tests in Hematology, Blood Coagulation, Flow Cytometry, Anatomic Pathology, Cytology, Immunohistochemistry, Microbiology, Serology, Oncology, Molecular Pathology and Cytogenetics.

What kind of Training and Development programs you are offering? There is too much of gap between the demand and supply in Indian Healthcare system. We have got worlds 17 percent population and the disease burden is 20 percent, now to cater to this disease burden we have 6 percent beds in India, just 8 percent of the world population of doctors in India and only one percent of lab technicians. Therefore it’s high time we should start educating and training people. At SRL we have a strong focus on training. Some of the training initiatives are Periodic training programs and Refresher courses for scientific and technical staff; HR Induction program- Organisation’s Vision, Values and Processes; Basic Orientation program-Technical Knowledge & Selling Skills; Specialised Program-High end Test Knowledge; Managerial effectiveness program-Self Awareness; Managing team, Sales Management, Persuasion & Influencing, Communi-

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cation; High Potential Program based on Competency framework-Helps in Succession Planning & Talent Management; CARE-(Customer, Attract, Retain & Engage)-Business Process development (Phlebotomist & Customer Care Executive); Trainer’s Training Program for Doctors & Product Management Team; Web Based Learning and Assessment.

How much market share you have in the Diagnostic industry in India? What are your expansion and modernisation plans? SRL has more than 40 percent share of the organised diagnostic market in India. Over the past years, we have expanded to every nook and corner of the country. At present we have an enviable network of around 250 labs and around

a patient is suffering from a chronic disease ie Cardiac Ailment, Thyroid or Diabetes then it needs to monitor on regular basis. The idea of investing in R&D is that these tests give the accurate results and through these R&D we try to reduce the cost of the test as in India people are very price conscious. We are also working very closely with institutions like Mayo Clinic. The reason why these clinics work with us is because we have that kind of expertise to churn out tests which are cheaper. Through us they also get the opportunity to penetrate in the newer markets.

Tell us about your presence in the international market? Today we have approximately 50 odd collection points outside India.

We are getting tests regularly from South Africa, Middle East, CIS countries and from the Far East 4500 collection points. Right now our focus is to optimally utilise the vast capacities that we have built and consolidate the business. We are selectively looking to enter international markets through strategic partnerships. Our expansion in the near foreseeable future will be more opportunistic. SRL has been at the fore front of championing the latest cutting edge technologies in diagnostics in the country. Our R&D wing continuously evaluates and validates new technologies as and when they are introduced.

Please tell us about your R&D setup in the country? The main purpose of R&D and coming out with new things is to give accurate results. You need to have an accurate test which gives you the right results. This will also help in Diagnosis, Prognosis and monitoring of disease. So if

We are getting tests regularly from South Africa, Middle East, CIS countries and from the Far East. We do get samples from other countries but by in large we get samples from these parts of the world. We are dealing with the best companies in the world today and the reason why we are able to get so many samples from abroad is because we are cost competitive and are giving the same technology, same expertise as available in the western countries. Earlier most of the stuff which was practiced was manned but now the technology has shifted to more of automation and the benefit of automation is that it gives you more accurate results, it can handle large volumes and the turnaround time is generally good. Moreover we are among few companies which is in a very big way into Molecular diagnostics.

Cover Story

Diagnostics

Shift from Preventive

to Predictive Diagnostics P

lease share your growth story in India industry?

We started as an ultrasound clinic to cater to the radiology imaging needs of South Mumbai in early 1980s, and have since then expanded our presence to offer the best of technology in radiology and pathology in various parts of the city. We had a vision to enter into preventive healthcare diagnostics and so we pioneered medical check-up plans in South Mumbai much before others entered this field, and had good success both at a retail and corporate. Today contrary to a lab set-up expansion model, each of our labs offer end-to-end radiology and pathology including CT Scan and MRI in most of our centres– and so each centre has an investment of close to 25 crore with state-of-the art imaging equipments. Today, we also have presence in Bangalore and Pune and are limited in physical expansion plans. Going forward Colour Doppler and ultrasound is an exciting technology to deploy in the diagnostic industry and offers an exciting proposition for a city like Mumbai. However, the diagnostic industry is becoming highly competitive and we have to have some differentiating factor to offer an edge all the time.

Tell us more about the partnership model with Sancheti Hospital in Pune? This is a unique partnership for us where the hospital has outsourced its entire diagnostics department to us and we manage their lab and radiology. So we have a 3T MRI, CT Scan, Ultrasound, Colour Doppler and 2D Echo. It is a revenue share model that offers a win-win situation to us as well as the hospital – the hospital saves on heavy

Rahil Shah

CEO, NM Medical

“We are bullish on the hospital outsourcing opportunity and have 7-8 hospitals in pipeline within Mumbai” investment in diagnostics and instead invests more in surgical, in addition as we bring-in customers from outside the hospital ecosystem it also brings a new channel of patients for us as well as the hospital. And our doctors get the advantage to work with the best radiologist in the city and learn from them on a case to case basis.

Please share the trends in disease diagnostics in India? In India cancer and cardiac dominate the diagnostic volumes and now we are seeing a surge in Vitamin testing and allergy diagnostics especially the younger population. I look forward to an upward trend in the cardiac CT and CT angiography as cardiac attack episodes have become more common now than before. With available of low dose high quality CT scan, one must popularize this among 45 years and above age population. Cancer diagnostics has also seen a growth trends, however the

industry is waiting for an evolution of molecular markers that go to predictive than preventive that is molecular genetic markers. However this is high cost challenge and we are waiting for the cost and affordability.

Please share your growth strategy going forward? I believe that healthcare is a regional business and not a national one, and so while we continue to look for opportunities in western India that includes Maharashtra and Gujarat. While we continue to look forward to grow with standard centre set up across Mumbai and new cities that includes a full-fledged imaging and lab set up in addition to lab only centers. We are also bullish on the hospital outsourcing opportunity and have 7-8 hospitals in pipeline within Mumbai. It is an upcoming growth model and the industry will see more of diagnostic outsourcing from hospitals in the coming times.

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Cover Story

Diagnostics

Lab Automation Accelerates Quality Control T

ell us about the growth trends for the Abbott Diagnostics division in India?

