eHealth January 2014

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

volume 9 / issue 1 / JANUARY 2014 / ` 75 / US $10 / ISSN 0973-8959

USICON 2014

Urology scaling greater heights

IRIA 2014

Innovations in Imaging Technology

Urology ehealth.eletsonline.com

eHealth Magazine

Dr Rajeev Sood on Emerging Frontiers in

volume

issue

ISSN 0973-8959

Contents EXPERT SPEAK:

40- Good Engineering is

the Backbone of Healthcare Technology

Maninder Singh Grewal, Chairman and MD, Healthfore Technologies

SpecialTY:

44- Developing an

Automation Concept that is Right for your Laboratory

Experience the Future in Imaging

Dr Arun Raizada, Senior Consultant and Head Biochemistry, Medanta, The Medicity, Gurgaon

46- Technology

Special Focus:

30- Computerised Radiology-

- Urologic Science Touching New Horizons

Mixed to Perfection

Revolutionising the Cardiac care

31- PC PNDT Act- A Maze for

Dr Tapan Ghose, Director and HOD, Cardiology, Paras Hospital, Gurgaon

Dr Rajeev Sood, Professor and Head Urology, Dr RML Hospital and PGIMER, Delhi

Ultrasound Suppliers

32-Rural Markets Driving Growth

POLICY:

18- Pioneer in spreading

Health Informatics Awareness

Dr Suptendra Nath, Project Director, CHI, MoHFW, New Delhi

20- CGHS Empanelled Private Hospitals Express Concerns

COVER sTORY:

24- Experience the Future in

33- Teleradiology one of the fastest growing segments

IN PERSON:

38- Medicash-Bridge

between Medical Tourists and Hospitals

Gopal Verma, Chairman, e-Meditek Group

tECH TREND:

48- When taking a Second Opinion do so from the best

50- Emerging Changes

Imaging

and Innovations Redefine Phlebotomy

27- Awaiting Arrival of

Neeraj Raghuvanshi, Business Director, Preanalytical System, BD

Ultrashort TE Technique

28- Cardiac Imaging for a Healthy Heart

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editorial

NEW Year, NEW Expectations! Come January – the start up season of hope, promise and expectations, when we find everything old transforming into new. Around this time, we are keen to draw up resolutions, improve performances and chart out goals for greater achievement. Wake up calls are ringing in all verticals of healthcare too. New guidelines are emerging and science is scaling greater heights at a pace that overshadows the past. A lot of things emerge by surprise or just chance discovery (the success in stem cell transplants) that may be taken as a consolation but the real hard work sustains the process of miracle. ‘Gene editing’ for instance, may be the dream driver for scientists working on the genetic technology. The current issue of eHEALTH marks the ninth annual issue and we continue to chart the wheels of ICT in healthcare. We take a look at the Indian Health Summit that aims at bringing greater transparency and integrated health system envisioned for the next decade. Besides the usual array of articles, we focus on few of the events that will impact the Indian health care scenario. USICON 2014 is slated to play a crucial role in shaping the public health perspective in various verticals associated with urology, namely - breakthroughs and technological highlights, Organ donation, Oncology and Men’s health. The conference will have scientific programs and extensive training sessions, giving attendees a chance to sign up and master new skills. The other event, IRIA 2014 showcases the upcoming challenges and forthcoming solutions in radiology. Radiation dose, safety issues, emerging technological marvels like high resolution ultrasound and host of data driven decisions in radiology leading to better image interpretation opens up a health care vertical that everyone is looking upto. Today patients are agog with questions being addressed to physicians who look further to the radiologists for leadership. The upcoming conference aspires to fulfil this vision and we provide a peek into the events along with industry and expert insights. Other events include a relook at lymphoma at RGCON 2014. Titled ‘Lymphoma, Biology to Therapy’ is an effort to address the grey areas of malignant neoplasms of the lymphoid tissue. Enjoy the issue and accept our best wishes for a fast forward 2014

Dr Ravi Gupta ravi.gupta@elets.in

january / 2014 ehealth.eletsonline.com

news

Hybrid Clotting Means Fewer Injections, Better Disease Control A Phase III clinical trial led by UC Davis researchers has confirmed that a new coagulation factor (rFIXFc) dramatically reduces the number of injections needed to maintain effective clotting for hemophilia B patients. The recombinant protein fuses clotting factor IX with an immunoglobulin (antibody) molecule, which prevents the body from rapidly metabolizing the hybrid protein. As a result, rFIXFc can be administered once a week, or even every two weeks, rather than every other (or every third) day. This extended half-life could have an enormous impact on hemophilia treatment. The findings appeared in New England Journal of Medicine.

Pressure Mapping helps reduce pressure ulcers New research published in wounds, the most widely read, peer-reviewed journal focusing on wound care and wound research, demonstrated improved patient outcomes in the prevention of pressure ulcers for intensive care unit (ICU) patients with the use of Wellsense’s M.A.PTM. The results of the study, “A Continuous Bedside Pressure Mapping System for Prevention of Pressure Ulcer Development in the ICU: A Retrospective Analysis” show real-time, ongoing pressure monitoring using M.A.P successfully aided in decreasing pressure ulcer occurrence in ICU patients by helping care providers effectively detect pressure and reposition patients within the context of existing National Pressure Ulcer Advisory Panel standardized guidelines.

And now Nutrition Report Cards too Parents receiving academic report cards throughout the school year is common place, but a new Cornell University study shows that for healthier nutrition, parents should opt to receive a nutrition report card, too. “This pilot study underscores that a nutrition report card is feasible and efficient… Although the results are preliminary, they suggest that [nutrition report cards] may be helpful in nudging children toward more healthy, less expensive options … at little cost to the school district,” according to Cornell behavioral economists Brian Wansink and David Just.

The Medical Defence Union Reports 40% increase in Social Media enquiries

The Medical Defence Union (MDU) is reminding doctors to be careful what they post online after several recent articles have highlighted confidential patient information being shared by doctors through social media. The organisation which represents more than half of the UK’s doctors has seen an increase of 40% of calls from members in relation to the internet and social media, and warns that doctors must be cautious about the information they chose to share and should consider the GMC’s social media guidance when posting online.

New Trial to help healthy Women avoid Unnecessary Breast Operations

Researchers at the University of Birmingham and University Hospitals Birmingham NHS Trust are launching a breast screening study aimed at improving the treatment of ductal carcinoma in situ (DCIS) by only operating on women who need surgery. Many unnecessary operations including mastectomies are being performed on women who show signs of DCIS rather than cancer. DCIS means there are abnormal cells in the milk ducts. These abnormal cells are sometimes described as neoplastic or pre-cancerous but they are confined to the milk duct and present no threat to health

january / 2014 ehealth.eletsonline.com

Novel Tissue Engineered Bone Graft achieves successful repair of Bone defects Researchers at the Department of Orthopaedics, of the Second Affiliated Hospital of Xi’an Jiaotong University Health Science Center, led by Dr. Kunzheng Wang and Dr. Pei Yang have developed a novel biomimetic tissue engineered bone graft based on rabbit adipose derived stem cells (rASCs), collagen I and a porous beta-tricalcium phosphate (β-TCP) scaffold. Furthermore, the critical-sized bone defects model of rabbits was used to evaluate the efficiency of the construct. This discovery, reported in the December 2013 issue of Experimental Biology and Medicine, provides a novel candidate for bone defect repair.

Bone destruction in diseases: New target Identified for prevention

The skeleton is constantly being remodelled by the breakdown of old bone by cells called osteoclasts and the formation of new bone by cells called osteoblasts. This coordinated activity is essential for maintaining healthy bone. However, excessive osteoclast activity leads to bone destruction in skeletal diseases such as osteoporosis, rheumatoid arthritis and cancer metastases in bone. A family of signaling enzymes known as phosphatidylinositol 3-kinases (PI3Ks) control diverse cell functions but, up until now, little was known about the function of specific PI3K isoforms in osteoclasts.

Research Linking Autism Symptoms to Gut Microbes called ‘Groundbreaking’

A new study showing that feeding mice a beneficial type of bacteria can ameliorate autism-like symptoms is “groundbreaking,” according to University of Colorado Boulder Professor Rob Knight, who co-authored a commentary piece about the research appearing in the current issue of the journal Cell. The autism study, published today in the same issue of Cell, strengthens the recent scientific understanding that the microbes that live in your gut may affect what goes on in your brain. It is also the first to show that a specific probiotic may be capable of reversing autism-like behaviors in mice.

Directing Radiotherapy to Tumours while Sparing Vital Organs Using Computer-Controlled Couch Swivelling patients around on a computercontrolled, rotating table could deliver high doses of radiotherapy to tumours more quickly than current methods, while sparing vulnerable organs such as the heart, brain, eyes and bowel. Sophisticated computer modelling could be used to slowly move the table – known as a couch – and a radiation source in three dimensions to direct radiation precisely to the patient’s tumour, researchers have suggested.

Cancer-prevention Strategies Should Improve with Discovery

Researchers at UCLA’s Eli and Edythe Broad Center of Regenerative Medicine and Stem Cell Research have discovered a mechanism by which certain adult stem cells suppress their ability to initiate skin cancer during their dormant phase – an understanding that could be exploited for better cancer-prevention strategies. The study, which was led by UCLA postdoctoral fellow Andrew White and William Lowry, an associate professor of molecular, cell and developmental biology who holds the Maria Rowena Ross Term Chair in Cell Biology in the UCLA College of Letters and Science, was published online in the journal Nature Cell Biology.

january / 2014 ehealth.eletsonline.com

news

How Cells Remodel After UV Radiation

Researchers seek a unified theory of aging

Researchers at the University of California, San Diego School of Medicine, with colleagues in The Netherlands and United Kingdom, have produced the first map detailing the network of genetic interactions underlying the cellular response to ultraviolet (UV) radiation. The researchers say their study establishes a new method and resource for exploring in greater detail how cells are damaged by UV radiation and how they repair themselves. UV damage is one route to malignancy, especially in skin cancer, and understanding the underlying repair pathways will better help scientists to understand what goes wrong in such cancers. Principal investigator Trey Ideker, PhD, division chief of genetics in the UC San Diego School of Medicine and a professor in the UC San Diego Departments of Medicine and Bioengineering, and colleagues mapped 89 UV-induced functional interactions among 62 protein complexes. The interactions were culled from a larger measurement of more than 45,000 double mutants, the deletion of two separate genes, before and after different doses of UV radiation.

New demographic data show how diversely different species age – biologists cannot explain why Despite aging being one of the hottest topics in the media recently, scientists have no coherent explanation for it. Both life spans and mortalities vary from species to species. The fact that the probability of dying rises with age applies to humans, but is not principally true. This is shown by a catalogue of 46 species with their respective mortality and fertility rates, which has now been published in the science journal Nature. It is the result of a long-term data collection project led by scientists at the Max Planck Institute for Demographic Research (MPIDR) in Rostock, Germany, and at the Max-Planck Odense Center on the Biodemography of Aging (MaxO) in Odense, Denmark.

Imaging Technology Could Unlock Mysteries of a Childhood Disease: Respiratory Syncytial Virus By the time they’re two, most children have had respiratory syncytial virus (RSV) and suffered symptoms no worse than a bad cold. But for some children, especially premature babies and those with underlying health conditions, RSV can lead to pneumonia and bronchitis – which can require hospitalization and have long-term consequences. A new technique for studying the structure of the RSV virion and the activity of RSV in living cells could help researchers unlock the secrets of the virus, including how it enters cells, how it replicates, how many genomes it inserts into its hosts – and perhaps why certain lung cells escape the infection relatively unscathed. That could provide scientists information they need to develop new antiviral drugs and perhaps even a vaccine to prevent severe RSV infections.

january / 2014 ehealth.eletsonline.com

New Understanding of Chlamydial Disease Investigators at the Institute for Genome Sciences at the University Of Maryland School Of Medicine have developed a new technique that can track the activity of a disease-causing microbe and the host cell response to that pathogen simultaneously. Using the new method to examine Chlamydia trachomatis infection, the study team observed how the response of the infected cell contributes to one of the hallmark outcomes of chlamydial disease — tissue scarring. Their findings appear in the journal PLOS One. Chlamydia trachomatis is an intracellular, disease-causing bacterium responsible for the most common human sexually transmitted infections (STIs) and infectious blindness (trachoma) globally. Sexually transmitted chlamydial infections are often asymptomatic, and cause tissue damage and scarring.

zoom in

Green Revolution

in Sterilization

Hospitals administrators are turning to more eco-friendly options

espite major advancements in technology, surgical procedures are still associated with complications such as infections and sepsis. Lack of antiseptic measures and unsafe instrument sterilization practices often lead to surgically-induced infections. A robust instrument sterilization system thus plays a vital role in not only minimising risks of infections, but in also ensuring faster turnaround of instruments in the operation theatre, thus improving the overall efficiency of the hospital.

