Architecting HEALTH Network: February 2008 Issue

v o l u m e 3 | issue 2 | F E BRU ARY 2008

A Monthly Magazine on Healthcare ICTs, Technologies & Applications

Cover Story: Architecting Health Network - building a foundation for health connectivity Michael Gill, Cisco Internet Business Solutions Group

Page 8

Exclusive Interview: Network for Healthcare Jagdish Mahapatra Vice President - Sales Cisco System (India) Page 12

In Conversation: Quality par-excellence Mack Banner, CEO Bumrungrad International Hospital, Bangkok

Page 20

Power Hospital: Bumrungrad International Bangkok, Thailand Page 24

Technology Trends: GE makes digital X-Rays affordable eHEALTH Research Team Page 35

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ISSN 0973-8959

Rs. 75

16-18 April 2008 Luxexpo, Luxembourg

THE INTERNATIONAL EDUCATIONAL AND NETWORKING FORUM FOR eHEALTH, TELEMEDICINE AND HEALTH ICT Med-e-Tel offers opportunities to meet and network with qualified buyers, specialists, users, healthcare providers, industry representatives, researchers, and policy makers from 50 countries around the world.

The event provides hands-on experience and an opportunity to discover and evaluate new products, systems and technologies and to hear about the latest ehealth/telemedicine news and trends.

Med-e-Tel features an extensive educational and conference program with more than 150 presentations and workshops on a wide variety of telemedicine and ehealth topics.

Med-e-Tel 2007 was accredited by the European Accreditation Council for Continuing Medical Education to provide 18 CME credits for medical professionals. Accreditation for the 2008 event is also underway.

Topics will include a.o.: - personal monitoring systems - use of ICTs in independent living for the ageing and disabled - chronic disease management - mobile ehealth solutions - telemedicine for diabetes care - telecardiology - telepaediatrics and child health experiences - telenursing

- telepsychiatry and mental health - interoperability and standardization - maximizing the potential of ehealth in low resource settings - early warning for infectious diseases - satellite communication - elearning - and more

Additional events being planned in conjunction with Med-e-Tel 2008, include meetings and workshops by some of the following organizations: - International Society for Telemedicine & eHealth - International Association of Homes and Services for the Ageing / Center for Aging Services Technologies - European Commission & European eHealth Projects - World Health Organization - European Telecommunications Standards Institute - World Academy of Biomedical Technologies - United Nations Office for Outer Space Affairs - Centre de Recherche Public – SantÊ For registration, exhibition and sponsorship applications, conference program, hotel and travel information, newsletter subscription and more, go to: www.medetel.lu

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w w w . e h e a l t h o n l i n e . o r g | volume 3 | issue 2 | February 2008

Cover story

8

Architecting Health Network Michael Gill Cisco Internet Business Solutions Group

Exclusive Interview Jagdish Mahapatra Vice President - Sales Cisco Systems (India)

12 power hospital

24

Bumrungrad International Bangkok, Thailand

in conversation

20Quality par-excellence

Mack Banner Chief Executive Officer Bumrungrad International Hospital, Bangkok

February 2008

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w w w . e h e a l t h o n l i n e . o r g | volume 3 | issue 2 | February 2008

technology trends

35

GE makes digital X-Rays affordable

eHEALTH Team

zoom in event report

38

Telemedcon 2007

46

Exchanging health information

Susan Thomas, eHEALTH

Telemedicine Society of India, 1 - 3 November 2007, Chennai

perspective

54

Patients get powerful

eHEALTH Team

event report

44

Workshop on carotid Intervention Escorts Hearts Institute and Research Center, 18 January 2008, New Delhi

REGU LAR SEC TIONS

india news 16

BUSINESS NEWS 28

wORLD NEWS 40

NUMBERS

57

events diary

58

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IN-BOX I have been a regular reader of your newsletters and surveys ..very informative.

Simanta Talukdar, Business Manager Wipro HealthCare IT

Congrats on the informative article on Medical value travel.

Dr.Rajkrishnan, CEO, Dr.Rajkrishnan’s Dental Clinic, Kerala

Hi, received the January copy... its great! We would be grateful if you can send another copy.

Jamila Joshi, Manager - Branding & Promotions, Seed Healthcare Solutions Pvt. Ltd.

I came across this site which seems to be very informative, precise & important.

Reenila Sandhu, Product Manager, Medical Equipment Loans, ICICI Bank

Congratulations on taking out a GREAT Annual Issue.

Fantastic copy. Here’s to many more…

Anantharaman S Iyer, Regional Director (India), TrakHealth Pvt. Limited, Delhi The issue looks fantastic ..much appreciated and such a great result.

Louise van der Kraan, Regional Marketing Executive, iba Health, Australia Received the copy of the annual special issue.

Thanks for the beautiful and informative journal with special focus.

Dr K C Mishra, Director, National Insurance Academy Pune Your News Letter and Portal were quite intresting and indeed very informative.Your news on tele medicine situations, HIPAA and upcoming programmes along with select interviews were something I will like to flag for my work.

Tanmoy Bose, FICCI

Editorial Guidelines eHealth is a print and online publication initiative of Elets Technomedia Pvt. Ltd. an information research and media services organisation based in India, working on a range of international ICT publications, portals, project consultancy and highend event services at national and international levels. eHealth aims to be a rich, relevant and wellresearched information and knowledge resource for healthcare service providers, medical professionals, researchers, policy makers and technology vendors involved in the business of healthcare IT and planning, service delivery, program management and application development. eHealth documents national and international case studies, research outcomes, policy developments, industry trends, expert interviews, news, views and market

intelligence on all aspects of IT applications in the healthcare sector.

Contributions to eHealth magazine could be in the form of articles, case studies, book reviews, event report and news related to eHealth projects and initiatives, which are of immense value for practitioners, professionals, corporate and academicians.

We would like the contributors to follow the guidelines outlined below, while submitting their material for publication: Articles/ case studies should not exceed 2500 words. For book reviews and event reports, the word limit is 800.

An abstract of the article/case study not exceeding 200 words should be submitted along with the article/case study.

All articles/ case studies should provide proper references. Authors should give in writing stating that the work is new and has not been published in any form so far.

Book reviews should include details of the book like the title, name of the author(s), publisher, year of publication, price and number of pages and also have the cover photograph of the book in JPEG/TIFF (resolution 300 dpi). Book reviews of books on e-Health related themes, published from year 2002 onwards, are preferable. In the case of website, provide the URL. The manuscripts should be typed in a standard printable font (Times New Roman 12 font size, titles in bold) and submitted either through mail or post.

Relevant figures of adequate quality (300 dpi) should be submitted in JPEG/ TIFF format.

A brief bio-data and passport size photograph(s) of the author(s) must be enclosed.

All contributions are subject to approval by the publisher.

Please send in your papers/articles/comments to: The Editor, eHealth, G-4, Sector 39, NOIDA (UP) 201 301, India. tel: +91 120 2502180-85, fax: +91 120 2500060, email: info@ehealthonline.org, www.ehealthonline.org

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Volume 3 | Issue 2 | February 2008 president

Dr. M P Narayanan

EDITORIAL

editor-in-chief

Ravi Gupta group directors

Maneesh Prasad Sanjay Kumar Sr. manager - PRODUCT DEV EL OPMENT

Dipanjan Banerjee mobile: +91-9968251626 email: dipanjan@ehealthonline.org research A ssociates

Susan Thomas

Net(t)Work of Healthcare !

A secure, reliable and efficient IT network can be an important performance differentiator for any service provider... and in particular, for multi-location chain of facilities.

With increasingly faster adoption of electronic environment at all levels of business, the need for high-speed, high-volume, high-security networks for seamless exchange of voice, video, image and data are on a rise.

Sales executiv e

Arpan Dasgupta mobile: +91-9911960753 email: arpan@ehealthonline.org Manager - sales

Amitabh Mukherjee mobile: +91-9871686548 email: amitabh@ehealthonline.org Sr Graphic Designer

Bishwajeet Kumar Singh Graphic D esigners

Chandrakesh Bihari Lal (James) Ajay Negi Om Prakash Thakur web

Zia Salahuddin Santosh Singh subscriptions & circul ation

Manoj Kumar (+91-9210816901) manoj@ehealthonline.org editorial correspondence

eHealth G-4 Sector 39 NOIDA 201301, India tel: +91-120-2502180-85 fax: +91-120-2500060 email: info@ehealthonline.org printed by

Vinayak Print Media, Noida Gautam Buddha Nagar (U.P.) India does not neccesarily subscribe to the views expressed in this publication. All views expressed in the magazine are those of the contributors. is not responsible or accountable for any loss incurred, directly or indirectly as a result of the information provided.

Although networking solutions are a plenty in the market, only few of them match up to the technological and functional capabilities as desired for healthcare institutions. In order to meet such requirements that are already being sought by most top-of-line healthcare companies of the country, Cisco Systems recently rolled out its ‘Medical Grade Network’ (MGN) solutions in India.

Already a success in most western markets, MGN promises to be the answer to networking woes of IT managers and business heads in the healthcare industry.

Equipped with robust architecture, best- in-class technological standards, highest levels of security and a high throughput capacity, MGN can provide seamless business functionality within and across all players of the healthcare ecosystem... linking service providers to insurance companies, TPAs, government agencies and patients... and in the process bringing efficiency, quality, convenience and cost saving. Know more about this in the cover story of this issue, by Michael Gill from Cisco Systems, Hong Kong.

Keeping with our endeavour to showcase best-in-class healthcare facilities from across the region and bring valuable thoughts from champions of the global healthcare industry, it is our pleasure to present in this issue, a coverage of Bumrungrad International, Bangkok, following a tete-a-tete with the CEO Mack Banner ...get them under the sections ‘Power Hospital’ and ‘In Conversation’.

Medical technology is doing wonders for the world... improving each passing day and bringing new possibilities to life. A breakthrough innovation of GE Healthcare is soon going to make traditional X-rays ‘a-thing-of-the-past’. The latest launch of their ‘Tejas XR 6000’ is all set to make digital X-ray systems affordable like never before ! ...delivering high quality digital X-ray images for physicians at a fraction of the cost of existing systems. Catch up with this revolutionary product under ‘Technology Trends’.

Do check out our regular sections, and certainly the new addition from this issue – ‘Numbers’ ...that you can crunch on !

We look forward to your comments and suggestions.

is published by Centre for Science, Development and Media Studies (CSDMS) is published & marketed in collaboration with Elets Technomedia Pvt. Ltd. (www.elets.in) © Centre for Science, Development and Media Studies www.csdms.in February 2008

Ravi Gupta Ravi.Gupta@ehealthonline.org

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cover story

Architecting

Health N E T W O R K Building a Foundation for Health Connectivity Health IT tends to be a catch-all phrase and includes almost anything electronic that displays or transports information. This article focuses primarily on the transportation of information and the provision of applications in a connected environment, where connectivity is the defining factor.

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orget most of what you know about using the Internet. Think instead about communities and families living across a region, and imagine how electronic healthcare services would support them.

Today, the focus is increasingly on understanding the dynamics across multiple health agencies and developing an architectural information and communications technology (ICT) response. In this context, ICT architecture refers to the process of determining the principal design attributes associated with connecting people, entities, and services in a planned manner in order to optimize delivery, cost, and scalability. Significant activity is occurring in many regions and countries. The capability of ICT to be transformative1, particularly in terms of system efficiency, is not disputed2 and often claims to provide tangible benefits in specific areas such as health.3 In the European Commission report (titled ‘National Strategy for e-Health’) an evaluation of 10 e-health case studies yielded the observation that - “given the right approach, context, and implementation process,

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Michael Gill, Cisco Internet Business Solutions Group

February 2008

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ICT-based solutions can indeed improve the quality, access and efficiency of healthcare provision”. However, realisation of actual and tangible benefits happen only after couple of years. In this context, it may be worthwhile to highlight a study by RAND Corporation, which modelled the impact of EMR adoption in United States and found the potential benefit in monetary terms to be as much as US$ 77 billion per year.4 People live in places and move across geographic areas.

In doing so, they tend to form identifiable communities.

Mixed in among these communities are general practitioners, specialists, pathologists, radiologists, elder-care facilities, community health services and hospitals. People needing care regularly move through a geographic area seeking support and treatment. Patients are discharged from hospitals, sometimes requiring ongoing care from a general practitioner.

Elderly patients and/or chronic-care patients may move between facilities and may require a wide variety of medical providers over extended periods.

It has been observed that most health activity happens in the community, and not in the hospital.

Health systems tend to be acutecentric and as such, Across Health Domains ignore the burden of care required in a community setting, particularly for chronic-care patients.

When primary care fails, the demand increases on ambulatory system, such as outpatient care. This increase can cause failures in the outpatient system, resulting in more hospital admissions.

This scenario is the foundation for two emerging concepts.

The first is that health-related information and services need to be available and accessible throughout a region and across all patient and health provider segments, if quality, safety, and inclusivity have to be equitable. Information availability and accessibility are directly tied to significant, positive and improved health outcomes.5 The second concept is that a systemic failure in one part of the health system can have major ramifications on other parts of the system. This is because costs tend to be high in the hospital and low in the community and systemic failures magnify cost, often exponentially. Put another way, errors and mismanagement cost much more to recover at the hospital end than at the community end of the care spectrum, yet relatively little effort is expended to improve community care. Think of it this way 10

- an inpatient admission represents a failure of ambulatory management.

Patients and their families “move” through regional, state or national health systems. The efficiency and effectiveness of their “journey” bear directly on improved health outcomes. This is, for example, reflected in a reduction in waiting time for emergency treatment or surgery, or in reduced admission rates for diabetes sufferers because of improved case management. This journey also impacts how families and individuals seek medical support, particularly in chronic-care areas. Mental health is typical among these.

The fundamental proposition is that providers and patients need to connect in a timely and appropriate manner. That connection via electronic means is the primary opportunity given the principles of a patient’s journey, which can start at his or her home, neighbourhood or village – through the system. Only when one is connected reliably and securely can the exchange of information and electronic services take place.

