creating a value chain in diagnostics: February 2012

asia’s first monthly magazine on The Enterprise of Healthcare

volume 7 / issue 02 / february 2012 / ` 75 / US $10 / ISSN 0973-8959

www.ehealthonline.org

Labs go Hi-Tech p-20

At the Forefront of Diagnostics p-38

Latest ‘Tech KID’ on the Roads p-24

Creating a Value chain in Diagnostics Healthcare delivery trends and novel therapeutics help refocus the role of laboratory medicine in disease management to the patient

volume

issue

contents

ISSN 0973-8959

cover story Creating a Value chain in Diagnostics

With more and more Indians becoming part of the middle class there is rise in health consciousness in the society, and this in turn is leading to an exponential growth in the segment of diagnostic laboratories

By Dhirendra Pratap Singh

INTERVIEW Murali Rao Associate Vice President- Healthcare, Technopak

Perspective

speciality

“Accreditation is Need of the Hour”

“In Today’s Diagnostic Sector, Technology is more Important than Pathologist”

“Indian Diagnostic Market is Evolving”

Dr Poonam Das, Director – Institute of Lab Medicine, Max Super Specialty Hospita

Latest ‘Tech KID’ on the Roads

By serving in emergency situations with great deal of efficiency, the MMUs mark the beginning of a new age of technology in the healthcare industry

COO & Medical Director, Artemis Health Institute, Gurgaon

february / 2012 www.ehealthonline.org

‘How Antimicrobial & Flame Retardancy Matters in Fabric?’

Hygienic environment and patient privacy is now important facilities that a patient is looking for now days

zoom in

Mobile Phones “Always There Always On”

Mobility is the next big thing to happen to the healthcare and medical research industry

in conversation Dr Devlina Chakravarty

Swallow Tablets for Better Healthcare

spotlight

tech trends LIS ensures quicker availability of test results, thereby reducing the time to report, which can save invaluable patient lives

The improved techniques in radiology have dramatically increased the range and the scope of diagnostic information

A revolution is happening in healthcare sector. It is called: Telemedicine 2.0

Kaushik Basu, Chief Operating Officer, Elbit Medical Diagnostics Ltd

Labs go Hi-Tech

At the Forefront of Diagnostics

tech story

Dr Nilesh Shah, Director and COO, Metropolis Healthcare Ltd

news

28 38 44

News- mHealth News - Policy News

P U NG rchm a a I m h h H t COMI c 16 sso DEL a EW N

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

coming up mumbai, june

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

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

hyderabad, august

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

For updates visit healthcareleaders.eletsonline.com

volume

issue

asia’s first monthly magazine on The Enterprise of Healthcare

President Dr. M P Narayanan

Editor-in-Chief Dr. Ravi Gupta

gm Finance Ajit Kumar

dgm strategy Raghav Mittal

programme Dr. Rajeshree Dutta Kumar specialist product manager Divya Chawla partnerships & Sheena Joseph Alliances Shuchi Smita Editorial Dhirendra Pratap Singh, Anand Agarwal, Pragya Gupta, Shally Makin (editorial@elets.in) Sales & Delhi ncr Marketing Rakesh Ranjan Mobile: +91-8860651635 Fahimul Haque, Jyoti Lekhi, Ragini Shrivastav (sales@elets.in) Mumbai: Rachita Jha Pune: Shankar Adaviyar Bangalore: Puneet Kathait Hyderabad: Amit Kumar Pundhir Ahmedabad: Sunil Kumar Circulation & Jagwant Kumar, M: +91-8130296484, Subscription Gunjan Singh, M: +91-8860635832 subscription@elets.in Design & Bishwajeet Kumar Singh, Creatives Om Prakash Thakur, Shyam Kishore

inbox Ordinary TB is easily cured by taking antibiotics for six to nine months. Please note that TB can be cured by antitubercular drugs like Isoniazid, Rifampicin, Ethambutol etc. So delete the word antibiotic and use Antitubercular Drugs. Dr Sudhir Khetarpal on “Totally drug-resistant’ tuberculosis found in India” It is an encouraging info that the government hospitals are improving their services because, under the RSBY scheme, the government doctors get 25 percent of the total cost of the procedure. Now these doctors are competing with private sector doctors to provide benefits to the poor. Dr Rajesh Choda on “We plan to develop a national database system called CIES”

Web Ishvinder Singh, Anil Kumar IMG Gaurav Srivastava, Prateek Mittal IT infrastructure Mukesh Sharma, Zuber Ahmed

Events Vicky Kalra

human resource Sushma Juyal

Healthcare is one of India’s largest sectors, in terms of revenue and employment, and the sector is expanding rapidly. I am pleased to see the current issue of eHealth. The role of the magazine in promoting health IT is significant. Dr Manjul Prakash on “The Health Brigade” Health information technology is the fastest growing segment of more than $1 trillion global healthcare marketplace. The eHealth magazine covers various aspects of health IT in depth and sharpens the readers’ analytical views in this sector. Nikhil Dave on “Catalysts of Change”

legal R P Verma Accounts Anubhav Rana, Subhash Chandra Dimri Editorial Correspondence eHEALTH, G-4 Sector 39, NOIDA 201301, India, Tel: +91-120-2502180-85, fax: +91-120-2500060, email: info@ehealthonline.org

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

What is the cost of MRI HIFU treatment for single Fibroid & multiple fibroids? Do they differ

or is it the same? What are the time consumptions & any preparations required? Babu on “APOLLO hospital announces the launch of MRI-HIFU”

february / 2012 www.ehealthonline.org

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

editorial

From Dis-ease to Health-ease The International Diabetes Federation estimates that the number of diabetic patients in India has more than doubled from 19 million in 1995 to over 41 million. Cardiovascular diseases (CVD), cancer and stroke account for 53 percent of all deaths and 44 percent of disability-adjusted life years. The truth is that the Indian population is starting to move from the cheaper to treat “infectious diseases” to the more complex and expensive “lifestyle diseases,” which often require greater diagnostic and therapy related interventions. Lifestyle diseases are set to assume a greater share of the healthcare market. Diagnostic laboratory industry, which is estimated to be worth around 10,000 crore in India, is largely fragmented and unorganised. According to estimates, there are about 100,000 pathology laboratories in India, of which only 200 are accredited. But we see this industry consolidating over a period of another ten years. The health insurance industry will drive the growth. About 75 percent of our revenue comes from Indian market, while the remaining 25 percent revenue comes from international market. ICT bridges the gaps by automating the entire process of testing - starting from the on-line patient booking to the registration of the sample and then finally getting the report digitally signed after analysis of the sample. Had the entire process been done manually, the possibilities of human error would have been much higher. In this issue we are featuring stories on radiology and ultrasound. There have been dramatic advances in radiology in the past few decades. The modern imaging armamentarium includes multidetector row CT, MRI with a host of advanced sequences, PETCT, digital mammography, etc. While all segments in healthcare have benefited from such technologies, those that have seen the greatest beneficiaries are the sub-specialties, particularly neurology/neurosurgery, oncology, orthopaedics and cardiology/cardiac surgery. The cheapest diagnostic tool in the medical equipment industry is ultrasound. With booming population, and increased awareness about the portable ultrasound systems, there has been an increase in the misinterpretation of the Pre-Natal Diagnostics Techniques (PNDT) Act. The market today is witnessing increased competition and lack of awareness. Colour Doppler segment dominates the Indian ultrasound market. There is a 12.9 percent growth in revenues with 3D and 4D imaging in cardiology and radiology. Then there is the section on tech trends in which we have focussed on some very interesting themes.

Dr. Ravi Gupta ravi.gupta@elets.in

february / 2012 www.ehealthonline.org

Cover Story

Diagnostics services constitute one of the most critical components of medical care. Around 70 percent of treatment decisions in India are based on test results. Diagnostics may not be perfect for curing the disease, but they can be helpful to a large extent.

FEBRUARY / 2012 www.ehealthonline.org

Cover Story

Creating a Value Chain in Diagnostics With more and more Indians becoming part of the middle class there is rise in health consciousness in the society, and this in turn is leading to an exponential growth in the segment of diagnostic laboratories By Dhirendra Pratap Singh, dhirendra@elets.in

he laboratory plays a central role in healthcare. By one estimate, 70 percent of all medical decisions are based on laboratory results. And now all the laboratories strive to use latest technology. However, technology cannot be an end in itself; it is only the means to an end. Optimising performance means that workflow and technology are integrated to yield an operation that will meet all the clinical needs and financial goals of the organisation. The International Diabetes Federation estimates that the number of diabetic patients in India has more than doubled from 19 million in 1995 to over 41 million. Cardiovascular diseases (CVD), cancer and stroke account for 53 percent of all deaths and 44 percent of disability-adjusted life years. Thus, the Indian population is graduating from cheaper to treat “infectious diseases” to the more complex and expensive “Lifestyle diseases” which require greater diagnostic and therapy interventions. Lifestyle diseases are set to assume a greater share of the healthcare market. Step back in time and pose a contrast: life expectancy has shot up in India, from 23 at the turn of the 20th century to 65 years, while death rates have come down—from 25 per thousand to eight. The truth is that we used to die of dreaded infections in circa 1900. Around 70 percent of treatment decisions in the country are based on test results. Diagnostics may not be perfect for curing the disease, but they can be helpful to a large extent. Diagnostics services constitute one of the most critical components of medical care. The Indian diagnostic market is worth US$ 2 billion, and constitutes four percent of the overall healthcare delivery market. It is expected to grow at a CAGR of 21.2 percent, which is supported by a historical five year CAGR of 20 percent. The industry is highly competitive and price-driven with kickbacks and business referral payments in the absence of a regulatory body. Medical Lab (Pathology)

makes up 60 percent of the diagnostics market, whereas radiology and imaging constitute 40 percent of the market. Diagnostics is widely classified into In-vitro business and Invivo business; they are equal in size in terms of turnovers and both are growing at a 20 percent year on year. Consolidation is sensed in in-vitro segment, where 90 percent business is still with unorganised laboratories. Out of the 60,000 laboratories, where testing is done, only 200 are accredited. Only 1000 of them are worth calling laboratories. By the year 2020, at least 60 percent of in-vitro business is expected to become organised. As on date only 10 percent is organised and though it has taken 40 years to move to 10 percent, this is likely to grow to 50 percent in just next 10 years. Growing awareness on quality and brand puts unorganised laboratory at check and thus allowing the organised sector to move faster. Though the industry is growing 20 percent per year, the organized players are moving at 30 percent and Thyrocare is moving at 40 percent which obviously says market share of brands are growing faster.

Major Players An estimated 90 percent of such centres belong to unorganised sector. The organised sector is largely dominated by Dr Lal Path Labs, Metropolis, SRL Religare and Thyrocare. Major branded players in the Indian diagnostics market include names like Super Religare Laboratories, Dr Lal Pathlabs, Quest Diagnostics, Thyrocare and Metropolis. Super Religare Laboratories is servicing nearly 1550 hospitals/path labs along with its subsidiary Piramal Diagnostic Services Private Limited. They offer a comprehensive range of over 3,300 diagnostic tests, from the routine to the highly specialised tests. Dr Lal Pathlabs has 65 laboratories at present in India and it is looking to add another 35 this year. The company has decidFEBRUARY / 2012 www.ehealthonline.org

Cover Story

ed to invest Rs 150 crore this year on acquisitions in India and abroad. The company is also looking to acquire assets in Middle East, Bangladesh, Sri Lanka and other South Asian nations. Quest Diagnostics has operations in the US, India, UK, Brazil, Puerto Rico, Mexico and Ireland, it is a Fortune 500 company. In India, it has set up facility in Gurgaon, Haryana. It has recently launched a wide array of testing for diagnosing and monitoring blood cancer in India. Thyrocare is among the top laboratory brands in India. It is growing at 40 percent annually. Another major player Metropolis has created an Indian Association of Pathology Labs, under the umbrella structure of CII (Confederation of Indian Industry), in view of representing the industry in front of the government. The company has been into the process of promoting three more tests viz. He4 (Ovarian Marker – Gynaecological), Hair DX (Genetic hair loss – Dermatological), DNA paternity test, for the Indian citizens.

FEBRUARY / 2012 www.ehealthonline.org

Accreditation and Regulations There are a lot of hidden costs in getting accredited as you have to pick up the tab of lots of global first class travels of auditors. Moreover, getting accredited is not particularly helpful as the common man, or even the fraternity of doctors, is not tuned towards the importance of accreditation. Any laboratory gets even government business and that makes accreditation “unattractive for many”. It is just 200 versus 60,000 and it would take another 10 years to see 10,000 versus 60,000. The Indian diagnostic industry needs regulation. There are no set criteria in terms of infrastructure, technology and qualification for setting up a diagnostic laboratory. The diagnostic sector under the Indian regulatory framework has low entry barrier with the only requirement being registration under the Shop and Establishment Act. The National Accreditation Board for Testing and Calibration Laboratories (NABL) is the sole accreditation body with the criteria assuring accuracy, reliability and conformity of the tests results.