In India we are leaders in immunology, clinical chemistry and haematology. On offer is a comprehensive suite of solutions necessary to meet the testing needs of large and complex health systems. Our products focus on providing innovative technologies and solutions that provide critical information needed to help doctors make better and faster decisions about patient treatment & monitoring and improve disease management. Our new launch includes assays such as High Sensitive Troponin and Epstein Barr Virus. New products also include CELL-DYN Ruby, Emerald for haematology and the Vitamin D test for the ARCHITECT platform. Many laboratories perform Vitamin D tests on the ARCHITECT platform because of the excellent result quality. Since its launch Vitamin D test has seen rapid adaptation and growth.

What are the key modernization indicators and technology investments that are giving a labs and clinics today a competitive edge today? Laboratories today have evolved in the last decade. Semi-automated instruments have been replaced by full automation. Manual sample registrations have made way for barcode registration. Results which used to take more than two to three days can now be gathered in a minutes, which allows physicians to have the important information needed for patient care. Today, laboratory focus is on providing quality results to the patient; due to this, many labs have registered for

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etration of insurance, Rupee depreciation and low priced reagent sales.

What are the key medical segments that are contributing to the growth story of the diagnostic industry in India?

Rajesh Pandya

Country Manager, Abbott Diagnostics, India

accreditation with NABL [National Accreditation Board of Laboratories] or with CAP [College of American Pathologists] which are considered quality standards. The key modernization factors include a shift from contemporary technology to CLIA [Chemi Luminescence Immuno Assays] based technology; consolidation of clinical chemistry and immunochemistry platforms; and less turnaround time.

As an industry expert tell us your views on the growth segments for the diagnostic industry in India? Immunology has led the value growth in the diagnostics industry, while clinical chemistry has shown volume growth. Specialized assays like Vitamin D, Vitamin B12, Metabolic, Oncology, Cardiac, Hepatitis and HIV diagnostics are also seeing rapid growth. However, an impediment of ideal growth for the industry has been high fragmentation, prevalence of laboratories without accreditation, quality control, low pen-

The in vitro diagnostics market in India has gathered momentum and has been experiencing tremendous growth in the last few years. The market will exhibit steady growth in the future considering high patient population growth; an increasing number of hospitals and diagnostic labs; innovation by pharmaceutical companies; chronic diseases; a demand for cost effective, faster and sensitive results; increased affluence of patients; and increased healthcare awareness. We have seen growth in thyroid, fertility, hormones, tumour and metabolic markers to name a few. While thyroid, fertility and hormone testing have become a routine investigation; we have observed high volume growth and value growth in metabolic, oncology and cardiac markers. The new assays are significant contributors in Immunoassay growth.

Tell us more on the latest trends in laboratory automation systems in India, and what will be the benefits for the clinics? Lab automation is moving toward total lab automation from pre-analytics to post-analytics. The benefit for the clinics is fast turnaround time and less human intervention, which helps labs in meeting total quality management and overall process improvement. We focuss on offering new IT technology for laboratories in order to reduce the complexities involved in workflow processes.

zoom in

Nitrile glove for infection protection The skin on a laboratory professional’s hand is the first defense against possible infection from a diagnostic specimen & assays. Any cuts or lesions of the skin are possible sources of entry for bacteria and viruses. Best and well protected way to protect hand skin is wearing a nitrile glove while in action

here is no room for contaminants when it comes to the diagnostic industry and for conventional reasons; the use of latex gloves is highly popular in this particular field. The rubber material used for latex exam gloves is considered as an allergen meaning that it can lead to allergies if worn by people with sensitive skin. Due to the allergen element of latex gloves, the demand was shifted to gloves that were fabricated from materials like neoprene and nitrile as these were synthetic and latex-free. Nitrile exam gloves have become the popular synthetic alternative to natural rubber latex, minimizing the risk of contact dermatitis caused by an allergic reaction to natural rubber proteins. Nitrile is a unique type of polymer that provides superior chemical and tear resistance. Medical grade cornstarch powder is used as a donning agent in latex gloves.

This is not used in nitrile gloves as they are poly-acrylate coated from inner side to facilitate easy & smooth donning. This means with nitrile gloves you’re also eliminating the powder which is a well proven carrier of latex allergens and assays. Being a powder latex free and powder free glove, nitrile ensures that specimens are not contaminated and assays are not inhaled.Latex is strong but nitrile is stronger and more tear resistant when formed into gloves. They are also generally favored because of the latter’s susceptibility to small pinprick holes that are not easily seen by the naked eye. Nitrile protects against contaminants like blood-transfused pathogens and so on. When it comes to nitrile, this is also highly resistant against petroleum based solvents and the like. Not only does nitrile protect you when it comes to pathogens but it

also gives you better grip and resists electric charges at the same time. Nitrile forms a skin-tight barrier that is naturally activated by the heat from the hands wearing it. The fit becomes more exact the longer you have the gloves on. For various diagnostic laboratory tasks, dexterity is tremendously important and this is why the synthetic material is best utilized in laboratory or clinical settings. Ansell a global leader in barrier Protection has devised a product – MICRO-TOUCH Nitrile which meets the barrier protection demands of diagnostic professionals optimally. The thermo-elastic material assures even more comfort. An inner polymer coating facilitates donning, while the lack of powder considerably reduces the risk of skin abrasion – thus giving latex-like comfort and safe handling advantage. To know more about the product please visit http://www.ansell.com/

December / 2013 ehealth.eletsonline.com

Tech Trends

Refurbished

Markets-On the Rise State of the art equipments are a key differentiator for any practicing radiologist to cut away competition. To override the price hurdle of buying new technology, many are investing in refurbished equipments for their hospitals, clinics and imaging centers. Rachita Jha, ENN explores more

iagnostic and Imaging facilities have direct co-relation with growth in number of hospitals and clinics in any region. The healthcare industry is now growing in its smaller cities and towns with new hospitals and clinics mushrooming across India. With this rise in number of patients, the need for low cost yet advanced imaging equipments has come into the market - and arrival of refurbished goods has become stronger now than before.