Clearly, there is an underlying point here of empowerment and patient-centricity.

On the provider side, the implication is that communication is a catalyst for collaboration – the more interactive the nature of connection, the higher the probability of successful collaboration actually taking place. In other words, providers can obtain and exchange information and services at the point of care in order to reduce errors, create faster flow-through, improve patient satisfaction and, in short, help ensure better healthcare. The following examples illustrate this point.

Unlike a banking or government general services network, connectivity in health usually occurs among multiple, autonomous provider entities. This situation introduces a huge set of complexities not addressed in simpler networks found in banking and transportation. Connectivity in healthcare is fundamentally of a higher order than any other network configuration due to the need to develop design and governance responses compliant with local ownership requirements. In addition, the amount of data transmitted, such as data from radiology images, far exceeds that of bank transactions. Furthermore, the level of security required is variable, and the ability of the network to deliver www.ehealthonline.org

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network for healthcare of healthcare with the connected healthcare ecosystem.

This Network helps create collaborative relationships among all members of the connected healthcare ecosystem, enabling a connected healthcare community through interoperable processes, technology, and people to provide ‘anywhere, anytime’ information.

The Network provides an optimized framework for the healthcare industry by meeting healthcare’s unique needs for interoperability, security, availability, productivity and flexibility. Recognizing that every healthcare institution has different needs—whether it is a hospital, a clinic, or an academic facility— the Cisco Medical-Grade Network provides a framework that defines network strategies and policies that are purpose-built for each environment. By building networks within the organization that meet these needs, the stage has been set to expand the organization’s reach into the connected healthcare ecosystem.

What business critical advantages will MGN bring in and how does it promise to enhance service quality and operational efficiency of service providers?

Cisco’s MGN solution will enable healthcare organisations to enhance patient safety with more timely and accurate results and protection of patient data, as also to improve patient satisfaction by reducing wait times and stream line patient care process.

It will also help optimize technology investments by fully integrating with existing systems and applications and minimize Jagdish Mahapatra the risk of costly downtime through self healing capabilities.

Vice President – Sales, The Cisco Medical-Grade Network provides the advanced Cisco Systems (India) technologies and infrastructure one needs to support their business capabilities and meet their business objectives. The Cisco has announced the roll-out of its Medical Grade Network Network is an emerging, health industry-specific architecture (MGN) offerings in India, targeting the domestic healthcare that defines an optimally performing healthcare network based on four service providers. What is the technology framework and solution key factors: architecture of MGN? Resilience - High-quality health services depend on uninterrupted • access to clinical systems and data. With a focus on maintaining With the roll out of Cisco Medical-Grade Network we look forward to continuous uptime, the Network optimizes the accessibility and build awareness amongst hospitals and healthcare practitioners of the transmission of vital-often lifesaving-information, to and from the benefits of technology in the sector through our partners and healthcare point of care. seminars across the nation.

Protection - Fully embedded network wide security enables the • The Cisco MGN creates the foundation technology from which Network to provide comprehensive protection of information information can be disseminated within the hospital or healthcare and applications through the use of identity authentication tools, system. By interconnecting independent healthcare entities that are now firewalls, intrusion detection systems (IDSs), and self-healing technology-enabled by the Cisco MGN, Cisco supports the transformation capabilities.

services and information at the point of care can often have severe physical consequences for the patient if a network failure occurs. Another point of differentiation is that many of the provider entities have already developed electronic responses to varying degrees of maturity and 12

sophistication, and may have upward of 400 old and new applications that need to function and exchange information.

Reliance on the Internet without a critical assessment www.ehealthonline.org

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•

Responsiveness - Doctors and other medical personnel can access information at any time, from any location, through wireless-enabled and remote-ready applications and devices. A VLAN “guest network” enables business partners and other non-employees to gain secure network access.

Interaction - By converging voice, video, and data on a single system and dynamically connecting in-house and remote medical staff to one another, the Network strengthens communication among caregivers and allows for higher-quality patient care.

While the benefits of connectivity may be different for each segment of the health community, the benefits to the patient are the same: the delivery of safe, affordable, and accessible healthcare. In the end, it is simply about connecting people to enable access to critical health information anywhere and at any time.

Since western markets are considerably advanced than India’s, their level of technological maturity is quite understandably higher. What has been your experience with deploying MGN and similar solutions for providers in advanced economies?

Adoption of technology by the healthcare sector has changed its dynamics across the world. With the advent of Internet technologies and rapid access to information; management and delivery of healthcare information has emerged as an issue of prime concern. Collaboration of technology, telecommunication and information has given rise to innovative practices such as e-health. These practices have opened up opportunities to provide healthcare facilities to patients better, faster, at lower costs and higher levels of convenience.

IT adoption among healthcare institutions in India is still comparatively low as compared to developed economies (average IT expenditure of large hospitals is still at 2% of annual turnover in India). In this scenario, how do you strategise to market high-end solutions like MGN? Do you have plans for offering shared services infrastructure for SME players?

In India the overall healthcare market is booming. A CII-McKinsey study reveals that the total healthcare market in the country could increase to US$ 53-73 billion (6.2-8.5 per cent of GDP) in the next five years.

Currently, India’s domestic consumption of healthcare services is low but is expected to increase as the economy develops. The organised healthcare industry in India is still in its nascent stages and will take another couple of years to start taking shape.

The growth in the organized sector, from IT product/solutions vendor point of view, has created a need for provisioning specialized solutions to these players. Cisco has designed its Medical Grade Network (MGN), as an architecture that offers all these critical features that the healthcare sector demands for.

Cisco, has identified this space as one of the key growth areas for networking based on the plans that both national and international

of user needs, security,6 and service reliability is akin to sailing without a compass. The volume of medical reference material, the size and complexity of CAT (computerized axial tomography) scans and X-ray images, the move to videobased consultations, and the need to preserve confidentiality February 2008

healthcare service providers have for India.

Over the next couple of years Cisco will be strengthening its position in this market.

Cisco has also introduced its innovative ‘HealthPresence Pod’ in India. Can you elaborate on the Pod and how can it benefit healthcare providers in delivering services?

As part of its healthcare strategy, Cisco has piloted a HealthPresence Pod which can help the hospitals to take their service delivery closer to the patients. Using the Pod, the government’s public health clinics too can offer healthcare services to patients residing in remote locations. Designed

by Cisco’s team in Australia, HealthPresence Pod is currently deployed in Bangalore as a pilot.

The Pod may be installed at any public space such as a mall or an airport or a railway station. A patient may walk into the Pod, video-conference with his doctor, plug in basic records such as EMR, and seek his/her Cisco’s HealthPresence Pod advice. This way, the patient is not required to go to the hospital or the clinic which may be a few kilometres away from his house.

The Pod can thus bring convenience to the patients and also extend the service delivery points of private sector hospitals and government’s PHCs. As an extension of this concept, this Pod may even be set up inside a van. The Mobile HealthPresence Pod can then reach to patients residing across a wide geography, revisiting the same locations periodically. Cisco will further develop the solution taking inputs from hospital customers in India and carry out the deployments through partners. The fees charged for these services will be determined by hospitals and PHCs. Once deployed, Cisco’s role will be only maintenance and support.

What is the business volume you are expecting from the Indian healthcare market over the long term? What is the expectation from South and South-East Asia as a whole?

At this point, Cisco is working with its partners to build awareness for the benefits of putting in place a robust communication and information network, which will provide the foundations for advanced healthcare solutions.

It would be premature to peg a figure to the volume of business expected, but given that healthcare consumption as a proportion of average household consumption is expected to triple from 4% (1995) to 13% (2025), Cisco believes that the sector is on the verge of major growth and we are positioning ourselves to take advantage of this.

are all factors that have to be taken into account to find new approaches to healthcare delivery. The health industry is required to know that the information has been sent and received, is free from computer viruses, and is intact, irrespective of its complexity or volume, particularly in crisis 13

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health environments. General practitioners require secure e-mail, automatic hospital discharge summaries and the ability to access the latest patient condition information quickly. Such service guarantees are not possible across the Internet.

There is no guarantee that the e-mail you sent to a family member overseas will actually arrive. This is simply not good enough for critical health information. And if we introduce telemedicine or general practitioner-to-medical-specialist video conferencing across a region, for instance, the volume of video-based traffic could exceed the connection capacity normally available for the Internet. At a system level, national health monitoring for conditions such as arthritis, and for access to databases and financial information, is increasingly required in real time to aid planning and insurance outcomes.

Currently, it is not possible to add features onto pre-existing, older networks. The ability to scale from a few ad-hoc, videobased conferences among clinical practitioners to multipoint conferences on a regular basis needs to be designed into the network from the start. Such a network architecture response takes into account the quality of service requirements in a scaled system so that consistency and quality are evident across the entire geography and the entire electronic network as well.

Security for networked communications is complex. The model adopted in the financial services sector tends to resemble a “fortress” orientation where all access points are limited and access is restricted, irrespective of need. For the healthcare industry, such a model will not work because of the numerous, autonomous provider entities. Access to the electronic assets of a health system would be based on communities of interest and on the need to connect to a service or database. For example, general practitioners may require their own electronic community with its own access control in the form of passwords and authentication, or hospitals may require quite a different model with access gateways between general and specialist hospitals. And, elder-care facilities and medical specialists may require their own electronic community that interconnects with selected providers such as pathologists and pharmacists. In other words, security in health is multi-layered and should be built on a foundation of double redundancy and virtual private networks.

Conclusion

In the current health sector, which is a mix of public and private providers, the transmission of messages, services, and images is done through a series of networks, some of which are interconnected.

Establishing national health connectivity will likely lay the foundations for building connectivity in other service areas such as education, public safety, and regional economic development. Much of this thinking is currently encapsulated in policy developments around deploying national broadband. While this is useful, the national development of a health-sector response suggests building regional pointsof-presence7 where other services, such as education, are also aggregated. This, in turn, suggests architecting for more than health services; it suggests providing partitioned capacity for other services, which may, from a health sector perspective, reduce costs of infrastructure development and increase political support.

The foundations for health connectivity include the following: • Requiring connection to all providers • Providing access and gateways for patients • Recognising that an area-based health strategy is more desirable than simply focusing on the transfer of acute and emergency-care information • Understanding the patient’s journey through the system, and his or her information requirements • Connecting and communicating to promote team-based clinical problem solving and, thus, changing work practices references 1.

The Indian Government plans to install online and video-based kiosks in 100,000 villages, providing agriculture purchase services, education, and health support services.

2.

“e-Government Strategy”, page 6, Australian Government Information Management Office, March 2006.

3.

“National Strategy for e-Health,” page 2, Ministry of Health and Social Affairs; “New Zealand Health Information Strategy,” page 34, Ministry of Health, August 2005; “eHealth Is Worth It” study, European Commission, September 2006.

4.

“The RAND Study of Potential Costs and Benefits of Electronic Medical Record System,” Richard Hillestad, Ph.D., RAND Corporation, September 21, 2005.

Modern network technology design is moving in such a way that many intelligent functions can be performed by the network itself. Such functions include virus detection and denial of service attacks, combining messages, and thorough data packet inspection. These developments imply that the provision of network-based electronic services in healthcare is much more than simply providing connectivity. Managing compliance with a specified security policy probably needs to be centrally managed. The security model deployed in healthcare is much more akin to that of an airport where “passengers” are allowed access to different areas based on their needs.

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5.

Public Services Summit @ Nobel Week, December 2006. Tele-dermatology pilots in Norway observed a 40 percent decline in face-to-face specialist consultations.

In New Zealand, chronic-care telehealth services achieved a 60 percent decline in hospital admissions.

6.

“Symantec Internet Security Threat Report,” Symantec Corp., January 2006.

According to the report, there were 6,110 “denial-of-service” attacks per day from January 1 to June 30, 2006. And, Web application vulnerabilities made up 69 percent of all vulnerabilities.

7.

Points-of-presence (PoP) are geographically dispersed access points for subscriber connection, consisting of Layer 1, Layer 2, or IP access transport services sourced from commercial telecommunications carriers, and providing firewall, encryption, IP VPN termination, and other services.

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NEWS REVIEW

INDIA

Industry calls for separate regulation of medical devices While the country’s Health Minister Anbumani Ramadoss announced recently that the government was having a relook at the drug policy in the country and was working towards establishing quality standards, for which it has already introduced the Drugs and Cosmetics (Amendment) Bill, 2007 in order to facilitate setting up of a Central Drugs Authority and introduce centralized licensing for manufacture of drugs.

The inclusion of medical devices as a part of the overall description of drugs has drawn serious concerns from the medical devices industry. It has been suggested that medical equipment / medical devices be added as a independent definition and be defined as per the Global Harmonization Task Force to include any instrument, apparatus, implement, machine, appliance, implant, in vitro reagent or calibrator, software, material or other similar or related article intended by the manufacturer to be used alone or in combination, for human beings for one or more of the specified purposes.

There is also a need for separate provisions for the regulation of medical devices since they cannot be clubbed with provisions relating to drugs and cosmetics in view of the completely different characteristic of devices and equipments as compared to drugs and cosmetics.

The Government of India is proposing

Healthcare vouchers for the underserved The financially-weaker section of the society may hope to get better healthcare facilities from privately-run hospitals in the future. The government is planning to issue healthcare vouchers to the poor who could use it as a currency in private hospitals. Hospitals, in turn, would get full refund from either the government or accredited insurance companies.

Some states like Uttar Pradesh and Jharkhand have already tried this successfully in pilot projects.

Haryana, Karnataka and Kerala too have tried public-private partnership and insurance schemes to provide healthcare access to people. Private hospitals and insurance companies will be accredited with the government for this purpose. The proposal is part of a blueprint for healthcare reforms outlined in the eleventh five year plan.