The nature of competition in the diagnostic industry would undergo significant change. This is because the National Clinical Establishment Act, 2010 would make registration and quality compliance mandatory for laboratories and diagnostic centres. While at present accreditation of laboratories is not necessary in India, it can still become a mandatory law in times to come. This can potentially check the growth of small local level players, while the large players such as Dr Lal Path Labs, Super Religare Laboratories, Metropolis and Quest Diagnostics will be able to expand faster. This is in contrast to the present situation where unorganised sector contributes to major share of the industry. Absence of strict regulatory environment had led to mushrooming of large number of small sized diagnostic centres providing limited services. ISO, NABL, CAP (College of American Pathologists) accreditation can help develop structured framework for quality control and assures compliance to stringent national and international quality re-

Cover Story

“Information Technology has Taken a Giant Leap in the IVD Industry” The diagnostic market in India is undergoing sea change. Powered by technology, which is dominated by Corporates and driven by new-age consumers, the diagnostic laboratory market in India has taken a giant leap forward. Large giants from all over the world are finding the Indian market to be very attractive, and they have set up their operations in India e.g. Quest Diagnostics. ICT bridges the gaps by automating entire process of testing from on-line patient booking to the registration of the sample and then finally getting the report digitally signed-in after the analysis of the sample. Going forth, ICT will play an important role in data mining of information in pathology and diagnostic industry. Lab automation has also taken on a new level of importance in the ability to actually get instruments interfaced to various laboratory information systems (LIS). Information technology has taken a giant leap in the IVD industry, thereby reducing the dependence on a technically qualified individual to be present at all times during the analytical procedure without compromising on established levels of care. Due to increasing consolidation in the in-vitro diagnostics market, Indian market dynamics are expected to change the way it changed in USA, where 20 years back, there were at least 30,000 labs, and now, 4-5 major chains of organised players control 30 percent of the total market. Clinical Labs will undergo consolidation in future, thereby moving from unorganised to organised (20 percent organised market by 2020). Also, Insurance companies prefer tie ups with labs that have quality control, uniform systems of billing and services. This will further fuel the growth of organised sector within the clinical lab segment. Ageing population and lifestyle related disorders would be the future growth drivers for this market along with medical insurance. The sector’s growth will be driven by the country’s growing middle-class, which can afford quality healthcare Diagnostic industry is largely driven by Innovations. Innovations which are critical in this segment are seen at following two levels: Product innovations: Under this category, new tests are being offered. Molecular diagnostics is the most valuable one. The testing will play a greater role in predictive diagnosis and will be an enabler for personalised medicine. Also, several new instruments, which are convenient to use and are compatible with other electronic devices like mobile phones, have been the latest offerings in this area. Service-level innovations: This includes value-added services like online services, collection of samples and home delivery of reports.

Murali Rao Associate Vice President- Healthcare, Technopak FEBRUARY / 2012 www.ehealthonline.org

Cover Story

Labwatch

The diagnostics industry is highly fragmented with the largest players accounting for less than 15 percent of the total diagnostics market. Out of the 60,000 laboratories in India, only 200 are accredited and only 1000 of them are worth calling as laboratories. Unorganised laboratories are growing at the rate of 10 – 15 percent, while the organised corporate chains having less than 10 percent share of the total market are growing in a much faster rate at 25 – 30 percent, annually. By the year 2020, at least 60 percent of in-vitro business will become organised since, though slow, things are moving in right direction. Life expectancy has shot up in India, from 23 at the turn of the 20th century to 65 years, while death rates have come down—from 25 per thousand to eight. As of now only 10 percent is organised. Even though it has taken 40 years to move to 10 percent, this is likely to grow to 50 percent in just next 10 years. The Indian healthcare market is growing on an unprecedented high rate of 16 percent year on year. From Rs 1, 02,600 crore in 2005, it now clocks Rs 2, 00,000 crore and is projected to reach Rs 3, 00,000 crore by 2012. Source: Indian Diagnostic Industry and Market Report 2011

quirements all of which are imperative in a vital service sector like healthcare. The fast growing diagnostic sector opens several avenues for partnership between the Indian and International Diagnostic companies. There is huge potential in the Clinical Research and Trials market by combining the unique strengths of Indian and US companies, US companies are the leader in Pharmaceuticals and Biologics Research and Development. Indian companies can leverage their extensive expertise in Life sciences, the large number of CAP accredited labs in India and the huge patient base, to collaborate with US companies in organising large scale and complex clinical trials at low costs. There is good potential to develop training and accreditation programmes for the Indian market. There is a need to design cheap, high quality equipment for Indian markets and device creative financing options and low cost, effective IT solutions for the Indian market.

Fragmented Industry Diagnostic laboratory industry, which is estimated to be about Rs 10,000 crore

FEBRUARY / 2012 www.ehealthonline.org

in India, is largely fragmented and unorganised. According to estimates, there are about 100,000 pathology laboratories in India of which only 200 should be accredited. But ten years from now we see this industry consolidating and the health insurance industry will drive the growth. About 75 percent of our revenue comes from the Indian market, while the remaining 25 percent revenue comes from the international market. ICT bridges the gaps by automating entire process of testing, starting from the on-line patient booking to the registration of the sample and then finally getting the report digitally signed after analysis of the sample. Had the entire process been done manually, the possibilities of human error would have been higher. In future, ICT will play an important role in data mining in pathology and diagnostic industries, which are growing leaps and bounds. Diagnostics is an important part of healthcare and thus proper regulations needs to be in place, be it terms of regulations for opening a laboratory or mandatory accreditations. Some private companies, especially those that are en-

gaged in the health business are striving to increase the health awareness among the common man, not only in metro cities but in the Tier-II, Tier-III and smaller towns. In recent years, the workload on laboratory personnel has increased two to two-and-a-half times. An increase in the capacity and directions of laboratory investigations should be reflected in the quality of the work, or in the accuracy and reliability of the acquired data. But this is possible only when laboratories are equipped with modern technology, permitting a sharp rise in production and in the reliability of investigation results. Delivering the right data in a timely and cost effective manner while improving the sensitivity and specificity of the test is the need of the hour and the industry needs to gear up for single workstations that can carry multiple workloads. Experience has confirmed that full automation is a very gradual step towards efficiency in laboratory work and lab automation still continues to evolve. The drive or thrust for smaller, faster, and more-accessible devices is increasing. Emerging markets have different needs with respect to the test menus, technologies used and operating procedures. Thus, made-to-order solutions need to be developed for these markets. To survive and succeed in these challenging conditions, it is imperative for laboratories to look for ways to adapt and implement new strategies that can help them in saving costs. In today’s competitive environment, revenues per test are seeing a continuous downtrend. So the testing centres have to increase their productivity in order to survive. The paradigm shift towards improved quality, error-free services, and the need to ensure patients’ satisfaction has prompted laboratories to adopt novel technologies such as automation and point-of-care systems. Advances in nanotechnology and genomics have enhanced the role of diagnostics in the healthcare market, thereby facilitating the shift towards personalised medicine.

速

In Conversation perspective

“Accreditation is Need of

the Hour”

Max Healthcare, with its mantra of star facilities and cutting-edge technology, is writing a new chapter in India’s healthcare services. Dr Poonam Das, Director – Institute of Lab Medicine, Max Super Specialty Hospital, shares her perspectives on the clinical laboratory business in India What is your outlook on diagnostic industry in India? The diagnostic industry has evolved considerably over the past decade. It is now positioned as basic accompaniment to diagnosis and treatment of all kinds of diseases. There is a clear focus towards providing relevant service to any clinical setting, be it emergency care, care on an OPD basis or inpatient healthcare delivery. The ever-increasing level of awareness among our patients has also helped in streamlining the evolution of diagnostic services.

february / 2012 www.ehealthonline.org

What is the level of IT applications in your laboratories? How is it adding value to the efficiency of your business? Diagnostics have been the most automated vertical among all specialities for several years. Automation became a standard during the late eighties and the early nineties. Technology has grown by leaps and bounds over the years since then. After every couple of years upgrades are required to meet the ever-changing needs of the business. The IT systems in the Lab are state-of-the art. Lab doctors and technologists are adept in using these technologies for bringing out efficient, precise and accurate outcomes in fastest possible turn-around-times. In an environment like ours, where we have state of the art labs in all our hospitals, with a super-speciality central lab at Saket, a single central database linked over a private cloud can bring immense value by integrating all Max hospital labs together. There are checks and balances in every sub-process with the system forming the backbone on enforcing policies. A robust MIS structures ensures quality management and adherence to norms and expected TATs. Operational flow in the lab is fully IT enabled: Every specimen is bar-coded at sampling, all our analysers are bi-directionally interfaced, test orders are by a CPOE enabled EHR system and the verified results become available to the inpatient areas instantly. What is the share of organised and un-organised laboratories in the diagnostic sector? It is estimated that there are around 65000 medical laboratories in the country, of which a few more than 280 are NABL accredited. A smaller number are in the process of getting accredited. An acceptable laboratory is one that is run by a qualified medical professional with a relevant post-graduate degree in that facility’s field of diagnostics. Only about 50 percent of the labs satisfy this criterion. The rest may be considered unorganised. However, some exceptions are permitted in rural settings given the need of fostering healthcare penetration in rural areas. What is the role of accreditation and regulations in the diagnostic sector in India? Accreditation is the need of the hour. With the ever increasing scope of diagnostics, the control over the quality of service provided cannot be left to individual laboratories. There can be a large number of reasons why “good lab practices” suffer in the absence of accreditation. The value of diagnostic results is as good as the quality control that goes behind completing the analysis. Accreditation certifies that a lab is proficient in testing. This provides a degree of authenticity to the lab’s reports. The current drive toward accreditation is improving the overall level of efficiency in the diagnostic industry. Eventually accreditation will contribute to minimising instances of analyses, which use sub-par practices. This will improve the confidence level of clinicians and patients.

perspective

“In Today’s

Diagnostic Sector, Technology is more Important than Pathologist” Metropolis, a leading corporate run chain of diagnostic centres in India, has a vision for growing as an institution while standardising the norms for the entire industry. Dr Nilesh Shah, Director and COO, Metropolis Healthcare Ltd in conversation with Rachita Jha, shared insights on the current scenario in India’s diagnostic laboratories

Please provide a brief background of Metropolis and its reach in India and overseas? Metropolis is one of the first reference laboratory chains in India. When we started it was a difficult terrain, and there was many difficulties in transfer of samples from one part of the country to another. There were issues of sample integrity. Hence we went ahead on the strategy of opening labs across the country. Today we have our own supply chain mechanism in place. We have more than 75 labs in India and in Sri Lanka, UAE and South Africa. Currently we are expanding into Mauritius and African countries. We are targeting 100 labs in coming year; many of these new labs could come by way of acquisitions. We use bar codes on the samples to ensure they are not mixed with others. Patient are assured of the confidentiality and accuracy of his/her report. What is the share of organised and un-organised laboratories in the diagnostic sector? What is the market share that Metropolis plans to have in next 2 years? Diagnostics sector is an unorganised sector. We don’t know the exact number of laboratories, whichy exist in the country, as there is no mandatory procedure for registration. Also, there are no pre-requisite qualifications laid down to start a lab, even the accreditation is not mandatory. These policy lacunae have led the diagnostic industry to move into the unorganised sector. In the developed world, they usually have a law making

february / 2012 www.ehealthonline.org

registration compulsory. Accreditation is mandatory. Over the years, we have seen the emergence of the large corporate labs in the organised sector, however, these constitute only 8 percent of the industry, the rest 92 percent lie in the unorganised sector. In last 15-20 years, we have been seeing the positive trend of corporate hospitals including laboratories as their internal infrastructure. The diagnostic sector in India will take a minimum of 15 years to be of global standards. What is the level and nature of IT applications in your laboratories? How is it adding value to your business efficiency? In the diagnostic sector, technology is more important than pathologist. Each machine runs on IT and the entire, end-to-end process of a lab from the entry of the patient to the delivery of his/her reports is done by use of IT. Even the accuracy of the report is driven by IT. It helps me even in sorting out, how many reports are normal and how many have discrepancy. IT has become so important, that I can’t afford to have my IT systems down for even an hour. And with its growing role and functions in the diagnostic sector, I foresee a time when I will need more IT personnel than pathologists. In today’s competitive times, if I want to have an edge over others in terms of quality, service, turn-around-time and efficiency, then I have to keep adding new features to deliver better service and keep going up the ladder. IT and services are going to be the key differentiator.

perspective

Well known for its quality processes and quality reporting, Elbit is one of the leading medical diagnostics laboratories in Southern India. Kaushik Basu, Chief Operating Officer, Elbit Medical Diagnostics Ltd, shares his perspectives on the clinical laboratory business in India and Elbit’s journey through this dynamic market