Conventional Methods Although steam-based autoclaves have been around for decades, they require huge amounts of water and exhaustive installation for functioning. Moreover, delicate instruments such as endoscopes and micro-surgery sets are heat and moisture-sensitive and cannot be sterilized through this method. Flash Sterilization too is not an alternative for such devices as it leads to damages.

Why go for Green Sterilizers Many hospitals are aiming to be carbon-neutral in the near future. Improving the sterilization facilities in a hospital and going for green sterilizers is one such important measure that could reduce the toxic output from a hospital, while enhancing costeffectiveness at the same time. The “Green Revolution in Sterilization” is aimed at reducing the detrimental effects of sterilization services on environment, patients, and healthcare workers. There are many tangi-

ble and intangible safety and cost benefits associated with green sterilizers and adopting them would make hospitals pollution-free and cost-effective. However, hospital administrators should ensure that speed and efficacy of sterilization is not compromised.

H2O2 Gas Plasma Sterilization The low-temperature Hydrogen Peroxide (H2O2) gas plasma sterilization system meets all the key characteristics of a perfect green sterilization technology. The system saves costs and resources and makes the instrument reprocessing cycle, fast and efficient. It is eco-friendly and safe for patients, healthcare workers, and instruments. It drastically reduces the post-operative infection rate. Moreover, the system is simple to install and easy to operate. This technology has been in use in the US since 1993, whereby H2O2 gas is injected in a vacuum chamber

containing the instruments to be sterilized. This is followed by application of a strong electric field that creates plasma, which is extremely effective against micro-organisms. The plasma process ensures that the entire sterilization cycle remains non-toxic, and releases eco-friendly by-products (water vapour and oxygen) at the end. Thus, the sterilized instruments are free from toxic residues and do not require aeration or washing before use. For more information, please write to ASP at tkamala1@its.jnj.com, call on 09380180019 or visit http://www.aspjj.com Reference: https://www.aspjj.com/us/sites/default/files/ Frontiers/Winter-2009/ASP%20Go%20Green%20 AD-55290-001%20Rev.%20A.pdf Article approval reference: JJMI-MAASP/1309449

STERRAD® Systems Technology – Safe Solution STERRAD® Systems protects the instruments, users, patients and environment in a healthcare facility, using low-temperature H2O2 Gas Plasma for terminal sterilization of medical devices, with no toxic residue. Key Features: Ü Ensures a safe working environment Ü Results in no odors or hazardous emissions Ü Requires only a simple plug-in for electricity Ü Saves hours of aeration Ü Has been proven to be gentler on devices than peracetic acid and steam Ü Produces only ordinary oxygen and water vapour as byproducts

Ü Can quickly process heat and moisture sensitive devices

january / 2014 ehealth.eletsonline.com

Health watch

LYMPHOMA -

Biology to Therapy RGCON 2014 titled “Lymphoma, Biology to Therapy” is an effort to hear about these interesting stories from the great raconteurs and experts from the country and abroad. We hope to catch your attention and make you a part of this exciting experience of teaching - learning.

ymphomas are a group of malignant neoplasm of lymphoid tissue. There are 2 main types of lymphomas - the Hodgkin lymphoma and the Non-Hodgkin lymphoma. The former has 5 subtypes and the latter nearly 60, with each having a distinct biology that determines the way these tumors look under the microscope, spread to various part of the body, respond to treatment and the optimal treatment required. Classifying lymphomas has been difficult and still an evolving process. Newer insights into molecular biology will help refine the classification. Grey zone lymphomas continue to be diagnostic and therapeutic nightmares. Some breaking news in double hit lymphomas and B Cell Lymphoma unclassifiable intermediate between DLBCL and HL has started emerging and shall soon build up into a proper story. Scientists are busy defining molecular alterations of lymphoma cells. This shall provide insight into why these cells grow rapidly or live indefinitely and freeze at some point in maturational process that precludes progression to competent lymphoid cells capable of normal immune reactions. Once this is understood, drugs may be developed that block this process. As an example, Bruton’s tyrosine kinase (Btk) is an element of several signal-transduction pathways regulating survival, activation, proliferation and differentiation of B cells. Engaging Btk by an inhibitor can block these ef-

January / 2014 ehealth.eletsonline.com

fects and has been approved for usage in Chronic Lymphocytic Leukemia and Mantle Cell Lymphomas. Likewise, Diffuse large B cell lymphomas, the commonest of all lymphomas, has been separated on the basis of gene expression profiling into three more homogenous categories, of which “Activated B Cell Type” a poor responder to chemotherapy has its molecular pathway thread bared yielding thrilling information with immense potential for use in precision therapy of Activated B Cell Type of DLBCL. Lymphoma cells contain protein antigens on their surface. Monoclonal antibodies that identify these antigens are capable of destroying the lymphoma cells while causing little toxicity. This treatment strategy has already proven effective. Besides, rituximab, a whole lot of new immunotherapies Dr. Anurag Mehta Director Lab Services Organizing secretary RGCON 2014

are joining the armamentarium in treatment of relapsed lymphomas. In addition, a variety of “drug –antibody” combinations have been introduced recently. Anti CD30 antibody conjugated to a toxin (brentuximab vedotin) has been approved for use in Anaplastic Large Cell Lymphoma and Hodgkin Lymphoma. Exciting insights in understanding Biology of Lymphomas is culminating in improved therapeutic options and an insidious but sure paradigm shift in care of lymphoma patient. RGCON 2014 titled “Lymphoma, Biology to Therapy” is an effort to hear about these interesting stories from the great raconteur and experts from country and abroad. We hope to catch your attention and make you a part of this experience of teaching learning. Dr. Vineet Talwar Sr. consultant Oncology Organizing secretary RGCON 2014

Special focus

Urologic Science Touching New

Horizons

Urological disorders are becoming more frequent and they have a profound effect on the quality of life. Dr Rajeev Sood, Professor & HeadUrology, Dr RML Hospital & PGI-MER, Delhi, Nominated Urologist to the President of India, Consultant Urologist to the Parliament of India and the Organising Secretary of USICON 2014, discusses with Shahid Akhter, ENN, the emerging frontiers in urology that will shape USICON 2014 (29 Jan â&#x20AC;&#x201C; 2 Feb, 2014) Dr Rajeev Sood

January / 2014 ehealth.eletsonline.com

After more than three decades USICONâ&#x20AC;&#x2122;s annual conference is being organized in New Delhi. What are the highlights of the 47th Conference? USICON 2014 is poised to play a vital role in shaping public health perspective. It will focus on various causes that will impact the basic health issues, including those related to urology. This branch is closely related to and at times over laps with various other medical verticals like oncology, nephrology, andrology, endocrinology, gynecology, to name a few. The four basic verticals envisioned by the conference are associated with breakthroughs and technological highlights, Organ donation, Oncology and Menâ&#x20AC;&#x2122;s health. The conference will have scientific programs and extensive training sessions, giving attendees a chance to sign up and master new skills. These are regularly updated on the website.

Please elaborate on advancements in urology that one may expect at the Conference under the theme of â&#x20AC;&#x2DC;Basics to High techâ&#x20AC;&#x2122;? Advancements in urology are multifold and can be classified into two broad groups - progress made by the pharmaceutical industry that has resulted in new drugs and the chain of technological innovations that have enriched the application in urology and oncology. In the pharma domain, advanced molecules, nano technology, recumbent molecules and target therapies are the emerging frontiers that have hit the headlines. Many firsts are scheduled to be launched at the conference, with target organ being prostate. This ranges from Mirabegron (by Astellas Pharma) to Degarelix ( by Ferring Pharma) and LHRH Antagonist for cancer. â&#x20AC;˘ OAB (overactive bladder) affects more than 400 million people

â&#x20AC;˘

worldwide. A new treatment, BETMIGA (Mirabegron) has received approval from the European Commission (EC) for the treatment of overactive bladder (OAB) symptoms in adults. Mirabegron represents the first new class of treatment in OAB. Botulinum Toxin A, popularly known as Botox (by Allergan) and widely known for its use in facial rejuvenation, has been indicated for overactive bladder. It was approved by FDA in August 2011 for injection into the bladder muscle for treatment of leakage of urine (incontinence) in adults with overactive bladder due to neurologic disease. Degarelix is a new form of hormone therapy that reversibly binds to the GnRH receptors, inhibiting the production of testosterone. By suppressing the production of testosterone, tumor growth is inhibited. Abiraterone( by Johnson & Johnson), approved by FDA in 2011, is used in treatment of men with castration resistant prostate cancer. LHRH antagonist is a Prostate Cancer Hormone Therapy. It is generally used for advanced prostate cancer with bone metastasis.

Emerging technologies are exciting and they hold the promise of changing urologic surgeries. Please outline USICONâ&#x20AC;&#x2122;s role in the technological advancements ? Almost one third of surgical admissions are associated with urological disorders and they are getting more and more common. Medical care is becoming increasingly expensive as new advancements in diagnosis and ever expanding use of technology in treatment is becoming the standard of care. Urological surgery was among the last surgical disciplines to gain

USICON 2014 Highlights Live 3 D High Definition High Luminosity Display Live transmission of Robotic and Laparoscopic Surgeries from AIIMS Internationally acclaimed faculty with extensive coverge of current changes and recommendations Online integration of scientific content Mobile Application and web portal

recognition as a separate entity from general surgery in terms of medical training and practice. Today urologists may consider themselves lucky enough to be working in a very technological environment. Robotic surgery is fast emerging as the standard of care for various urological conditions. It has gained recognition for its potential advantages to the surgeon as well as the patients. With the advent of Minimally Invasive Surgery (MIS), there is a huge potential for endoscopic Intervention. For better vision 3D technology, USICON 2014 will be the launch pad for laparoscopic surgery by Olympus, Storz, Aesculap. Tookad Technology ( approved in Mexico) is being introduced for the first time as localised cancer prostate image guided targeting, HIFU ( high intensity focused ultrasound) for kidney and prostate tumours by EDAP and SONA BLADE. The full range of lasers with advanced versions like Greenlight 180, Thulium 200, Holmium 200 are to be introduced at USICON 2014 for Indian surgeons. EIGEN technology of focused biopsies by fusion of ultrasound in imaging to target therapy to the localized early cancer. This will give 3D and 4D accurate image of the tumour.

january / 2014 ehealth.eletsonline.com

Special focus

Men’s Health is a global issue. International Men’s Health Week is observed universally but seems to be a non issue in India. As an urologist, how do you address this lack of concern ? True, men’s health month is celebrated across the globe. It is to spread the awareness of preventable health problems in men and to encourage early detection and follow up treatment of the disease. There are lots of awareness activities across the globe but we are lagging behind. This has been a neglected domain and this concerns almost half of our population. Most of the government schemes and health programmes still focus on child, maternal health and communicable disease. When health for all by 2020 is the goal, men’s health comes to the centre stage and concerned urologists are following the global initiatives. This will help the policy makers, fellow academicians and clinicians to understand the importance and implications of such health related moves and measures. India is to host the World Congress on Men’s Health in 2015. We recently won the bid, with myself as the Congress Chair, in the recently held World Congress in Washington where other bidders from Australia, New Zealand, Japan and Malaysia too participated.

How will aging impact the society? It is all the more important because the aging population of new India is exposed to disease burden and the young generation is equally vulnerable due to social role and mental stress of the male. This leads to men being more vulnerable in our Indian society and the result is that man’s life span is shorter than the woman’s by 5 years. Lifespan of an average Indian has increased but the quality of life should also have improved. There is lack of awareness and access to medical fa-

January / 2014 ehealth.eletsonline.com

During USICON 2014, we intend to create new incentive for public awareness where clinicians and other stake holders will be donating their bodies in unprecedented numbers which will go a long way in educating and encouraging the people to come forward for organ donation cilities are limited. This leads to more suffering as the aged are even discarded by their families as destitutes and untouchables. Imagine an elderly suffering from overactive or unstable bladder, leading to frequent bed wetting or nocturnal enuresis. Suicides, renal stones, malignancies, accidents and trauma are two to four times more in men. Work place stress, computerization, electronic towers, array of gadgets have added to the infertility and sexual dysfunction. Contrary to the belief female sexual dysfunction is more prevalent than male sexual dysfunction.