The government’s target is to lower the cost of healthcare for the tax payers as well as to increase access to quality care for the poor. As per the latest official data, Indians spend about 6% of their consumption expenditure on health care. Families’ out-of-pocket expenditure on healthcare accounts for about 72% of the total health expenditure incurred in the country. Consumers end up spending heavily for private healthcare as government spending in healthcare remains below 1% of the GDP. 16

to set-up the Medical Devices Regulatory Authority of India (MDRA). The MDRA would be expected to formulate appropriate guidelines to be a national certifying and regulatory agency in India for medical equipment and devices. In this connection, it is very important to ensure that there is not regulatory overlap for the medical devices industry.

The Draft Medical Device Regulation Bill 2006, and the proposed MDRA is based on tenets of European Medical Device Directive, which is largely accepted even by the Global Harmonization Task Force (GHTF) recommendations.

The proposed constitution of the Central Drugs Authority of India and Drugs Consultative Committee also needs to be reconsidered to increase the maximum number of members to include representatives from all fields including manufacturers of drugs, cosmetics and medical devices who can understand and analyze the points from the industry specific perspective.

Intel (India) develops remote health monitoring device US microchip maker Intel is developing a technology to allow remote monitoring of a person’s health through signals from a hand held device.

Intel’s Indian and US researchers have built a prototype which would alert a person carrying the wireless device, and doctors monitoring the person’s health, to any impending medical emergency.

The Santa Clara, California-based chipmaker’s research facility in Bangalore is playing a leading role in development of the system.

Mobile health monitoring would cut costs and give access to preventive healthcare to under-served populations and rural communities, Rattner said.

Last year, the healthcare unit of General Electric unveiled a portable, battery-operated electrocardiograph that monitors heart functions and can be understood even by physicians who are not specialists in the field.

The product will enable physicians to treat patients, particularly in rural areas, where two-thirds of India’s 1.1 billion population lives but lacks access to good medical facilities.

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British NHS patients soon to be treated in India The British government will allow patients with non-emergency conditions to be treated in Indian hospitals under a scheme paid for by British taxpayers.

The scheme will enable British patients to use Indian healthcare facilities previously denied to them.

Under current EU regulations, insurance only covers treatment that falls within three hours of flying time from the European patients’ country of location.

Last month, India’s Trade and Commerce Minister Kamal Nath had in his visit to London said that the NHS could cut patients’ waiting time by outsourcing treatment to India, prompting a positive response from British authorities.

Growing waiting lists in NHS-run hospitals has become a political issue in Britain. Some 300,000 foreigners came to India for medical treatment last year.

AIIMS like Ayurveda institute to come up in New Delhi An AIIMS like Ayurveda institute will be set up in the capital to carry out clinical research, drug safety evaluation and scientific validation of the traditional Indian system of medicine.

A meeting of the Union Cabinet, chaired by Prime Minister Manmohan Singh, approved the establishment of the All India Institute of Ayurveda (AIIA) as an autonomous organisation under the Department of AYUSH. An 11-acre plot in Sarita Vihar in south Delhi has been identified for setting up the AIIA, which will also have a 200 bed research and referral hospital for facilitating clinical research.

The institute will initially be set up as an autonomous registered body of the Ministry of Health and Family Welfare and will be fully funded by the Central government with the objective of raising it to the status of Deemed University in 10 years. The institute will offer post-graduate and doctoral programmes in the identified fields of research.It will have four major divisions - Department of Fundamental Research, Division of Drug Development, Standardisation, Quality Control and Safety Evaluation, Division of Clinical Research and Teaching, and Research and Referral Hospital.

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Hiranandani hospital outsources radiology services to Wellspring Leading drugmaker, Nicholas Piramal India has announced that its subsidiary Wellspring is partnering with Dr. L H Hiranandani Hospital for the complete outsourcing of the radiology department at Dr. L H Hiranandani Hospital to Wellspring.

Dr. L H Hiranandani Hospital is a 130-bedded, state-of-the-art tertiary at quaternary care hospital. It has recently been accorded NABH accreditation, the only hospital in Mumbai and the western region of India to have received this distinction. The hospital has centres of excellence in interventional cardiology, orthopaedics, minimal access surgery, bariatric surgery, human reproduction and aesthetic surgery. Talks are on with preeminent healthcare groups in the country to plan for more hospitals in the future.

Wellspring is the largest provider of diagnostic services in India and currently has 85 centres spread across 57 locations. It is also the only player that offers end-to-end diagnostic solutions, covering the full range of radiology and pathology tests.

Wellspring will install a state-of-the-art 1.5 Tesla MRI machine costing over INR 50 million (the first of its kind) in the area in Dr. L H Hiranandani Hospital, and will operate the existing radiology facilities within Dr. L H Hiranandani Hospital.

Wellspring has already been entrusted with the diagnostics facilities of many renowned hospitals, such as Guru Nanak, Lok and Bhakti Vedant in Mumbai; Jeewanmala and Ashlok in Delhi; Mittal in Ajmer and Shanti Nursing Home and Shanbag Nursing Home in Bangalore.

ICICI Venture buys majority stake Mysore hospital ICICI Venture, part of the financial conglomerate, the ICICI Group, has announced that it has taken a majority stake in the Mysorebased healthcare company, Vikram Hospital Private Ltd (VHPL).

The investment, for a consideration of INR 96 crore, has been made through ICICI Venture’s wholly-owned subsidiary, Iven Medicare India Private Ltd. The company, which now had a super speciality tertiary care facility in Mysore, is establishing five more super speciality hospitals in that city, apart from expanding the cardiac care facility at its main hospital in Mysore.

They also plan to set up hospitals in other districts and invest INR 300 crore in the next two or three years, resulting in an additional capacity of 1,500 beds in super speciality facilities.

The company is focused on only providing secondary and tertiary healthcare, while adopting a “doctor-driven model”, so that the local doctors would not feel the company is competing with them.

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NASSCOM: INR 100 cr fund for small cos including medical devices Software industry body NASSCOM announced the formation of a fund with an initial corpus of INR 100 crore to help individuals and very small companies in setting up their businesses. The anchor investors in the Nasscom-ICICI Knowledge Park Innovation Fund (NIIF) - are Tata Consultancy Services, Bharti Airtel Ltd and ICICI Knowledge Park, Nasscom said. Nasscom President Kiran Karnik said the fund would have a corpus of INR 100 crore to start with, but this could be increased to INR 200 crore in future. There will not be more than ten institutional investors in the fund.

The fund will invest in a cross section of sectors such as medical devices, life sciences, wireless technologies. It will invest in early stage companies and help academicians as well as researchers looking to commercialise their inventions.

Karnik said while the larger firms have the resources to invest in innovations, smaller ones fail to scale up due to lack of timely availability of seed capital. Besides, there are certain fields where the risks are high and gestation periods long and the new fund will help meet the requirement of these entrepreneurs, Karnik added.

Singapore’s Parkway eyes 50% stake in Khubchandani (Mumbai) Singapore’s Parkway Group which owns one of Asia’s largest hospital chains, plans to pick up 50% stake in Mumbaibased Khubchandani Hospitals for INR 155 crore.

Mauritius-based investment holding firm Koncentric Investments will hold the remaining 50% stake in the firm which plans to set up chain of hospitals and healthcare facilities in India.

Currently, Khubchandani Hospital has 10,000 equity shares paid up capital. These are held by Dr Prakash Khubchandani who is the MD of the hospital and Mrs Tarana Khubchandani.

As per the plan, Khubchandani Hospitals intends to set up a USD 80 million multispecialty hospital in Mumbai soon. The hospital is close

to acquiring 10,000 sq feet of land in the city. The construction of the hospital is expected to start by the end of the year and could be completed in three years, sources said. When contacted, Khubchandani Hospital officials declined to comment.

At present Parkway has a joint venture (JV) with Apollo Group, India’s largest hospital chain, to set up hospitals in West Bengal. Currently the JV has a hospital in Kolkata. Parkway Group also has another company Apollo Gleneagles with Apollo Group to set up PET CT Scan centre in Hyderabad. The Singapore-based firm is learnt to have received a noobjection nod from the Apollo Group and has sought approval from the government to go ahead with the new venture.

Parkway Group runs a chain of hospitals, clinics, laboratories and other healthcare facilities in Singapore, Brunei, Vietnam, Malaysia and Indonesia. Parkway Group has been looking at expanding its presence in the healthcare sector of the country. Koncentric Investments is a holding entity owned by two Indians, atleast one of whom is related to the existing promoters of Khubchandani Hospitals.

DIAL to transfer airport medical unit to pvt hands The Delhi International Airport Ltd (DIAL) is planning to handover its medical unit to a private hospital soon.

It has been reported that DIAL has been discussing the options

February 2008

with six hospitals — Indraprastha Apollo, Max Healthcare, Fortis Hospital, Escorts Hospital, St Step hen’s and Holy Family Hospital.

At the Hyderabad Greenfield Airport, the medical unit is handled by Indraprastha Apollo Hospital.

The medical unit at the airport was started in 1984 when a close relative of former Vice-President, V V Giri, died of cardiac arrest at the airport. The CGHS doctors posted at the airport for curative checks could not help him. Soon, a full-fledged medical unit was set up at the airport.

The unit has 21 beds - four at IB domestic terminal, two at IA domestic terminal, eight at the international terminal, six at the casualty centre situated at the airside and one at the cargo. Every month, the unit treats around 2,700 patients. Other than the medical unit, the Indira Gandhi Internation Airport also has an aircraft emergency medical centre below the apron control area to handle about 150-100 patients.

The patients visiting the unit include passengers, airport staff and other visitors. The doctors are given specialised training in aviation medicine and to handle aircraft crash situations. The doctors are also trained for helping in investigations in a crash.

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IN CONVERSATION

Mack Banner Chief Executive Officer Bumrungrad International Hospital, Bangkok

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QUALITY par-excellence

Bumrungrad is partnering with a hospital in Abu Dhabi to build a new facility at US$ 544 million – this, after discovering that as many as 70,000 UAE national travelled to Bangkok last year for medical treatments. Your achievement in setting new standards in healthcare delivery has surely been noticed globally. Have other nations approached you for such partnerships?

Expansion into health care services outside of Thailand has been done through Bumrungrad International Limited (BIL), an associate company of Bumrungrad Hospital Public Company Limited. BIL owns and operates hospitals and healthcare facilities in seven countries in Asia and the Middle East including Asian Hospital in Manila, Philippines, Bumrungrad Hospital in Dubai, UAE (under construction), manages Bumrungrad Mafraq Hospital in Abu Dhabi, and Asia Renal Care, the largest chain of renal dialysis centers in Asia. The Company focuses on ownership, acquisition and management of hospitals and healthcare delivery companies in the Middle East and Asia.

It is specifically interested in expanding into Malaysia, India and China.

In just six years, Bumrungrad has witnessed a doubling in the number of its overseas patients that currently accounts for 53% of your patient revenues. What is your view in terms of the fast growing healthcare industry in countries like India? Do you foresee any competition on the foreign patient revenue that may come your way?

India and Singapore have been competitors in this sector for some years, this is not new to us. Korea, Taiwan, the Philippines and Malaysia have also announced national initiatives to attract medical tourists. So the field is definitely getting more competitive.

February 2008

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in converrsation

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healthcare destination foreign patients?

for

The combination of medical quality, service excellence, and value for money, as mentioned above. Plus, Bumrungrad has been focusing on the needs of international patients for 10 years now. In 10 years you learn a lot about the services and processes needed for this type of patient. Our staff of interpreters; our referral processes and International Medical Coordination Office; our network 22 international agents and our Airport Arrivals Lounge at the new airport here – these are just a few of the innovations we have developed.

The large numbers of patients you handle must require careful and strategic management of medical records, clinical operations, administration and ERP. How do your services leverage on IT?

Bumrungrad International Hospital, Bangkok

But we actually welcome this competition, for two reasons.

First, we cannot develop the category by ourselves. There is so much untapped potential, it actually helps to have many players spread awareness of medical travel and its benefits.

Second, we think Thailand in general and Bumrungrad in particular have distinct advantages versus these other destinations, that appeal to many patients. Our unique combination of international medical quality, warm Thai service, and value for money do not come together anywhere else.

Apart from the low Dollar-Baht ratio, what would you say are the prime factors for Bumrungrad being a preferred 22

Ten years ago we wanted to build the ideal hospital back office IT system. We could not find existing software that met our needs so we developed it ourselves. We spun off a company, Global Care Solutions, and they designed a product named H2000, which is a single-source, integrated system for finance, operations, medical records, strategic information, even medical image management.

This system has kept improving over the years, and to say it has been a key to our success would be an understatement.

I’ll give you an example. We see an average of 3,000 outpatients a day. Half come in without appointments.

You know what the average waiting time is to see a doctor?

Seventeen minutes. I don’t know of any other hospital in the world that can match that sort of efficiency. Hospital administrators visit us and they are amazed at how high a return we get on our assets.

It has not gone unnoticed. As part of Microsoft’s visionary healthcare strategy, they searched the world for best-of-class hospital management software. Last month they finalized a www.ehealthonline.org

deal to acquire Global Care Solutions, our system. They thought it was that good. So now we not only have the world’s best hospital IT system; we have the world’s most successful software company next door to us, and we are their R&D partners for improving this system.

What is your annual IT budget and how do you plan for technology investments in future?

We plan IT investments to support our overall objectives. Operational efficiency is an example of an objective that most people would associate with IT strategies. But as a hospital we have objectives like patient safety and customer service that are just as important. For example, one of our recent investments is a pharmacy robot, this complex piece of machinery that prepares and dispenses medications in pre-packaged dosage units according to our doctors’ orders. It doesn’t generate revenue or profits; the reason for it is that it reduces the potential for human error and increases patient safety.

What specialities and superspecialities do you offer at Bumrungrad? What medical innovations do you have to your credit?

We offer over 30 speciality centers here, and our 945 doctors represent 55 sub-specialities, things as specific as Paediatric Cardiology, Aviation Medicine, facial pain, sleep disorders – virtually everything.