“Indian

Diagnostic Market

is Evolving” Please provide a brief background of your company. Tell us about its reach in India and overseas? Initially, Elbit Medical Diagnostics Ltd. was 50:50 joint venture with an Israeli company, Elbit Imaging Ltd. The Indian promoter in the joint venture was the late M P Chary, the Co-founder and Vice-Chairman of Dr Reddy’s Laboratories (DRL). In the year 2000, the venture became a wholly owned subsidiary of Chary group. Elbit is one of the few diagnostics centres offering comprehensive diagnostics-imaging, pathology and nuclear medicine under one roof. Elbit has three state-of the-art centres, in Hyderabad, Bangalore and Vizag. The company has two referral labs, the first at Hyderabad and the other at Bangalore. Both the labs are certified by NABL (National Accreditation Board for Laboratories). All Elbit centres are certified by ISO.

february / 2012 www.ehealthonline.org

What is your outlook on diagnostic industry in India? Indian diagnostic market is evolving. It was worth around US $ 2.4 billion in 2010. Even though organised sector market share is only 12 percent, it is growing very fast and it is likely to become 50 percent in the coming decade. Increased health awareness and affordability is driving the demand for “Quality Diagnostics”. Medical practice is undergoing a paradigm shift from “treating” to “early detection and prevention”. Diagnostics plays a major role in accurate detection of health risk and diseases at early stage. The industry is poised to grow by over 20 percent year to year in next 10 years. Both Imaging and Pathology have become equally important in diagnostics. What is the nature of IT applications being used in your laboratories? Elbit laboratory is completely automat-

ed. We run a dedicated ERP system. The entire set of operations from billing to report delivery is totally computerised. The patients can download their pathology reports directly from our website. They don’t even need to visit the centre for report collection. We also offer teleradiology solutions for remote reporting of CT and MRI scans. What is the role of accreditation and regulations in the diagnostic sector in India? In India there are over 30,000 small labs run mostly by technicians. Majority of these labs do not follow the quality standards. They churn out reports, which are either falsely positive or falsely negative. The poor quality of these reports often results in wrong diagnosis. This leads to increased health care costs, complications and even higher mortality. It is necessary for Government to intervene in the sector. A legislation needs to be passed for making accreditation of the diagnostics centres mandatory. What is the future growth model of the company? Elbit’s growth model is to offer affordable diagnostics to the BOP (Bottom of the Pyramid) areas. This means that we are focussed on bringing innovative technologies like Teleradiology, Telepathology and tele-ECG to tier-II, tier-III and rural markets.

26 - 27 July, 2012, New Delhi

Where Education Takes Centre Stage

Conclave of Global Leaders in Education

Expo: Global showcase of education technologies

Thematic Sessions Confluence of Thinkers, Innovators, Experts Expositions on Digital Technologies Interactions with School and College Leaders highlights • Power tracks on > School Education > Higher Education • • • •

Ministers’ Conclave Secretaries’ Conclave Industry Leaders’ Conclave Education leaders’ conclave

Awards: Recognising global innovation and excellence in education

Programme chair

Prof. SS Mantha Chairman, AICTE

For Programme Inquiries: Sheena Joseph, E: sheena@elets.in, M: +91 8860651644 For Sponsorship and Exhibition Inquiries: Fahimul Haque, E: fahim@elets.in, M: +91 8860651632

www.worldeducationsummit.net

tech trends

Labs go Hi-Tech LIS ensures quicker availability of test results, thereby reducing the time to report, which can save invaluable patient lives By Dhirendra Pratap Singh, dhirendra@elets.in

aboratories constitute the core operational component in any specialty hospital set up. Often, they are the most humongous generators of data and information, providing the most crucial input for doctors to decide the course of treatment. With increased adoption of process automation in hospitals, the demand and market potential for Laboratory Information Systems (LIS) is growing. Laboratory information system is a generic term used to denote the computer systems in clinical and research laboratories. It is a suite of software applications for managing the daily operations/workflow of a laboratory. LIS has multiple modules for data collection, tracking, analysing, reporting or delivery of results. The data can be related to patients, lab employees, samples, results, instruments, consumables or reagents. LIS

february / 2012 www.ehealthonline.org

can be used for workflow management, accounts and control of instruments if integrated with the system. While the LIS plays an important role in ensuring accurate laboratory results, it does not work alone. The test results/reports of patients are usually interfaced with the electronic medical records (EMR) to ensure that clinicians can get access to updated/complete test results. Together with patientsâ&#x20AC;&#x2122; results gathered from other departments (e.g. Radiology), the EMR enables the clinician to obtain a comprehensive overview of patientsâ&#x20AC;&#x2122; medical histories. This enhances the clinical decision-making process and ultimately leads to improvement in standards of patient care. LIS can support sub-specialties of the pathology laboratory, including haematology, chemistry, immunology, blood bank, surgical

tech trends

pathology, anatomical pathology, flow cytometry and microbiology. The inputs into a LIS have a uniquely identifiable physician order and a matching patient sample. These are then matched with the patient record and the order is processed. The outcome of the test is manually or electronically added to the patient record for access by the physician. LIS can ensure quick availability of test results and analysis in ICUs, operating rooms and emergency room settings. When there is faster turnaround time, there are better chances for saving the life of a critically ill patient. LIS can be integrated with point-of-care diagnostic devices at these locations for information management. The value of providing detailed results to clinicians in real time cannot be undermined. A majority of initiatives advocating the use of information technology in hospitals or clinical practices focus on EMR systems. While advantages of EMR systems have been substantially proven, an often-overlooked aspect of healthcare delivery automation is the use of information technology in clinical laboratories. India is burdened with different types of cancer and infectious diseases. The country contributes over 132,000 cases of the estimated 500,000 cervical cancer cases globally per year. Thus India’s contribution is of more than one-fourth of the world’s total cervical cancer cases. The role of diagnostics in addressing rapidly growing diseases is significant. Local healthcare providers have increased their reliance on diagnostic testing systems in order to be able to make the best decisions for their patients. The growing middle-class also recognises the value of pathology testing and is willing to pay for these tests. This is reflected in the over 20 percent CAGR in the last five years in India’s diagnostics industry.

Benefits LIS provides a number of benefits. It can ensure quicker availability of test results and analysis in ICUs, operating rooms or emergency room settings. LIS can be integrated with pointof-care diagnostic devices for information management. The value of providing detailed results to clinicians in real-time cannot be undermined. In a study conducted at Massachusetts General Hospital, the clinicians’ improved accuracy in 70-80 percent of the cases, as expert opinions of pathologists got facilitated through the LIS. The concerned pathologist used an LIS with clinical decision support for providing narrative interpretation with every lab result to cohort of clinicians. Sanjay Kumar Jain, Managing Director, Akhil Systems Pvt Ltd., says, “The flexible and easy to configure setups help meet the reporting requirements of all branches of the laboratory. The product is designed for automated bi-directional data exchange with the laboratory equipment, which will help reduce chances of incorrect data entry and also help reduce the time involved in processing the final reports. The system is capable of communicating with external systems using HL7 and EDI standards.” He adds, “When the lab receives any specimen in the system, the specimen is assigned a chorological number accord-

“The product is designed for automated bidirectional data exchange with the laboratory equipment, which helps reduce the time involved in processing the final reports” Sanjay Kumar Jain Managing Director, Akhil Systems Pvt. Ltd ing to the predefined defined criteria for each branch of the laboratory. The systems also generates bar coded labels, which are run on the laboratory equipments. The labels are scanned and the patient’s tests and related information are read by the machine and the tests are processed further.”

LIS and SaaS Cloud computing offers a new approach that will transform the delivery and consumption of IT services of a company in future. In cloud computing, Software as a Service (SaaS) is a very promising field, one that brings a lot of benefits in LIS. SaaS is a model of software deployment, where an application is hosted as a service provided to customers across internet. Peter Jose Palal, Product Manager, Encora Technologies, says, LIS on a SaaS platform presents a cohesive model of applications that helps hospitals and labs of disparate nature to seamlessly interact among themselves and execute lab orders and receive results in a faster and efficient way. LIS on SaaS platform makes information technology available to the patient, physician, lab technician, etc., making them a close knit community and is the best example of software emancipation of humankind. It can be called ‘The Facebook of LIS’, except that it’s highly confidential!” The online services in SaaS include subscription-based models, on-demand applications and hosted services. They provide end users with a consistent experience across various client devices. Microsoft SharePoint Online is an example of such a service. Google, Amazon, SalesForce.com, IBM, Zoho and CRM are examples of SaaS cloud providers. SaaS (software as service) is being used to deliver a variety of e-Governance cloud services, such as Singapore’s Trade Net-a Single electronic window platform, that enables imporfebruary / 2012 www.ehealthonline.org

tech trends

central monitoring system, which picks up subtle changes in trends. Such a system is being set up under the World Bank funded Integrated Disease Surveillance Project in India. LIS can provide surveillance data to public health agencies, using the accepted standards, and these data could be about reportable diseases, infections, tumour registries, etc.

Evidence based medicine tools

“LIS on SaaS platform is the best example of software emancipation of humankind” Peter Jose Palal Product Manager, Encora Technologies

tant stakeholders within the supply chain to reduce the time needed to facilitate the trade process. In 2009, SaaS had a worldwide market share of USD 9.6 billion, while IaaS (Internet as a service) had a worldwide market share of USD 1.3 billion. By 2013, the SaaS market will grow to USD 17 billion, while in the same time frame IaaS will have an almost six-fold growth to USD 7.6 billion. IaaS will be on a high growth trajectory given that it provides options for customisation and standardisation. Disease surveillance for earlier detection of epidemics is another important benefit. LIS systems can be connected with a

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LIS can also facilitate evidence-based medicine. As the healthcare industry matures in terms of infrastructure and innovative technologies, the next goal of care delivery demands clinical excellence through evidence based medicine tools and benchmarks. Evidence based medicine is already being promoted globally and has been proved beneficial for all stakeholders - clinical teams, hospital management, and the patients. Evidence based medicinal tools, like clinical protocols and clinical pathways, provide explicit and well defined standards of care for the clinical teams and support multidisciplinary care planning. From a management perspective these tools reduce healthcare costs, reduce patient documentation, optimise management of resources and help continuous clinical audit. They improve clinical care by delivering superior outcomes, improved clinical effectiveness and patient satisfaction. These tools can also be integrated with the existing EMR for providing decision support to the clinical teams. Clinical protocols and pathways based on evidence available from the Indian sub-continent are now available and need to be adopted in healthcare settings to achieve the next level of quality. The right amalgamation of modern infrastructure, innovative technologies and clinical skills guided by evidence based tools will go a long way in bridging the gap in the Indian healthcare industry. The systems can be used for trend analysis, tracking of disease profiles and conducting research studies. Laboratories generate a lot of data, running into millions of test outcomes everyday. This data can be matched with appropriate clinical records to determine outcomes, which could dynamically influence the treatment plan. In a study, about 25 percent of primary care physicians found the expectations of care beyond the scope of their knowledge.The physicians will be well served with a LIS, which helps to provide interpretations to ordering physicians that are specific to patients’ needs and conditions.

tech trends

Latest

‘Tech KID’ on the Roads

By serving in emergency situations with great deal of efficiency, the MMUs mark the beginning of a new age of technology in the healthcare industry By Shally Makin, shally@elets.in

echnology has created a buzz in the healthcare industry; it challenges the doctors to keep track of the health of all their patients. The Mobile Medical Unit (MMUs) knocks at your door and delivers medical help, thus making emergency services easily available in all parts of the country. Accessing medical help was never that easy before the introduction of MMU in the country. Such special purpose vehicles plan to make an effort to take healthcare to door step of the public in rural areas, especially in under-served areas; the Government of India has approved mobile medical units at one MMU per district under the National Rural Health Mission (NRHM).

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As a part of NRHM’s mission 20052012, provision of a mobile medical unit at district level for improved outreach of services had been suggested. A mobile medical unit is a strategic step in the direction of achieving the aim of having improved healthcare in non-approachable areas.

Need of the Hour India does not have a single system, which can play a major role in managing emergency medical services. There are different emergency numbers in India’s 28 states and seven Union Territories. Hospitals in the country provide different telephone numbers for ambulance services. Clearly, India is in need of proper

emergency medical service that can be accessed from anywhere in the country. The existing fragmented system falls terribly short of meeting the demand. Emergency services department was made an independent entity in 2009, while trauma continues to be one of the major causes of death in India. The Centralised Accidents and Trauma Services (CATS) set up by the Delhi Government in the early 1990s, was then standardised to serve patients in emergencies. Legislation for emergency services in India has often proved to be ineffective in meeting emergencies. There is a need for having a common access number, trained paramedics, gradation

tech trends

of ambulance and hospitals, network of hospitals. It is also needed to define physical and human resources that will be needed for the service. Especially north-eastern states, due to their difficult hilly terrain, non-approachability by public transport, and long distances for reaching the health centres necessitate the need of MMU with specialised facilities for the patients requiring basic specialist examination.