How do you co relate the life style disorders vis-i-vis men’s health? India had launched a new national health programme in 2011. For the first year, thirty target districts were identified but goals remained far from being fulfilled. This needs intervention of professional bodies and social organisations. Polity needs to be sen-

tisized and bureaucracy to be stimulated to understand the otherwise disastrous outcome. India is acknowledged as world capital for diabetes – the major killer cause of kidney failures; sexual health is worse in India due to diabetic hypertension and we are leading in global tobacco consumption.

Why are we so lax in prostate cancer awareness ? Prostate cancer in India’s aging population is sharply increasing. At one point of time, we were seventh in male cancers but today we have become the leading nation in male cancer and so is the case of other malignancies. Like female screening programmes in breast cancer or cervical cancer, there is no well defined strategy for males who are more prone to oral cancer, tuberculosis, etc Morbidity and mortality due to these disparities is on the increase at a glaring pace. Urologists and oncologists are disproportionately in small numbers, access to medical facilities to

Globally, organ transplantation has made dramatic progress over the last few decades. How do you evaluate the Indian scenario and your road map by way of USICON 2014 ?

diagnose and treat are few and far. USICON in 2007 started prostate disease awareness programme which was piloted in Delhi, yet other than Delhi, no other state adopted it as health programme. Globally, it started in the US in 2003 when Col Powell himself suffered from prostate cancer which resulted in awareness drives and presidential proclamation declaring prostate day and gradually it was emulated by other nations. We were not too far in 2007 but pace got hindered due to lack of understanding of the long term effects of the drive. USICON 2014 is determined to address this and implement strategies to bridge the gap.

How do you visualize the pace and progress of technology and research in Indian healthcare? We are not far behind the new advances, technologies and skills yet we are adopting rather than innovating and researching. It is ironical that a major chunk of service providers and doctors of fame in countries like US are

Time to bridge the gap Way back in 1994. President Clinton had signed a bill establishing National Men’s Health Week in the United States. 20 years have passed by and we have not moved beyond the pink ribbon ! It is time now to focus on men’s health which is not about exclusive male issues but it impacts the society at large. It is more of a family issue that touches the life of wife, mother, sister, etc…

of Indian origin. We need to address this question and ensure that our talent gains global recognition. It is our responsibility to ensure that major institutions, professional bodies, academic institutions, research organisations, public sector, social organisations come forward to provide and accelerate research facilities and opportunities in addition to awareness drives. Add to this the political vision and will.

Organ and tissue transplant are steadily improving almost everywhere but we in India are lagging behind. It is not just about the lack of awareness among people but what about facilities, man power, acceptance of cadaver donation procedures, legislation, etc.. There are so many empty spaces. The number of patients who die due to kidney failure is in lakhs but kidneys available as organ are only in thousands and that too by close relatives who relent after much persuasion. India needs to emulate Spain, Belgium and Norway where the law presumes it as ‘consent’ where individuals are automatically considered an organ donor unless they choose to opt out. Spain is a world leader due to its measures and implementation. Their success is attributed mainly to the sensitive way transplant coordinators approach the bereaved families. Spanish Model has been recommended by the WHO. One body can give or improve life to at least 31 people. In India, one lakh patients enter renal replacement programs annually. The Indian government has brought about a new legislation on organ transplant and has constituted various boards in institutions like AIIMS and RML to promote and encourage organ donation.

Liver transplant has picked up in few institutions but why other organs are still in infancy? During USICON 2014, we intend to create new incentive for public awareness where clinicians and other stake holders will be donating their bodies in unprecedented numbers which will go a long way in educating and encouraging the people to come forward for organ donation.

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policy

Pioneer in spreading Health Informatics Awareness G

ive a glimpse of your Journey, from a medical graduate to the project director of CHI of National Health Portal?

Currently the Project Director of the Centre for Health Informatics of the National Health Portal at the National Institute of Health and Family Welfare, Ministry of Health and Family Welfare, Government of India, New Delhi, Prof Suptendra Nath Sarbadhikari , in an interaction with Ekta Srivastava, ENN, elaborates more on the health informatics awareness and role of ICT in healthcare 18

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I did my MBBS from Calcutta University in 1989 and then went for PhD in Biomedical Engineering from Institute of Technology, Banaras Hindu University. I have been the founder and director of Supten Institute and CAL2CAL Institute. Then I joined department of Health Informatics at Bangladesh Institute of Health Sciences, Dhaka, Bangladesh as founding professor and HoD. I also served as the faculty positions with the IIT (Kharagpur), the Manipal, Amrita and PSG groups, and post-doctoral positions in the Indian Statistical Institute, Kolkata and had been the fellow and faculty of the PSG-FAIMER South Asia Regional Institute I am also the member of the Expert Committee on Standards for Electronic Medical Records, working groups on Indian Health Information Network Development (i-HIND) and Health Literacy and Portal, of the Ministry of Health and Family Welfare, Government of India. I joined, on contract, National Institute of Health and Family Welfare, Ministry of Health and Family Welfare (MoHFW), Government of India on January 23rd, 2013 as the Project Director of the Centre for Health Informatics (CHI) of the National Health Portal (NHP). I am hoping to establish health informatics as a fully fledged academic discipline in India. â&#x20AC;&#x153;Clinical Informaticsâ&#x20AC;? has now become a Board Certified medical subspecialty in the USA. My goal is to see India come out with

a proper National e-Health strategy sooner rather than later, so that an appropriate authority can be in place for overseeing smooth e-Health implementation throughout the country.

Please tell us something about National Health Portal? Since November 15, 2013 the NHP has gone live for beta testing. The National Health Portal is funded by the Ministry of Health and Family Welfare, Government of India and is being developed by the Center of Health Informatics, National Institute of Health & Family Welfare to promote health literacy. In a country as vast and diverse as India, the aim of the portal is to achieve the herculean task of being a single point of access to public health informatics including conceptualisation, design, development, deployment, refinement, maintenance and evaluation of information systems relevant to public health. The dissemination of this information in consumable formats is arguably the most challenging aspect and can significantly contribute to decreasing the burden of disease in the country. Access to health information is one of the foremost rights of humankind. Inadequate or poor health information can increase the risk of hospitalisation or even disease burden. Medical information that is not tailored for consumers can be confusing and deciphering this can be difficult. Therefore, availability of reliable, high quality health information is important for the promotion of health among the population. Keeping in mind the magnitude of the project and the multiple stakeholder needs, the portal was concep-

tualised with the intent of leveraging cloud computing right from the start. Data sovereignty, a high uptime SLA guarantee, and the need for elasticity and self-service management were all critical in choosing the combination of BSNL IDC and Dimension Data as the cloud services provider.

How do you think Information & Communications Technologies (ICT) as a tool to make information rich nation in healthcare and medical education? The state of health care delivery in India is well summarised by the World Bank (2005) that had reported “a detailed survey of the knowledge of medical practitioners for treating five common conditions in Delhi found that the average doctor in a public primary health center has around a 5050 chance of recommending a harmful treatment”. If that is the condition of the doctors, what could be the condition of the patients? Obviously, we need to increase the awareness among all that information is available, and, if not, it should be actively sought. While getting authentic health information is not always easy, now it is

possible to use ICT, especially mobile technology to access appropriate information. Whereas ICT provides a platform, generating useful and correct health information remains a big challenge. While there are some limitations in Government implemented projects, as all our fingers are not of the same size, work culture too varies from place to place – whether government or private. We need to look at the positives and enhance those to make things work in good time. The efforts to introduce ICT in medical education will pay in long run, if we harness its potentials to fit to our needs. Of course, there is a definite need to continue research to find out the usefulness of any system designed (including cost effectiveness and cost benefit). While I’d be personally very happy to go on elaborating on this par-

ticular question, let me be very brief. Web 2.0 tools like wikis, blogs, podcasts and webinars are now becoming regular modes of instruction. Further, the explosion of online social networks activities is giving us the opportunity to reach the students and patients (User-driven healthcare) at the place where they may be spending a considerable amount of their wakeful time. Virtual Learning Environments (VLEs) are now becoming part of mainstream learning activities.

What are the core areas in healthcare that need proper address? Human resources for health (HRH) problems are going to increase and inter-professional collaboration and task sharing would be inevitable. WHO has established a target minimum ratio of 23 health professionals

Success Mantra I’d like to quote Swami Vivekananda: “Take up one idea. Make that one idea your life – think of it, dream of it, live on that idea. Let the brain, muscles, nerves, every part of your body, be full of that idea, and just leave every other idea alone. This is the way to success.” (typically made up of a combination of doctors, nurses and midwives) per 10,000 inhabitants as necessary for achievements of the health MDGs. Digital tools can help in optimizing resources. Tele-health and mobile health initiatives are also moving in that direction. Virtual storage (of health information) presents with the advantages of easy access, safety of backups and no worry about storage space. While the issues of privacy, confidentiality and security are genuine, technology is advancing day by day to take care of those. Nevertheless, an effective National e-Health Strategy will be necessary.

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Policy

CGHS Empanelled

Private Hospitals Express Concerns Treating over 26 lakh beneficiaries - government employees, pensioners and their families, of them 400,000 from Delhi and NCR currently covered under Central Government Health Scheme (CGHS), the major hospitals around the country finally raise their concerns about the rising pending bills and rates uniformity By Ekta Srivastava, ENN

GHS is the mother of all health schemes. For Universal Health Coverage to protect weaker sections of the society, it is important that remuneration and timely payment for CGHS schemes are standardized. This will help charitable and private hospitals to extend their services to all the government sponsored health schemes. It is important for CGHS scheme to work with the network hospitals and address their grievances,â&#x20AC;&#x2122;â&#x20AC;&#x2122;said, Dr Devi Shetty cardiac surgeon, Narayana Hrudayalaya, Bangalore Members of Association of Healthcare Providers India (AHPI) along with key private healthcare providers in India recently express their concerns on CGHS. According to them, most of the charitable and private hospitals, which are empanelled under CGHS to treat Central Government employees and pensioners, are not being reimbursed within reasonable time for the healthcare services offered. Moreover, the tariff for procedures arrived by CGHS is very low. As a result, the services to CGHS beneficiaries are not financially viable for private and charitable hospitals.

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Dr Devi Shetty, Cardiac Surgeon, Narayana Hrudayalaya, Bangalore CGHS has recognized a number of charitable and private hospitals and diagnostic centers across the country and so its beneficiaries can access specialty and super-specialty healthcare facilities in these empanelled hospitals. The package rates are fixed by CGHS for different procedures and medical treatments. The

empanelled private hospitals and diagnostic centers are required to provide cashless treatment to pensioners and their dependants holding valid CGHS card and referral from CGHS authorities. They are also expected to extend services to the pensioners and their dependants in case of medical emergency on showing of only the CGHS card. Hospitals import expensive diagnostic and medical equipments paying high import duties. In some cases it takes 7 to 10 years to recover the cost of equipment and consumables. With steep increase in foreign exchange rate in the last few years and funds crunch due to non-payment from CGHS, the hospitals are getting into huge debts, incurring heavy interests from the banks while funding the government schemes. The hospitals have been in discussion with the Director General of CGHS on the issues since May 2013. The issues have not been addressed or resolved till now.

AHPI Concerns The AHPI, which claims to represent

Good acoustics and hygiene ensure a quicker recovery in hospital. Noise levels in patient rooms often exceed acceptable levels, creating stressful environments for patients and staff. Hospital Acquired Infections are also a serious threat and patients must be protected against them. A healthcare facility needs a high level of hygiene plus confidentiality, concentration and tranquility, which decrease stress on both patients and staff. With Armstrong you can bring these important attributes from ideas to reality, creating a truly healing space and ensuring a quicker recovery in hospital. Armstrong World Industries (India) Pvt. Ltd. Boomerang, A-304, Chandivali Farm Road, (near Chandivali Studio) Andheri (E), Mumbai - 400 072. Tel: 022-3048 0800, Fax: 022-3046 0439 / 2491 3604 e-mail : helpdeskindia@armstrong.com

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Policy

around 10,000 private and charitable hospitals across the country, also asked the government to look into revision of rates for various procedures, anomalies in payment structure and refund of unauthorised deductions from running bills. The AHPI comprises the biggest private hospitals in India including the Apollo Group of Hospitals, Medanta, Fortis Healthcare, Max Healthcare, Sir Ganga Ram, PD Hinduja, Lilavati and Narayana Health. â&#x20AC;&#x153;The hospitals believe that this move will spur the system to correct the prevailing anomalies and establish better working arrangement benefiting all stakeholders,â&#x20AC;? APHI director General Girdhar J Gyani told. With steep increase in foreign exchange rate and funds crunch due to non-payment from CGHS, the hospitals are getting into huge debts, incurring heavy interests from banks while funding the government schemes, he added.