We have a clinical research program but we are not a research or teaching hospital, so I don’t want to represent us as an institution that pioneers new treatments. However, we offer some of the most advanced care and technology in Thailand, and we would compare well with top hospitals in the US. Some examples of advanced things we do here are HD Brachytherapy, deep brain stimulation, brain stents, hip resurfacing, image guided radiotherapy, capsule endoscopy, digital mammography with computer-aided detection, and bone marrow transplants. I could go on but that gives you a sampling.

February 2008

‘‘Thailand in general and Bumrungrad in particular have distinct advantages versus other destinations, that appeal to many patients.’’

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power hospital

Bumrungrad International Bangkok, Thailand

Inpatient Facilities  554 Inpatient Beds  500 Medical/Surgical/OB/Paediatrics beds  26 Adult Intensive Care beds  14 Cardiac Care (CCU) beds  9 Paediatric Intensive Care beds  5 Level III Neonatal Intensive Care beds  57 Deluxe rooms, 21 VIP Suites and 2 Royal suites Outpatient Facilities  24-hour Emergency care including emergency cardiac catheterization  Ambulance & Mobile Critical Care Fleet  Hospital 2000 Information System  150 clinic examination suites  Capacity : 3,500 OPD patients per day  Outpatient Surgery Centre

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‘Bumrungrad’ is a Thai word pronounced as ‘Bahm-roongRAHT’ - meaning ‘care for the people’.

Bumrungrad International is a globally recognised and accredited, multi-speciality hospital located in the heart of Bangkok. Founded in 1980, Bumrungrad is the largest private hospital in South-East Asia, with 554 beds and over 30 speciality centers. The hospital offers state-of-the-art diagnostic, therapeutic and intensive care facilities, working as a holistic one-stop medical centre.

Bumrungrad serves over a million patients annually, of which over 400,000 are international patients. They include thousands of expatriates who live in Bangkok and other neighbouring countries, and visitors from more than 190 countries across the world who come here for treatments. In order to cater to the special needs of international patients, www.ehealthonline.org

The Bumrungrad facility is run and managed by an American-led international management team . It has more than 2,900 employees on board, with 900 physicians and dentists (most of them having international training/certification) and over 800 nurses and paramedics. the hospital has set up a medical coordination office, staffed by doctors, nurses and interpreters.

to provide quality care in all medical specialities including invasive cardiology, cardiac and neurosurgery.”

Accreditations Bumrungrad has many firsts to its accreditation credits.

It was the first hospital in Asia to be accredited by the USbased Joint Commission International (JCI) in February 2002 and re-accredited in April 2005. It was also the first private hospital in Thailand to be awarded Hospital Accreditation based on US and Canadian Standard, and the first hospital in Thailand to be re-accredited. In addition, it has an internationally certified laboratory and also the first one to be re-accredited outside the U.S.

The hospital features a 24-hour Emergency Room; 19 operating theatres; 4 types of intensive care units (adult, paediatric, cardiac and a Level III neo-natal ICU); and a rehabilitation centre.

Technological Infrastructure The Red Cross gives Bumrungrad its top classification of “A” – defined as “a tertiary care centre which should be able February 2008

Surgical facilities include 2 cardiac catheterisation labs, 19 operating theatres (two specifically set up for cardiac surgery), a surgical navigation system; plus endoscopy, arthroscopy, lithotripsy and interventional radiology capabilities.

Other special capabilities include - complete diagnostic imaging; MRI; CT; 64 slices multi detector CT scanning; PACS digital imaging management; Image–Guided Radiation Therapy ( IGRT ) using Synergy – S system; Philips Linear 25

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accelerator dual energy photon ( 6&18 MV ) and a range of electron beams from 4-20 MeV; Big Bore CT Simulator – 16 slices; Simulator topometric devices for pre-radiation preparation of patients to ensure accuracy; 3-D computer planning system with direct connection to BI’s CT & MRI imaging systems; State-of-the-art Pinnacle treatment planning; 3D conformal brachytherapy treatment planning; Ultrasound guided – Brachytherapy ( IGBT ); Image Guided Radiation Therapy (IGRT); High-dose rate (HRD) brachytherapy and Custom block fabrication.

International Services The hospital has international representative offices in Australia, Cambodia, Ethiopia, Macau, Mongolia, Nepal, Seychelles, Sweden, Vietnam, Bangladesh, Canada, Hong Kong, Maldives, Myanmar, Oman, Sri Lanka and Taiwan.

The international patient services centre of the hospital provides special assistance such as - interpreters, insurance coordination, referral centre, e-mail correspondence, hotels, visa extensions, airport reception, embassy assistance, VIP airport transfer and local travel.

Special Facilities:            

2 Cardiac Catheterization Laboratories 19 Operating Theatres MRI, CT and Lithotripsy Nuclear Medicine PACS Radiology 64-slice CT Scanner 2 Cardiac Operating Theatres Interventional Radiology Neonatal Critical Care Transport Radiation Therapy (Linear Accelerator) Vitallife Wellness Centre Surgical Navigation System

Bumrungrad International is a complete medical campus Bengali, Cambodian, Chinese, French, German, Japanese, having its own medical heliport, over 140 outpatient clinic Korean and Vietnamese. rooms grouped into 30+ speciality centers and 125 hotel rooms and serviced apartments, housed in two campus The world-class Plastic Surgery Centre at Bumrungrad buildings for families and recovering patients.

International also deserves a special mention. It attracts a large number of patients from Thailand and abroad due Adhering to high quality customer service and best its excellent reputation for procedures such as cosmetic practices, service representatives at Bumrungrad are highly surgery, reconstructive surgery, skin treatment and hair multilingual, speaking languages like English, Thai, Arabic, transplantation.

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For Advertising Enquiries Amitabh Mukherjee Mobile: + 91-9871686548 Email: amitabh@ehealthonline.org Arpan Dasgupta Mobile: + 91-9911960753 Email: arpan@ehealthonline.org

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NEWS REVIEW

BUSINESS

IBM to help Sankara Nethralaya manage IT infra

Lankan hospital collaborates with Manipal Health Systems

IBM is partnering Sankara Nethralaya, a speciality institution for ophthalmic care in Chennai, to help manage its IT infrastructure.

The hospital has implemented IBM’s Network Operations Centre-Inside (NOC-Inside), to its business operations. NOC–Inside has an asset-based integrated service approach and allows the hospital a 360-degree view of its IT infrastructure for effective monitoring.

The hospital has automated IT monitoring, inventory management and service desk operations. NOC-Inside generates daily reports, allowing it to keep track of the hardware and software inventory and ensure software licence compliance.

These also help the hospital verify the service level commitments of their service providers and gauge their performance.

With this, Sankara Nethralaya claims to have reduced its manual intervention in day-to-day operations by almost 60 per cent.

NOC-Inside was developed by Network Solutions (NetSol), a Bangalore-based network integration company.

The Asiri Group of Hospitals, Sri Lanka has tied up with Manipal Health Systems, a premier Indian healthcare provider, to facilitate state-of-the-art medical services in the Island nation.

The MoU aims to enhance the existing expertise and superspecialities of Asiri Hospitals.

“We are proud to be associated with established partners with proven track records and expertise. This is a good news for the healthcare and medical service industry in the country and an excellent step forward for Asiri Hospitals in our continuous effort to be one of the best health service providers in the region,” Pathirage said after signing the MoU. While Manipal Health Systems’ R Basil said, “This association will bring out the best of clinical excellence and a patient - centric culture to this nation.” The two sides will encourage medical and health professional groups to share experiences through seminars and training programmes. Established in 1987, Asiri Hospital is one of Sri Lanka’s premier private hospitals providing state-of the-art facilities, while Manipal Health Systems is one of India’s key medical enterprises.

Present model of PPP fails to woo pvt healthcare A lack of clear modalities on the public-private partnership (PPP) model is delaying the muchhyped entry of the private healthcare sector as a big-time service provider in government hospitals across India.

Barring a few instances, none of the major corporate healthcare entities have so far announced plans to partner with the government in a big way.

“The corporate hospitals will not be interested in government facilities unless the partnership models are clearly defined.” , says

Fortis Healthcare CEO Shivinder Mohan Singh.

Vishal Bali, CEO of Workhardt Hospitals, agrees. “For PPPs to happen, there have to be very clear cut frameworks laid down by the state governments. The standards should help such partnerships become a viable model on a long-term basis.”

Though the PPP model appears distant, state governments are trying to evolve institution and location-specific partnership deals.

According to the Planning Commission, 60 new government medical colleges and 325 new nursing colleges are expected to come up during the next five years.

“This will have to be scaled up 4-5 times by private sector if we need to meet the demand.” RR Shah, member secretary, Planning Commission, points out.

“On the operational side, lot of public infrastructure needs to get into the hands of private sector. Most of the tertiary services, and to a large extent, secondary services, should be operated by the private sector.” says Shah.

TCS to revamp IT infra of Cholamandalam MS Cholamandalam MS General Insurance Co has announced a tripartite tie-up with Tata Consultancy Services (TCS) and CMC Ltd to revamp its IT infrastructure.

The new system will ensure improved service delivery processes for customers across branches in India. The deployment is in line with the company’s expanding business and the changing requirements of a free market in the insurance de-tariff regime.

While the software is a proprietary general insurance system of CMC, 28

TCS will manage its customisation and successful deployment over the web. Benefits to customers will include delivery of policies at remote locations, facilitation of alternate modes of payment such as credit card, mobile telephony and web and improved speed of interaction such as issuance of policies and settlement of claims.

The project will go online at 100 Cholamandalam MS offices across the country in the first phase in April. Cholamandalam MS General Insurance is a joint venture between the Murugappa Group and Mitsui Sumitomo Insurance of Japan.

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Global medical tool makers throng India Foreign medical device manufacturers, mostly from the US, are increasingly entering the US$ 2 billion domestic medical equipment market.

The tremendous growth projections have also prompted foreign medical equipment makers to float Indian subsidiaries - 30 of them received import clearances in 2007 alone.

Boston Scientific, Abbott, Becton Dickinson, Guidant, Medtronic, B Braun, Johnson & Johnson, DePuy, Advanced Medical Optics and Stryker are among those whose Indian subsidiaries received approvals to import medical devices in 2007.

A recent FICCI-Ernst & Young study has predicted 15-20 per cent growth for the Indian medical equipment market and estimates it at about $5 billion by 2012.

According to Anjan Bose, Chairman - Medical Electronics Forum, FICCI, India has to join hands with the industry to decide on an appropriate monitoring mechanism for quality control of medical devices reaching India.

Though the domestic industry shares the same view on the need for clarity in the regulations binding medical equipment, it alleges that Indian regulators adopt double standards in giving marketing approvals for medical devices.

Domestic players also allege that the absence of pricing norms is allowing bigger players to charge exorbitant prices for their imports.

Incidentally, the growing demand for medical devices and its cost have also found mention in a study carried out by the Delhi-based Society for Economic and Social Studies.

Wipro GE Healthcare expects INR 800 crore revenue from project Wipro GE Healthcare Ltd., the Indian sales and marketing arm of GE Healthcare, the world’s largest healthcare and diagnostics technology company by sales, is targeting revenues of over INR 800 crore from a public - private partnership programme in the Indian diagnostics market.

The company is in talks with several state governments in India to set up diagnostic facilities at major public hospitals, and is aiming to cover a majority of India’s medical colleges under this programme within the next three years.

GE Healthcare, owned by General Electric Co., will help set up diagnostic centres equipped with its computed tomography or CT scan systems as well as its MRI systems, in these hospitals.

The partnership will reduce diagnostic imaging costs for patients by approximately 30%, and by up to 50% for below poverty line patients.

GE Healthcare, which manages its marketing and sales business in India through the joint venture with Wipro Ltd, initiated its first public-private partnership programme by signing a contract with the Madhya Pradesh government and Sanya Hospitals and Diagnostic centre to set up a diagnostic centre at the Netaji Subhash Chandra Bose Medical College Hospital in Jabalpur.

Projects in Gujarat and Rajasthan are in the pipeline.

February 2008

Philips, Artemis tie up for research in diagnostic devices trials

Gurgaon-based health care firm, Artemis Health Sciences Pvt. Ltd and Royal Philips Electronics NV plan to start three research studies using advanced medical technologies, in a bid to find more efficient and cheaper ways of diagnosing diseases.

Data from the studies will add to the Philips research database, while Artemis hopes to use the high-end imaging and scan machines to detect blockages in the heart at a fraction of the present cost, and spot tumours early. A study for FICCI estimates that the market in India for medical devices and equipment will more than double to US$ 4.98 billion (INR 19,450 crore) by 2012 from US$ 2.18 billion in 2007. Of this, radiology equipment such as MRI , CT scans and ultrasound machines will account for a sixth of the market.

Philips is talking with health care chains about partnerships and Artemis too, will look out for tie-ups with drug, biotech and medical device firms.

“We are trying to test the hypothesis that this CT scanner is as effective as the conventional angiography.”, said Hassan Tehrani, a teaching consultant at Artemis and part of the Phillips-Artemis research team. “We already know it is cheaper, faster, non-invasive and reduces the hospital stay from a day to few hours.”

The second study will test if a 3Tesla MRI machine is more effective than older generation scanners in diagnosing tumours.

The machine at Artemis is the only one of the kind in India so far.

The last study will use ultrasound machines to test the prevalence of ‘aneurysms’ in 3,000 subjects.

Mastek to raise US $40 mn for buyouts abroad Offshore outsourcing company and IT giant, Mastek, is raising $40 million in order to acquire companies with intellectual property rights in the insurance and healthcare space.

They are looking at companies in the range of $10-20 million with 100-200 manpower strength for acquisition. The company already offers services in the insurance and healthcare sectors.

The acquisitions are expected to consolidate its expertise and strengthen its presence in the domain areas.

The acquisitions would also add to Mastek’s customer base.

While the company wants to increase its revenue shares from the US and the UK, it is also looking for specific state government-led projects in the domestic market.