Modelling the ‘Unit’ The initiatives to deliver quality health services through MMU is well appreciated in states like Bihar, Haryana, Jharkhand, Madhya Pradesh, Maharashtra, Himachal Pradesh and others. These states have equipped most of their districts in the first phase itself. The projects are majorly implemented through a PPP model. The expanded role of private players including Tata motors, Siemens, Bafna Healthcare and Swaraj Mazda, in delivering healthcare

services has made such medical facilities units to be on roads to assist the needy ones. Ambulances are categorised into various sub-categories such as emergency ambulance, patient transport ambulance, response unit and charity ambulance depending on their functional use. The major producers of these vehicles are Swaraj Mazda, Force Motors and Maruti Suzuki India Ltd. GVK EMRI has already proven to be one of the most accessible services connected just through one single number. Following its footsteps, various other hospitals including Fortis and Medanta have started their emergency services which are equipped with the latest technologies accompanied by a doctor, nurse, X-ray technician, lab assistant, OT (operation theatre) assistant and a paramedic. Today the MMUs are designed in a way to have facilities for emergency operation, pathological investigations, incubator and kits for pregnancy and HIV

tests. Advanced investigation gadgets like portable X-ray machine and ultrasound machine and ECG machine too would be available in these mobile units. A basic MMU would also distribute free medicines to the needy ones and would have all the emergency drugs, antibiotics, anti-allergic, antipyretic, iron and folic acid tablets in addition to other medicines, which are used in common diseases. MMUs provide free check-ups and medicine to people of 60 plus age group. They also attend to lower age groups in case of emergencies or if mobility of the patient is a problem. The multi-utility vehicle is proving to be a good ambulance in case of an emergency. A high roofed Winger Ambulance from Tata Motors is a preferred vehicle for ambulances. It can be redesigned for allowing smooth drive and safety ‘within budget’ price. It has also been termed as ‘Hospital-on-Wheels,’ one that meets the technological requirements. Such MUVs are designed to have the least car-like

Tête-à-Tête with Dr Dina J Shah, HOD Emergency Medicine, Fortis Hospital, Noida

In India, services need to be more approachable. People think that emergency does not need any equipment, but we A well equipped ambulance is really the need of the hour. Ambulances at Fortis are of high standards. A mobile medical unit should be in each and every district. We can also have larger ambulances, which can be equipped with a consulting room, x-ray and examination room. Of course there

must be enough space for people to consult their doctors and nurses. MCI recognised emergency medicine as a separate entity in August 2009. In another 10 years, qualified trained doctors will be on the move to deliver emergency services. The system must be able to address primarily basic burns, poison, bites, fracture, splinting, etc. Basic Life Support (BLS) Ambulances provide transport to patients who do not require extra support or cardiac monitoring should include splint treatment and CPR capabilities with advanced life support system. Ambulances provide transport to patients who need a higher level of care with certain systems such as plus defibrillator, ECG, cardiac monitor, portable ventilator, suction machine, resuscitation kit, electrocardiogram, emergency medicines and pulse oximeter. We have set up separate network in Fortis with a one number system cen-

tralised to all Fortis centres including Jaipur, Mumbai, Chandigarh and Bangalore. A doctor can provide advice on mobile and the information can be used to organise better treatment of the patient. Combining ambulances with ER is the biggest step taken by the Fortis group. Central calling system has been working for 6 months. Fortis will soon start using Mercedes ambulances, which are imported from Turkey and will be seen on the roads once the licensing processes have been cleared. The advance training to the paramedics is being observed. Central calling, tracking system, 3-way call, data collection and other medical facilities in the ambulances contribute to the digitisation of the entire process. To avoid failures of losing lives of critical patients the system insists on training personnel to build confidence in them to deal in critical situations.

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tech trends

Flying High Aero medical operations in India are gradually developing the expertise to provide medical assistance in far flung areas. Many critically ill patients will be able to benefit from the robust medical platform of this service. • Eurocopter India Private Limited intends to develop a countrywide MRO network. The service will be developed in collaboration with Pawan Hans Helicopter Ltd., which is the world’s largest civil operator of AS365 Dauphins. The AS365 Dauphins will be used for in-country MRO service. There are also plans to transform an AS365 to serve as a full-flight simulator capable of training the flight crew. • Air Rescue One, a service that is available 24/7, is a joint initiative of Deccan Charters and Escorts Heart Institute and Research Centre and Apollo Group of Hospitals. • Dr Nitin Yende established Vibha Lifesavers as a comprehensive medical transport system in 1996. Their range of services includes providing medical escorts to commercial airline, stretcher

In Column

services to evacuate critically ill patients to any destination in India and abroad. • Ashoka Rescue provides Geriatric Care and expert opinion on medical problems. It can transport Specialist Consultants through Chartered and Commercial Airlines. • To give a fast and affordable air medical transportation Prime Air Ambulance has latest Aircrafts. Prime Air Ambulance’s aircrafts are well equipped with medical equipments. The trained flight crew is trained in medical methodologies. • Fortis Escorts Heart Institute has a dedicated team trained in aero - medical transport of critically ill cardiac patients. For evacuation, a fully trained team, comprising of a cardiologist, an anaesthetist, a nurse, a cardiac surgeon (if required), with all the essential life saving equipments like the ventilator, defibrillator, monitor, IABP and so on, is dispatched to the destination in a 6 - 8 seater aircraft/ helicopter.

Anjan Sen, Director, Strategy and Operations, Deloitte, India Do you think an emergency service in India needs to be better approachable and equipped? Despite development in overall healthcare, India is yet to see a comprehensive Emergency Medical Services (EMS) system in place. It is a well-accepted fact that a patient who is given basic treatment by trained professionals and is shifted to a medical facility within 15-20 minutes of any emergency has the greatest chance of survival. With an increase in population and more number of vehicles plying on Indian roads, number of accidents is on the rise. Reaching hospitals can take hours which could prove to be fatal to the patients. All these factors included, there is a need for

noise, vibration and harshness (NVH) levels. A bump-free ride and a 100 percent comfortable patient drive is important. Speed, manoeuvrability, efficient braking and suspension, and high grade ability and stability is also a must. Priced between ` 4.70 Lakh to ` 6.55 Lakh, Tata Winger is one of the most economical ambulances in the market. Swaraj Mazda on the other hand has been a long time leader in the industry with thoughtfully designed vehicle to transport patients speedily and comfortably. The ambulance has a complete first aid kit, oxygen supply system with 2 no’s outlet, anti acidic stain free vinyl floor, rear flood light, fire extinguisher, wash basin, foldable stretcher cum trolley, provision for pure drinking water and electrical provision for ac/dc supply ( 220 v / 12 v ). Transportation of critical patients to hospitals in emergencies should be a comfortable experience. This will assure safety, including efficient LSPV (Load Sensing Proportional Valve) brake system and low centre of gravity for better stability. Fog lamps, which offer excellent visibility during winter is an important requirement. As a part of Corporate Social Responsibility, many companies have come forward in improving emergency services. Wockhardt Foundation has entered into a strategic alliance with Welspun to jointly launch Mobile Health Reach, a healthcare programme in Mumbai.

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well-equipped ambulance services in India. These ambulances should be easily accessible and should have trained professionals with basic healthcare facilities in place Tell us about the various Mobile medical Units being operated across the country. In India, we have a lot of fragmented mobile medical units in operation. Typically, most state governments run mobile emergency units which are reachable at the phone number 102/ 108. Local institutions and corporate hospitals also provide mobile medical units which transport patients for a particular charge. Some NGOs have launched mobile healthcare units to serve targeted sections of the society. Smile

tech trends

Siemens healthcare has a come up with a refurbished concept of mobile medical unit. Sanjeevan, a mobile healthcare clinic developed by Siemens Ltd and equipped with Siemens healthcare technology will be deployed at Medanta. At Wockhardt Foundation Mobile Medical Units come under 3 broad mobile programs-Mobile 2000, Mobile 2000 I, Mobile 2000 Urban. Dr Huzaifa Khorakiwala, CEO, Wockhardt Foundation has designed these programs to meet a specific need. Mobile 2000 programme has been aimed at delivering free primary healthcare at rural India in systematic and professional manner. Under the Mobile 2000 program, we aim to start operating 1000 mobile units by June 2017 and delivering primary healthcare to 25 million Indians in rural and remote India. There are advancements in the diagnostic equipments where results can be shown on the spot in a cost effective range. Telemedicine shows a great scope in keeping these medical units well connected. At Wockhardt Foundation we believe in the 3 B’s – Big, Best and Beautiful. We aim to provide quality healthcare to 25 million Indians through the Mobile Medical programmes, which will cover people from poorer sections of society. By June 2017, our Mobile 2000 umbrella will have more than 1000 mobile units for the poor, weak and needy and would play

Dr Huzaifa Khorakiwala CEO, Wockhardt Foundation

“At Wockhardt Foundation, we aim to provide quality healthcare to 25 million Indians through the Mobile Medical programmes, which will cover people from poorer sections of society; By June 2017, our Mobile 2000 umbrella will have more than 1000 mobile units”

Foundation (an NGO) provides medical services for women and children in urban slums and remote rural areas. Avert Society, another NGO; in association with other NGOs provides mobile and free HIV/ STI testing and treatment to at-risk population. Corporate entities like GVK EMRI and Religare Voyages are also in the business of offering ground and air ambulance services respectively. How far do you think such mobile services can deliver healthcare facilities to the masses? Smile Foundation’s ‘The Smile on Wheels program’ at present has 12 operational projects running in 11 locations covering 172 slums with the population of 10.67 lakh in 9 states of the country. Since inception in 2006 this program has directly benefitted 3, 89, 552 beneficiaries. Similarly, there are other initiatives which have been able to serve lakhs of people across the country in delivering healthcare. We will need innovation in delivery and reach and usage of technology to cover more needy

a sizeable role in addressing the primary healthcare to the masses of India. Such ambulances, which boast of latest advances, can be customised as a Mobile Medical Unit, Critical Care Unit, Blood Transportation Van and much more. The mobile medical units are proposed to have specialised facilities and services such as X ray, ECG and ultrasound to address the diversity and ensure the adoption of most suitable and sustainable model for MMUs to suit their local requirements. The software enables real-time tracking of ambulances, using GPS to ensure the closest ambulance can reach an emergency caller. All control room staff is trained EMDs (Emergency Medical Dispatchers) who carefully question callers to determine the type of emergency, extent of injuries suffered, and possible instructions before the ambulance arrives. EMDs also stay in contact with the ambulance staff to coordinate with the medical workers at area hospitals. With the introduction of such state-ofthe-art ambulance facilities in all parts of the country, the health status of rural and urban population can be improved. Such advanced life support systems are slated to become more popular, as the healthcare industry makes a major attempt to delivering healthcare at your doorstep.

patients. In the long run, we will also need to monetize the service offerings to keep delivering mobile healthcare services on a sustainable basis. The government needs to get involved to improve overall access to the masses. How do you perceive the advancements in the technology being used for such medical units over the years? Advancements in technology can help the doctor (sitting in the medical facility) to guide the caretaker in the ambulance to give proper first aid to the patient so that his chances of survival increase. Automatic transmission of information regarding vital signs and then calculated decisions based on that information can save crucial time which can be life saving for the patient. At the same time the hospital can also be prepared with all necessary arrangements for the patient to arrive so that immediate actions like surgery could be done. For mobile medical units which cater to patients in the remote areas, telemedicine and advancements in remote diagnostics can drive the industry forward. february / 2012 www.ehealthonline.org

news mhealth

Smartphones blamed for increasing risk of health data breaches The number of physicians using smartphones has reached a near-saturation point. Meanwhile, the number of data breaches is going up. Recent reports by Manhattan Research have found more than 81 percent of physicians use a smartphone, up from 72 percent in 2010. Also on the rise have been data breaches, which, according to research released in December by Ponemon Institute, have risen 32 percent in the past year. Ponemon found that 96 percent of all health care organisations surveyed said they had experienced at

least one data breach in the past two years. The report did not specify the percentage of breaches from mobile devices. But it stated, “Widespread use of mobile devices is putting patient data at risk.” Larry Ponemon, chair and founder of Ponemon Institute, commenting on its first study of patient privacy and data security, said, “This year it seems the issue of mobile devices has ratcheted up, because the adoption rate of smartphones that are really smart, or tablet computers, seems to have increased significantly.” Ponemon said mobile devices create a security risk

in two ways. Data can reside on the device and can be accessed. Also, the device can be a way of gaining access to data that reside on electronic medical record systems at the health care organizations. Plus, many note, smartphones’ size makes them easier to lose than a laptop. Either way, someone who finds a lost device -- or the thief who stole that device -can gain valuable data if that phone is not secured. Ponemon’s study looked at only 72 health organizations. However, mobile device security is a primary concern throughout the health care field.