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Demand driven The concept of buying top branded medical equipments at an affordable price is the basis for refurbished medical equipment market in India. A very large number of people still cannot afford to have the latest medical facilities due to its high cost of equipments and refurbished medical equipment solves this problem to a large extend. â&#x20AC;&#x153;Diagnostic imaging market in India is approximately $ 600 million with annual growth rate of almost 15 percent. The Refurbished

imaging market is close to 30 percent of total radiology imaging industry with an annual growth rate of 20 percent,â&#x20AC;? says Himanshu Bhatt, Director, KS Biomed Healthcare. Overall growth of imaging industry has been very fast mainly due to expansion plans of public as well as private sector hospitals and diagnostic centers. Also excellent plans of Indian government to facilitate their hospitals with high-tech modern diagnostic facilities are resulting in such a promising future of radiology imaging industry.

Growth segments The growth for the refurbished market has been primarily due to growing demands for advanced Computed tomography (CT) technology that has expanding its footprint in smaller cities and towns hospitals, clinics and diagnostic centres. Elaborating on the other growth segments, Som Panicker, VP, Sanrad Medical Systems says, “Practically there is a scope for refurbished imaging equipments in all areas of modality like ultrasound, X-ray , CT and MRI. But if you analyze very closely there are some challenges too in each area. Ultrasound the technology is growing very fast and cost is coming down and relative equipment life time is lowest out of all this imaging modalities. So buying a refurbished ultrasound is easier but maintaining for long duration is not practically possible. Ultrasound systems are becoming like more and more portable and the scope of refurbished ultrasound market is limited compared to high value equipments like CT or MRI.” This is also reflective of the geography of tier II and tier III cities that are driving the demand for these equipments is low compared to CT technology. The trends surely indicate that there are many advantages of buying a refurbished goods however one has to be cautious on the vendor and be sure of his commitment to service and support when in need.

Trust and Accountability The limitation of cost and urgency of equipment procurement has given way to some mal-practices that have cast a shadow on the confidence of doctors to invest in refurbished goods lately. Sharing his views, Dr Bhupendra Ahuja, organizing chairman, Indian Radiology & Imaging Association of India (IRAI) Annual conference 2014 says, “This is a good trend if the company is providing a two to three year comprehensive warranty and service back up. The problem with vendors today is there is no ac-

Reliability & Service is Critical for Success

urrent market trend for refurbished goods…

Majority segment which has got maximum benefit is CT/MRI and ULTRASOUND segment from refurbished market. Also there are now authentic Supplier for mammography and bone densitometry systems which always remained an un-touched branch in spite of its maximum requirements for early diagnosis of cancer and other serious ailments. The key drivers to the growth in refurbished segment are an understanding need of niche market and Himanshu Bhatt products, reliability and established Director, KS Biomed Healthcare goodwill of an organization; satisfied end user of refurbished equipment and 24x7 Service back up of MNC level with domestic economical standards.

Advantages of opting for refurbished equipment… There are many benefits for the investor, these include an authentic refurbished equipment suppliers gives solutions of refurbished equipments with the same benefits as OEMs. The equipments are offered with extended warranty and attractive payment and financing options. Assured service facilities supported by high tech application trainings on equipments and in the long term hospitals and clinics get suitable economical solutions for latest medical equipments.

Upcoming segments for refurbished equipments… The key medical segment contributing to refurbished market is radiology imaging currently. It started with CT and continued to MRI and Ultrasound. There are few organizations which are specifically focusing on oncology segment with excellent refurbished solutions for mammography and Bone Mineral Density (Dexa Systems) which remained un-touched by radiology segment for many years till now.

Expansion plans in future… We have taken almost 14 years in this industry before starting our refurbished product segment with a clear long term vision of working with customers rather than for customers. We have planned only those products which normally other refurbished players not ventured into such as mammography and bone density. Customer’s investment is our responsibility rather than sheer business with us so we follow a very scientific and stiff selection processes for procurement of refurbish products though it may attract higher procurement cost.

december / 2013 ehealth.eletsonline.com

Tech Trends

Today 40 Percent Imaging

Equipments are Refurbished

hat are the growth trends for the refurbished equipment in diagnostic imaging in India?

In India there is a growing demand for all kinds of refurbished medical equipments and today 40 percent of all imaging equipments purchased are refurbished equipments. And equipments like CT, C-ram, Angio and MRI are in great demand than ever.

What are the major quality checks before going for refurbished equipment? For any buyer of refurbished medical equipment, three major parameters in choosing the right refurbished equipment are firstly the equipment has to be as much latest technology, not very old. Second, the system should be sturdy with proven performance and third that technical competence and efficient after sales service of supplier should be checked.

Your reflections on growth segments for the refurbished market for MRI, CT, Ultrasound in India Market for refurbished C-arm and Mobile Cath labs are growing. Refurbished CT market is the largest market in imaging segment market and the demand for refurbished CT up to 16 slice is the top priority in buying pattern. We see a huge market for refurbished CT in next 5 years in India. In the case of MRI, it is a complex situation as MRI is made by assembly of many sub units from different manufacturers and the technology is updated every year Investing in refurbished MRI can be only wise if you are sure of continuous support and technology is acceptable to present day use.

Please highlights some key medical segments that are driving the demand side for refurbished goods? Cancer treatment is regarded one of the most expensive

countability once sold. More confidence in the company should be there-company should be there established for more than 5 â&#x20AC;&#x201C; 6 years and have integrity as the doctor is investing significant amount of

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Som Panicker

Vice President, Sanrad Medical Systems

one due high cost of the medicine and equipments. Refurbished medical equipments like Linear accelerators, MRI and CT etc plays a very key role in bringing down the cost to a very large population. The demand for refurbished medical equipments is growing high as the number of cancer patients is also on the rise. Refurbished cardiology equipments like Angio and Cathlabs are also in great demand as a top branded equipments are not within the reach of a large number of medium hospitals with cardiology units.

money. The technology is changing so fast that the new version of equipments and within 6 month it becomes obsolete, and so a commitment from the company should be upgrading the hardware and

software without any cost.â&#x20AC;? Thus if the core issues of accountability, assurance and service are considered, refurbished goods are viable option for doctors practicing anywhere in India.

POLICY

“What’s in a Name

Palliative or Supportive Care!” By Siddharth Kundu

ho defines ‘Palliative care’ as an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual. Palliative care in India is in very early stages of development and is steeped in issues like narocotics laws, lack of awareness and expertise and finally the treatment costs. Today only 14 states in India have been successful in making regulatory changes to make available various essential psychotropic drugs for chronic pain management. The government is about to review and revise the policy to make these drugs available to end-stage cancer patients. This will be a great help to hundreds of thousands of patients across India. The Indian Association for Palliative Care (IAPC) has renewed its request to the government to speed up the passage of the bill that seeks amendment in the Narcotic Drugs and Psychotropic Substances Act. One of the basic differences between palliative care and other segments of healthcare is the holistic approach. This needs to start early so as to ameliorate the physical suffering of the patients and improve the quality of life. This is achieved by way of counseling services that may ease the emotional and spiritual distress and even help patients live longer. Palliative care may also offer financial benefit to patients and their families.