Different Tariffs This scheme has been considered as a benchmark or framework for several healthcare schemes in India. Hospitals offer services to the scheme holder patients at a fee structure lesser than the normal rates and in credit. However, there is no uniformity in the rates in any hospitals, for example MRI Orbits Code 367. Charges in Bangalore is `600 and in Chennai and

ral health care scheme (Karnataka government) costs `80,000 but under CGHS, it costs `55,000. CGHS beneficiaries are not poor. More than the issue of rates per se, the payments as per the scheme are delayed. To make matters worse, there are many deductions as well,â&#x20AC;? said Dr Shetty. â&#x20AC;&#x153;We need to survive first to serve others,â&#x20AC;? he added.

Pending dues

Dr Giridhar Gyani, APHI director General Hyderabad it is ` 5000 â&#x20AC;&#x153;The tariff for procedures arrived by CGHS is very low. As a result, the services to CGHS beneficiaries are not financially viable for private and charitable hospitals,â&#x20AC;? Gyani said. Since 2002, there has been no revision in the CGHS tariffs while in certain procedures, the rates were arbitrarily reduced. The members unanimously decided to demand a scientific costing analysis so that the government comes up with revised tariffs for all the service providers. â&#x20AC;&#x153;Some of the tariffs are way too low. For instance, a mitral valve replacement under the Yashaswini ru-

The Associations of Hospitals across the country request for: Scientific and realistic revision of tariff for procedures Automatic annual revision of tariff based on Consumer Price Index On time payment Clearance of pending bills Refund of 10% discount illegally deducted by UTI (to all hospitals for payment after 10 days) and stoppage of processing fee being charged by UTI 24 hr grievance cell Regular involvement with stake holders in decision making Refund of unauthorized deductions from running bills

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Private hospitals include the countryâ&#x20AC;&#x2122;s biggest set-ups like B L Kapoor, Medanta Medicity and Dharamshila Cancer Hospital in Delhi/NCR, Baptist Hospital in Bangalore and Ruby Hall Clinic in Pune, which have the pending bills tune up to `125 crore to be cleared. The private and charitable hospitals have come together to convey that if these issues are not resolved immediately, these hospitals will be constrained to withdraw the cashless facility to CGHS beneficiaries with effect from 15th January 2014 in Delhi, Andhra Pradesh and Karnataka followed by other states across the country. However, the CGHS beneficiaries can continue to avail treatment against payment at CGHS tariff, reported by AHPI. The hospitals believe that this move will spur the system to correct the prevailing anomalies and establish better working arrangement benefiting all stake holders. â&#x20AC;&#x153;They promised prompt payment recently but it has not materialised so far. If the government does not resolve the issue, hospitals across India will have to unanimously decide to stop the cashless treatment starting next year,â&#x20AC;? said Dr B Bhaskar Rao, President, ASHA. The CGHS tariffs were fixed in a haphazard manner, he said. While beneficiaries of the CGHS have alleged that CGHS-empanelled private hospitals are treating them indifferently and giving them a stepmotherly treatment.

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Experience

the future in Imaging

The 67th annual conference of Indian Radiological & Imaging Association of India (IRIA) is to be held in Agra, Uttar Pradesh from January 23-26, 2014 that beholds one of Seven Wonders of the World â&#x20AC;&#x201C; The Taj Mahal. The mega gathering of eminent international and national experts under one roof makes it a must attend for the radiology fraternity.

adiology is one most upcoming medical technology and is most preferred field of practice taken up by medical students in India. The growing interest in this field is evident from the record numbers of paper presentation received by IRIA committee at their annual conference to be held in Agra, Uttar Pradesh this year. It is one of the most awaited event by the corporate, academia and practitioners of radiology in India as they get access to eminent experts from across the global and various parts of Dr Rajeev Sood the country under one roof and update

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themselves on new discoveries, techniques and practical clinical applications in radiology.

Scientific Programme The uniqueness of this yearâ&#x20AC;&#x2122;s IRIA annual conference is evident from the balanced spread of session that seamlessly shift from technology modalities to morphological modalities based on various parts of the body. This has been designed especially keeping in mind the specific needs of radiologists for honing their technical skills and expertise. The topics to be discussed

at the premier conference includes temporal bone, head & neck, vertebral & spine, orbit, head & toe imaging, pulmonary imaging, cardiac imaging, neuro imaging, musculoskeletal imaging, pelvic imaging, abdominal imaging, vascular imaging, breast imaging and more.

Global Experts The tradition of IRIA annual conference has always been bring the global best experts and faculty and introduce latest technology trends, research and best practices to the Indian radi-

Agenda & Session Highlights • • • • • • • • • • • • •

ologists. The event offers a knowledge exchange platform for radiologists in India to partner with these international experts on various domains and connect on information, ideas and collaborative research. The inaugural day offers a power-packed series of expert lectures on CT, MR Spectroscopy, Ultrasound, Colour Doppler, high resolution ultra sound (HRUS), MDCT and MRI throughout the day. The day will begin with a technology benefit analysis on the latest in CT technology by Dr Harold Litt, Chief, Cardiovascu-

International Speakers • • • • • • • • • •

Dr. Bill Middleton, USA Dr. Edward Y Lee, USA Dr. Guenther K Schneider, USA Dr. Guy Frija, France Dr. Harold Litt, USA Dr. J Antonio Bouffard, USA Dr. Kazuro Sugimura, Japan Dr. Manpreet Gulati, Germany Dr. Mark Van Buchem, USA Dr. Nick R.Bryan, UK

Conventional Radiology Abdominal Ultrasound Small Parts Ultrasound Gynaecological Ultrasound Pediatric Radiology Social Radiology Computers & Radiology Interventional Radiology Nerve Imaging Imaging in Trauma Neuro Interventions Organ Transplant Foetal Anomaly

lar Imaging Section at Department of Radiology, University of Pennsylvania Health System, USA. An expert in diagnostic radiology he will share the practical medical and diagnostic advantages of the new versions of CT technology for Indian radiologists. He would also present on MR Imaging of patients with implanted devices. Research insights from Dr Albert Thomas, Director of Magnetic Resonance Spectroscopy, UCLA Radiological Sciences, USA will throw light on his work on MR spectroscopic techniques and evaluation for brain, breast, prostate and bone. The lecture by renowned radiologist Dr Edward Lee from Harvard Medical School also practicing at leading Children Hospital, Boston, USA, opens a new world of pediatric imaging advancements as he illustrates the improvements in advanced multi detector CT (MDCT) and MRI for noninvasive evaluation of pediatric airways and lungs. He would also present on multimodality imaging of pediatric congenital heart disease. The new arrival in the ultrasound technology is HRUS that has promising potential in diagnostic imaging more on this will be shared by Dr William D. Middleton from Division of Diagnostic

• • • • • • • • • • • • •

Temporal Bone Head & Neck Vertebral & Spine Orbit Head & Toe Imaging Pulmonary Imaging Cardiac Imaging Neuro Imaging Musculoskeletal Imaging Pelvic Imaging Abdominal Imaging Vascular Imaging Breast Imaging

Radiology Abdominal Imaging Section at Washington University School of Medicine. Neuroradiology has been at the forefront of imaging and diagnosis with remarkable insights into neuro-diseases. The biggest challenge in the neuro-imaging field is discriminating specific neurodegenerative diseases from the changes that usually occur as a result of normal ageing. Over the years, new technologies have introduced new processes to enable radiologists to apply their knowledge more effectively. World-renowned neuro-radiology specialist Dr Mark van Buchem, professor and chief of neuroradiology at Leiden University Medical Center in the Netherlands and a clinical director at Medical Delta Imaging Institute will be sharing his expertise on differentiating neurodegenerative disorders from changes in the ageing brain through the use of new Magnetic Resonance (MR) technologies and techniques. Dr R. Nick Bryan known internationally for his scientific contributions to radiology, particularly neuroradiology and clinical applications of MRI will elaborate on computer assisted diagnosis and neuro-imaging for diseases of the brain. Dr. Bryan is Emeritus Professor of Radiology at

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University of Pennsylvania Health System, USA.

Technology Trends Taking a giant leap from previous yearsâ&#x20AC;&#x2122; conference, the committee has put in hard work on the technical and scientific value that the conference will offer to the attendees and delegates. The recent advances that are currently popular in the global radiology scientific community has been included in the scientific programme to ensure even the students from various medical colleges across India take back rich knowledge resource back with them. Some of these include CT Technology, MR Spectroscopy, Newer MRI Approaches, Multimodality Imaging, Colour Doppler, high resolution ultrasound, image interpretation, Analogue Mammography, Multidetector CT Evaluation, CT Angiography, Perfusion MRI, Digital Tomosynthesis, Dual Energy Spectral CT, Computer Assisted Diagnosis, Teleradiology, PACS, Cloud Computing in Radiology among many others.

Hands-on Training Keeping the delegate diversity from senior and eminent doctors to medical students in view, the IRIA 2014 committee has designed many handon-training and orientation session on basic, applied and advanced technical sessions mixed with workshops for all delegates. This is to extend the mandate of capacity building and continued education of the radiology community on new trends and technology for clinical applications of imaging in their daily practice. These include image interpretation workshop to explore

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hidden details of case presentations provide a comprehensive overview of the current radiological tools available in imaging. With rise in reproductive disorders especially deteriorating fertility conditions, there is a workshop on the theme of reproductive imaging on topic of male infertility symposium. In addition to the common practice of checking for foetus health by parents and role of radiologist in this field, the conference has focused sessions on anomaly scan of foetus, foetal echo-

Workshops & Symposia Male Infertility Image Interpretation Anomaly scan of Foetus Foetal Echocardiography Multiple Pregnancy Peripheral Vascular Doppler

cardiography and multiple pregnancy symposia.

Unmatched Experience The members of IRIA UP Chapter are host of this radiological extravaganza for the second time within a short span of nine years. The impressive agenda and scientific deliberations are evidence to the innovative and practitioner approach - the most important facet of this conference. An exclusive opportunity to connect with luminaries in the various sub-specialities of radiology, from our country & all over the world is a definite draw for the radiology community. It is all these facets together, that makes 67th Annual Conference of Indian Radiological & Imaging Association be held at Agra from 23 -26 January, 2014 an mustattend academic mega event which promises to enhance your clinical acumen & imaging skills as they are relevant today.

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Awaiting Arrival of Ultrashort TE Technique A renowned name in radiology with speialisation in neuro-imaging , Dr Rakesh K Gupta, Director and Head, Department of Radiology, Fortis Memorial Research Institute elaborates on the upcoming trends in radiology in background of the much awaited India Radiology and Imaging Association of India (IRIA) 2014 annual conference to be held in Agra this year

hat are the recent trends in neuro-imaging in India?

Neuro-imaging is routinely practiced all over the country. As evidence to this trend, we can say is by large and growing numbers of MRI centers and facilities with 1.5 T and above. These are today available not only in metro towns but also in B cities. Recently, we have also observed the arrival of more advanced techniques like MR spectroscopy, diffusion and diffusion tensor imaging, perfusion imaging and functional imaging that are now being routinely practiced in most centres with MRI available with greater than or equal to 1.5 T

What are the latest imaging technology available for neuroimaging and its advantages? Neuro-Imaging is an fast evolving spe-

cialization. Newer techniques like diffusion tensor imaging, fMRI, MR spectroscopy, perfusion MRI have made the difference in the management of stroke, tumour localisation and grading, defining micro-structural changes not visible on conventional MRI in a variety of neurological disorders. These are a definite boon for the medical fraternity.

What are the key ailments/ disease conditions in which neuro-imaging can play a critical role in diagnosis and treatment? Today most of the ailments need neuro-imaging to exclude or diagnose the neurological disorders. Hence it has

What are the medical education initiatives that can promote neuro-imaging knowledge, practice and expertise in India? We already have Indian Society of Neuro-radiology in India which once in a year conducts meeting discussing the diagnostic and therapeutic

â&#x20AC;&#x153;We are awaiting the arrival of ultra short TE technique which is likely to re write neuro-imaging become essential for management of neurological disorders. It has come as a specialisation need in radiology.

What is the most exciting feature of radiology that you are awaiting to arrive in India?

Dr Rakesh K Gupta

of bone imaging thus providing critical diagnostic information that can be life saving for the patient. In addition, techniques which are likely to complete the examination in four to five minutes is being developed, which will make it very efficient for diagnosis.