MIT researchers aim to use smartphones to track health issues

Bharti Airtel Religare Technologies to offer medical advisory

Researchers from the Massachusetts Institute of Technology have developed a mobile health tool that uses data collected from an individual’s smartphone to track potential health conditions. For a 2009 study led by MIT doctoral student Anmol Madan, researchers gave smartphones to MIT students and tracked who they communicated with, how often they communicated and where they traveled. The study found those students who had contracted influenza moved around much less than those without the flu. Researchers also found that students with depression had fewer phone calls and interacted less with others. After the study, Madan and his classmate Karan Singh started Ginger.io to market their mobile health technology, which uses machine-learning techniques to sort through the tens of thousands of data points that come from a smartphone each month. The tool works by tracking an in-

Airtel, India’s largest mobile phone operator, has recently tied-up with Religare Technologies, a company controlled by promoters of the Fortis hospital chain, to offer healthcare solutions and guidance over telephone. By paying an introductory tele-consultation fee of ` 15 a call, Airtel customers can get basic medical guidance on non-emergency health problems through this service, 24 hours, seven days a week. Airtel charges just 50p for this call. With a customer base of 173 million, Airtel’s latest value addition is expected to provide a productive platform for Religare to promote their e-health service. Says the latter’s senior vice-president, healthcare IT, Nitin Goyal, “Mobile health is an interesting area, with tremendous growth potential. The play is huge. We plan to build a credible base through this exclusive partnership. Airtel is not the first to introduce a mobile health scheme in the country, a recent trend. Some months earlier, telecom operators Aircel and Idea had launched a similar service in association with the Apollo Hospital group-promoted Healthnet Global. Such tie-ups are increasingly seen as a good value addition for telecom companies and a business opportunity for healthcare providers.

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dividual’s typical behavior patterns. When it detects a behavior deviation that could signal depression or other health issues, the tool could alert the individual’s family, friends or physician that an intervention might be necessary. The researchers said the tool does not read the content of conversations or text messages, and limits the data that are submitted to external organizations like insurance companies. In October 2011, Ginger.io raised $1.7 million in venture capital from True Ventures and Kapor Capital. Madan and Singh said they plan to use the funds to build a series of apps that health care providers, insurers and drug companies could offer to patients.

MAHARASHTRA STEERING E-INCLUSIVE ECONOMY APRIL - 2012, MUMBAI Meet & Network with Key decision makers & experts, bureaucrats & policy makers, service providers & IT vendors, telecom vendors & consulting firms, ICT entreprenuers & NGOs on innovative e-Gov implementations, government agencies & developmental organisations in the domain of ICT for Governance, Healthcare & Education in Maharashtra Engage with Colleagues and Experts handling similar ICT projects, dealing with transformation and GPR challenges, working on automation of back office processes and integration. Benefit from extensive & in-depth conference sessions on thematic areas in the field of e-Governance, e-Learning, eHealth, eAgriculture and CSCs.

Witness innovative solutions from within the Indian ICT industry and beyond at eMaharashtra which will showcase cutting edge developments in ICT. Key officials from IT, Health, Education, Urban Development, PWD, Agriculture, Rural Development, Home, Planning, Power, Finance, Transportation and Taxation departments; officials from districts and municipalities

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In Conversation

Dr Devlina Chakravarty COO & Medical Director, Artemis Health Institute, Gurgaon

february / 2012 www.ehealthonline.org

In Conversation

â&#x20AC;&#x153;IT Leads to Tangible Benefitsâ&#x20AC;? Dr Devlina Chakravarty, COO & Medical Director, Artemis Health Institute, Gurgaon, believes that there should be a seamless integration of different spectrums of healthcare. While speaking to Shally Makin, she sheds light on the dedication with which Artemis is providing care to its patients What is the role of ICT in hospitals? How far have you implemented it in your hospital? Artemis has created a strong IT infrastructure to strengthen its services. Spread across a total area of 525,000 square feet the facility focuses on offering patients technology-backed world-class healthcare delivered through leading medical professionals. Artemis has received Most Promising Start-Up of the Year 2007 award by Express Healthcare magazine and Best IT Implementation for the Year 2008 from PC Quest magazine for Hospital Information System. The hospital has one of the best integrated ICT systems. All the medical information is stored on EMR, which is seamlessly integrated with HIS and RIS. When a patient walks in, the medical records are already with the hospital, further delivering effective healthcare. Recommendations of a doctor can be recorded at every visit of the patient.

(BP/ heart beat, etc.) is updated and recorded. AHI has a web enabled Health Information System, which allows the authorised doctors to access patient data from anywhere in the world. Even when the doctor is travelling, he can offer a consultation or advice on the line of treatment. Appropriate measures are taken for protecting the data. The real time Image Guided Radiation Therapy (IGRT) is one of its kinds in North India. This allows for radiation to be delivered exactly where required, with minimal impact on the surrounding healthy cells. An Endovascular Suite equipped with the latest in 3D rotational imaging to perform neuro-interventional, cardiac catheterisation or peripheral endovascular procedures with precision. An in-house bio-repository and a 24-hour blood bank with the facility to conduct Individual Donor NAT (Nucleic Acid Amplification Test) is also a part of the IT systems enrolled in the hospital.

Please brief us about the various technologies, software applications, medical and diagnostic equipments being used in the hospital to providing effective healthcare. Artemis provides highest level of inpatient monitoring, paperless and film-less hospital information system along with top of the line communication technology. Seamless integration with the Hospital Information System in each department is enabled. Each patient (Inpatient or OPD) who comes to Artemis is given a dedicated code. All reports, data, medicine prescriptions are uploaded on the system and even if the patient walks in to AHI after a year, he need not carry any reports or files. AHI systems will have a copy of the records. The doctors can type their prescriptions and give it to the patient. We have in place an intelligent critical patient monitoring system with clinical decision support application backed by portal imaging technology. It is an integrated system through which the data of the ICU patients

How do you see Artemis standing upright in the healthcare industry? Artemis is striving towards creating a niche in the industry. The expansion of the institute to Delhi-NCR and other places is in the pipeline. It believes in providing excellent clinical outcomes, good services and becoming a preferred destination for international patients. Industry is innovating very fast; new technologies are being brought in all the time. There is a dire need of trained professionals in the industry. For many technicians, IT is a new field. We intend to judiciously use technology because it has increased the healthcare costs. In order to quickly incorporate IT in hospitals we need to keep tangible benefits. The vendors provide us with trained technicians and software experts to help doctors and the existing staff to operate the new systems and equipment. This proves to be a cost effective method, it also saves training time. With such high end latest equipment and infrastructure for predictive, diagfebruary / 2012 www.ehealthonline.org

In Conversation

â&#x20AC;&#x153;Artemis is striving towards creating a niche in the industry. The expansion of the institute to Delhi-NCR and other places is in the pipeline. It believes in providing excellent clinical outcomes, good services and becoming a preferred destination for international patientsâ&#x20AC;?

nostic and therapeutic imaging, the organisation can provide best possible treatment to the patient. Do you think such services have enhanced the level of healthcare delivery? Healthcare industry in the India is a sunrise industry. We have so many hospitals with best technology, IT back up and highly trained doctors and best infrastructure. There is a shortage of very well trained professionals and technicians. Since IT is the backbone of healthcare institutions, we are trying to poach experienced and qualified doctors to be part of tech-oriented hospital. We need high numbers of medical-IT professionals. Artemis follows patient-centric processes conforming to International Patient Protocols, thereby establishing new standards for service and care. The new arrivals have to basically do lot of learning on the job. A lot of reluctance was seen from the staff initially, but as doctors have realised the potential of IT, the acceptance amongst the staff and doctors has increased. Do you think ICT has started providing emergency services as well? If so, what are the services being provided in your hospital? Aero medical transportation is provided to the patients for emergency evacuation by air. It includes search and rescue systems. Skilled personnel are transported to the scene

february / 2012 www.ehealthonline.org

of accident, along with equipment and medical material to provide on-site. Inter-hospital or intra-hospital transfers, national or international repatriation, and transportation of donor organs and drugs is also offered. Domestic and international ambulance services are provided in case of emergency. Almost 40-45 percent conversion rate has been observed in case of critical patients, as the services provided to them are world class. However, there is a need of a centralised emergency number with fleet of ambulances, which can provide effective service. Ambulance plays a big role in trauma and accident. Most private hospitals look for their own patients. But the challenge is how to take care of the patient in case of a road accident. The issue of transporting the patient to the nearest hospital in case of an accident must be jointly addressed by the government and the hospitals. How do you see the advancements in the field of radiology over last few decades? Which areas of healthcare have mostly been benefited through such technologies? Radiology has progressed in leaps and bound. Today almost anything and everything can be diagnosed by radiology. Initially only x-ray and ultrasound has moved on to PET CT scanners, high Tesla MRI which does both anatomical and radiological imaging. Interventional radiology is the need of the hour today, because so many procedures require diagnosis of the disease. Radiology equipments, including ultrasound, can be of therapeutic use in some cases. It thus provides a simplistic, cost effective model of treatment leading to lower mortality and morbidity rate. The clinical outcomes are so good that the cost is valued for money and the ambience is excellent. In times to come, India can become the hub of medical tourism. I think itâ&#x20AC;&#x2122;s the great time for the healthcare industry to make hay while the sun shines.

Speciality

At the Forefront of

Diagnostics

The improved techniques in radiology have dramatically increased the range and the scope of diagnostic information By Dhirendra Pratap Singh and Shally Makin

february / 2012 www.ehealthonline.org

Speciality

adiology is the key diagnostic tool for many diseases. It plays an important role in monitoring treatment and predicting outcome. It has a number of imaging modalities in its armamentarium that have physical principles of varying complexity. This medical specialty employs imaging to diagnose and treat the diseases. Shortly after the discovery of xrays at the end of the 19th century, radiology has been a medical specialty that is dedicated to excellence in the provision of imaging services to support the care of patients. There have been dramatic advances in the field of radiology in the past few decades. Today the imaging armamentarium includes multi-detector row CT, MRI with a host of advanced sequences, PET-CT, digital mammography etc. While all segments of healthcare have benefited from such technologies, those that have seen the greatest benefits are the subspecialties of neurology/neurosurgery, oncology, orthopaedics and cardiology/cardiac surgery. Radiologists, these days, are involved in these technological developments and have been responsible for much of the evaluation of the strengths and weaknesses of different investigations. Radiologists have developed the knowledge of the appropriate integrated imaging algorithms, which maximises clinical effectiveness. They are responsible for the implementation of these developments into the clinical setting and for ensuring the best use of assets and healthcare resources. The improved image clarity and tissue differentiation in a number of situations has dramatically increased the range of diagnostic information and in many cases the demonstration of pathology without the requirement of invasive tissue sampling. The use of imaging for functional evaluation and cellular activity has created a new challenge for radiologists whose training has predominantly been based on the anatomical and pathological model with limited experience in physiology and cell function.

Market The radiology market in India is growing very fast with investment being poured in as a result of Indiaâ&#x20AC;&#x2122;s economic growth. There is a profusion of high-end imaging technologies, not just in the major metros but also in tier II and III towns. The technology gap between west and east has disappeared and the latest technologies are today unveiled in India simultaneously with the West. This is a heartening trend. Consumers are becoming more enlightened about their healthcare and diagnostic needs and more discerning of their choices, thanks to the availability of information on the internet today. People have started expecting quality imaging, and they are less likely to be manipulated by corrupt practices in our system, such as referral fees and the like. Indian health imaging market is expected to double from the existing `1,575 crore, in the next five years. X-ray, ultrasound, CT and MRI will drive this domain and collectively account for 68.6 percent of the health imaging market. Tele-radiology

holds 90 percent of the market share in the country, growing at 50 percent year on year. Since the days of X-ray, various technologies have exploded in the radiology market. Major evolution has been noticed in the domain of CT, MRI and ultrasound, while digital radiography and teleradiology have given a whole new meaning to diagnosis.

Interventional Radiology Advances in interventional radiology have simplified most of the procedures while retaining safety. There are fewer instances of trauma to patients. Besides angioplasty, drainage procedures, tumour ablations, and embolisations are now increasingly becoming image-guided, minimally invasive interventions, due to the refinements in technologies. Successful evolution of IR procedures could be attributed to advances, such as improved multidimensional imaging techniques, microcatheter technology, improved guide wires, small sized

t ke r ma g y n og owi l o r i ad is g ith ng lt r i a e su Th Indi ast w t be a re ic in ry f men as nom a ve vest d in eco is -end , in ure iaâ&#x20AC;&#x2122;s here igh gies po Ind h. T of h olo jor r of owt ion echn ma n tie gr ofus g t the so i pr agin st in t al s im t ju s bu own no etro III t m and II

balloon catheters, vertebroplasty, drug eluting and flexible stents and removable vena cava filters. Interventional radiology (IR) utilises various imaging techniques such as CT, MRI to guide percutaneous minimally invasive procedures for both diagnosis and therapy. This has paved the way for applying IR to a vast number of medical conditions that are otherwise performed using invasive methods. february / 2012 www.ehealthonline.org

Speciality

Interventional Radiology is Definitely What the Industry is Looking up to Dr. Rajesh Kapur, Vice President, IRIA spoke about the scope of technology in the field of radiology which has now paved the path for the shining waves to travel and diagnose, identify and treat the diseased part

How do you see the advancements in the field of radiology over last few decades? Which areas of healthcare have mostly been benefited through such technologies? The advancement in radiology has evolved from conventional x-rays to ultrasound, MRI CT scanners to many other devices. We have benefitted a lot with such medical equipments, which help surgical specialities, specifically prosthetics and gynaecology, to diagnose and treat effectively. Many a times the surgery used to be exploratory rather than identifying the diseased in the pre-operative phase. The surgeon opens up the abdomen and look for the diseased part. Unlike today when ultrasound gives a clearer view of the body parts, and leads to a better monitoring and developing of treatments or of conventional surgeries.