In FY07, the company’s revenues were INR 810 crore. It has close to 3,400 employees with a presence in the UK, Japan, South East Asia and the US. In India, the company has its offshore development centres in Mumbai and Pune, and has recently commissioned a third centre in Chennai which will employ close to 6,000 people.

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Opportunities for Digital India healthcare industry in India is growing at a phenomenol pace - so are the standards

INDIA

2008 29-31 July, 2008 Pragati Maidan, New Delhi

of service delivery. technology is redefining ways of care management, clinical processes and business pathways. be it providers, payers or patients ..everybody can be a winner when technology lends its magic wand and transforms the way we do healthcare.

Join us to find it all for yourself !

High powered sessions and panel discussions would focus on • IT Innovations in Healthcare Delivery • EMR Best Practices & Standardisation • Network Infrastructure for Connected Healthcare • TeleHealth Applications and Service Delivery • Medical Imaging & Diagnostic Technologies

...the definitive event on

healthcare ICTs, technologies and applications

• Information Sharing & Regulation for Insurance Sector • Investment Landscape in Healthcare & Medical Technology Industry • Medical Tourism - Opportunities for Healthcare Industry

...BE A PART OF IT

For Programme Enquiries Dipanjan Banerjee (dipanjan@ehealthonline.org; Mob: +91-9968251626)

For Sponsorship and Exhibition Enquiries Arpan Dasgupta (arpan@ehealthonline.org; Mob: +91-9911960753) Amitabh Mukherjee (amitabh@ehealthonline.org; Mob: +91-9871686548)

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Bosch buys health network

Israel’s Teva pharma to invest INR 4,000 cr in India

The Bosch Group has acquired US telehealth specialist and innovator Health Hero Network Inc., which focuses on remote health monitoring.

Health Hero Network develops and sells technology that allows the remote monitoring and management of patient health data.

Founded in 1992, Health Hero Network has handled 63 patients to date.

Telehealth is a young market with huge potential for growth.

Bosch is already involved in telehealth through a number of initiatives and subsidiaries, including Swiss Telealarm, a European provider of social alarm and nurse call systems. Together with the renowned Carité hospital in Berlin, Bosch experts develop new products for the care of cardiac conditions.

Asked whether Bosch would bring Health Hero Network’s services to Europe, a spokesperson said: “Health Hero Network fits very good in this portfolio and will help the Bosch Group to grow further in this field. One step will be this year in bringing Hero products to Europe.” The Bosch Group comprises Robert Bosch GmbH and about 300 subsidiary and regional companies.

Israel’s Teva Pharmaceutical Industries, the world’s largest manufacturer of copycat patented drugs (generics), plans to invest over $ 1 billion in India to acquire Indian drug companies and set up greenfield manufacturing facilities.

The investment is planned for the next 24 months. Teva recently acquired over 100 acres of land near Gwalior, Madhya Pradesh, to set up active pharmaceutical ingredient (API) manufacturing facilities matching the production capacity of domestic generic majors such as Ranbaxy, Cipla, Dr Reddy’s, Sun Pharma and Wockhardt.

Teva has an Indian arm, Teva India, and a research and development centre in New Delhi which it opened two years ago. It will reportedly target drug majors such as Cipla, Aurobindo, Matrix and Orchid, as well as Saraca Laboratories of Hyderabad.

India is an interesting geography not just for Teva, but for several global drug majors, which are attracted by the huge talent pool, scientific skills and cheap labour that has enabled Indian companies make drugs at about a third of the cost in the West.

Spectrum Health with Cerner and Microsoft to empower patients Spectrum Health announced its strategic relationship with Cerner and Microsoft Corp. to develop the Cerner Care Console(TM) solution, a consumer-centric technology which enables patients to take an active role in their care.

By integrating Spectrum Health’s knowledge about the patient experience with the Cerner Millennium(R) healthcare information technology (HIT) computing platform and Microsoft Windows Media Center, the Care Console system keeps patients informed about their condition, medical care and provider team during their hospital stay.

In addition, Cerner has also incorporated the use of Xbox 360 consoles into this system to offer patients gaming and entertainment experiences. Spectrum Health is pilot - implementing the Care Console system in one unit at its Butterworth Hospital in Grand Rapids.

Cerner and SpectrumHealth found that patients could benefit from communication tools easily accessible at the bedside that range from access to their daily care plan and reviewing radiology images to diversional activities such as e-mail, movies and video games.

The Care Console system provides a wealth of information to patients at the bedside, helping them to be more involved in the care experience. By utilizing the Care Console system’s various educational features, caregivers and patients can engage in dialogue about the patient’s condition, needs and experiences.

Says Kris White, vice president of patient affairs, Spectrum Health, “This healthcare solution will allow patients to not only have access to their health information but also to discuss it with their physician at the bedside and participate in their care in a meaningful way.”

Godrej set to hive-off medical diagnostics arm FMCG major Godrej Industries will transfer its medical diagnostics division to ICICI Venture-backed RFCL. The transfer will take effect from December 31, 2007. Earlier, on November 26, the sale of the medical diagnostics division had been approved by its board.

RFCL provides vitro diagnostics, animal health care, laboratory solutions and custom synthesis through its four strategic business units - Diagnova, Vetnex, Rankem and Neosynth.

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INDIA

2008

Opportunities for Digital India

29-31 July, 2008 Pragati Maidan, New Delhi

Hospital

CIOCONCLAVE healthcare is finally getting the better share of IT! a high growth rate of the industry, coupled with heightened focus on quality and efficiency of service delivery is fueling heavy IT investments from hospitals and care providers. no wonder why India is fast emerging as the leading Asian country in terms of growth in healthcare IT market. however, still, IT practices in this industry is neither standardised nor wellunderstood ..and to a large extent 'undermined'. there is a need for appropriate capacity building and unadulterated knowledge-sharing among solution providers, practitioners and end users. get all of these and much more when some of the finest IT brains of the industry get together this summer at the 'Hospital CIO Conclave' of eHEALTH India 2008.

To participate as a panelist Dipanjan (dipanjan@ehealthonline.org, +91-9968251626) For Sposnsorship Opportunites Arpan (arpan@ehealthonline.org, +91-9911960753) Presenting Publication

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Axon Lab, iSoft re-enter Swiss market

Healthcare industry wasting millions on software - report Healthcare organisations are wasting millions of pounds each year in failing to exploit the full potential of the software systems they are paying for, reveals a report of West Trax, an IT consultancy specialist.

The healthcare industry is one of 13 different sectors which are using less than half the standard software code they pay for.

West Trax undertook a software applications cost/benefit study, analysing data from 269 benchmarks in 13 different industry sectors.

It found that users were typically failing to fully exploit the potential of the standard software functionality that was available in their systems.

Even in most of the “best practice” systems in the study, more than 50% of the standard software transactions relevant to the users’ businesses and available in their systems, were not utilised.

At an IT conference last November, Steve Rogers, UK Managing Director of global software company SAP, challenged delegates to use their SAP assets more effectively. “I find it frustrating that the majority of you only seem to be using a modest slice of the software you have acquired.”, he said.

iSoft is re-entering the Swiss market through a distribution agreement, just 18-months after it sold its Swiss operations.

Under its new distribution agreement, Axon Lab AG, a service provider for diagnostics and molecular biology, will support iSoft in selling laboratory systems in Switzerland.

In June 2006 iSoft sold its operations in Switzerland to Nexus, a local provider of healthcare IT solutions.

Core elements of the agreement are the distribution, implementation and support of the iSoft laboratory solution, LabCentre. Axon Lab AG has been a dedicated service provider in the fields of diagnostics and molecular biology since 1989. The company installs and supports a range of diagnostic equipment and software applications.

The move is part of the IBA health Group’s plans for expansion within Europe. It is already a leading supplier of e-solutions in the UK, Germany, the Netherlands and Spain.

Silverline Technologies to enter healthcare Silverline Technologies is launching its healthcare sector through an investment of 15% with an option of 100% acquisition in a North American firm specializing in healthcare change and performance management.

Ravi Subramanian, chairman of the board, stated that the investment is a significant step towards making the company a focused leader in specific industry verticals. There is a growing need to build efficiencies due to high pressure on governments, globally, exerted by increasing costs in the segment. In US alone, the current spending of $1.7 trillion is estimated to exceed $2.7 trillion by 2009 and working on current projections, it could touch 20% of the GNP by 2015 - an estimated $4 trillion.

The company will spell out details regarding the initiative over the next few weeks. The company will leverage its global facilities in Canada, US, India and potentially Mexico to build on these initiatives.

The company recently acquired Omega Direct Response, a global provider of customer interaction and management services.

Cisco plans research centre in Qatar US networking giant Cisco has plans to establish a research and technology centre at the Qatar Science & Technology Park (QSTP). The project was unveiled at a meeting between Sheikha Mozah Bint Nasser Al Missned, wife of the Emir of Qatar, and Cisco chairman and CEO John Chambers.

The company recently unveiled a 5.8 billion-UAE dirham ($ 1.58 billion) information and communications technology (ICT) investment package for the UAE. The Qatar centre will be spread over three years, and will be used to work with the Qatar Foundation on projects to develop Qatar’s knowledge economy.

The first collaboration will be on Project iQ, which aims to create a collaborative platform that can be used by the Qatar Foundation to work with other organisations around the globe on research, education, health and youth employment initiatives. As part of the UAE investment, Cisco said it would expand its headcount, open a new regional headquarters at Dubai’s Knowledge Village and open an Abu Dhabi office.

The plan also includes an expansion of the Cisco Networking Academies programme, which works with academic institutions to give students skills and experience to prepare them for careers in the IT sector. In April 2006 Cisco pledged an investment of 1 billion Saudi riyals ($ 265 million) to the Saudi Arabian ICT sector. Cisco’s Saudi investment plan includes increasing headcount in the kingdom and establishing a technology and entrepreneurship centre and new networking academies.

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TECHNOLOGY TRENDS

GE makes digital X-Rays affordable GE Healthcare’s new Tejas XR 6000 high frequency X-ray promises to reduce the cost of direct digital X-ray systems to half of the price at which they are currently imported into India.

GE Healthcare recently announced the launch of ‘Tejas XR 6000’ in India - a next generation convertible X-ray system. The new Tejas XR 6000 will be manufactured at GE Healthcare’s plant in Bangalore. GE continues to focus on increasing affordability of high-end diagnostic systems to Indian doctors through local manufacturing. GE has rolled out a series of value products under the “In India, for India” program and is expecting to roll out several variants of Tejas X-ray systems during 2008.

X-ray is the primary and most widely used diagnostic imaging tool. However, the X-ray systems currently available in the Indian market are low powered, bulky and employ very old generation technology. The conventional X-ray system cost varies from Rs. 1 lakh to Rs.5 lakh, but compromises on technology, quality & radiation dose. The next level fully digital X-ray systems offer the most enhanced imaging solutions and are available in the range of Rs 1.5 crore – Rs 2.5 crore. This high initial investment has restricted its usage in India. The GE Tejas XR 6000 is available for less than Rs 15 lakh, and provides the best of both worlds – conventional, as well as future upgradeability to digital X-ray technologies. Tejas XR 6000 can be upgraded to a true digital X-ray at a fraction of the cost of digital X-rays available in the market today.

An estimated 60,000+ X-ray systems are in use in Indian hospitals and diagnostic centres. The market growth is estimated at more than 10% every year. Today, most of the Indian X-ray systems in use are older, out-dated technologies, which have been phased out in many developed and emerging countries.

With the Tejas XR 6000 convertible technology, GE Healthcare has provided a platform for Indian doctors to move towards a global standard of digital X-ray systems. The Tejas XR 6000 provides superior images at very low exposure surpassing conventional X-rays every time. The system creates a safer imaging environment by reducing exposure time, lowering radiation dose and eliminating soft radiation compared to conventional X-rays.

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“Tejas”, an ‘In India, For India” initiative, is in alignment with GE Healthcare’s vision to promote the concept of “Early Health” in India. Currently, 80% of X rays that are installed in the market are conventional X-rays as digital technology is not affordable for most Indian healthcare professionals. GE Healthcare has taken a significant step to address this need by making digital technology available at substantially reduced cost. X-ray is the primary and most widely used diagnostic imaging tool. This will help radiologists upgrade an analogue X-ray into digital X-ray for less than Rs. 60 Lakhs.”

V Raja, President and CEO GE Healthcare (South Asia)

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Innovation Trail @ GE

GE’s ‘In India, for India’ Program

GE revolutionized the X-ray market by introducing the first digital X-ray in ‘99. GE invested over US$ 500 million in developing its proprietary flat panel digital X-ray technology and the company has been granted more than 100 US patents. The technology is extended to multiple applications like cath-labs, mammography systems and a number of radiography X-ray applications. GE is one of the very few manufacturers in the world to manufacture digital detectors and over 10,000+ digital systems are in use globally. GE’s flat panel detector provides reliability and an optimized image quality for all digital radiography systems.

The modern, floating radiographic table has altered clinical approach in several ways. Patients find it much easier to get on and off this table. Further, the floating tabletop allows easy positioning of the extremities and various body parts for both routine and difficult radiographic examinations. The size of the floating tabletop radiographic table, is wider to accommodate trauma patients, and patients who would find it difficult to be positioned on a routine radiographic table.

GE has pioneered medical imaging products manufacturing in India. GE Healthcare was set up in India with a joint venture with Wipro Corporation in 1990 realizing the availability of advanced technology at affordable costs for even the rich towns and hospitals. The equipments had to be imported and the duty amount was extremely high and some times 100% of the value of the product, making it ill affordable. The way to bridge this gap is by manufacturing products locally. With this objective,GE launched the ‘In India, For India’ program, for manufacturing high-end medical equipments within the country, which helped reduce cost by nearly 70%. In addition, it made technology available to a larger number of clinicians and patients who otherwise could not have afford such facilities.

GE has rolled out a number of products under this program, such as - LOGIQ 100 (a black and white ultrasound system); Mac 400 (a portable, battery operated ECG system), Lullaby range of phototherapy systems; Maternal infant care monitors and HF Advantage (X-ray system).