We are awaiting the arrival of ultrashort TE technique which is likely to force us to re-write neuro-imaging. This is so as this technology offers an edge for its potential application

aspect of this discipline. Another big initiative has been to give super-speciality degree (DM) in Neuro-radiology which is being given in some of the premier institutions of this country. In addition, a number of workshops, seminars and meeting are conducted throughout the country to teach Neuro-radiology to the budding radiologists. These efforts are thus creating a new generation of radiologists specialised in neuro-imaging in India.

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Cardiac Imaging

For a Healthy Heart It is the teamwork of cardiologist and the radiology department that works wonders for the patient, says Dr Deepak Shinde, Interventional Cardiologist, Kohinoor Hospital New Imaging trends in cardiology CT Coronary Angiography is a technique that has become popular in recent times due to their low radiations and better imaginary advantages. This is a technique to diagnose coronary heart disease. A related procedure is the CT Cardiac Calcium Score. This uses computed tomography to check the accumulation of calcium or plaque on the walls of the arteries. These are essential to diagnose and treat heart ailments in early stages for the patients. One of our health insurance partner has both these test listed in their corporate health check plans as a routine. That is very beneficial for the patients as they get an in-depth analysis on the health of their heart; in addition it is an advantage for us to know of critical patients and early stages of their disease cycle.

The advantages of Cardiac MRI Cardiac MRI is similar to CT Coronary Angiography with another dimension

Dr Deepak Shinde

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and we come to know in details of heart pericardium, muscles, damage status. And these are routine abroad and are yet to arrive in India and are gold standard as their data is considered. In India, we suggest this only to specific group of patients with congenital heart diseases and cardiomyopathy. Radiology investigations are coming close to cardiology in recent times with major advantage for clinicians to make decisions and plan on surgery of patients.

Current Trends in Diagnostics In the new techniques that are used for diagnostics and therapeutics are concerned for coronary angiography, is that, on tools to help us with ac-

the blockage is normal or critical to resolve the dilemma of surgery. During the angiography, we transfer a pressure wire across the blockage and as it has a transducer at the tip of the wire, it measures the pressure difference between the blockages to suggest if the extent of blockage is leading to an inflow limitation. Second technique is Intra-Vascular Ultrasound (IVUS) that is a medical imaging method to study the details of the blockage by visualisations of the blood vessels especially plaque that cannot be seen by angiography. It gives us estimates of the vessel that is calcified, diameter of arteries and many more such details that help us

“Intra-Vascular Ultrasound helps us for extensive details of the blockage by visualisations of the blood vessels especially plaque” curate data of pressure, volume and other critical parameters almost the same over the years. The trend is now moving towards more of coronary angiography being done through the radial route due to the techniques that have evolved with improved devices especially the catheters and hardware. In addition to that significant developments has been the tools that provide us with data to help decide on the decision for going ahead for a surgery or not, particularly in the borderline cases. This includes fractional flow reserve (FFR) used to identify if

plan the procedure and post-surgery assessment of the vessels.

Role of radiology in cardiology Radiology is a branch of science that is critical to the medical practice; a lot depends on the radiologist today to make the most of his experience in this field and excel in his practice, interpretation and reports. As it is always the man behind the machine that brings knowledge and intelligence to a speciality doctor in their reports – it’s always a team effort of the radiologist and the specialist doctor that works best for the patients.

Mixed to

perfection

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Computerised Radiography to Perfection - Mixed DX-M - Computed Radiography from Agfa HealthCare

With features of superior image quality delivered by a unique cassette For Digital Mammography and General Radiography drop-and-go buffer – the latest needle based CR technology coupled with a powerful software promises high throughput for digital workstations

his next-generation computed radiography (CR) solution excellent image quality with high detective quantum efficiency and also supports a smoother workflow. The Agfa Healthcare DX-M comes with MUSICA2 advanced image processing software for consistently high image quality and enhanced details. The DX-M can be used as a centralized or decentralized digitizer in the radiography department, supporting general radiography as well as digital mammography. As the reader unit can also be used with general radiography detectors, the DX-M is ideal for healthcare operations with a tight budget that wish to achieve high image quality in their X-ray imaging. A significant dose reduction feature for all studies - particularly neonatology and pediatrics, where dose reduction is crucial is a value-add for clinics and hospitals for general radiology.

M-power The next generation gold-standard Multi-Scale Image Contrast Amplification (MUSICA) image processing software comes with new technology improvements that enhance both image quality and workflow for radiog-

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Suitable Segments • • • • • •

General radiography Digital Mammography Orthopaedics – extremities Dental Pediatrics and neonatal Full Leg / Full Spine

raphers and radiologists. They can now get more diagnostic information from their images, with a high level of detail in the mediastinum, sharp trabecular and cortical bone, a balanced presentation of both soft tissue and overlapping bone structures, visualization of subtle details in the abdomen, and a true representation of implants with clear bone interfaces. The next generation of MUSICA uses a new Fractional Multi-scale Processing (FMP) to increase detail.

Excellent Flexibility Powered by the ability designed to handle both needle-based detector plates (NIP), as well as standard phosphor plates (PIP), the systems offers outstanding flexibility for general radiog-

raphy. Needle-based technology delivers the high image quality demanded for mammography studies. Its mammography dedicated needle-based detector is compatible with existing mammography modalities, allowing you to continue to use your existing mammography X-ray systems. With no additional costly expenditure, your facility can move smoothly from having analog to digital mammography capabilities.

Closer to your patient In pediatrics and mammography, the cassette-based workflow makes it both effective and efficient. The cassettes allow easy positioning of your patient - a major advantage when working with children - and makes the system ideal for portable applications, such as in neonatal intensive care. The drop-and-go buffer and fast preview eliminate waiting times and facilitate a continuous workflow within the department. The five-cassette drop-and-go buffer can handle a mix of different sizes of both needlebased detectors and standard phosphor plates. The automatic cassette handling makes the CR system highly productive and user-friendly.

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PC PNDT Act â&#x20AC;&#x201C; A Maze for Ultrasound Suppliers Implementation of Pre-Conception and Pre-Natal Diagnostic Techniques (PC PNDT) ACT 1994 was a much needed measure, however has lacunae on comprehensive guidelines for industry

n country like India where there is visible disparity in treatment or perception to individuals based on their gender, implementation of Pre-Conception and Pre-Natal Diagnostic Techniques (PC PNDT) ACT 1994 was a much needed measure taken by Indian Government that has taken to control gender imbalance. The outcome of this legal action is very encouraging and in many states the gender imbalance is improving at a significantly fast pace. In addition to doctors and clinicians medical equipment industry also are co-operating extensively in implementation of this Act for over all benefit of all citizens of India.

Two Sides of the Coin Today, there are certain practical difficulties that the ultrasound industry is facing while following PC PNDT Act. All legal guidelines implemented by legal Act are compulsory and we as industry are bound to follow same while performing our business practices. From the time of its implementation PC PNDT Act is focused on stopping pre-natal sex determination and was applicable to all who were involved in this mainly, practitioners and patients. With additional amendments later on, this Act also implemented certain rules for ultrasound suppliers like manufacturer, vendor, dealer or distributor and also technical service provider. Individual registration of ultrasound supplier was made compulsory in each district of each state across the country. An ar-

Himanshu Bhatt, Director, KS Biomed duous task for the industry, yet this has been followed in all spirit and cause of the Act. A new challenge that has come in front of us is the practical difficulty of how to manage a legal demonstration of an ultrasound to a doctor. There is no clear guideline for demonstration process in the PC PNDT Act.

Absence of Demo Guidelines Ultrasound is an application base technology and there are continuously new technology features and advances in newer generation equipments and products. Live demonstration is a must for industry as well as for clinicians to watch, understand and monitor these technologies as there is a direct finan-

cial implication involved for both the supplier as well as the buyer. Basic aspect of image quality, over all resolution, measurement packages among others had to be demonstrated for a complete evaluation of system. Thus in absences of clear guideline in PC PNDT Act, ultrasound demonstration have become difficult and risky unless and until appropriate approvals are not taken for movement of the equipment. Also the interpretation of PNDT ACT is still not uniform to all the authorized offices and leaves huge risk of seizing complete equipment while demonstration process and one has to face legal consequences in spite of following over all rules as per PC PNDT Act. There are plenty of examples where one district office approves demonstration but in the same state another district office denies permission. Looking to these practical issues of conducting on-site live demonstration for each prospective buyer, we strongly feel that current time demands a clear co-operation from clinicians to take live demonstration either at approved site where same equipment is already installed or at manufacturers approved site where pregnant cases should be avoided while demonstration scans. An intervention from the government to release focused and transparent policy/guidelines in PC PNDT Act for ultrasound suppliers for supply and live demonstration of ultrasound systems would be a boon for the industry.

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Rural Markets Driving Growth Ratish Nair, CEO Sanrad Medical Systems

ow does the refurbished equipment market operate? What is the size of the refurbished medical equipment market in India?

A large part of Indian population does not have access to quality healthcare due to very high costs. Hence, many of the healthcare service providers view refurbished medical equipment as an alternative to new equipment. In recent times, we have seen demand for refurbished medical equipment is increase in India, especially as the healthcare service providers are focusing on Indian rural markets. Coupled with cost sensitivity, the demand for refurbished medical equipment has growing rapidly. The refurbished equipment market operates similar to other new equipment business, except for the fact that the business is concentrated more in the tier II-III towns/cities. Presently, the refurbished market is approximately 20 per cent of the overall equipment sold and almost 30 per cent of the sales in the private sector.

What are the opportunities and challenges associated with the business of manufacturing and selling refurbished equipment in India? Some cringe at the very mention of used or pre-owned. Whether it’s in the eyes of the buyer or the seller, the patient or the healthcare provider, there is often a negative association connected to these terms. Whatever we may call it, remanufactured, reconditioned, re-assembled refurbished, pre-owned, plainly speaking it comes under one class ‘second hand’ or ‘used’ equipment. If good quality refurbishment processes can be created with the active support of the man-

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Refurbished equipment vendors have few responsibilities to which they must adhere. Can you name a few parameters that you consider while designing refurbished medical equipment?

Ratish Nair ufacturing company, then refurbishing equipment in India will definitely give a tremendous boost to the business as costs can be greatly reduced as compared to refurbishing at facility abroad. To start a good quality refurbishing facility in India it is essential to have the involvement of the parent company manufacturing these goods, and that practically seems to be difficult presently. Moreover the present tax rates are much higher for manufacturers as compared to direct imports.

Can you name a few cities where the demand for refurbished medical equipment is high? The demand for refurbished medical equipment are more in developing states, specifically in states where infrastructure and healthcare facilities are growing fast. An approximate zone wise assessment indicates that the northern states in India are leading in volumes of refurbished equipment sales.

Due to complex nature of the equipment, the after sales support, quality of the product provided by the vendors directly impacts the reliability. Most important parameters being considered by us are age of the systems, emphasis on latest technology of the equipment, upgradability of systems, ease of availability of spare parts, actual users review in terms of stability of product and installation base in international market. Indian customers demand latest technology equipment supported by proper technical service with and assured 95 per cent + uptime for equipment which is the key to future business.

Where do you see this market in the next five years? India is the biggest market in Asia for refurbished medical devices. India is one of the largest emerging medical equipment markets in the world. It is estimated to grow at a rate of 15 per cent with a Compounded Annual Growth Rate (CAGR) to exceed $4 billion by 2015. The increased need can be attributed towards growth in medical tourism, increase in health budget, rise in population associated with increase in lifestyle diseases and growing economy have led to stupendous demand for medical devices. As a country, we are cost conscious and still evolving strategies towards managing toxic wastes. Refurbished medical equipment allows for affordable machines without sacrifice of quality.

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Teleradiology one of the

Fastest Growing Segments

Dr Ashish Dhawad, Founder & CEO, Medsynaptic

ell us on the latest technology for PACS and any new features launched for the benefit of practitioners? PACS is a fantastic solution which not just improves workflow within the hospital and patient care, but also results in substantial return on investment for the hospital by reducing films and other consumables. Any hospital which has more than three imaging modalities and moderate study volumes should definitely consider deploying a PACS or MiniPACS. Medsynapse PACS is based on latest technologies and is a true web-based solution unlike other solutions in market, which are partially web-based. We continually keep on improving the Medsynapse PACS to offer better functionality and Dr Ashish Dhawad

technology to our clients and that is why Medsynapse PACS has become so popular in a short time. We were the first in India to offer a true web based PACS, VNA, integrated collaboration platform, mobile viewing, FFID technology etc. With the latest version we offer many new features like integrated web based MIP/MPR/3D and several other advanced processing tools, dashboards, MIS reports, advanced RIS and intelligent worklist to name a few. The latest version also offers the fastest full fidelity download speeds which is way ahead of the competition. We have added a great innovation as in HTML5 based universal viewer, which can be accessed from any device or browser/OS.

centers, shortage of trained radiologists, skewed ratio of radiologists in urban vs rural areas, etc.