Radioembolisation is a latest technique of intra arterial radiotherapy. It involves delivery of Yttrium 90 labelled microspheres into the blood vessels supplying the tumour The new position of the radiologist became even more envious with introduction of multi-slice volume CT scanners, superconducting MRIs, SPECT and fusion imaging, and teleradiology. With emergence of interventional Radiology and its advantages of minimal invasiveness in treating diseases, the radiologist has come close to becoming a surgeon. The innovation of digital radiography (DR) system has significantly improved the clinical workflow and efficiency of the department. It has also helped shorten the diagnostic and therapeutic decision-making processes. Additional benefits

february / 2012 www.ehealthonline.org

are improved patient comfort, reduction in radiation doses, higher examination throughput (i.e. multiple examinations during one visit) and a more pleasant atmosphere in the waiting room (through shortened examination and waiting times for xray). The x-ray images are available throughout the hospital, in a PACS environment. All this represents major benefits for the patients. Radioembolisation is a latest technique of intra arterial radiotherapy. It involves delivery of Yttrium 90 labelled microspheres into the blood vessels supplying the tumour. These microspheres get embedded in small blood vessels inside the tumour and emit beta particles which treat the tumour. Since the average penetration of a beta particle is only two millimetres, the radiation therapy delivered is highly targeted and is limited to the area of interest.

Nuclear Medicine In the course of a Single Photon Emission Computed Tomography (SPECT) scan, a three-dimensional image is obtained by rotating the detectors of the gamma camera around the

Speciality

Tell us about the latest technology which has revolutionised the imaging and diagnosis worldwide. Latest technology is now revolutionising the imaging and diagnosis worldwide. It is true that x-rays have advanced a lot over the years. 6-7 years back, the investigation was done in dark rooms and today the X-rays are very well exposed in a full bright light creating better impressions and imaging thus developing a digitised data. The maximum benefit is from ultrasound because the current scanners are now much better in terms of high frequency and clarity. New additions in radiology are the contrast feature in ultrasound, which was earlier seen only in MRI. It can pick up infection with greater degree of accuracy. Ultrasound equipments need to be registered with the authorities before use. There are 35,000 systems registered so far that are catering to more than a million people. Elastography can now tell us about the malignant tumours, which appear to be a little harder. Ultrasound has also gone into the therapeutic part, as they are combining it with MRI generally used to diagnose fibroids for prostate and breast cancers. The applications are

diversified with a cutting edge technology in biopsy with a greater use of 128 slice scanners. MRI is also getting better with 1-1.5 and 3 Tesla being the latest in the industry. India is catching up really fast with technology in the radiology market. Molecular Imaging cardiac shows promising future. With the industry witnessing a constant change in terms of advancements, share your views on the changing market trends? The market shows great opportunities for private players to invest in the industry. The equipments are really expensive and thus needs to be upgraded with government chipping in and making it economical for diagnostic centres to create high end facilities. The investment is really high. The diagnostic equipment needs to be much more economical. It is better to buy the technology at the right point of time otherwise it becomes obsolete. So by the time you have installed a version of the equipment a new system with better features appears in the market. The finances need to be worked out in such a way that small centres should get solutions which are worth providing facilities to the patients.

patient. For evaluation, slices in any orientation can be reconstructed from the original three-dimensional scan. PET scanning is a nuclear medicine procedure that deals with positrons. The positrons annihilate to produce two opposite travelling gamma rays to be detected coincidentally, thus improving resolution. With the introduction of improved instruments, allowing acquisition of whole body images in under an hour, applications in oncology have opened avenues for expanded clinical use of PET. With a focus on adding functional information to the anatomic knowledge, the ability to diagnose and treat will get better. PET/CT scanners will continue to revolutionise oncology. Interventional techniques will get more and more refined and the combined impact will place radiology in the forefront of patient management. In future will see enhanced efforts towards greater use of molecular imaging, which will enable us to detect lesions before they attain even pin-head size and are only at cellular levels. By understanding the molecular basis of disease and developing methods to detect and treat changes in the body at the molecular level, physicians will be able to

What are the challenges faced by the standalone Indian radiology providers vis-a-vis multispecialty corporate hospitals? Funding is the major challenge in the industry as it takes up to 5 years for an imaging centre to survive in the market. The people should take one step at a time to set up a small facility centre in their neighbourhood. There is a scope for standalone centres, which are generally advised by private practitioners. They do not send their patients to the organisations such as MAX and Apollo, as they can lose their patients. What are your views on interventional radiology? Interventional radiology is definitely what the industry is looking up to. They are trained to be part of every speciality. From cardiology to paediatrics all use ultrasound for surgeries and the credit goes to the radiologist for being in a position to help different departments of the healthcare industry. Ultrasound equipments need to be registered with authorities before use. There are 35, 000 systems registered so far that are catering to more than a million population along with unregistered systems further gratifying the whole country.

identify diseases in the earliest possible stages. This will by far remain the major focus of research and development in clinical medicine in the 21st century. The increasing proportion of imaging modalities that generate images in digital form has lead to the development of digital image management systems. Such systems referred to as Picture Archiving and Communication Systems (PACS) are emerging in clinical and radiological environments. It is an integrated set of information technology systems designed to provide a complete solution for image management in a film-less radiology department. While introducing PACS to the hospital environment, it is critical to establish a Hospital Information System (HIS) or Radiology Information System (RIS) beforehand. Integration of Radiology Information Systems (RIS) with PACS is a defining trend in the imaging market. In radiology, the safety of patients and healthcare personnel permeates most features of the imaging process. It is necessary to use the lowest dose possible of the ionizing radiation to either achieve the necessary images and arrive at a correct diagnosis. february / 2012 www.ehealthonline.org

news policy

Rajiv Gandhi Jeevandayi Arogya Yojana launched in Maharashtra

The Maharashtra government launched the Rajiv Gandhi Jeevandayi Arogya Yojana, enabling families with annual income of less than ` 1 lakh to avail free medical facilities worth ` 1.5 lakh. Health Minister Suresh Shetty announced that this scheme, when fully implemented, would benefit close to 2.5 crore families.

However, Deputy Chief Minister Ajit Pawar, while praising the scheme, lamented the rising rate of population in the State. Pawar asked Chief Minister Prithviraj Chavan to consider making the scheme available for people with not more than two children. Maharashtra, under its State population policy of 2000, has accepted the two children “small family norm” as a criterion for the implementation of its policies. Free education for all children can only be availed for the first and the second child; candidates with more than two children are not eligible for the civic elections and under the Maharashtra Water Act, farmers with more than two children have to pay one and a half times water tariff to get the water entitlements. The Yojana, which will be run in a public private partnership (PPP) mode with the National Insurance Company, will be first implemented in eight “most needy” districts in Phase-1, benefiting 50 lakh families. The beneficiaries will each get a health insurance policy, the EMIs of which will be paid by the State government.

FDA approves new formulations of VIREAD® US Food and Drug Administration (FDA) has approved Viread® (tenofovir disoproxil fumarate) in combination with other antiretroviral agents for the treatment of HIV-1 infection in pediatric patients ages 2-12. The FDA approved a supplemental New Drug Application (sNDA) for three lower-strength once-daily tablets of Viread in doses of 150 mg, 200 mg and 250 mg for children ages 6-12. The agency also approved a New Drug Application (NDA) for an oral powder formulation of Viread for children ages 2-5. The active ingredient in Viread, tenofovir disoproxil fumarate, is currently the most-prescribed molecule for adults re-

ceiving HIV therapy in the United States. Viread was originally approved by the FDA in 2001 as a once-daily 300 mg tablet for individuals ages 18 and over for the treatment of HIV-1 infection in combination with other antiretrovirals. In March 2010, the 300 mg dose was approved for use in the United States among adolescents ages 12-17. In pediatric patients, the use of either the lower-strength tablets or the oral powder formulation of Viread is based on the patient’s age and weight. The safety and efficacy of Viread has not been established in children less than two years of age. In HIV-infected adult patients, the dose is one 300 mg

Viread tablet once daily taken orally, without regard to food. For adults unable to swallow Viread tablets, the oral powder formulation equal to 300 mg may be used. The pediatric regulatory applications for Viread were supported by clinical data from a Phase 3 safety and efficacy study of a Viread-containing antiretroviral regimen compared to an antiretroviral regimen containing zidovudine or stavudine in HIV-infected treatmentexperienced children ages 2-12. The safety profile observed in the study was consistent with that observed in clinical trials in adults.

India becomes polio-free nation India has completed one entire year without registering a single polio case in any part of the country. What makes the feat so remarkable is that in 2009, India recorded more cases of polio than any other country in the world. Philanthropist and co-chair of the Bill and Melinda Gates Foundation, Bill Gates says the achievement is a “huge milestone in the history of global health”. The aim of the Bill and Melinda Gates Foundation is to enhance healthcare and reduce extreme poverty around the world – with the eradication of polio a top priority. The Indian government has funded its

february / 2012 www.ehealthonline.org

own eradication program, and worked closely with organisations including Rotary International, the World Health Organisation and UNICEF. More than 172 million children are vaccinated at 800,000 vaccinations booths around the country. With a handful of countries recording polio outbreaks, Gates says funding must be sustained to ensure a comprehensive immunization effort in India and other countries—until there are no more cases. Otherwise they virus can spread back into countries where it has been eliminated. In 2010, there were less than 1,500 reported cases of polio around the world –

however Russia reported its first outbreak of the infectious disease in fifteen years. Polio has now almost certainly been eradicated from Australia - according to the Queensland Health Department, the most recent case of polio caused by wild poliovirus was in 1978.

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Tech Story

Swallow Tablets

for Better Healthcare A revolution is happening in healthcare sector. It is called: Telemedicine 2.0. This new revolution is providing many with the hope of access to quality healthcare anywhere, anytime By Pragya Gupta

andheld devices have very important role to play in hospital information management and patient care. Devices like PDAs, smartphones, tablets, hand monitors, and scanners are easily available in the market. Tablets are the latest in the array of devices that the healthcare segment is betting on. Usage of tablet computers and smartphones in health segment has had the effect of providing us with better outcomes in patient care. Tablets and smartphones are widely being seen as tools for expanding the reach of education. But now the healthcare industry is taking the leverage of handheld devices like tablets to have an efficient health service delivery.

The Rise of the Handheld Healthcare industry works as an enterprise, which has far too

february / 2012 www.ehealthonline.org

many critical needs and features. Enterprise segment has always been chasing after mobility. Tablets were first accepted as mobile computing devices by consumers, but gradually their significance has been realised by two important sectors where reach is still a challenge - healthcare and education. Healthcare delivery is a function of diagnosis, care plan and timely action. The handheld devices can help in reducing the time that is usually wasted in transmitting information from one interface to another. Devices can lead to seamless integration of information leading to a faster decision making process. However, use of new devices and technology must be combined with good clinical practices. The handheld products and its applications are accepted in the vertical because of the mobility it offers to the doctors and patients for care and administration.