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INDIA

2008 Opportunities for Digital India

29-31 July, 2008 Pragati Maidan, New Delhi

MEDICAL

TECHNOLOGY FORUM

the midas touch of technology has redifined medicare over the years! starting with the invention of 'stethoscope' till the modern day 'nuclear medicine' technology continues to revolutionise medical practise ..all of these, to create a healthier world. at the present day, 'India' is a synonym to 'Innovation' ..and a promising global hub of medical technology and manufacturing. with a booming healthcare sector, the market potential is enormous. there is a dire need to get over regulatory hurdles, create enabling environment for market access and encourage standardisation. get the leaders of this industry 'unplugged' at ‘Medical Technology Forum’ of eHEALTH India 2008

To participate as a panelist Dipanjan (dipanjan@ehealthonline.org, +91-9968251626) For Sposnsorship Opportunites Amitabh (amitabh@ehealthonline.org. +91-9871686548)

Presenting Publication

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EVENT REPORT

Telemedcon 2007 1 - 3 November 2007, Chennai

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he 3rd National conference of the Telemedicine Society of India (TSI) was held at Hotel Taj Coromandel in Chennai from 1-3 November 2007.

The event kicked off with a pre-conference workshop organized in conjunction with the conference, at the Indian Institute of technology (IIT) Madras, on 1st November. Dr. T. Ramasami, Secretary of the Dept of Science and Technology, Government of India was the chief guest and Dr. M.S. Ananth, Director of IIT Madras, presided over the events.

The organizers included Apollo Hospitals, Apollo Telemedicine Networking Foundation, Sri Ramachandra Medical University and Shankar Nethralaya. It was sponsored by Indian Space Research Organization (ISRO), Department of Science and Technology and Department of Information Technology of the Government of India and the World Health Organization.

175 delegates attended the extremely instructive workshop, which covered themes such as Organization & Management of Telemedicine, Tele-Radiology, Tele-Cardiology, Tele-Ophthalmology, Critical Evaluation & Auditing of a Telemedicine Unit, Standardization and legal aspects of the field. A programme booklet was also provided to participants.

There were live demonstrations of teleradiology and teleconsultation to villages using low cost indigenous equipment through VSAT enabled mobile vans of Shankar Nethralaya, Dr. Mohan’s Diabetes Research Center, an example of a ‘hospital on wheels’. A UK-based company illustrated a ‘Map of Medicine’ programme, currently in use at the National Health Service.

Dr. M. Karunanidhi delivering the inaugural address 38

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Representatives of Sankara Nethralaya Chennai and Aravind Eye Hospital, Madurai lectured on the dedicated use of VSAT enabled teleopthalmology vans. The Apollo Telemedicine Networking Foundation also contributed key insights into its experience of over 25,000 teleconsultations and of introducing formal courses on telehealth technology. The Apollo Hospitals Group set up the first Rural Telemedicine Center in Aragonda, Andhra Pradesh, and is now the the single largest Telemedicine solution provider in India.

The TSI conference was held along with the 12th International Conference of the International Society for Telemedicine and e-Health (IsfTeH) which was held in South Asia for the first time. They brought together 300 participants from India and across the globe. International delegates from Algeria, Austria, Australia Belgium, Bangladesh Brazil, Bosnia, Botswana, Canada,, England, France, Germany, Herzegovina, Maldives, Myanmar, Pakistan, Philippines, Spain, South Africa, Switzerland, Sri Lanka and USA participated in the national conference.

The IsfTeH included presentations on the ISRO Telemedicine Network Implementation, telemedicine teaching and case studies. Optimum utilization of the media for low-cost telemedicine, transformation of health care through ehealth and Design And Development of Portable Cardiac Telemedicine System were other areas discussed. International delegates from Bosnia and Herzegovina, Brazil, Singapore, Spain, Maldives and the USA contributed with the sharing of best practices and innovations. Privacy and security issues in the Indian context were also addressed. Each presentation was followed by an interactive question and answer session for a few minutes.

Lamp lighting ceremony at Telemedcon 2007

India can benefit from almost every aspect of telemedicine with its vast geographical area and varied topography.

Approximately 70 percent of the population lives in mote villages to which access is difficult and where infrastructure is poor. The Ministry of Communications and Information Technology has classified “Telemedicine� as one of the thrust areas for development in the country.

TSI promotes and encourages development, advancement and research in the science of telemedicine and its associated fields. Its membership consists of doctors, engineers, technologists and administrators, including 50 officers of the Armed Forces The TSI conference brought together stakeholders in telemedicine and helped create awareness about its application to the rural and remote parts of the country. The conference was well received and covered widely by the media.

The activities also included three video conferencing sessions from the USA. Chief Minister of Tamil Nadu, Dr. M. Karunanidhi addressed the delegates on pertinent topics related to the health sector, particularly, e-health. A total of 83 papers were presented on a range of topics such as telehealth in India, teleeducation and VSAT enabled teleopthalmology.

Sankara Nethralaya, Aravind Eye Hospital and Apollo Telemedicine Networking Foundation (ATNF) shared their IsfTeH promotes the dissemination of knowledge and practical experiences in the field. The ATNF shared its experience in Telemedicine and eHealth internationally and experience of overseeing more than 25,000 teleconsultations provides access to recognized authorities in the field across and of introducing formal courses on telehealth technology. the world.

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WORLD

news review

China unveils new healthcare scheme China recently announced an ambitious program to provide basic healthcare for every citizen in the world’s most populous nation. Chen Zhu, the Health Minister, speaking at the national Health Forum said the Healthy China 2020 program would provide universal national health service and promote equal access to public services.

With the ambitious title of Healthy China 2020, the program has multiple goals, including improving life expectancy, which this year has reached 73 years. It will be a massive challenge for the government, but the Health Ministry has been asked to fill what the Health Minister called ‘a significant gap between the Party requirements and people’s new expectations’.

There is another reason for China to work on the health system.

As Beijing gears up for the summer Olympic Games, China wants to strengthen disease-monito ring and evaluate any public health hazards.

In a related news it is reported that rising medical costs have become the top concerns of Chinese people, according to a new survey by the National Bureau of Statistics (NBS.) The survey of 101,029 families nationwide revealed 15.3 percent of those polled chose ‘medical and health services’ as one of their concerns. Growing public criticism of soaring medical fees, lack of access, poor doctor-patient relations and the low coverage of the medicare system had compelled China to launch a new round of medical reform.

Medical tourism covers soon in the West A recent report by Swiss Re forecasts that the globalisation of healthcare is expected to have a significant impact on the strategy of health insurance companies, and medical tourism covers will eventually become available in the West- a move that would boost the inflow of foreign patients seeking treatment in India.

In its report on Global Trends in Private Medical Insurance, Swiss Re has observed that in view of the significant savings potential, some experts believe that health insurance plans covering medical tourism will eventually become available and revolutionise healthcare delivery. The report said that a recent study shows that if one-tenth of US patients travel abroad for treatment, savings of US$1.4 billion could be realised after taking into account the cost of travel.

Many hospitals in low-cost countries like India are already getting international accreditation such as Joint Committee on Accreditation

of Healthcare Organisations and often employ medical and nursing staff with American or European professional certification.

India, considered one of the leading medical tourism providers, attracted five-lakh foreign medical tourists in 2006. Revenues totalled US$350 million and the annual growth rate for such services was 30%, the report said.

Although Thailand got less than a third of medical tourists coming to India, its revenues have been far higher at US$1 billion. At present, the obstacle to insurers providing cover for treatment in India is a lack of network with service providers.

Dell, Collexis launch BioMedExperts, an online social network Dell and Collexis Holdings Inc., have launched BioMedExperts-an innovative social networking community that will promote collaborative medical research and development.

BioMedExperts will allow health care and life sciences professionals to easily connect and collaborate with each other, as well as conduct research by providing 1.4 million biomedical experts with 12 million pre-established network connections from more than 120 countries. The site also provides the ability to analyse all associated professional connections within the network and view scientific publications.

Dell will provide computer hardware to power the Collexis-designed BioMedExperts. Dell will also provide marketing support for BioMedExperts, including co-branded marketing efforts and promotions at major life science research conferences.

The BioMedExperts community is an example of how technology can connect scientists, enabling them to attack new and more complex cross-disciplinary biological problems.

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NHS successfully implements PACS digital X-ray project The U.K. National Health Service (NHS) has completed a project to rollout digital X-ray and scanning technology to health trusts across England as part of the 12.4 billion pounds (US$ 24.6 billion) national NHS IT program.

The Picture Archiving and Communication Systems (PACS) technology replaces the traditional method of using film and paper by allowing X-rays and scans to be stored digitally and accessed by health professionals on computers and laptops. More than 473 million images have been stored using the technology, which cuts the cost of traditional film processing and storage, and the government said NHS trusts are reporting an average saving of 250,000 pounds (USD 495,000) in their first year of using PACS. The government also claims the technology is improving reporting and clinical decision-making and contributing to reduced patient waiting times between referral and the start of treatment. This innovative technology speeds up and improves the accuracy of diagnosis, saves time and improves the quality of care. Trusts are reporting that the time taken for radiologists and radiographers to issue reports to clinicians have typically been halved from more than six days to less than three and these report turnaround times continue to fall with some hospitals reporting all imaging within 24 hours.

The PACS technology has been rolled out over three years to 127 NHS trusts, with Leeds Teaching Hospitals the final one to complete on 10 December. Although the PACS project has been completed more fundamental elements of the national NHS IT program remain way behind schedule, such as the national electronic patient record project.

The NHS care records service will eventually consist of a national summary care record containing basic patient information which can be accessed in emergencies and a more detailed local care record containing more comprehensive clinical information for each patient.

Malaysian hospital develops its own Hospital Information System

Novel device to help monitor unattended ER patients

Hospital Universiti Kebangsaan Malaysia (HUKM) is developing its own Total Hospital Information System (THIS), the first by a government hospital in Malaysia.

Built entirely by its staff from scratch, the hospital’s THIS initiative has already attracted interest from distributors keen to market the system to government and private hospitals in the country. THIS costs millions of ringgit to implement but the market for such a system in Malaysia is huge.

In addition, the HUKM-developed THIS, called Caring Hospital Enterprise System (C-HEtS), is expected to be cheaper than similar systems available in the market. HUKM is also looking at the business model on how to provide C-HEtS to others.

HUKM adopted the first phase of the system for all its patients.

A total of 2,000 HUKM staff, comprising admission clerks, nurses and doctors, are utilising the system. Phase one involves patient registration, emergency department, admission, discharge and transfer, appointment and scheduling, operating theatre scheduling, medical record management, user profile, case-mix, statistics and full patient accounting system.

Under the second phase scheduled in 2009, HUKM will develop the CPOE (Computerised Physician Order Entry) and undertake integration using HL7 (Health Level 7) and DICOM (digital imaging and communication on medicine. Phase three in 2010 will involve clinical documentation and electronic medical record while phase four in 2012 will cover research and case-based learning modules as well as other modules. Despite the host of applications that C-HEtS offers, total cost for all the four phases is expected to amount to less than RM 20 million.

Scientists have developed a novel integrated wireless system that monitors patients’ vital signs and alerts the doctors at the time of danger.

This unique device called Scalable Medical Alert Response Technology (SMART), may prove to be a boon for doctors to monitor otherwise unattended patients. It consists of an infrared blood oxygen sensor that clips onto a finger, and chest electrodes that monitor heartbeat. Both electrodes and sensor are attached to a PDA that is assembled in a belt pack and runs software that monitors their readings, and triggers the alarm if they change to a worrying extent.

February 2008

SMART also sends the data to a PC monitored by a paramedic.

The device was tested on 145 volunteers in the ER at Brigham and Women’s Hospital in Boston, SMART was able to alert about three patients who were stable when admitted but later developed dangerously irregular heartbeats.

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Virtual aid to remote Fillipino patients

System keeps patients out of hospital

Patients in the remote areas of Philippines have been receiving virtual medical aid from doctors thanks to a project initiated by the University of the Philippines National Telehealth Center (NTHC) which is now using any available technology, such as short messaging service (SMS), to extend expertise to at least 30 government doctors stationed in different areas nationwide.

For the past two months, the NTHC has been fielding referrals

Patients in Sheffield with serious lung conditions are spending less time in the hospital and more time at home thanks to the use of a new monitoring system. People with Chronic Obstructive Pulmonary Disease, which covers lung conditions including emphysema and bronchitis, have been issued with ‘Telehealth’ equipment which enables medics to closely monitor their health and flag up any problems at an early stage.

By ensuring difficulties are picked up quickly, the approach has halved readmission rates to hospitals for COPD patients, freeing up expensive beds. Patients involved with the Telehealth project are issued with equipment to use at home which assesses their blood pressure, pulse rate, oxygen saturation levels and body temperature.

Readings are sent by computer to a centre where they are studied and clinicians will then alert doctors and nurses if there are any abnormal signs. Support can then be given to prevent the patient getting worse and needing hospital treatment.

COPD is more common in South Yorkshire because the condition affects people who worked in heavy industry and smokers - as the region has a high rate. The early stage of the disease may go undetected but early medical health can make a big difference to prevent further deterioration in the lungs. The aim of Telehealth is to encourage an improved quality of life for patients as well as reducing the need for them to be admitted to hospital.

from the doctor to the barrios serving in remote areas. The government doctors use text messaging to refer ‘problematic cases’ to NTHC, which in turn refers these cases to the faculty of the University of the Philippines College of Medicine.

The NTHC initiative aims to address the lack of government doctors in the Philippines, especially areas where they have lone practitioners. Experts and specialists are now concentrated in Metro Manila and key cities.

There are about 470 areas in the country where there are no government doctors. The NTHC is currently at the ‘testing’ phase, and the project is seen evolving later to include other practitioners like midwives. The NTHC gets at least one case referral a week.

Doctors who take part in the initiative earn leave credits.