How has the growth trend been for teleradiology and factors for growth?

Tell us more on the plans ahead for Medsynaptic in India?

Teleradiology is a very good example to showcase how technology and medicine can come together to benefit the people. Using the Internet a radiologist sitting at a remote location can promptly and accurately provide an interpretation for any scan and facilitate further treatment for a patient. This results in faster service, cost reduction and overcomes geographical boundaries. In the past few years teleradiology has been one of the fastest growing segments and almost every hospital/imaging center utilises it in one form or other. Factors which are driving the growth of teleradiology are improved infrastructure across India, rapid growth of new diagnostic

Tell us more on the recent hospital that have gone ahead for PACS? Several prestigious hospitals in India and many other countries have elected to go for Medsynapse PACS because of the better technology, features and service that we offer. To give some examples we have deployed a private cloud based PACS for Apollo Group in Chennai. SRMC Chennai has recently implemented Medsynapse PACS and QRG Hospital from Havells group has also chosen Medsynapse for both their hospitals.

We have always been an innovator in the PACS and teleradiology space and our endeavor has been to bring the latest and best technology at affordable cost to the users. We plan to launch several new initiatives in the coming months, which will further benefit our user community and help them deliver better patient care. Having attained a leadership position in the PACS and teleradiology market in India, our focus is now to aggressively expand our presence in international market. We have already achieved good success in implementing Medsynapse PACS in several countries and the positive feedback has given us confidence to dream that we can be a major player globally.

january / 2014 ehealth.eletsonline.com

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Allenger launching new diagnostic

systems and technology

llengers a Chandigarh based medical equipment manufacturer which was founded in the year 1987 has always been instrumental in bringing cost effective solutions for the medical fraternity, be it X-ray systems, C-arms, Mammography, Lithotripters, Cathlabs, TMT,OPG, Monitors and the latest being the DR Systems and Softwares. Allengers has also got the privilege to be selected for the PHD Award 2013 by the PHD Chamber Jury out of many esteemed companies from all over the country. During IRIA 2014, Allengers would be launching an eco model of its fixed DR system, the “DigiX eco” and also a light weight mobile DR system the “RollX DR”. With the launching of these DR systems like RollX DR and DigiX eco, Allengers has further embarked upon a mission to provide cost-effective imaging solutions thereby enabling healthcare centers to adopt them at very reasonable prices. The future of radiography will be digital and technology based. The pace at which the Digital Radiography ( DR ) is advancing is noteworthy. DR is the fastest digital imaging technology available at this time, as in this speed can be used not only to improve the healthcare facilities productivity but also to save the patients time. So keeping this in mind, Allengers is all set to also launch and introduce during IRIA 2014 a software based technology: 1-Allen Cloud PACS 2-Dual Energy Subtraction Allengers “All Cloud PACS” is a web based PACS server with a distributed mirrored image database. The technician at the modality (Digital X-Ray, CT,

January / 2014 ehealth.eletsonline.com

MRI, Cath Lab) can upload diagnostic images to the server. The All Cloud PACS database is easily accessed by using a simple browser (Internet explorer, Firefox, Chrome). It can also be accessed through a smartphone with a browser. New fast streaming technology enables images to be viewed almost instantly. It is a truly web based PACS, no software is required to be installed in the PC. The user (radiologist) requires only a user name and password. The radiologist can view images and report directly on the browser. Uploaded report will be downloadable at the modality only in “pdf” format so that no alterations can be made. Also digital or scanned signature can be added to the report. This will enable a truly filmless environment. Allengers “All Cloud PACS” has multilayer security and firewall so that patient confidentiality is maintained. Security features and accessible information can be configured as per user requirements. Accounting and MIS features ensure that a “Pay per Patient” model can be easily adopted. Not long ago, the idea of sharing radiological images and exams using the Internet seemed impractical. Patients worried that secure information within their personal health records would be compromised, and radiologists found it cost-prohibitive. But times have changed. A growing consensus believes that a constellation of tools, located remotely but connected by the Web, is the solution to securely and cost-effectively sharing the health records. Although in the U.S this concept is already there, yet in India it is going to be a new concept and is bound to grow leaps and bounds as it is going to be

an efficient computing infrastructure for all healthcare facilities. As such Allengers “All Cloud PACS” is going to be instrumental in providing Filmless Radiology and Distance Radiology services helping hospitals to scale with ease and manage resources in a much better way. “Dual Energy Subtraction” is an advanced application for Allengers flat panel true digital radiography systems. A PA/AP chest radiograph exam is performed with the acquisition of 2 images at different energy levels less than three seconds apart and the application generates four views: • A standard low kV radiograph • A high kV radiograph • A soft tissue image with the bones subtracted • An image of the bones and any additional calcified structures. Dual Energy separates bone tissue and soft tissue, allowing radiologists to view these in separate radiographic images. Dual Energy eliminates obstruction from overlying bones and provides more information on calcification content. Ability to detect pulmonary nodules and multiple metastatic lesions is highly improved with Dual Energy Subtraction. The technique is helpful in visualizing small lesions that may be obscured by bone. This versatile application software is being commissioned at Mahajan Imaging Centre, Defence colony, New Delhi. With RollX DR, DigiX eco, All Cloud PACS, etc Allengers continues its passion for excellence and commitment in providing cost effective solutions be it DR or the other medical diagnostic equipments. We encourage you to visit our website www.allengers. com to learn more about our products and services.

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????? in person

Medicash - Bridge between Medical Tourists and Hospitals Trends indicate that, due to sky rocketing health care costs and insurance premiums,patients from the western world have started seeking life saving treatment/surgeries in low wages countries especially India. Gopal Verma, Chairman, E-Meditek Group, interacts with Ekta Srivastava, ENN, about the role of Medicash for international patients

ew England Journal of medicine calls this new breed of growing patients as Medical Refugees. They use low cost destination like India for life saving surgeries (Milstein and Smith, 2006). Thus, with established edge in surgical treatments, India is poised to play an important role in one of the world’s fastest growing industry of Medical Tourism.

Medical Tourism in India Today medical tourism is seems to be promoted by every country around the world. Though the reality is that in most cases they offer sub- standard facilities and limited skills or qualifications. India has tens of thousands of skilled physicians and nurse practitioners. Over the last two decades, the economic boom in India has led to the building of medical facilities & infrastructure that rival the very best then the western medical care that the west has to offer. Many of the physicians that practice in these hospitals and clinics have returned (to India) from the U.S. and Europe, leaving behind successful practices. With India’s top rated education system churning out 20,000-30,000 doctors and nurses every year and with half a dozen world class medical cooperations serving medical tourists, the above predictions does not seem to be a distant reality, provided the stake

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holders initiate the right move in the right direction.

E-Meditek Global E-Meditek Global in association with Nepal Investment Bank launched Nepal’s First Healthcare Pre-Paid Card today. NIBL MediCash card will be available in Nepal for a nominal price and will empower them to carryout medical expenses beyond any constrain on the limit of monetary transaction in India. Also, the medical treatment and related services would be offered at a discounted rate. The card provides for an ease, convenience and

tance both medical and non-medical to Nepali visitor visiting India for medical treatment. This card not only redefines the way one saves money, but also increases convenience when one needs assistance the most: be it sickness at midnight, admission into a hospital, online search, appointment with doctors, emergency medical evacuation, access to your old medical record. Additionally, there are many other services like online support and access to critical information that is designed to suit every individual and family. “ The holder of card gets access to wide range of medical and non-medical

This card not only redefines the way one saves money, but also increases convenience when one needs assistance the most savings to the patients travelling to India for medical treatment, consultation and follow up visits. The card aims at promoting medical tourism in India. Gopal Verma, Chairman, E-Meditek Global said, “We are proud to launch Nepal’s first Healthcare prepaid Card in association with NIBL. This card is inspired by the concept “Friend in Need is a friend in deed” and works exactly in the same fashion. It is a one stop solution and provides complete assis-

concierge services like Ambulance Service, emergency evacuation services, escort services to dependents and delivery of Medicines at discounted rates. Further, this card offers access to negotiated IPD packages, provides platform to compare the treatment cost and helps in deciding the Hospital for the treatment. All patients travelling to India will only need to submit the treatment intimation form either online, by visiting the website www.niblmedicash.com, or vis-

iting any of the Nepal Investment Bank Branch. On receipt of the Intimation /information, E-Meditek Global will assign a dedicated relationship manager who will be assisting the customer throughout his visits which includes complete assistance at the time of hospitalization and discharge. E-Meditek has created an integrated network of medical service providers that includes more than 5000 hospitals, 4500 diagnostic Centers and 3000 individual practitioners Pan India and avail medical benefit at discounted / negotiated rates. NIBL Medicash card will act as a bridge for those seeking assistance while on medical visit to India. The commitment in providing quality service from our partner EMeditek Global is commendable and we are confident that the benefit our customers will reap from this NIBLMedicah Card will exceed beyond monetary value. Shortly to explore more market opportunity, EMeditek will be coming in Bangladesh , Fizi, Srilanka,including ten more countries by the end of the March.

not have any transparent mechanism in place. There are touts ever where, and then some doctors in those countries which have the referral arrangement to some particular hospitals here, making the industry more vulnerable. These issues if sorted out properly will grow more confidence among the patients who wish to come here. Speaking about the systematic workflow chairman believes that the whole engagement should start before the patient start his journey to the India. “We have 24*7 support, we can set-up their appointment with the relevant doctors, we can exchange the diagnostic reports with the respective doctors, ahead of their coming to India. So that the bonafide need of the procedure is established in advance.”

Challenges ‘’For last 10years medical tourism is catching up and it can go faster provided certain eminent issues taken care of or addressed by the government, which pre-dominantly relates with the visa rules and facilitation of making the payments to the hospitals, says Emeditek, Chairman. Further he added, currently when someone comes to India for medical treatment, they either take cash or travel cheque but most hospitals prefer cash payment. Secondly, if someone here is in medical visa and stays beyond 15-16 days, he is supposed to report the local police authority. Now, if someone is critically ill or under treatment then how will he comply with this requirement? Last, medical tourism industry is very unorganised, and does

Gopal Verma

January / 2014 ehealth.eletsonline.com

expert speak

Good Engineering is the Backbone of

Healthcare Technology Maninder Singh Grewal, Chairman and MD of HealthFore Technologies Limited, over 25 years of experience, intimately involved in the growth of the industry, with acquisitions and organic growth aligned to BFSI and HealthCare IT. In an interaction with Ekta Srivastava, ENN

ow is your Journey in HealthFore Technologies; please share your experience?

Maninder Singh Grewal

January / 2014 ehealth.eletsonline.com

In these 3 years, we have come a long way in establishing ourselves as a major player in the Healthcare IT market. Working with doctors, radiologists, pharmacists etc we have been able to translate that domain knowledge into technology products. Our solutions automate clinical pathways and workflows, while facilitating collaborative decision-making and complying with healthcare regulations. We have clients in Nigeria, Dubai, Hong Kong, Abu Dhabi, etc and these have complemented our Indian presence where we now have many installations. We endeavor to make healthcare more accessible and affordable using information technology to bridge the supply demand gap. We have a unique advantage as we draw experience and deep knowledge of the healthcare lifecycle from the extensive experience of running hospitals in Fortis, of diagnostic experience from SRL Labs, of distribution in Religare Wellness and finally Insurance through Religare Health Insurance.

There is a wealth of experience and knowledge available in this ecosystem and this knowledge and experience is the foundation on which we are building our Hospital Information System product – Magnum Infinity as well as for the mHealth, Tele-Radiology and other services that we are building.

You chair the NASSCOM NOIDA Regional Council which recently organized the NasscomAnnual Technology Conference (NATC), what are your thoughts behind that initiative? While India remains a world class provider of IT services, it was our endeavor to focus on pure technology as that is the foundation behind key product companies and will play a significant role in increasing the share of higher value IP and Technology driven business. This is a personal passion for me and I believe that good engineering is the backbone of technology and more and more of Indian IT’s next generation of successful companies and entrepreneurs will be built with brilliant engineering and great technology. Intuit, ThoughtWorks, Makemytrip, inMobi etc are hugely successful companies anchored on cutting edge technology but the 10x programmers behind these companies and the technology that drives their business, remain in the background. The NATC endeavors to find these 10x programmers and specialists around Cloud, Big data, Mobility and Analytics and bring them to the forefront so that they can be the inspirations for GenX, GenY and Milleniums that will lead the new wave of IT from India.With over 300 attendees and 40 speakers, the conference was a great success and I am sure NATC 2014 will be much bigger and become a much awaited event in IT calendars.