Tech Story

Devices improving healthcare delivery There are two major roles that tablets play in healthcare. The first is clinical role that is for patient care and the second is for non-clinical role, which is mainly administrative in nature. In the clinical process, these devices are directly used for diagnosis and care like the glucose checks, blood pressure equipment, ECG and ultrasound, etc. Over a period of time these devices have become smaller and smaller and are now more or less ‘portable’. Their non-clinical use offers CEOs and managers the facility to track the performance of the hospital. Use of tablets and smartphones keep them connected round the clock through closed group emails, group instructions, customer feedback, graphs, charts, etc. These days it has become common for ordinary stores and nursing counters to use the bar code scanners for quick disbursal. “Typically hospitals where I worked they use Bar code scanners in lab for sample collection and processing in automated equipment. There are glucometers in wards, portable USG, ECG, Blackberrys for communication and emails for all senior managers, and few other devices,” says Dr Akash S Rajpal, MD and CEO, EKOHEALTH Management Consultants Pvt Ltd and former AGM-Operations and IT Head, L H Hiranandani Hospital. Healthcare providers are always hard pressed for time. The premise of a handheld device is to bring information in a mobile work environment at the time of need. Such a promise holds a huge benefit in a healthcare setting. This can free the provider from being tethered to a desk. “In our hospital, we have implemented mobility of access device at the point of care by the use of ‘Computers on Wheels’. Access of diagnostic images on handheld devices and patient ADT messages are also being made available. Looking at the new age of tablets, I soon see some of the roles done on COWs moving to these tablets. Additionally, these tablets have good software’s for handwriting recognition, which the doctors really need for entering notes

into the computer,” says Neena Pahuja, CIO, Max Healthcare Pvt Ltd There are many other critical applications where tablets and handhelds are playing crucial role. Some of the important areas where handhelds are being adopted include ECG (OPD/ Consulting rooms, wards, ICU, casualty, and monitoring devices while shifting patient with bed/ambulance), Blood pressure devices, USG(portable in ward/ICU), Pulse oximeters (ICU/

Neena Pahuja CIO, Max Healthcare Pvt Ltd

Casualty), diabetes insulin monitors, fetal heart monitor(labour room/ward), TENS (Transcutaneous Electrical Nerve Stimulation(physiotherapy/ward/OPD), Tablet PCs for consultants, nurses to view patient charts/communication), inventory scanners (bar codes in lab, pharmacy and stores), Smartphones in administrative and nursing for dose calculation, home alerts, home monitoring devices after discharge

Market and players

“We are actively planning to extend the reach to our various data sources on hand held devices. Towards this end we are looking for windows based devices which should be cost and power efficient, and provide new features like handwriting and voice recognition”

A report has estimated that total handheld healthcare device market is about US$ 9 billion. Total sales in 2009 for patient monitoring tools was about US$ 6 billion and PDAs, Smartphones, Tablet PCs and handheld scanners generated about US$3 billion. Market is expected to grow at a rather fast pace. Many players have now introduced customised tablets for healthcare. RIM, Apple, GE Healthcare, Global Media, Medtronic, Omron, Siemens Healthcare, Socket Mobile, Welch Allyn, HP, Motorola, etc. are now offering products in various platforms. In fact, Blackberry and Apple are leaders in tablet and smartphone market in healthcare. Android platform based devices are also gaining momentum in the market as the open platform of Android is an attraction. With the increasing utility of these products more and more healthcare providers are seeing tablet as a solutions for providing better service and internal hospital management. Still there are many hospitals, which have not adopted these february / 2012 www.ehealthonline.org

Tech Story

Healthcare’s wish list from handheld devices • Tablets are easy to use. They are also durable and function for long durations of time on a single charge. • Devices like bar code scanners, biometric authentication, document scanner etc should be preferably built in. • The devices have to enable doctor’s to use computers in a more user friendly way. • Tablets should increase productivity by being very responsive, fast, bug free and secure. • The devices must be more economical to incorporate in large numbers. • There must be a system of faster connectivity • A cheaper option will also help low rung ambulances to be equipped with such devices for better patient safety. • Doctors are looking for converging device and comprehensive radical information system. handheld devices due to reasons like lack of supporting infrastructure in the hospital, resistance among doctors, security related issues, etc. But they are welcoming tablets with open hands and looking forward to adopt these devices in near future. Dr Karanvir Singh, (Head of HIS Implementation), Sir Ganga Ram Hospital (SGRH), Delhi says, “Personally, I feel that

Dr Anand Vinekar

Associate Professor & Head, Department of Pediatric Narayana Nethralaya Bangalore

“We need to integrate solutions to cover the patient - doctor gap thus we have started using Blackberry solutons at our institute”

february / 2012 www.ehealthonline.org

handheld devices have a big role to play in hospital information systems.” However, the hospital is yet to adopt tablets. Many hospitals have started by using handheld devices from one vendor, and gradually they started using devices from multiple vendors. For instance, Narayanan Netralaya started with iPad and now they are using blend of iPad and BlackBerry. Similarly, Max healthcare is using iOS, Android, and Blackberry, all of which allow the provider to access diagnostic images and results in real time, helping a faster formulation of care plan. For mobility on EHR, they are working on Windows based tablets. Dr Anand Vinekar, Associate Professor & Head, Department of Pediatric Retina & Pediatric Visual Rehabilitation, Narayana Nethralaya Postgraduate Institute of Ophthalmology, Bangalore, says “With the use of these devices, I can talk to patients and ensure that I am seeing your reports and images according to the condition we will call you for consultation. If technician gives the report, patient feels that the doctor has not seen report or not paid attention. We thought we need to integrate it to cover the gap so we have started with Blackberry solutions.”

Opportunities Galore The adoption level at private hospitals is more than that in government. However, government hospitals are gearing up to equip themselves with tablets and other handheld devices.

Tier -2, 3 and rural markets offer huge potential for tablet and smartphone companies. This is a market that needs infrastructural revamp to integrate handheld devices in non clinical function. The increasing popularity of 3G and WIMAX technologies in the rural areas and smaller cities will reinforce the adoption. Hospitals that have experience in tablets are looking for acquiring more and more tablets. “We are actively planning to extend the reach to our various data sources on hand held devices. Towards this end we are looking for windows based devices which should be cost and power efficient, and provide new features like handwriting and voice recognition,” says Neena Pahuja, CIO, Max healthcare

Factors for choosing handheld devices Security – If doctors use their own tablets than there should be a way of making sure they can be used securely. Mobility – Mobility is the key. While opting for any device it should be cross checked whether it suits your requirement. For instance, to conduct remote consultations with a patient faster connectivity and high resolution camera options in a tablet is a must. Battery life – Mobility can only be offered if tablets have battery backup for long hours. Invest in devices with a long battery life and short recharge time. Available apps – Different tablet runs different apps, so it is really important to research and compare what all application are available on different platform. The tablet should be chosen that supports all the apps that a doctor needs. Central file system – The Android operating system includes a centralized file system. The iPad lacks this, meaning files might not be easily movable from one app to another. Note-taking style – Certain tablets allow freehand sketching and longhand note-taking, which some doctors may prefer. *Charts are based on ehealth’s interaction with CIOs

Tech Story

“Tablet Technology Goes a Long Way in Establishing Effective Services” This is an emerging space. It could be annoying to put it as a market cap, because, it’s just an outcome. We have deployed services at various places like Narayana Nethralaya, Max Hospitals and Nanavati Hospital in Mumbai. Our technology platform provides seamless support to the right and relevant partner for developing deployed solutions. What can be the emerging areas where these Playbooks or tablets, the hand-held devices can be used? Recently, we launched the e-track on Playbook. e-track is an equipment that sets in the ICU and monitors about 12 or 14 parameters of the patients in the ICU. This kind of technology made this collaboration very much easier. Another area is urban-rural telemedicine to remove the rural part. Technology reduces the time and thus facilitates better healthcare service delivery.

Annie Mathew

Head of Alliances and Developer Relations, Research In Motion (RIM), India

Please give us an overview about tablet market in India especially in healthcare segment? Tablet devices could deliver a lot to doctors, practitioners and telemedicine experts. In India, there is a huge need to outreach the rural population through technology such as telemedicine. These tablets actually make a massive change in the way we deliver services. It is going to bridge the gap between doctors and the number of patients. This helps him track many patients and he can actually talk to the patient via video chat. These technology interventions actually go a long way in establishing how big vendors are making it available in the right time at the right place. The devices which are out of the field can be controlled from a central location, and that’s what a Blackberry enterprise server does. So BlackBerry Enterprise Server at the core allows this data from those devices securely and a specific compression technique reduces the band width and battery usage.

By when do you think we can expect such services expansion in India? Teleopthalmology solution in Narayana Netralaya or the e-track which is the ICU monitoring has already emerged as a success and the pilot phase will be finished by March. We are working with government and government hospitals to create a commercial and sustainable model. The early adopters as of now are definitely the private players. But definitely government hospitals are also coming up. We have seen lot interest a lot of interest from the government side also at the telemedicine congress, the Cardiology Society of India. A huge interest from the e-governance groups at the centre, from NRHM, they are all very interested and they are discussing this technology and they are supporting this. The government has equally invested in this, just waiting for right model that will make it scalable and sustainable. What should be done to overcome concerns about privacy and lack of infrastructure support? We need secure relations in India where the patient demands for privacy of his reports irrespective of the fact how minor a problem may be. In rural setup, a doctor addresses one patient in a single room with others waiting in the same room, thus violating the privacy of the patient. When I talk enterprise grade then we shouldn’t be quiet. We can still make it work through a sustainable solution.

february / 2012 www.ehealthonline.org

news

EHR

EHRs among top technology priorities for health care executives Electronic health records are among the top 10 technologies that health care executives should pay close attention to this year, according to a new report from research firm ECRI Institute, Healthcare IT News reports. The report -- titled, “Top 10 C-Suite Watch List: Hospital Technology Issues for 2012” -- aims to help health care executives prioritize their efforts to implement

Education

Medical students using virtual human bodies to learn about anatomyfor health care executives New York University’s School of Medicine is pioneering the use of 3-D sim-

ulation technology to teach medical students about human anatomy, the New York Times reports. In a laboratory at NYU Langone Medical Center in Manhattan, anatomy students wear 3-D glasses to dissect

virtual human bodies that are displayed on a projector screen. Using a computer, students can examine closeup views of simulated 3-D organs and other anatomic structures that are animated to function as they would in a living body. John Qualter -- an assistant professor of educational informatics at NYU’s School of Medicine and the founder of BioDigital Systems, which created the virtual human models -- said the program is “like a living

digital textbook.” Qualter said BioDigital plans to further develop the technology on its medical education website to provide a searchable, customizable map of the human body that could be used by physicians and medical websites. NYU administrators said they plan to use the virtual human bodies as a complementary teaching method that will not replace the use of real human cadavers, which provide a more tactile understanding of anatomy.

and improve health care technologies. In its discussion of EHRs, the report notes that medical device integration and the federal meaningful use program ultimately aim to improve health care and patient safety. Successful deployment should not only ensure reimbursement, but also enhance patient safety and quality of care, facilitate nursing workflow and increase physician and nursing satisfaction.

Corporate Update

Bharti Airtel Religare Technologies to offer medical advisory Airtel, India’s largest mobile phone operator, has recently tied-up with Religare Technologies, a company controlled by promoters of the Fortis hospital chain, to offer healthcare solutions and guidance over telephone. By paying an introductory tele-consultation fee of Rs 15 a call, Airtel customers can get basic medical guidance on non-emergency health problems through this service, 24 hours, seven days a week. Airtel charges just 50p for this call. With a customer base of 173 million, Airtel’s latest value addition is expected to provide a productive platform for Religare to promote their e-health service. Airtel is not the first to introduce a mobile health scheme in the country, a recent trend. Some months earlier, telecom operators Aircel and Idea had launched a similar service in association with the Apollo Hospital group-promoted Healthnet Global.

Diagnostics

US diagnostic market to witness unprecedented growth The US diagnostic market holds a significant share in the global diagnostic market, and accounts for the majority of the total healthcare market. A huge investment in research and development, and commercially successful innovations in the diagnostic industry has facilitated the US to outperform other prominent diagnostic markets, including the EU and Japan. According to a latest report, “US Diagnostic Market Outlook 2014”, by RNCOS, the increasing prevalence of chronic and infectious diseases, emergence of new technologies in molecular diagnostics, and awareness among health professionals and patients will lead to a further growth in the US diagnostic market. The report, which is spread over 60 pages, provides an in-depth research and rational analysis of the current demand for the diagnostic products and clinical lab services market in the United States. It also provides the forecasts for IVD products, medical imaging equipment and clinical lab services market for 2012-2014.

february / 2012 www.ehealthonline.org

news

Radiology

Pharma

FDG uptake of thymus measured by PET/CT is an effective indicator for the differentiation of mediastinal lymphoma from normal thymus in pediatric patients, according to a study published in Radiology. Heike E. Daldrup-Link, MD, of Stanford University School of Medicine in Stanford, Calif., and colleagues wanted to evaluate the use of PET/CT in diagnosing malignant lymphomas, which are the most common pediatric malignant masses of the anterior and middle mediastinum. More than two-thirds of pediatric patients with Hodgkin lymphoma and half of pediatric patients with lymphoblastic non-Hodgkin lymphoma present with a mediastinal mass, according to the study’s background information. The researchers retrospectively reviewed 282 FDG-PET/ CT studies in 75 pediatric oncology patients, who were divided into four groups: 16 with anterior mediastinal lymphoma (group a), five with anterior mediastinal lymphoma with subsequent recurrence (group b), 16 with lymphoma outside the mediastinum (group c) and 38 with other malignant tumors outside the thymus (group d). The analysis included the measurement of maximum standardized uptake values of anterior mediastinal mass, thymus (SUVt), on PET images. Results of the study showed a mean prechemotherapy SUVt of 4.82 for group a, 8.45 for group b, 2.00 for group c and 2.09 for group d. Postchemotherapy SUVt for group b was 4.74 and thymic rebound was seen in 44 percent of patients at an average interval of 10 months from the end of chemotherapy.

Biocon , India’s top-listed biotechnology company, expects to generate larger licensing income from pharmaceuticals business, its Chairman and Managing Director said. The Bangalore-based drugmaker earlier said consolidated net profit fell 15.8 percent in December quarter, while revenue rose 3 percent. The sales growth in the fiscal third quarter ended December 31 was flat on lower licensing income.The company said, licensing fees and income dropped to 292 million rupees in October-December from 768 million rupees a year earlier. Biocon’s presence straddles four main therapeutic areas – Diabetology, Cardiology, Nephrology and Oncology – even as it plans to introduce two new divisions, Comprehensive Care, and Immunotherapy, this year.