Key Facts • 2 to 2.5 million cancer patients in the country at any given time • Less than half percent have access to palliative care treatment • Every hour more than 60 patients die in India from cancer and in pain • Seven hundred thousand to nine hundred thousand new cancer cases are detected every year (National Cancer Registry Programme )

Lack of education and awareness As of now medical colleges in India are in the process of introducing palliative care in their curriculum. Of late, Medical Council of India has introduced courses in palliative medicine( 3 year post graduate course in palliative medicine). We also need to broaden the course of palliative care by educating not only the clinicians but paramedics and all other healthcare providers with regard to the elements and appropriateness of palliative care. Cancer is universal but the greatest problem that we face in India is lack mass awareness about cancer and scanty administrative facilities for early detection. In India, cancer is detected mostly in its later stages, when it has compromised the function of one or more vital organ systems and is widespread throughout the body. The solution lies in early detection and greater awareness.

Siddharth Kundu

Palliative care aims to l provide relief from pain and other

distressing symptoms; l affirm life and regards dying as a normal process; l intend neither to hasten or postpone death; l integrate the psychological and spiritual aspects of patient care; l offer a support system to help patients live as actively as possible until death; l offer a support system to help the family cope during the patients illness and in their own bereavement; l use a team approach to address the needs of patients and their families, including bereavement counselling; l enhance quality of life, and may also positively influence the course of illness; l apply early in the course of illness, in conjunction with other therapies that are intended to prolong life.

December / 2013 ehealth.eletsonline.com

Curtain CurtainRaiser Raiser

Better Imaging for Healthier Lives

IRAI 2014:

The annual conference of Indian Radiological & Imaging Association (IRAI) opens a window of opportunity to learn and update themselves on the latest technologies, innovations and success stories says Dr Bhupendra Ahuja, organizing chairman, IRAI 2014.

lease share with the highlights of this year annual conference?

Please share some insights on the themes of discussion in the scientific programme?

As global and national think-tank experts, doctors and practitioners descend in Agra for 67th Annual Conference organized by Uttar Pradesh state chapter on January 23-26, 2014, the association is excited as many new initiatives have been taken to ensure each participant gains knowledge on the latest advances on radiology & imaging technology. In all we have designed the conference, exhibition to attract more participation from the PG students and doctors in private practice as they are extremely tied up in their daily work routine to acquaint themselves with new advancements. We have received this year, 600 oral presentation, 480 poster presentations which is a very encouraging response. We are going to 25 e-stations as kiosks and 25 PCs and laptops with categorized presentations and papers for the delegates to browse and read through. We have also developed a mobile application wherein there will be regular updates on the conference sessions, speakersâ&#x20AC;&#x2122; profiles and questions can be posted on the session that will be displayed on the screen live. In addition to the technical sessions, we are taking the initiative to define the reporting standards and protocols for radiologists, so that each radiologist who reviews the images and scans should have their reports in a uniform reporting standard.

We have changed the pattern of thematic discussion from purely systemic to a blend of modality-based sessions. The agenda has an esteemed list of speakers from 180 faculties of which 45 are from other countries. The discussion will be around the technology advancements that are prominent in the radiology and imaging in India. In CT technology, we have observed lately that there has been an increase in the number of slice capacity from 120 to about 256 slice, so we have an renowned speaker to guide us through this recent advancement and understand is the CT slice technology is help or hype. Secondly, we are talking of the latest technology in MR technology which is functional MR â&#x20AC;&#x201C; as till now all aspects of imaging was about the structures of the organ and the drawback was that we could not assess the functional features. Newer technology in ultrasound will also be discussed like 3D and 4D ultrasound and as PET CT and PET MR are new arrivals in radiology space, we will discuss the opportunities and challenges in this technology as well at the event.

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What are your views on taking high quality radiology services to rural areas? We have to install good hospital set

Dr Bhupendra Ahuja ups in the rural areas especially upgrade our primary health centres as imaging and diagnostics needs come from clinical practice and hospital infrastructure. Thus health infrastructure is a predecessor for imaging centres to reach out to patients in the rural areas. We are encouraging all states to have their own annual CME or conference each year; so that the radiologist community is mobilized across the state on annual basis and the workshops will educate the radiologist and PG students on the latest technology arrivals each year. Such workshops can also be held at district and taluka level to reach out to wider population of radiologists across the state.

Organized by

HospiArch 2014 PUNE a 2 Day Conference 2014 PUNE HospiArch

Organized by

17th & 18th Jan, 2014 a 2 Day Conference 17th & 18th Jan, 2014

HOSPITAL PLANNING DESIGN & ARCHITECTURE HOSPITAL PLANNING DESIGN & ARCHITECTURE

HOSPIARCH HOSPIARCH

India's BIGGEST Conference series on Hospital Planning, Design & Architecture... Successfully conducted @ Chennai, Hyderabad, Mumbai, Bangalore, Kochi and Delhi in 2012 India's BIGGEST Conference series on Hospital Planning, Design & Architecture... Successfully conducted @ Vijayawada, Chandigarh and Lucknow in 2013 Successfully conducted @ Chennai, Hyderabad, Mumbai, Bangalore, Kochi and Delhi in 2012 Enriching Presentations & Eminent speakers from across the country Successfully conducted @ Vijayawada, Chandigarh and Lucknow in 2013 Doctors, Hospital Administrators, Architects and Consultants on one platform Enriching Presentations & Eminent speakers from across the country Organized by India's leading Healthcare Event Organizers Doctors, Hospital Administrators, Architects and Consultants on one platform Organized by India's leading Healthcare Event Organizers