How has HealthFore technologies penetrated in Indian/ international healthcare market? We have an extensive road map with

our partnerships and projects across regions. To name a few, Gulf Diagnostic Center Hospital deployed the Magnum suite of solutions covering the administrative, clinical, support, financial and Insurance sections of the provider facility to ensure each department used the application to generate an EMR. Another success story was where HealthFore provided an interface for Quality HealthCare Medical Services (QHMS) Limited, Hong Kong, to electronically transfer the diagnostic images and radiology reports in Magnum PACS, of the patients referred by the State Hospital Authority (HA) to make them available in HA Clinical Management Systems (CMS)/ Electronic Patient Record (ePR) that

image flow from district hospitals to a data center and on to a radiologist. HealthFore supplied the software and integrated the hardware for the project setup and is operating this in 8 districts in a PPP mode.

Are there special considerations in addressing the India HealthCare IT market as compared to the huge opportunity in the segment overseas? We believe that for any HIT project to be a success, the hospital including doctors and physicians and other staff and the technology provider must forge a strong collaboration. We work with various hospital providers

Our focus goes beyond synergies with our group companies in this sector; we have strategic relationships with Microsoft, Oracle, IBM, HP, and other Industry leaders to bring their technology breakthroughs to the HealthCare sector are run by the HA in Hong Kong. Another winning example which is in Nigeria where we are participating in a public-private partnership (PPP) project by IFC in a transformational 10 year project. The technology component would be provided by HealthFore across multiple hospitals. The basic frameworks being HealthFore’s Magnum Infinity Hospital Information System, Picture Archiving Communication System (PACS) and Radiology Information System (RIS). In India, we have implemented HealthFore’s Magnum Imaging (RIS/ PACS) product in a Tele Radiology system in the state of Assam. We have established a complete Web based enterprise class Tele Radiology solution that will archive and manage the

to achieve this by complementing the work of the physicians and doctors to enable them to cope with the very significantly larger volume of patients in India while trying to be accessible and affordable in the Indian context. The spend on Healthcare is increasing whether from Government or private providers and the Indian healthcare market is expected beUS$ 160 billion by 2017. Indian healthcare providers plan to spend `5,700 crore (US$ 916.40 million) on IT products and services in 2013, a 7 percent rise over 2012 revenues which were `5,300 crore (US$ 852.09 million), as per a report by Gartner. Healthcare organisations are enhancing their budget allocations on IT beyond traditional spend of roughly one percent of their annual budgets.

january / 2014 ehealth.eletsonline.com

expert speak

Extension of these initiatives to the Insurance sector will be another driver for increased adoption of Health IT in India With a maturing private healthcare sector, private hospital chains and large hospitals have become major consumers of Healthcare IT solutions. The Government of India and many of the states are aggressively moving state healthcare systems toward IT adoption and several state governments are utilizing external funding (eg. World Bank funds) to create e-health initiatives for their state health units. The Ministry of Health and Family Welfare has already published a standard for EMR and is constantly reviewing its adoption. A standard for Meta data is also expected shortly. These are significant initiatives that will enable IT to become universal in the state and private healthcare systems.

Please tell us more about HealthFore’s PPP model in India? The demand for high quality and specialty healthcare services in Tier 2 and Tier 3 cities will play tremendous role in furthering mHealth and Telemedicine services. As I mentioned, we see India as a huge potential in the coming years. Our recent success with the Government of Assam to setup the Tele Radiology services across various districts hospitals in the region is a perfect example of how we are focusing to expand our PPP models. We have established a complete Tele Radiology solution that will help to manage the data & streamline the image flow from district hospitals in the state of Assam. The system captures data from the X-Ray/CT Scan and using Magnum PACS to archive and forward the image to our radiologists in Guwahati. In case a further referral is needed, the image is forward for further diagnosis and opinion to a panel of expert Radiologists in Delhi. This enables

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the treating physician to get the best diagnostic advise available even in a very remote area. HealthFore’s vision is to use technology to provide innovative and transformational healthcare solutions and services in our target market segment.

What are the innovations that you are planning to introduce in the healthcare informatics space? Information Technology use in HealthCare complements the deep technology already present in the sector in the form of MRI/CT/PET imaging as well as many of the tools like endoscopes and gamma knifes etc that

For a developing country like India, an affordable healthcare on a universal basis is paramount. How organisation such as yours can provide technologies to improve patient outcomes while also reducing the cost of healthcare? For every economy worldwide, healthcare inflation and healthcare spending are always a definite concern on the GDP and the gap between the spend required and the funds available in most countries is large. A country like India where the majority still finds it unaffordable to get access to health facilities, introducing mHealth and tele-health at PHC and CHC level

HealthFore’s IT products and services are built on leading edge technology. We increase the reach of healthcare by investing in R&D surgeons and doctors are familiar with and use extensively. With the ever changing technology, there is a need to keep abreast of all the advancements which are taking place in the technology spaces. We also find that a whole new field of healthcare analytics is opening up for looking into how big data can combine with internal data to new areas like predictive diagnosis etc. HealthFore’s Magnum Infinity HIS offers a comprehensive Healthcare Information Management System (HIMS) for managing every segment of the healthcare environment. To achieve complete automation, Magnum Infinity HIS is tightly integrated with HealthFore’s other healthcare products like Medical Imaging –Picture Archival and Communication System (PACS), Patient Relationship Management, Knowledge Management and Business Intelligence Applications.

through PPP models can make a huge difference in providing better care at low cost. At HealthFore, we are majorly focusing in building such PPP models, providing access to the latest in healthcare technology across remote regions with different states.

Please outline some of the innovative products launched recently and products in pipeline? In our continual efforts to enhance and innovate products, we have launched our Cloud based Magnum Imaging (RIS-PACS) product. Magnum Imaging has also received 510(k) clearance from the United States FDA to market its PACS & DICOM viewer software server software system, for diagnostic imaging and report interpretation. Magnum Infinity is a NextGen HIS which will use social media like Facebook/ IOS/ Mobility etc to facilitate collaboration and information flow across users.

specialty

Developing an Automation Concept that is Right for your Laboratory Dr Arun Raizada, Senior Consultant and Head Biochemistry, Department of Laboratory Science, Medanta

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Expertise in free Radicals, Immunology, Cardiac & Cancer Research, Dr Arun Raizada, Senior Consultant and Head Biochemistry, Department of Laboratory Science, Medanta The Medicityâ&#x20AC;&#x2DC;, has vast experience of 38 years in research, teaching and clinical practice. In an interaction with Ekta Srivastava, ENN, Dr Raizada speaks about the technology advances in Clinical Biochemistry considering it an evidence based medicine

How technology has changed the face of the Clinical Biochemistry Laboratory? There have been significant changes in Clinical Biochemistry over last 60 years, particularly the last 10 years with the introduction of total laboratory automation. The introduction of automated instrumentation, computerisation and commercially prepared reagents has had a significant impact on the role, skills and employment prospect of laboratory scientists. In addition, the development of Information technology and automation in laboratory medicine has allowed laboratory professionals to keep pace with increase workload. It is not surprising to point out that under pressure to reduce cost, while maintaining or improving quality, Clinical Biochemistry looked to manufacturing models of production for answers and the vision from those observations was of total laboratory automation.

What is the role of the Medical Laboratory Scientist in Healthcare? A Medical Laboratory Scientist (MLS), formerly known as a Medical Technologist (MT) or Clinical Laboratory Scientist (CLS), functions as a medical detective, performing laboratory tests that provide physicians with information that assists them in preventing, diagnosing and treating diseases and maintaining patient wellness. The medical laboratory scientist performs a wide variety of laboratory tests, ranging from simple dipstick urine tests to complex DNA tests that help physicians assess risk of diseases. Using test results, physicians can uncover diabetes, cancer, heart attacks, infections and many other diseases. Medical laboratory scientists interact with physicians, nurses, pharmacists, and other members of the healthcare team to provide timely, accurate information so the patient can receive the correct medical treatment.

Medical laboratory scientists use sophisticated biomedical instruments and technology, microscopes, complex electronic equipment, computers, and methods requiring manual dexterity to perform tests on blood, body fluids, and tissue specimens. Clinical laboratory testing sections include clinical chemistry, hematology, Immunohematology (Blood Bank), immunology, microbiology and molecular diagnostics.

What you think about the desirable technology in Clinical Biochemistry? With the number of testing parameters increasing day by day and with the rising demand from the customers, we need to go in for more automation.

additional testing will be needed. Ideally , giving correct diagnosis in protein electrophoresis or Immunofixation it is important that sample integrity is maintained. We discuss certain type of test types have different sensitivity and with respect to Clinical diagnosis if any additional testing or repeat testing is required in near future. As new tests become available, which is happening at a meteoric pace, we need lead time to implement the testing. We also need to invest the time and effort for the next wave of potential targeted therapies. We are now in an exciting time, where Clinical Biochemistry front and center in terms of personalizing the oncologic care of patients.

â&#x20AC;&#x153;Quality means doing it right when no one is lookingâ&#x20AC;? as rightly said by Henry Ford is our first commitment towards disease diagnosis Total laboratory automation will be the only solution, because this not only improves turnaround time, but also the quality of results and less dependency on manpower. Therefore, when an institution decides to go for automation, they have to choose the vendors in such a way that all their testing needs are met using minimum number of equipment and also in order to avoid any downtime, similar equipment needs to be provided as back up.

These advances in testing must have implications for the collaboration between Biochemist and oncologists. Could you describe how you work with oncologists with respect to these tests? In communicating with our direct patient care colleagues, we discuss the Clinical picture in correlation to laboratory result and the likelihood that

Tell us something about Medantaâ&#x20AC;&#x2122;s Department of Clinical Biochemistry? Clinical Laboratory Services of Medanta - The Medicity is a state-ofthe-art department provided with the finest equipment for comprehensive diagnostic support to their clinical counterparts and a patient-centric approach. Biochemistry analysis is one of the most important areas within Clinical Laboratory catering more than 60% of the workload in central Clinical Lab. The next generation Biochemistry laboratory concentrates not only on routine Clinical Biochemistry test but also on wide range of immunological diagnostic test, latest Acute Kidney injury and Cardiac markers. Apart from this we have wide range of special investigations like protein electrophoresis, Immunofixation, therapeutic drug monitoring and diabetic panel.

january / 2014 ehealth.eletsonline.com

specialty

Technology Revolutionising

the Cardiac Care Dr Tapan Ghose

Dr Tapan Ghose, Director and HOD Cardiology, Paras Hospital, well versed in coronary interventional procedures & cardiac electrophysiology, Dr Ghose, in conversation with Ekta Srivastava, ENN

ow technology is improving the healthcare in India?

All the doctors are basically students of science. They have been handling computer technology directly or indirectly in their business. At the present time most of their journals have electronic versions and majority of us are

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updating ourselves with in 24 hours of publication of the journal. If you talk about handling computers like printing data into the HIS and generating computer database and giving electronic typed prescription then the utilisation rate is variable depending on the hospital, work en-

vironment and the exposure. Most of the doctors would like to participate and actively pursue the computer knowledge and they would also utilize the computer in their everyday activities in patient care, which includes access to various journals, access to guidelines to clinical practice of medicine and generating database. Most of us are using emails/computers for correspondence with the patients. Whats Up is a good application that is being utilised very often by the residents for quick transfer of ECG and other data. Therefore, such applications should always be explored. Both computer and mobile technology has revolutionised the cardiac care in India. We have been transmitting data across the different parts of the country, teleconferencing (telemedicine) is a feature in most of the corporate hospitals. This gives access to tertiary care consultation to the remote corners of the country. PACS and computer database allows us to share the same across pan India. Radiologists can now interpret the data from far off distance.

What are the challenges of Biological Valve development? Biological Valve is already there in the market. It is is available for commercial use. Any valve has to go through animal experimentation before human use. They have to go through rigorous clinical trials before they are approved for commercial use.