PET can detect mediastinal lymphoma in children

Biocon sees larger licensing income from pharma

Corporate Updates

Wal-Mart plans ambitious expansion into medical care

Wal-Mart issued a statement saying its request for partners to provide primary care services was “overwritten and incorrect.” The firm is “not building a national, integrated low-cost primary health care platform,” according to the statement by Dr. John Agwunobi, a senior vice president for health and wellness at the retailer. The nation’s largest retailer is planning

to offer medical services ranging from the management of diabetes to HIV infections, NPR and Kaiser Health News have learned. In the same week in late October that Wal-Mart said it would stop offering health insurance benefits to new parttime employees, the retailer sent out a request for partners to help it “dramatically ... lower the cost of healthcare ... by becoming the largest provider of primary healthcare services in the nation.” The 14-page request, which you can read here, asks firms to spell out their expertise in a wide variety of areas, including managing and monitoring patients with chronic, costly health conditions. Partners are to be selected in January. Analysts said Wal-Mart is likely positioning itself to boost store traffic, possibly by expanding the number of its

in-store medical clinics and the services they offer. The move would also capitalize on growing demand for primary care in 2014, when the federal health law fully kicks in and millions more Americans are expected to have government or private health insurance. “We have a massive primary care problem that will be made worse by health reform,” says Ian Morrison, a Menlo Park, Calif.-based health-care consultant. “Anyone who has a plausible idea on how to solve this should be allowed to play.” In-store medical clinics, such as those offered by Wal-Mart and other retailers, could also be players in another effort in the health law: collaborations between doctors and hospitals to streamline care and lower costs. february / 2012 www.ehealthonline.org

spotlight

‘How Antimicrobial &

Flame Retardancy Matters in Fabric?’

Hygienic environment and patient privacy is now important facilities that a patient is looking for now days. As per advancement of time, technology is the solution for growing market in fabrics for health care sectors

indow Techs (India) Pvt Ltd is suggesting fire retardant anti-microbial textile, this special fabric reduces the formation and growth of bacteria by adding carrierbound silver to the fiber polymer. The antimicrobial properties, as well as the permanently flame retardant polyester fibers constitute the basis for a new generation of functional textiles – their flame retardant properties release hardly any toxic fumes in the event of fire. This textile can be use in any form, where textile comes in any healthcare/public building. Window techs has a unique fabric which is fire retardant and anti microbial for patient privacy and facade window, which may be used in public and medical uniform also. In Hospital Infrastructure India 2011 Conference which was just held in Mumbai Dr R Chandrasekhar “Chief Architect at DGHS” says any of products and equipment that we are using in healthcare or any other public sectors should have flame retardant. That is applicable for textile also, as we already saw in AMRI hospital case smoke inhalation is the primary cause of death in victims of indoor fires. In Dr Chandrasekhar’s suggestions we already have anti microbial and flame retardant fabric which can reduces the formation and growth of bacteria, as well as the permanently flame retardant polyester fibers constitute the basis for a new generation of

february / 2012 www.ehealthonline.org

functional textiles – their flame retardant properties release hardly any toxic fumes in the event of fire.

tate your eyes and lungs and can cause heart and lung problems, stomach pain, diarrhea, vomiting, and stomach ulcers.”

Antibacterial and antimicrobial fabrics

Features of hospital privacy curtains

Antibacterial fabrics are typically the heavier, 12 ounce fabrics. They come in a wide range of solid and subtly patterned colors and they are ideal for any type of medical facility. The antibacterial component is applied to the curtains to help to minimise and reduce the growth of fungi, molds and mildew that can develop in any type of an indoor environment. In addition antibacterial treatment of hospital privacy curtains can help control the growth of MRSA, which is a very virulent and treatment resistant form of staph infection. Antimicrobial fabrics offer many of the same benefits as the antibacterial fabrics. This fabric, when used as hospital privacy curtains, resists mold, mildew and bacteria growth but it also has stain and odor release properties that make them durable and long lasting. It is non-toxic and harmless which will not pollute the environment. Eco intelligent polyester is the first polyester with all environmentally safe ingredients, including a new catalyst that replaces the heavy metal antimony, a known toxin. According to the Agency for Toxic Substances and Disease Registry, “Breathing high levels for a long time can irri-

The most important feature of good hospital privacy curtains is that they are well constructed and the fabric used is effective as a privacy barrier. This is essential for compliance with many fire regulations and safety protocols in hospitals, doctor’s offices and patient care facilities. Hospital privacy curtains can also be important in setting the tone or the environment within a specific examination or treatment area. Patterns that include subtle colors, natural motifs and colors found in nature are always popular and will match almost any neutral or natural type color scheme. As per Vishal Saraf, Managing Director, Window Techs India Pvt Ltd Concern’s the success of this preventative approach depends primarily on using an antimicrobial agent that is effective, safe, fire retardant, durable, affordable, and adaptable to a variety of materials.

AUTHOR Vishal Saraf, Managing Director, Window Techs India Pvt Ltd

national conference on ict in Public safety, security & disaster management

march 1, 2012 The Claridges, New Delhi Secure IT 2012 – India’s premier security conference – is a forum where the latest trends, practices and developments in the broad areas of information security, border security, homeland security and data security would be deliberated upon.

Key Speakers

A convergence of policy makers, government functionaries, academicians, industry leaders and professionals at a single platform, Secure IT 2012 would explore and examine the roles and ramifications of the new technology applications and services in comprehending the best available practices towards securing the citizenry. Secure IT 2012 will discuss issues such as threat of cyber terrorism, data security, security against malware, use of IT in border security and in disaster management.

Focus Areas • • • •

Disaster Management Public Safety and Security Policy and Government National Cyber Security Framework Infrastructure Security; Interstate Cooperation; Border Management; Police Reforms • Telecom vulnerabilities, attacks in telecom networks • Data Security, Data in Cloud

Shambhu Singh Joint Secretary, (North East), Ministry of Home Affairs, GoI

Dr Gulshan Rai Director General, CERT-In, Government of India

Maj Gen R C Padhi Military Survey (GSGS), Ministry of Defence Indian Army

Target Audience • • • • • •

Security experts from Government and Corporate Cyber law specialists Representatives from government Security and intelligence agencies Disaster management agencies Researchers studying security issues

Maj Gen (Dr) R Siva Kumar Head (NRDMS) & CEO (NSDI), Dept of Science and Technology, GoI AND MANY MORE...

For Programme Enquiry Contact: Sunil Kumar, Mobile: +91 8860635837, sunil@elets.in For Business Enquiry Contact: Ragini Srivastava, Mobile: +91 8860651650, ragini@elets.in | Jyoti Lekhi, Mobile: +91 88860651634, jyoti@elets.in

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zoom in

Mobile Phones “Always There Always On”

The new patient monitoring tool may not be quantifiable right now, but industry experts state that mobility is the next big thing to happen to the healthcare and medical research industry By Vikrant Patnaik

he healthcare and medical research field is experiencing rapid transitions. With continuous innovation in technologies, healthcare is bringing many better facets of treatment and patient care forward, giving the patients the best of healthcare experience that one could receive. With the growth and ease to access internet and other upcoming technologies, there have been a plethora of changes happening across industries and the healthcare and medical research industries are no exception to it. As on today, the mere definition of healthcare initiatives for hospitals has broadened its horizons from just dispensing basic “treatment” to having more patient concentric services and thus, satisfaction. In this era, with technologies such as internet and mobiles playing a pivotal role in our lives, ensure that such services are within the reach of the common man and patients coming from different socioeconomic strata. Well, what we are talking about is bringing on board a smoother registration processes, better patient care in the hospital premises, improved preoperative observation and post operative care and a robust administration tool. It is a fact that hospital staff and doctors spend large amounts of time in capturing and accessing patient information, which can be reduced to a great extent using a combination of internet’s allied services and mobile technology. Getting quicker and accurate information for quick decision making and actions that are more “to the point” oriented are just some key advantages of

february / 2012 www.ehealthonline.org

mobility services in a healthcare environment and which is the need of the hour. While the in-hospital service and experience is commendable today, there still is a large gap in terms of monitoring patients once prescribed to a particular treatment or discharged post treatment. It is quite a hassle for physicians and doctors to keep a track on patients’ health status and there is an innate requirement of continuously monitoring a patient’s health given the support that we can get from technology. Although there are ways and means for keeping a check on the patient’s status of health, we must look at new and innovative ways that are not only simple to use but are omnipresent. If one gets to thinking, the only common denominator that exists across different societal levels is a mobile phone, from a vegetable vendor to an auto-rickshaw driver to a high flying business or corporate person; most of them carry at least one mobile device if not two.

Introduction to smart phones With the different types of mobile phones available in the market, access and affordability has increased multifold. Mobile devices with the latest features such as touch, internet, applications and 3G have made it an extremely handy device that can perform almost everything at the push of a button or a mere “touch”. Healthcare and self care application can be developed allowing both patients and the medical fraternity to use it for multiple functions. Custom enterprise level applications can

be developed for hospital staff for better hospital and patient management. With robust and secure back end web based functions to support, the turn around time can be improved by many folds. Mobile technology can be used in areas like patient monitoring, treatment adherence, geriatric care and wellness, post operative care and follow up, remote patient data capture, chronic disease management, ante natal and maternity care, rural health, stepping up from EMR (Electronic Medical Records) to MMR (Mobile Medical Records), hospital bed side monitoring systems using mobile technology and many more. There are several areas where mobile technology can be used to improve efficiency, save time and costs in healthcare institutions and regulated research, including clinical trials. Some of the key areas that encompass the use of mobile and internet technologies with some business concepts and implementation techniques are discussed ahead. Patient records in hospitals are an important source of information for medical practitioners and the hospital staff to take critical decisions. With primitive methods still being used largely to capture medical records, a systematic and compliant system to record, store and retrieve information is the need of the hour for instant and real time data capture and viewing by the medical staff. An instance of which would be, key patient records should be entered and found quickly in the doctor /nurse/ HOD‘s mobile phone and further can also

zoom in

be checked on their computers. Nurses can provide real time patient health status information to the doctors from the patient’s bed side using a mobile phone that allows every nurse to log in with a unique id thus keeping all patients information and transaction secure and audit trailed, thereby saving time on multiple rounds to all wards, resources, reducing logistics and space to store and keep all these paper based records. In multi-specialty hospitals, huge paper inventories are made on a day to day basis, which makes retrieval of records delayed and more tedious. Being aware of the fact that time is something that is most precious in a hospital environment; such delays make patient experience sour, making them frustrated. A simple and handy method of patient data collection such as using the mobile phone will save hospital staff from the burden of tedious pen and paper data capture, storage and retrieval. Since the security of patient data is important, the information can be stored in compliant server farms that follow global standards of compliance regulations and security guidelines. It thus makes a lot of sense for a healthcare institution or an organisation to ramp up their turn around time in terms of internal operations etc.

At this point, our thoughts should be more oriented towards “Patient Care and the Patient” wherein the present day technology should be leveraged, to be at par with the fast approaching future and the growing competition globally.

Opportunity and its cost implications Using latest trends and technologies in a sector that evades changes is a challenge. The benefits of technology can be explained and quantified with a credible ROI (Return on Investment). Patient Health is the most important fact on which the healthcare industry thrives is the patients’ health status and being, which directly or indirectly brings a cost value to the organization implementing such solutions. Better healthcare service and patient experience brings in belief and faith towards a particular institution and thereby more loyalty towards a particular brand – “building up Brand Equity”. Reminder systems and automatic storage of data in the central HIS servers would allow reduce logistics and administration and ensure quick retrieval of data as against a paper based approach, thereby saving on time and money both. Doctors can use their computer systems to track the compliance

levels of the patients thereby being sure that their patient’s health is monitored on a regular basis. Reminders could also be sent as interventional messages and for doctors’ visits, which would ensure that the patient will come for his/her visit. On the whole we are looking at a considerable return on investment for hospitals and healthcare institutions over a period of time. Several other areas in the healthcare sector can benefit from mobile technology, some of which are widely known but less used. Industries globally have been using mobile technology and reaping benefits from it. Healthcare providers gain more while improving patient monitoring by providing them with our mobile competencies. It would be our primary motto and consistent effort to keep the healthcare fraternity educated and execute such advancements and initiatives towards making the patient’s health better.

AUTHOR Vikrant Patnaik Sr Manager, Global Marketing and Business Communications NowPos M-Solutions Pvt Ltd www.padisys.com

february / 2012 www.ehealthonline.org

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For Sponsorship Enquiries & Programme enquiries Jyoti Lekhi, jyoti@elets.in, +91-8860651634 Fahimul Haque, fahim@elets.in, +91-9873277808 Divya Chawla, divya@elets.in, +91-8860651643 Rachita jha, rachita@elets.in, +91-9819641110

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