Contact

09742439404/ Contact 080 23473633 09742439404/

amenbs@gmail.com

080 23473633

amenbs@gmail.com

KEY TOPICS Architectural challenges involved in Building a New Hospital KEY TOPICS Budgeting & Financial Planning for a New Hospital Project Architectural challenges involved in Building a New Hospital Planning & Designing a New Hospital Budgeting && Financial Planning for a New Hospital Project Re-planning Redesigning an existing Hospital Planning & Designing a New Hospital Planning a GREEN Hospital Re-planning & Redesigning an existing Hospital Marketing Strategies & Branding for a New Hospital Planning a GREEN Hospital Manpower Planning for a New Hospital Marketing Strategies & Branding for a New Hospital Quality standards applicable to Hospital Planning Manpower Planning for a New Hospital IT Solutions for a New Hospital Project Quality standards applicable to Hospital Planning IT Solutions for a New Hospital Project

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expert SPEAK

Working Towards Healthier India A key GE priority is to help prevent the ‘analysis paralysis’ that practitioners face today, by using technology to surface the most relevant data, contributing to accurate and faster care. Terri Bresenham, President & CEO, South Asia, GE Healthcare, shares her views and vision with Shahid Akhter, ENN

E Healthcare’s spirit of volunteerism is laudable. Can you please tell us more about the ‘Mission on wheels’ that you flagged off recently.

It is a special purpose vehicle called “Mission Healthier India” with about 20 low cost healthcare technologies on board. The vehicles will travel to the nooks and corners of rural India. One of the things we realized is that there is a gap of awareness on how the technologies are benefiting the people in a primary care. And even if they know that, they assume that these technologies are expensive. So, we are trying to accomplish both - giving them their first hand exposure into the technologies and explain what it can do in patient diagnosis and discuss its affordability.

Considering GE’s global outreach in Healthcare, Indian market is just a small fraction. How do you perceive and address this small fraction?

december / 2013 ehealth.eletsonline.com

India is an incredibly important market for us. One of the unique characteristics of the Indian market is that it’s not like other markets in the sense of government reimbursements or private insurance. There is much lesser government reimbursement and relatively little private insurance. The market is driven more by consumerism than any other market in the globe so that makes it one level more competitive and also very focused on value and super value. So I’d say that’s a very defining characteristic. It’s a very big market with a lot of people.

tals. It is a great value proposition for all parties involved – Government do not have to invest in expensive medical technologies or skilled manpower to run these centres. It is taken care of by a consortium involving GE and a service provider. Government has to simply provide space for setting up these high end centres that are world class and can provide world class service at Government fixed rates to more patients who need them. It is also an additional benefit for government run medical colleges to provide access to students to get their hands on technology training.

Please tell us more about GE’s Health care public-private partnership in India.

GE Healthcare is believed to have invested $2 billion in software development. Please elaborate on this aspect of Industrial Internet.

GE Healthcare is the first company in India to create a PPP model in the space of radiology imaging way back in 2007. Today, we have PPP projects in 12 States and the recent one with Maharashtra will equip over 22 hospi-

Our industrial internet mission is to create and enable technology and services that can improve the way healthcare is delivered to patients globally.

like ultrasound, CT etc. as early as 1991. GE Healthcare was the first company to set up a world class R&D Centre for healthcare solutions. Today, GE Healthcare has 3 manufacturing plants in India and the largest healthcare R&D Centre to design and develop newer, lower cost solutions to improve access to quality healthcare in India and the world. GE Healthcare is the largest domestic healthcare company in India with $570 million revenue. Every year, we release between 50-60 new innovations in imaging and diagnostics area. Our technologies help do 700,000 procedures or support as many lives every day in the country. It

“By identifying, liberating and analyzing the data captured by software and technology, caregivers will have the information they need when they need it to help enable them to prevent, diagnose, treat and cure. We’re on a positive path but more must be done to build productivity which can lead to higher quality patient care. A key GE priority is to help prevent the ‘analysis paralysis’ that practitioners face today, by using technology to surface the most relevant data, contributing to accurate and faster care.”

Please tell us about GE’s foray into the Diagnostics (imaging) in the Indian market. GE Healthcare has a rich 115 plus years in providing healthcare solutions including healthcare imaging, life sciences, detection and navigation systems, healthcare IT and care solutions. GE Healthcare has been present in India from early 70s. GE Healthcare formally entered India through a joint venture with Wipro in 1990 and is the leader in healthcare technology solutions in India. Wipro GE Healthcare was the first company to set up a high end manufacturing plant for healthcare imaging systems

low cost solution called “Akta Start” to automate and lower cost of protein purifications at laboratory scale.

Please outline some of the innovative products launched recently and products in pipeline? There are a number of innovations we do in India and a number of innovations we bring to India from our labs across the world. We launch about 50-60 newer innovations every year. In India, we are targeting to develop 100 new solutions and have launched about 25 including few this week spanning across all healthcare imaging and other specialties. For example – Brivo XR 115 is a mobile high

GE can fuse its 100+ year track record of revolutionizing healthcare with tomorrow’s technology to stay ahead of constantly evolving healthcare needs is a great achievement and we thank the Indian healthcare fraternity for their trust and support in our growth. Today, GE Healthcare is at work for a healthier India focusing on 5 critical components – Firstly,we are working to bring down the maternal and infant mortality rates. • The second part of the mission is to lower the cardiac disease burden and especially address the ‘golden hour’ in a cardiac attack to save lives. • The third area is oncology as it being a huge burden in India and growing. We expect to launch a cost effective India designed PET/CT soon. • The fourth area is about designing products in India for India and the world which can provide super vaue to our users. We target to bring about 100 lower cost solutions that can improve healthcare access. We have already launched 25 solutions from India and most of them are distributed around the world too. As on today, we are launching a

frequency system we are launching today. This is a first of its kind system and offers lower radiation that is safe even for newborns. Another example is a series of ultrasound systems – LOGIQ- Both LOGIQ and Voluson are high end platforms. They were also expensive as they were being imported and now we have redesigned them in India to lower the cost thereby making them more accessible to doctors. We have also made imaging easy with tools such as Scan Coach. Silent MRI is an exclusive and first of its kind of technology to hit the market recently. We will see a series of innovations getting introduced in the upcoming RSNA including features like Dose Watch to help users manage radiation dose better. In India, you will see new super value technologies coming in the area of oncology, maternal infant care, patient monitoring and general imaging in the next few months.

december / 2013 ehealth.eletsonline.com

expert speak

Second Opinion Consultation

Need of the Hour Armed with a belief that the technology has the potential to change the way healthcare is delivered in India, the IIM Calcutta graduate Sachin Chaudhary passed over the opportunity to be the CEO of a leading chain of hospitals in India and started a healthcare service providing company Medical Second Opinion in Gurgaon. In conversation with Ekta Srivastava, ENN, he talks about the technology driven eConsultation in healthcare

rief us about Medical Second Opinion?