Robots that help elderly Robosoft’s Robuter prototype French robotic specialist Robosoft has demonstrated a prototype service robot which can help elderly and handicapped people stay at home. The robot is a homecentric robot, which combines the internet and robotics technology to provide daily-life services to people staying at home.

The aim of the robot is to show how service robots can help elderly and handicapped people by connecting to the internet, enabling social interaction, remote telemedicine, cognitive prosthesis and much more. Robosoft has designed the robot to allow providers of services to customise it and offer various services to their customers. The new robot uses the same technology as Estele, the remote tele-echography system already in operation in four French Hospitals.

This new prototype is already available for evaluation. It illustrates services that can be performed by robots at home such as social interactions, remote telemedicine, cognitive prosthesis and domestic duties like cleaning.

By connecting to the robot via the internet, relatives are able to ‘visit’ grandma, find her in the apartment and chat. In the same way, physicians can remotely visit their patients who are at home.

This robuter is also able to monitor and record person and house’s activities, thanks to dedicated sensors, in order to make sure everything is fine.

The robot will also help to deal with sensitive issues, such as forgotten daily duties such as taking medications due to mental illness. The robot is based on robuLAB10, an off-the-shelf mobile platform, and a robuBOX, the generic robotic middleware based on Microsoft Robotics Studio, that comes with every robot produced by Robosoft.

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India and China create new global healthcare models Sobha Renaissance Information Technology (SRIT) today announced the second position conferred to its joint venture ‘Sunpa Sobha Software China Ltd. (3S)’ with the Chinese telemedicine major, Yunnan Sunpa Image Tel Tech Co. Ltd (Sunpa) by the largest circulated mainline daily in the Yunnan province of China, ‘Yunnan Daily’.

The Daily qualified top 10 most important events in the South-Asian region across industry verticals and functionalities. The first position was awarded to the ‘First Indo-Chinese Joint Anti-terrorism Military Training’ organized in Kunming, China in December, 2007. The ranking was published through its print daily on the 27th of December 2007.

The joint venture targets effecting healthcare cost sustainability and affordability by controlling the major cost components of medical devices, medical expertise and logistics. Majority of the healthcare cost in developed countries can be accounted to the medical expertise/services component. Various contributing factors like the imminent economic recession looming over major economies, issues

of unsustainable health care models in the larger pool of developed healthcare industries the world over, highlight the need for costeffective, collaborative efforts in healthcare scaleable globally.

SRIT through its JV is strategically placed to roll out innovative healthcare delivery models, given its command over a large part of the healthcare delivery value chain. SRIT along with its Chinese Partner has today under its umbrella, software, medical devices and telemedicine services infrastructure expertise.

The JV currently manufactures more that 50 telemedicine capable medical devices like Scanners, Video Conferencing Systems, Telepathology Microscope, Blood Pressure Monitors, Digital Stethoscopes, Mobile Video Carts, etc. It develops productized software for Hospital Information Management System (HIMS), Picture Archival and Communications Systems (PACS), Electronic Medical Records/Patient Medical Records (EMR/PMR) and a wide range of solutions for TeleRadiology, Tele-Cardiology, Tele-Pathology, Tele-Oncology, TeleDermatology using various technological components from within the group today. The JV operates one of the largest active telemedicine networks in the world, with upward of 100,000 telemedicine centers, 4000 specialists and about 700 technologists currently.

Online DNA test service in Europe funded by Google A private firm funded by Google Inc has recently launched its Web-based DNA test in Europe, hoping to build on a successful start in the United States, where the US$ 999 service went on sale in November.

Subscribers to 23andMe, mail a saliva sample and, four to six weeks later, get the results online, allowing them to learn about inherited traits, their

BOOK RELEASE

ancestry and- probably with the help of a professional- some of their personal disease risks.

The Website, which takes its name from the 23 pairs of chromosomes that make up each person’s genome, says it will display more than half a million data points in users’ genomes in a form they can visualise and understand.

The site does not currently make interpretations about a user’s risk for developing such diseases as cancers, Alzheimer’s disease and diabetes, though users could in some cases get help from experts to make some basic assessments. The service may prove controversial in countries like Britain, where some experts say DNA tests are often of little value and can trigger unnecessary health worries.

Telesurgery Kumar, Sajeesh; Marescaux, Jacques (Eds.) 2008, XXIV, 190 p. 64 illus., 57 in color., Hardcover ISBN: 978-3-540-72998-3 “TELESURGERY” is the first ever book on Remote Surgery released by Springer -Verlag at Germany.

This first ever book on Telesurgery lays the foundation for the globalization of surgical procedures (including ophthalmology), making possible the ability of a surgeon located in one part of the world to operate on a patient located in another.

Written by international experts from around the globe, this book explains clinical, technical issues and collective experiences of practitioners in different parts of the world practicing a wide range of telesurgery applications. This book is presented in such a way that should make it accessible to all professionals, including surgeons, nurses, allied health professionals and computer scientists.

Chapters from a host of renowned international authorities are incorporated. This ensures that the subject matter that tends to focus on recent advances in telesurgery is truly up to date.

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EVENT REPORT

Workshop on Carotid Intervention Escorts Heart Institute & Research Center 18 January 2008, New Delhi

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he Escorts Heart Institute and Research Center (EHIRC) organized a workshop along with cardiologists, neurosurgeons and neurologists on 18 January to launch the Indian Council of Carotid Intervention (ICCI).

Carotids are arteries supplying blood to the brain and their blockage leads to “Brain Attack� or Strokes. 50 percent of strokes occur due to carotid blockage. Dr. Atul Mathur, Founder Chairman of ICCI and Director of Cardiology at Escorts Heart Institute and Research Center emphasized the growing importance of carotid stenting - a recent medical innovation in angioplasty aimed at preventing strokes. It is a new and less invasive technology which doctors believe is set to become standard treatment in the future.

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Hardening of the arteries or atherosclerosis can cause a build up of plaque, causing them to narrow and stiffen and ultimately reducing blood flow to the brain. Carotid stenting can decrease the rising number of strikes considerably if blockages are detected in patients at an early age. The blockages are removed and the artery walls strengthened during the procedure. Carotid stenting is far less penetrative than the traditionally used endarterectomy.

The council will play the important role of putting in place adequate policy guidelines with a focus on safety and efficacy of the new methods. Its members include Dr. M.S Hiramath, Pune, Dr. P.C. Rath, Hyderabad, Dr. K.K. Haridas, Kochi, Dr. Rabin Chakrabarti, Kolkatta, Dr. Shriram Rajgopal, Chennai, Dr. George Joseph, Vellore, Dr. Bimal Someshwar, Mumbai, Dr. Subash Chandra, Bangalore and Dr. H.K. Bali, Chandigarh.

Dr. Mathur also expressed concern about the hesitation of health care providers to adopt new technologies. A tremendous amount of research and innovation is ongoing in the field of interventional cardiology and medical professionals need to increasingly adopt new and innovative approaches to intervention and treatment of cardiovascular diseases.

cause of disability. It is thus, also a public health issue of serious proportions.

ICCI is a formal body of ten prominent doctors from across the country, which will govern and supervise a carotid stenting module. It primarily focuses on training and accreditation to doctors, skill enhancement, research, collaboration with international research organization and exchange of academic activities at a global level.

Established in 1988, EHIRC, a medical facility center, has provided high-standard cardiac care for the past 19 years. The hospital is backed by the most advanced in-house laboratories and is arguably the largest stand alone cardiac center across the globe. It has installed the first Da Vinci Cardiac System in the region. Amongst its pioneering technical innovations are techniques of minimally invasive and robotic surgery, the Escorts Heart Alert Service which provide an expert ECG interpretation over telephone within minutes of any chest complaint/symptoms, and diagnosis of cardiac defects in fetal life using advanced, specialized echo cardiograph techniques.

It has already treated 300 patients using the carotid stenting technique. Three of the ten ICCI members belong to Escorts.

Strokes are currently the third most important cause of Dr. Atul Mathur is the first Indian doctor to receive a US death after cancer and heart attacks and the single biggest patent on a medical device for carotid access.

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health information eHealth Initiatives in the USA The multi-stakeholder, non-profit eHealth Initiative (eHI) recently released the results of its Fourth Annual Survey (2007) of Health Information Exchange at the State, Regional and Community Levels in the United States of America, taking stock of 130 community-based health information exchange initiatives. We seek to take stock of the situation as it now appears in the US, and what kind of learning it proposes to the rest of the world.

H

ealth information exchange (HIE) is defined as the mobilisation of healthcare information electronically across organisations within a region or community. The goal of HIE is to facilitate access to and retrieval of clinical data to provide safer, more timely, efficient, effective, equitable and patient-centered care.

eHealth Initiative and its Foundation

Formal organisations are now emerging to provide both form and function for health information exchange efforts. These organisations often called Regional Health Information Organisations, or RHIOs, are generally geographically-defined.

eHI engages multiple stakeholders, including clinicians, consumer and patient groups, employers, health plans, health IT suppliers, hospitals and other providers as also its growing coalition of more than 200 state, regional and community-based collaboratives, to reach an agreement on and drive the adoption of common principles, policies and best practices for improving the quality, safety and effectiveness of healthcare through Information and Communication Technologies.

They develop and manage a set of contractual conventions and terms, and arrange for the means of electronic exchange of information, and develop and maintain HIE standards.

The results of eHealth Initiative’s Fourth Annual Survey (2007) of Health Information Exchange at the state, regional and community levels in the United States of America indicate that at least 125 communities across the U.S. are continuing to bring together multiple stakeholders to focus on the secure exchange of health data to improve health and healthcare for patients.

The eHealth Initiative and its Foundation are independent, non-profit affiliated organizations sharing the same mission - to drive improvements in the quality, safety, and efficiency of healthcare through information and information technology.

Need for information exchange

Many patients visit more than one provider at various sites of care over time. In order to make the best decisions for their patients, providers need accurate, complete and up-to-date data. In which case, well and securely managed health information exchange has the potential to increase efficiency, Of the 130 initiatives included in the 2007 sur- lower costs and increase safety and effectiveness. vey, 20 are just getting started, 68 are in the process of implementation, 32 are operational, five are no longer Today healthcare costs are also on the rise, due to lack of moving forward, and five did not respond to the survey up-to-date patient information which makes healthcare dequestion regarding stage of development. livery inefficient and often unsafe, as also due to unnecessary 46

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costs stemming from factors such as duplicate testing.

cent, respectively, offering these services in 2007.

Health care spending in the United States as reached an all time peak. In the eHI survey, 99 percent of HIE organisations said healthcare provider inefficiency due to a lack of information to support patient care was a significant or moderate driver for the project. And more than half (60 percent) said rising healthcare costs were a significant driver for their activity. Standardisation, and secure information exchange would improve quality and safety of care while eliminating costs.

Supporting direct care delivery continues to be the focus of health information exchange efforts, but providing population health related services continues to be an emphasis for some—particularly more advanced stage initiatives.

In terms of supporting care delivery, twenty-nine percent of 2007 respondents provide “results delivery” services to the users of the health information exchange initiative-up four percent from 2006, while 25 percent offer clinical documentation services, and 21 percent offer enrolment or eligibility checking services.

At the same time 16 percent of 2007 survey respondents are offering chronic care management services, while 11 percent are offering quality improvement reporting to clinicians. HIE initiatives are increasingly adding support functions to augment data services.

Leadership and organisation

Increase in health information exchange

Patient privacy and security concerns Information exchange in the healthcare domain is a most sensitive issue, more so than even in the financial sector, since lives are at stake. Accuracy and timeliness are of paramount importance, as are the security of the data exchanged.

However, a key difference here is also, the multi-point accessibility requirements of this kind of data.

HIE initiatives are continuing to formalize their operations through the creation of formal legal entities. They are continuing to establish legal entities to support their operations, with more than half (55 percent) having established legal corporations, 14 percent continuing to be incubated within another organisation, and eight percent remaining a “loose group of collaborators”.

For those who have created a legal organisation structure for their efforts, more than two-thirds (68 percent) have chosen a non-profit corporation model, while eight percent have chosen a limited liability company model, five percent have chosen a for-profit corporation model, and five percent have chosen a “virtual model”--which is not a legal entity, but an initiative formed under contractual arrangement.

Planning for a safe, secure data exchange is therefore a Clinicians, community health centers, employers, health priority for HIE efforts. Most place a priority on exchanging plans, hospitals, patients, and quality improvement organisadata that leads to better patient care first. tions are most likely to play a governance role in health inforA majority of these HIE efforts are exchanging (or expecting mation exchange efforts. to exchange within six months) data related to outpatient and For the most part, health information exchange initiatives inpatient episodes, laboratory results, emergency department episodes, pathology results, and enrolment and eligibility in- have migrated to a model whereby multiple, diverse stakeformation. More than three out of four (76 percent) are em- holders are participating in the effort. ploying the use of standards to exchange data electronically.

Those organisations that are participating in the governance of health information exchange efforts include hospitals, priPrimary focus of HIE initiatives mary care physicians, health plans, community health clinics, Overall, the percentage of health information exchange initia- local public health departments, patient or consumer groups, tives exchanging data is on the rise with 34 percent of 2007 speciality care physicians, employers and quality improverespondents currently exchanging lab data and 32 percent ment organisations. exchanging data related to outpatient episodes, up from 26 Trends for HIE organisation are beginning to emerge. A mapercent and 21 percent respectively, in 2006. Exchange of emergency department episodes, inpatient episodes, outpa- jority are led by a neutral, multi-stakeholder entity. More than tient laboratory results, and radiology results are also up from half are incorporated, and 70 percent of these efforts are fol2006, with 30 percent, 28 percent, 28 percent, and 26 per- lowing non-profit models.

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Challenges As in 2006, and consistent with findings from eHI’s June 2007 report, the most difficult challenge for health information exchange efforts is the development of a sustainable business model.