Medical Second Opinion is a healthcare company to address growing requirements for Second Opinion. At MSO we offer exclusive aggregation of finest doctors and hospital providers from India and abroad. Patients who have been diagnosed for any tertiary level procedure/ surgery/ medical intervention seek a second opinion before they undergo the procedure. Since the popular

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doctors of the country largely live in metropolitan cities, accessing them becomes an issue for these patients. Our aim at MSO is to bridge this gap and connect doctors and patients by leveraging technology that is available to all.

Help us understand the process from Medical Second opinion (e-Consultation), how does it work? Just like other online portals in the market that enable customer to book tickets, movie or shop, MSO healthcare platform, the patient has to take four easy steps to take a consultation • Create a health account by registering on www.medicalsecondopinion.co.in • Define the clinical problem and upload relevant reports • Select a specialist from the panel • Pay and send to get a response within 24 hours For assistance, they can also connect with the helpdesk on our toll free number 1800-200-9901.

How do you think that ICT based services are different from brick and mortar concept? Electronic services are much different than a physical hospital in its very ethos. While doctors belong to a hospital, with our portal, we have brought together the finest of the doctors from a plethora of hospitals. Thus, reaching out is solely to the doctors which in the other case is largely with the hospital. The most differential offering of an ICT based service is the ease of accessibility. Anyone from anywhere can connect with their choice of doctors making it cost effective, time saving and less cumbersome. Eventually as technology is gaining foothold within the young population, what is expected to happen is an increased awareness about personal health with a rise in the

number of consultation taken. The population in general is expected to become more proactive to their health than reactive, which we are now and this will lead them to the hospitals. “Our aim is for every patient to take second opinion from the best doctors before undergoing a surgery.”

How the technology is empowering patients? Technology builds a sense of responsibility and ownership of health in an individual because of the ease to access that it has endeavored. Instead of a patient going to the doctor, it

Second opinion from them. Imagine a patient from Jodhpur getting a consultation for his cardiac problem from the head of cardiac, Mayo Clinic in the USA, Dr. Bijoy Khanderia. Similarly, our other doctors are headliners in their specialties as well. In addition, we have signed up 700 plus hospitals across country where our patients can avail discounted services. With Fortis, Apollo clinic, Artemis, CIMS, Shalby, Dr. Mohan’s Diabetes Center, Narayan Hrudyalaya, Paras, Max, Global Health city, Cocoon etc. Amidst all this in a very short span more than 10 corporate have signed up with us, with a few thou-

“Our aim is for every patient to take second opinion from the best doctors before undergoing a surgery” brings the doctor to the patient. Acting as a discovery platform, patients get aware on ‘who’ the best in the industry for each specialty are, because of the finest being a part of the panel while getting a direct access to them. All this can be done while sitting at home and using internet or downloading the MSO mobile app to consult them directly in this modern health care approach. This leads to the empowerment of the patients that have a best assembly of hospitals and doctors and their choice to use them.

What has been your mantra for success in this domain? Healthcare is ultimately delivered by doctors. And our focus from the first day has been to sign up the right doctors. Mostly the senior doctors which were not as easily accessible to patients in remote parts of the country now have the opportunity to seek

sands registrations on our platform, every day we have more than few 100 new visitors on platform.

Future plan As we complete our bi-yearly targets, our focus of work in the coming months is going to in the introduction of more facilities in our healthcare platform. We plan to add video consultation as a way to connect with the doctors while taking the consultation. We also plan to expand our specialties by 6 more. There are talks at different stages for getting doctors from Singapore, US and the UK. Work is also in progress to sign up more corporate from abroad. We have recently signed a joint venture in Singapore and Congo and are working to set up our MSO subsidiaries there. Meanwhile, a cross platform mobile application that works on apple, android and blackberry is also in its final stages.

december / 2013 ehealth.eletsonline.com

policy

NATHEALTH - the next wave of progress in Indian Healthcare

ATHEALTH has been created with the Vision “Be the credible and unified voice in improving access and quality of healthcare”, leading Healthcare Service Providers, Medical Technologies Providers, Diagnostic Service Providers, Health Insurance companies and other stakeholders have come together to launch NATHEALTH (Healthcare Federation in India). The Federation was formally launched by Dr Sayeda Hameed, Member, Planning Commission, Government of India, C K Mishra, Additional Secretary - Ministry of Health & Family Welfare, Chandrajit Banerjee, Director General, CII in the presence of Dr Prathap C Reddy, President, Shivinder Mohan

C K Mishra,

Additional Secretary, Ministry of Health & Family Welfare, GOI

Singh, Vice President and Anjan Bose, Secretary General, NATHEALTH on 23rd October, 2013

NATHEALTH is a forum where various Healthcare Stakeholders have come together to work along with decision makers to create an environment to fund long term growth, help develop and optimise healthcare infrastructure and encourage innovation. NATHEALTH will also try to help shape policy and regulations, bridge the skill and capacity gap and support best practices/promote accreditation. It is a forum that will facilitate the shift in mind-set, delivery and decision making with a vision to help build a better and a healthier future for the citizens of India. The launch also witnessed the release of the White Paper on “Enabling access to long-term finance for healthcare in India’ by NATHEALTH

Key Highlights • Leading Healthcare Stakeholders come together to facilitate sector growth and progress • India battling with the dual burden of communicable & non communicable diseases simultaneously • Cardiac disease and cancer have emerged as the top two causes of mortality in India • Access to cancer care is the biggest challenge; about 70 percent of patients diagnosed with cancer die within the first year • India requires a capital investment of INR 162,500 Crore (USD 26.2 billion) to fulfil the projected bed requirement of 6,50,000 by 2017 • 70 percent of India’s Healthcare infrastructure is concentrated in the top 20 cities • There exists an 18-year difference in the life expectancy noted between Madhya Pradesh (56 years) and Kerala (74 years)

Dr Prathap C Reddy, President, NATHEALTH

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• The government can lead to the creation of healthcare infrastructure through the establishment of a healthcare infrastructure fund (HIF) with an initial corpus of 15,000 crore INR

Dr Sayeda Hameed,

Member, Planning Commission, Government of India

in association with PwC. Spearheading NATHEALTH secretariat, healthcare veteran Anjan Bose, Secretary General, NATHEALTH expressed that modelled on the lines of NASSCOM, NATHEALTH is intended to play a pivotal role in empowering Indian Healthcare and bring quality healthcare closer to every Indian. On this occasion Dr Prathap C Reddy, President, NATHEALTH expressed, “Although when healthcare is progressing, there is still a large

Shivinder Mohan Singh,

Vice President, NATHEALTH

section in India that doesn’t have access to quality healthcare facilities. NATHEALTH would act as a catalyst to bridge the gap, encourage development and optimize healthcare infrastructure for the progress of Healthcare Sector to the next level”. Anjan Bose, Secretary General, NATHEALTH, expressed that Indian Healthcare is uniquely placed at this point of time. The positives and negatives are at constant interplay. At one end, we have developed a highly skilled medical ecosystem, at the other end; we have a massive disease burden and inadequate infrastructure. We need to come together onto a common platform and work together with decision makers to create an enabling environment that will power the next wave of progress in Indian Healthcare. Dr Prathap C Reddy added “According to the findings of the white paper, India is battling with the dual burden of communicable & non communicable diseases – rural India accounts for not only 70 percent of communicable disease cases, but also over half of non communicable disease.” “Indian Healthcare Fraternity needs to come together today to erase the ignominy of being a disease capital of the world in many areas. I hope that NATHEALTH members will do something that is very much required in the country to bring innovative and affordable Healthcare to the people,” added Dr Prathap C Reddy. Shivinder Mohan Singh further informed that Cardiac disease and cancer are the two major causes of increased rate of mortality in India and access to cancer care is a big challenge with only around 325 comprehensive cancer centres, despite about 1.2 million newly diagnosed cancer patients every year. Anjan Bose said, “Despite healthcare being accorded infrastructure status, the benefits of this are yet to accrue to the healthcare providers. To avoid unmet goals at the end of the 12th plan period, India will conservatively

need to aim to add atleast 6,50,000 beds to meet the project bed requirement by 2017. To achieve 6,50,000 beds, India will require a capital investment of INR 162,500 crore (USD 26.2 billion), which is more than 50 percent of India’s annual healthcare expenditure. This will require enabling access to long-term and concessional funding similar to core infrastructure that would require a strong Public Private Partnership”. “Most of the country’s health expenditure is supported by private spending and the constitution of public

Anjan Bose,

Secretary General, NATHEALTH

funds is not adequate Despite healthcare being accorded infrastructure status, unlike roads and airports, the healthcare sector has lagged significantly in PPP. All of this needs to change” added Dr Rana Mehta, Leader for Healthcare, PwC India. Anjan Bose informed that already NATHEALTH have nearly 50 members. We are expecting more participation in times to come. Shivinder Mohan Singh said, “Our Mission is to enable the environment to fund long term growth for Indian healthcare and support best practices and promote accreditation”. We would also like to encourage innovation and help bridge the skill and capacity gap that is a very serious concern.

december / 2013 ehealth.eletsonline.com

Health Watch

Predicting Genetic

Bleeding Disorders Researchers at Sir Ganga Ram Hospital, New Delhi, claim to have developed the worldâ&#x20AC;&#x2122;s first Genetic-Bleeding Risk Score for patients who are on oral anticoagulant therapy. Dr Risha Nahar, Scientist at the Centre of Medical Genetics, SGRH with Ekta Srivastava, ENN, elaborates on the same

Dr Risha Nahar,

Scientist, Centre of Medical Genetics, SGRH

December / 2013 ehealth.eletsonline.com

orld over anticoagulants are used for treatment and prevention of thrombosis (blood clots) since early 1940s. Thrombosis is the formation of a blood clot inside a blood vessel obstructing the flow of blood in veins or arteries. Many organs of the body like legs, heart, kidneys, brain, lungs etc are affected by thrombosis. Anticoagulants are used to treat or prevent formation of thrombus. Despite its common usage, oral anticoagulant (OAC) therapy is associated with significant bleeding complications. Commonly used oral anticoagulants are warfarin or acitrom. This study was aimed to identify and compare the proportion of South and North Indians who are carriers of the common CYP2C9 and VKORC1 polymorphisms. In order to get a finer picture of variability in anticoagulant response (adverse effects and therapeutic dose requirement) among North Indians, a systematic prospective study including larger cohort of patients (n = 310) with well defined clinical and extended candidate gene-SNP panel was executed. According to the researchers, no one in India or world has ever derived and validated such a predicting score. They say the score will help greatly in reducing the economic burden of adverse drug reactions and incidence of bleeding complications.

ymorphisms. Additional three important variables were added in the model based on the evidence of association in the literature - history of malignancy/ cancer, history of bleeding, and hepatic or renal disease. The genetic prediction model was validated in an independent cohort in whom it showed a two-fold increase in the sensitivity as compared to the clinical model.

Anticoagulation Therapy

The study which has been published in the International Journal of Genomic Medicine that too in novel pharmacogenetic dosing algorithm devised includes novel genetic factors that can guide the clinicians to prescribe the right dose for a particular patient. It will also enable them to make appropriate clinical decisions such as avoidance of concomitant interacting drugs, lower initiation dose, frequent INR monitoring and dose titrations. Therefore, predictive bleeding scores, dose predictions based on genetic algorithms along with improvement in the quality of anticoagulation can improve the therapeutic efficacy of anticoagulants and minimise the incidence of bleeding complications.

Anticoagulant Coumarin anticoagulant drugs are used in the treatment and prophylaxis of venous and arterial thromboembolic events; warfarin and acenocoumarol being the most widely prescribed worldwide. The widespread use of these drugs is limited by the wide inter-individual variability (20 fold) in the dose required to achieve therapeutic anticoagulation. Current dosage protocols (based on demographic or clinical information)

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run the risk of severe bleeding and hemorrhage (when on higher dose) or slow and inadequate anticoagulation (when on lower dose).