This was identified as a very difficult challenge by 56 percent of 2007 survey respondents. One of the primary reasons that health information exchange sustainability has been such a difficult issue for both national and local leaders is that the current reimbursement system, which largely rewards both volume and fragmentation, serves as a disincentive for sharing health information across healthcare stakeholders.

Funding is another challenge for all HIE efforts. Ninety-one percent of all respondents cited “securing upfront funding” as either a very difficult or moderately difficult challenge. Just under half (46 percent) of all HIE efforts report federal government grants and contracts as a current revenue source for upfront funding. Alternative funding sources for sustainability include advance payments from data sources. Some of these HIE efforts receive advance payments from hospitals and physician practices. A smaller number of advanced HIE efforts receive advance payments from other stakeholders, including public health, laboratories, payers, and purchasers to support ongoing operations.

service to their customers and 63 percent are providing “clinical documentation” services.

In addition more than one fourth of such initiatives are offering services that are designed to improve population health, including disease or chronic care management services (32%), quality improvement reporting for clinicians or purchasers/ While health information exchange initiatives continue to payers (29% and 26% respectively), and providing laboratory rely on federal and state agencies for up-front funding, the results reporting for public health agencies (28%). level of funding provided by hospitals is up considerably from 2006, moving ahead of government funding as the top funding source.

Recognition of the need for health information exchange In 2007, the top sources of upfront funding for health information exchange initiatives were hospitals (53 percent), federal government grants and contracts (44 percent), state government (43 percent), private payers (32 percent), and philanthropic sources (31 percent). Funding for ongoing operations is increasingly reliant upon non-governmental sources. Although HIE efforts vary greatly in organisation and structure, yet they share another common challenge- accurately linking patient data and engaging health plans.

Stage 1

Stage 2

Getting organized; defining shared vision, goals, and objectives; identifying funding sources, setting up legal and governance structures. (Multiple, inclusive meetings to address needs and frameworks)

Stage 3

Transferring vision, goals and objectives to tactics and business plan; defining your needs and requirements; securing funding. (Funded organizational efforts under sponsorship)

Stage 4

Well under way with implementation -technical, financial and legal. (Pilot project or implementation with multiyear budget identified and tagged for a specific need)

Stage 5

Fully operational health information organization; transmitting data that is being used by healthcare stakeholders.

Stage 6

Fully operational health information organization; transmitting data that is being used by healthcare stakeholders and have a sustainable business model.

Stage 7

Demonstration of expansion of organization to encompass a broader coalition of stakeholders than present in the initial operational model.

Vision for the future Despite difficulties with achieving sustainability, the 2007 survey report indicates that at least 32 health information exchange initiatives across the U.S. have made progress, identifying themselves as “operational” or “transmitting data that is used by stakeholders”, as compared to the 26 initiatives which identified themselves as operational in 2006.

The operational HIE initiatives identified by the survey are actively exchanging data including outpatient episodes (84%), laboratory results (73%), inpatient episodes (64%), and radiology results (63%). Three quarters of operational HIE initiatives are “delivering results” (such as laboratory results) as a February 2008

among multiple stakeholders in your state, region or community. (Public declaration by a coalition or political leader)

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While one-half of advanced stage, operational initiatives received up-front funding from the federal government, many are now receiving ongoing revenues to support operations from non-governmental sources including hospitals (58%), private payers (46%), physician practices (46%) and laboratories (33%), and three-quarters of such initiatives are no longer dependent on grants to support their sustainability.

that benefits everyone, and facilitate the flow of the clinical information needed for care delivery, much of which resides locally.

Although HIE initiatives differ in many ways, survey results and eHI experiences with states, regions and communities indicate that those who are experiencing the most success share the following characteristics: -Governed by a diverse and broad set of community stakeholders; -Develop and assure adherence to a common set of principles and standards for the technical and policy aspects of information sharing, addressing the needs of every stakeholder; -Develop and implement a technical infrastructure based on national standards to facilitate interoperability; -Develop and maintain a model for sustainability that aligns the costs with the benefits related to HIE; and -Use metrics to measure performance from the perspective of: patient care, public health, provider value, and economic value.

Most operational initiatives utilise subscription fees or membership fees from data providers or data users to support ongoing operations. A majority of operational initiatives charge transaction fees to data users while a large number charge transaction fees to data providers.

Learning by example

eHI’s 2007 survey report highlights 32 health information exchange initiatives that have identified themselves as fully eHI is working closely with operational initiatives to gain operational. These organisations share some common characmuch needed insights regarding a set of near-term business teristics that offer guidance for a path forward. cases for the use of electronic clinical health information to continue to advance both policy and on-the-ground progress Three quarters of operational initiatives are no longer dein this area. pendent on “non-operating revenue�, which are described as grants or advance payments. Operational initiatives derive their revenues for ongoing operations from hospitals, physician practices, private health plans and so on.

Recipe for success

Source: eHealth Initiative, Second Annual Survey of State, Regional and Community-based Health Information Exchange Initiatives and Organizations, August, 2005

For the first time since the survey was conducted, the government was not cited as the top provider of up-front funding for all health information exchange initiatives. According to the 2007 survey, 53 percent of all initiatives received start-up funding from hospitals, while 44 percent received start-up funding from federal grants and contracts and 43 percent received funding from state agencies. One third of all initiatives have received start-up funding from private payers.

The eHealth Initiative began both tracking and supporting the efforts of multi-stakeholder efforts at the community level in 2003, recognizing the importance of not only national leadership, but also leadership at the local levels where care is delivered. In addition to national focus on both standards and financing to address sustainability, both leadership and collaboration among multiple stakeholders at the community level is needed, to build social capital for information sharing, build business cases for sharing the costs of an infrastructure 50

A strong majority of operational initiatives are exchanging outpatient episodes (84 percent), outpatient laboratory results (76 percent), laboratory results (73 percent), inpatient episodes (64 percent), and radiology results (63 percent).

Role of the state State policymakers are continuing to demonstrate leadership in using health information technology and health information exchange to drive improvements in health and health care. As this report shows, a number of states are also moving forward in tandem with federal efforts on the development and adoption of policies for improving health and healthcare through health information technology (HIT) and electronic health information exchange (EHIE).

Recently, America has seen a significant increase in statelevel legislative action regarding health IT and quality improvement. While there was virtually no legislation at the state level related to health IT prior to 2005, in 2005 and 2006 thirty-eight states introduced 121 bills specifically focused on health IT, and of those, 36 bills were passed into law in 24 states. Since the beginning of 2007, 208 bills have been introduced across all 50 states that refer to the adoption or implementation of health IT, nineteen of which have been signed into law in sixteen states.

State legislation is becoming increasingly sophisticated, calling for a focus on improving the quality of care through the use of health IT, rather than focusing on health IT alone.

Several of these bills also authorize funding of state initiatives, or establish exploratory and investigative task forces to facilitate state progress.

U.S. governors are also playing a critical role in moving www.ehealthonline.org

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forward. To date, 20 executive orders have been issued by governors in 15 states, which are designed to drive improvements in health and healthcare through the use of IT--nine executive orders in 2007 alone.

Some Health Information Exchanges in the US Few government initiatives such as the latest US$1.3 million grant from the U.S. Department of health and Human Services Centres for Medicare and Medicaid Services that seeks to connect Evansville with a growing network of health care providers that share patient information online of the non- of a patient’s medical data: patient demographics; medication profit Indiana Health Information Exchange, seem encourag- lists; allergies; advance directives; information on physicians ing. treating the patient; and a medical problem list. In addition, healthcare workers will be able to employ paper-record scanThe exchange, which consists of 33 hospitals, 7,200 physi- ning and indexing of advanced directives and patient consent cians and 2,445 practices statewide, can deliver lab results, forms. reports, medication histories, treatment histories and more in a standard, electronic format.

In another example the Ann Arbor Area Health Information Exchange is moving into the pay-for-performance realm with Another example is that of the Brooklyn Health Informa- help from a two-and-a-half-year-old data-sharing technology tion Exchange, organised by Maimonides Medical Center and deployment. other healthcare organisations in New York. Incorporated as an independent not-for-profit corporation in New York, The Michigan HIE went live with NextGen Healthcare’s the BHIX involves a collaboration of the leading acute, post- Community Health Solution in the second half of 2005. The acute, and long-term healthcare providers serving residents of product provides a central data repository that lets physicians New York, scheduled to be operational in July 2008,. securely exchange patient data, the company said. HIEs can also use NextGen CHS to track patient safety and quality iniIt will provide a secure electronic infrastructure for shar- tiatives. ing clinical information among multiple healthcare organizations.

The Community Health Solution lets the HIE’s four member practices collect quantitative and qualitative data on paIt will facilitate care for approximately 200,000 patients. tients. With the data, Blue Cross Blue Shield of Michigan deThe initial partners include Maimonides Medical Center, a veloped a series of clinical indicators that set the HIE on the 700-bed hospital that had almost 40,000 patient discharges pay-for-performance path. last year; Kingsbrook Jewish Medical Center, a 600-bed hospital with almost 10,000 patient discharges last year; four LIGHTing up the world nursing homes; three certified home-healthcare agencies; and two payers.

Nations around the world are growing more interested in how IT can improve the access, quality, safety and efficiency It is designed to improve care as patients transition from in th eir healthcare systems. A number of countries have imdepartments or facilities, reduce service duplication, and af- plemented interconnected electronic health infrastructures, ford physicians and other healthcare workers with fast access either regionally or nationally. In doing so, these countries to patient information. have faced vexing challenges and have developed a myriad of strategies to address them.

Technology can optimise patient care, minimise the risk of medical errors, and reduce administrative and other operatThe eHealth Initiative established the Leadership in Global ing costs and the BHIX’s goal is to provide exceptional patient Health Technology (LIGHT) initiative in 2004 to facilitate care and service through the strategic deployment of technol- learning and information sharing among these HIT innovaogy. tors and other nations, in both the developed and developing world. The eHI LIGHT Resource Center is designed to inform The BHIX exchange, which is to be operational in July debate and global dialogue as well as build collaboration and 2008, will allow BHIX partners to aggregate and manage pa- an international learning community around these issues. tient data in their own clinician practices, while also giving inDetailed survey results can be found at http://www.ehealthinitiative.org/2007HIESurvey/ dividual physicians and healthcare workers who are members Susan Thomas of the BHIX access to patient data at different care settings.

Research Associate, eHEALTH Authorised users will be able to access a portal through secure susan@ehealthonline.org Internet-enabled workstations to view six key data elements 52

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PERSPECTIVE

Patients

get

POWERFUL In a recent ruling of the Supreme Court, prior consent of patients have been made mandatory for all surgical procedures, unless in critical medical conditions

Public complaints against malpractices of private hospitals and nursing homes overinflating bills by performing unneccessary or additional surgical procedures within a scheduled operation is often been heard of ...but hopefully, not any more !

In a path-breaking ruling, the Supreme Court has levied legal obligation on all hospitals and nursing homes to get formal consent of patients before subjecting them to any surgery.

Exceptional allowance may be given in such conditions that are life-threating for the partient and/or have considerable medical consequences. Under normal circumstances, if any additional surgical procedure is deemed necessary during the course of a scheduled operation, the medical team will need to wait till the patient regains consciousness and gives his/her consent for the same.

Uptil now, additional surgical procedures used to be performed with consent from relatives of the patient, while he/she was still at the operation theatre. Often, such situations were exploited to unneccessarily increase the billing amount, causing financial damage to patients and their families.

This ruling came in context of a case dating back to 1995, where a female patient was operated upon for removing her ovaries, while undergoing a diagnostic procedure at a private hospital. Although the court was agreeable to the fact that the 54

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operation was done for benefit of the patient, it held that it was done without consent of the patient, resulting in permanent disability to attain motherhood.

While announcing the judgement, Justices B N Aggarwal, P P Naolekar and R V Raveendran underlined the need for ‘informed consent’ from patients as a legally binding prerequisite for all surgical interventions. The bench laid out a detailed guideline for doctors on “prior consent for additional procedures”. It was held that such a move will safeguard innocent citizens from getting duped in the hands of greedy hospitals.

Salient points of the Supreme Court guideline for hospitals and nursing homes are The fact that the unauthorised additional surgery is beneficial for patients, or that it would save considerable time and expense of the patient, or would relieve the patient from pain and suffering in future, are not grounds of defence against charges of negligence or assault.

The only exception to this rule is where the additional procedure though unauthorised, is necessary in order to save the life or preserve the health of the patient and it would be unreasonable to delay such procedure until patient regains consciousness and takes a decision.

Consent given only for diagnostic procedure cannot be considered as consent for therapeutic treatment. Consent given for specific treatment procedure will not be valid for conducting some other treatment procedure.

Salient points of the Supreme Court guideline for hospitals and nursing homes:  The fact that the unauthorised additional surgery is beneficial for patients, or that it would save considerable time and expense of the patient, or would relieve the patient from pain and suffering in future, are not grounds of defence against charges of negligence or assault.  The only exception to this rule is where the aditional procedure though unauthorised, is necessary in order to save the life or preserve the health of the patient and it would be unreasonable to delay such procedure until patient regains consciousness and takes a decision.  Consent given only for diagnostic procedure, cannot be considered as consent for therapeutic treatment. Consent given for specific treatment procedure will not be valid for conducting some other treatment procedure.  There can be a common consent for diagnostic and operative procedures when they are contempalted.

There can also be a common consent for a particular surgical procedure and an addtitional or rther procedure that may become necessary during the coouse of surgery.

There can be a common consent for diagnostic and operative procedures when they are contemplated. There can also be a common consent for a particular surgical procedure and an additional or further procedure that may become necessary during the course of surgery.

eHEALTH Team

read articles and interviews online at

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NUMBERS

Large hospitals are spending only

2%

of their turnover on IT

Total healthcare market in India is estimated to be US$

75

billion in next five years

11%

More than

of all new patents come from biomedical engineering

China has more

industry

than

60,000

hospitals for its 1.3 billion people

Healthcare industry will create

9

million jobs by 2012

February 2008

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