Benefits of Pharmacogenetic Testing In the United States of America, savings of almost $1.1 billion are estimated annually from health care budget. These savings are mainly because of avoidance of about 85,000 serious bleeding events and 17,000 strokes annually. The numbers applicable in India would be even greater if preprescription genotyping becomes a part of clinical practice in our country. Additionally, associated mortality, morbidity and the cost of management of drug-related adverse events can be substantially minimised thereby reducing the economic burden on the Indian health care system.

GBRS This study is the first to devise and validate a genetic bleeding risk score (GBRS) for predicting bleeding among first-time users of oral anticoagulants. The derived model included four variables; older age (>65 years), presence of Factor V Leiden mutation, VKORC1 rs9934438 and CYP2C9 rs1057911 pol-

Clinicians in India tend to start with small dose of oral anticoagulant that is gradually increased based on the INR values in the first two weeks. However, despite this type of cautious anticoagulation management in the present study, the incidence rate of minor and major bleeding was observed to be 16.9 and 4.5 per 100 patient-years respectively. This is higher than that observed in other countries. Genetic screening for bleeding predictors using simple scoring method, as derived in the present study, has the potential to rule out some of the uncertainties in the adverse effects of anticoagulants, and can greatly reduce the economic burden of bleeding. Further to this Dr I C Verma, director, centre of medical genetics, SGRH, added, “The present research focused on deriving and validating a ‘Genetic Bleeding Risk’ (GBR) score based on genetic and non-genetic factors associated with bleeding (both minor and major) in patients on long term anticoagulation therapy. Apart from variants in CYP2C9 and VKORC1 genes, variants in APOE, ABCB1 (MDR1), CYP4F2, F5 and F2 were also analysed in the current study.” The study was conducted on 310 patients from the departments of vascular surgery, cardiac surgery and neurology from August 2009 to August 2012 at SGRH, after approval from the Ethics Board Committee of SGRH and is in accordance with the ethical standards of Declaration of Helsinki (World Medical Association).

zoom in

Hospital Build & Infrastructure India

The 4th Edition Of Hospital Build & Infrastructure India Exhibition & Congress To Highlight The Growth Potential Of Hospital Infrastructure Sector

he 4th edition of Hospital Build & Infrastructure India Expo (HBI), India’s premier trade event on hospital infrastructure, planning, supplies and healthcare development, is to be held at Pragati Maidan, New Delhi from 12th – 14th December 2013. HBI is the only trade event in India targeted at those directly involved in the investment, planning, design, build, operations and management of healthcare facilities covering public and private hospitals, clinics and specialty centres. The show is organised by Informa India, part of the England head quartered Informa plc. The Indian Health care industry is slated to reach US$ 160 billion by 2017 with an anticipated growth rate of 22% annually and HBI shall provide the necessary platform for professionals to access latest products & technologies and upgrade to world standards. HBI is supported by Associations and organizations such as Federation of Indian Chambers of Commerce & Industry, Biomedical Engineering Society of India (BESEI), Federation of Hospital Administrations (FHA), Indian Society of Hospital Waste Management (ISHWM), Indian Association of Structural Engineers (IASE), the Association of Hospital Administration, School of Planning and Architect New Delhi, Philips, the Indian Institute of Architects (IIA) and National Accreditation Board for Hospitals & Healthcare Providers (NABH). Over 100 Indian and International exhibitors shall showcase a variety of products and technologies like hospital

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furniture items, Storage units, waste management equipment, patient transportation/safety systems, hospital security systems, medical apparel items, hospital management group services, water treatment tools building materials, construction tools, architectural products, engineering tools and catering supplies, cleaning tools and sterilization products, HVAC tools, IT systems, medical gases, and real estate development facilities in addition to Efficient healthcare equipments. A major attraction at the event will be a global Conference on “Health Systems Design & Operations for ensuring patients’ safety, disaster mitigation and quality of care” co-presented by Association of Healthcare Providers India

(AHPI). The conference will witness the largest gathering of healthcare policy makers, industry leaders, architects, planners, hospital entrepreneurs, academia and Bio technology giants! The presence of eminent representatives from governmental ministries brings up the overall business value of the event further. Says Guru Prasath, Group Exhibitions Director, Informa Exhibitions, “The healthcare industry in India has witnessed a massive increase in investment over the last few years which requires a world class forum with multitrack content across the breadth of this expanding sector.” For mor information, please visit http://www. hospitalinfra-india.com/.

launch pad

GE Unveils High Frequency Mobile X-ray Safer Even for Newborns GEâ&#x20AC;&#x2122;s India designed new Brivo XR115 Ultra* High Frequency 100 mA mobile X-ray is safer, 40% faster, smaller and easier to move around General Electric Company (GE) announced today the launch of Brivo XR115, a next-generation Ultra*-high frequency mobile X-ray system designed and developed in India for the world. The new GE Brivo XR 115 addresses 5 critical problems faced by radiologists and radiographers; image quality from Mobile machines of critical anatomies like the spine, patient discomfort which can occur while shifting from hospital bed to the X ray room, higher radiation uncontrolled patient movement that occurs during pediatric imaging, and the potential safety issues that can exist moving equipment between wards. Brivo XR 115 is safer for even Newborns: Brivo XR 115â&#x20AC;&#x2122;s Ultra* high frequency system with 200 KHz makes x-ray imaging safer for all patients and most importantly radiographers who are using the system through the day. 100mA machine is 40% faster than the 60mA machine. It is Ultra*high Frequency and leads to lower radiation dose. With lower radiation and other safety features, it is safe even for newborn babies.

Software Supports Enhanced Image Sharing Capabilities Image Suite also features new CARESTREAM OmniLink Software that can provide secure Web-based transmission of imaging studies and deliver many of the capabilities of a virtual private network at a fraction of the cost. OmniLink Software enhances the sharing of images by offering rapid transmission speeds, high-level security features, and the ability to compress and encrypt files for transmission. This software notifies the sender and receiver when an imaging study is received and alerts the sender if the file is not received. It also supports transmitting image to a PACS using cell phones or mobile devices for healthcare facilities outside of the U.S. Image Suite systems provide DICOM storage for MR, CT and ultrasound exams and reporting software allows users to create, edit and view reports attached to studies. Users can output imaging exams to CD/DVDs, DICOM printers and other PACS systems. Imaging services providers of all sizes can minimize capital investment and achieve obsolescence protection by purchasing PACS, image sharing and vendor-neutral archiving on a pay-per-use basis with Vue for Cloud-Based Services.

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