What will be the next 10 years for the Interventional Cardiology? Next 10 years for interventional cardiology, we will see tremendous

Commandants for the healthy heart: The 10 commandants of healthy living is based on the knowledge gained from INTERheart study where patients with first myocardial infarction were analyzed. This study involved 12461patients in 52 countries. The follow up period was 4 years. Based on this study, the risk 9 modifiable risk factors could explain the 90 percent of the disease in the population. I have added the traditional Indian yoga to the list to formulate the 10 commandants for you. • No Smoking- Quit smoking, both active and passive smoking is bad. Use of non-smoking tobacco is also equally bad. • Diabetes- As defined by fasting blood glucose ≥ 126 highlights blood sugar. Diabetes should be diagnosed and controlled. • Lipids- Hyperlipidemia is a very strong and preventable cause of heart attack. This should be treated at the earliest. Diet, exercise and statin are the treatments which are lifelong. • Hypertension- High blood pressure should be detected and treated. Diet, exercise and medication are the treatments, which are lifelong again. ‘ • Physical activity- One should be physically active, 35-40 minutes of brisk physical activity and aerobic exercise is cardio-protective. Exercise should be routine in the life of every individual for the increase in longevity. • Diet- Diet should be rich in fruits, vegetables and less in saturated fats. Table salt consumption should be stopped. Salt consumption should not exceed 5gms of common salt (1 teaspoon full per head per day). Cooking medium is important; the oil should be heart healthy. Olive, Canola, Sunflower, Mustard are heart healthy. Ghee consumption should be least. Milk products should be consumed the minimum. • Obesity- As defined body mass index (BMI) should be diagnosed and treated. Normal BMI is 18-24.9. 25-30 is overweight. More than 30 is obesity. More than 35 is morbid obesity. This should be treated in consultation with the dietician. • Psychological Factors- Social interaction and mental health is important for cardiac diseases. Negative emotions, depressions, isolation, living alone, stress at workplace, type D personality (one who has all negative thoughts), all increases the chances of first heart attack. So, the mantra of healthy living is –‘Don’t Worry, Be Happy!’ • Alcohol- Alcohol consumption has been shown to be cardio protective in studies in the western population. However, the data from our country (from reanalysis of the INTERheart data of patients participating from Indian Subcontinent) shows that consumption of alcohol does not protect the Indians from heart attack. (Population attributable risk 1.06) • Yoga- Yoga has shown to reduce blood pressure, heart rate and prevent the development of first atrial fibrillation in the population. Performing yoga exercises under the guidance of a trainer is associated with good cardio vascular outcome. Listening to Indian classical music-both instrumental and vocal has been shown to reduce the heart rate and blood pressure, hence this should be a part of healthy living and heart healthy environment-both at home and workplace.

amount of growth in terms of usage of new technology, growing numbers in terms of interventions, growth of more cath labs in the state and district head quarters. This is going to give our population more access to tertiary care facilities at at doorstep. More and more bio-reservable stents will be used and metallic drug eluting stents will practically minimise the use of bare metal stents. We will see growth of few centres of excellence in percutaneous aortic valve replacement. Cardiac transplantation will show growth in numbers. Artificial heart valve implantation, biventricular device implantation and ICD implantation will increase in numbers.

What is the difference between open heart surgery (bypass surgery) and angioplasty? The difference between open heart surgery and angioplasty is that angioplasty is a minimally invasive procedure. There is no cut injury to the skin. Hospital stay is shortened to 24-48 hrs. Patients can rejoin his duties within 48 hours of the procedure. Bypass surgery requires 7 days of hospitalisation and at least 30 days of rest before the patients can rejoin his duties.

How does a patient decide which option is best? A patient is given full information about the utility of both the procedure. Left main disease, triple vessel disease with LV dysfunction, multi vessel coronary disease with diabetes and CAD with high syntax score does better with bypass surgery. Rest of the diseases can be managed by angioplasty and stents. One area where angioplasty is superior to bypass surgery is acute myocardial infarction and ACS (acute coronary syndrome). TransRadial primary angioplasty is the norm of the day. Patients decide about the procedures after discussing the pros and cons of the procedures along with the physician. Wish you a Healthy Heart!

january / 2014 ehealth.eletsonline.com

Tech trends

When taking a Second Opinion do so from the best Medical Second Opinion sourcing leading doctors to patients in tier 2 and 3 cities and medical tourists

ith the growing propensity and need for quality healthcare, several hospitals including leading chains are making inroads towards the new healthcare markets of tier 2 and 3 cities. However, setting up in such new markets, sourcing the best doctors is a daunting task that most of the setups are largely faced with. For most specialists, years of hard work has been spent on building a name for them while setting up in the bigger cities is left behind, making the transfer to a new land. In this scenario, what the patients

of such smaller cities lack most is the access to these leading specialists. To seek a consultation from these doctors, the patients in the towns are forced to travel long distance to the cities. For every consultation the patient seeks extensive planning in terms of scheduling appointments, travelling the distance to reach a doctor and sometimes having to wait long hours to the final consultation. All this charge high cost, time and energy for the sick patient and his family members accompanying. The agony of the patient is accentuated if severe discomfort and pain preludes the impending surgery.

Therefore MSO Expanding the quality tangent of healthcare provider innovations, Medical Second Opinion (MSO) offers solutions that table the geography disconnect while providing the best options for second opinion needs. A second

“MSO has really aggregated finest clinicians across specialties, for a patient who doesn’t have any background to healthcare” Dr Sajan Hedge, Apollo Hospital, Chennai

Key Differentiators • Aggregation of India’s finest doctors from different specialties and leading hospitals available to give medical consultations through web, mobile or OPD modes. • Unlike the patient visiting the doctors, MSO makes it possible for the doctors to visit the patients through the Connected OPD service. • While being a discovery agent for patients, they can also access the best providers while ensuring quality in continuum of care after their consultation. • It saves huge costs for the patient and increases transparency. Sachin Chaudhary, Founder, CEO, Medical Second Opinion

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• Creates a harmonious ease in taking second opinion using the platform, Mobile, VC or OPD.

“Effectively, MSO process yield is as simple as the reverse in process of traditional consultation derivative. As against the patient visiting a doctor for consultation, here, the doctor comes to the patient to give a second opinion consultation”, simplifies MSO Founder & CEO, Sachin Chaudhary.

“Eventually as technology is gaining foothold within the young population, what is expected to happen is an increased awareness about personal health with a rise in the number of consultation taken,” believes MSO Joint Replacement specialist, Dr. Pichai Suryanarayan from Apollo Chen-

How It Works

“It makes my job easier to make the first point connection or to carry forward the consultations after the surgery with the patient directly” Dr Pichai Suryanarayan, Apollo Hospital, Chennai opinion helps minimize clinical error while ensuring a peace of mind. “So if this comes from those doctors who have months of waiting for a consultation owing to their popularity and that too without the travel hassle and within 24 hours, a patient especially from Tier 2 and 3 city have enough reasons to rejoice”, offers MSO Medical Head for Jaipur Dr. Usha Khurana.

Differentiator

“Contrary to the belief, a knowledgeable doctor will not be upset if their patient seeks a second opinion ” Dr Meenakshi Sundaram, Apollo Hospital, Chennai

The Second Opinion mode is not just cost efficient but also proves to be a boon for patients living in any part of the world to reach out to the doctors without making the effort of the travel. At the same time, the company sets up its own OPD centre known as Connected OPD service, the first one of which has already been launched in Jaipur. The doctors empanelled with Medical Second Opinion travel to the tier 2 and tier 3 cities as per a cyclic schedule giving the patients in these cities an opportunity to be consulted by the finest. This opportunity to connect with the finest specialists also witnesses a large traction of patients from the smaller cities and the towns and rural outlets around them to be a part of the event. MSO also has city level MSO equivalent clinicians to offer second opinion in case of an emergency. These are leading clinicians from that city.

“About 70% of our patients are outbound. Being a part of MSO helps me to screen and prioritise cases that help in better output on my part for the patients” Dr K Vijil Rahulan, Global Health City, Chennai nai. This builds proactiveness on the part of the general population of the country while forcing the decision makers to quality healthcare through innovative verticals.

Users of Mso

Panel

MSO performance data points that around 65% of the traffic comes from tier 2 and 3 cities. This is largely due to the need to bridge the patient and provider gap that exists in the country viz a viz the geographic barriers, users from smaller cities are compounding the online consultations for their second opinion requirements. Patients travelling from outside India also form a sizeable number of the user portfolio. Most of the patients to undergo tertiary surgeries are using MSO platform to connect with the specialists.

MSO has in its ambit the likes of Dr Vikram Shah and Dr Pichai Suryanarayan for joint replacements and orthopedics; Dr. Bijoy Khanderia, the Chief of Cardiac Sciences, Mayo Clinic from USA and Cardiac specialist Dr. Keyur Parikh from CIMS Ahmadabad, India’s leading liver transplant surgeon Dr. Anand Khakhar; ex AIIMS oncologist, Dr. Vinod Raina; lung transplant mogul, Dr. Vijil Rahulan; Bariatric Surgeon Dr. Mufazzal Lakdawala, Neurosurgery specialist Dr. V.S Mehta and sixty more such doctors from a selected eight specialties.

january / 2014 ehealth.eletsonline.com

tech trends

Emerging changes and

Innovations Redefine Phlebotomy Neeraj Raghuvanshi, Business Director, Preanalytical System business at BD Diagnostics, in conversation with Shahid Akhter, ENN, shares the risks and solutions in Phlebotomy Neeraj Raghuvanshi

Phlebotomy is laden with risks - both for patients and health workers. There are chances of blood borne infection, contamination of specimen which can lead to misdiagnosis. How does BD play a role in upgrading the practices by way of innovation in products and devices ? Any other BD initiative to curtail the unsafe practices ? Since the invention of evacuated blood collection system date about 60 years back, BD has advanced the science of specimen collection. In todayâ&#x20AC;&#x2122;s evidence based healthcare delivery system, up to 70 percent of all medical decisions are based on laboratory results. In order to generate reliable and consistent results, laboratories need to ensure good specimen quality â&#x20AC;&#x201C; that is achieved through standardized blood collection devices - this is offered through BD Vacutainer range of products. Besides, since blood filled needles have been known to be much more infectious than the sharps used for other purposes, it is critical that the healthcare workers are protected from needle stick injuries. BD introduced several safety products that ensure minimized exposure to the healthcare workers after the needle has been withdrawn from the patient.

january / 2014 ehealth.eletsonline.com

Dr. Bijoy Khanderia Chief of Cardiology, Mayo Clinic, USA

Dr. Anand Khakhar Transplant & Hepatologist Apollo Chennai

Dr. Sajan Hegde Spine surgeon, Apollo Chennai

Dr. Anand Khakhar Joint replacement, Shalby Hospitals, Ahmbd

Dr. Darshini V Shah

Dr. Pichai Suryanarayan Orthopedics surgeon, Apollo Chennai

Aesthetics & Cosmetic Dermatology

Dr. Ifneela Meraj

Dr. K K Saxena Interventional Cardiologist Apollo Delhi

Dental Cosmetic & Implantology

Shalby Hospital, Ahmbd

Kubba Skin Clinic, New Delhi

â&#x20AC;&#x153;Medical SECOND OPINION aggregates best of the clinicians from leading hospitals and across specialities into a single platformâ&#x20AC;?

www.medicalsecondopinion.co.in For hospital and clinician empanelment, contactmegha@medicalsecondopinion.co.in +91 8826508882

India Head Office 1, Unitech Trade Center, Sector-43, Gurgaon, Haryana - 122001, India Board: +91 124 4009200 Fax: +91 124 4040002

Dr. Avnish Seth Gastroenterologist Fortis, Gurgaon

Dr. Vinod Raina Oncologist Fortis, Gurgaon

Dr. N. Murgan Transplant & Hepatologist Apollo, Chennai

Dr. Keyur H. Parikh Interventional Cardiologist CIMS, Ahmbd

Dr. Ajeet Bana Cardiovascular surgeon Fortis, Jaipur

Jaipur Golden Hospital, New Delhi

Dr. Jagdish Chander Mohan Interventional Cardiologist

Dr. Meenakshi Sundaram Consultant Gynecologist Apollo Chennai

Dr. K Vijil Rahulan Pulmonologist Global Health City, Chennai

Singapore Office 17 Phillip Street # 05-01, Grand Building, Singapore-048695 Board: +65 65387777 Fax: +65 65331144

MSO Connected OPD Domestic

International

Jaipur Dehradun Srinagar Lucknow Indore Vizag Bangalore +18 other cities

Myanmar Congo Nepal Afghanistan Bangladesh

tech trends

Besides the availability of quality devices, it is critical that healthcare workers are regularly trained on best practices guidelines as well use of new methodologies. During the last ten years, BD in India has put tremendous efforts towards increasing the awareness of laboratory personnel in better and safer blood collection practices. Every year BD India conducts training programs for close to 10000 healthcare workers in a year on best practices in blood collection.

The way specimens are collected and by the time it reaches the lab for analysis, is there any chance of spoilage of the sample leading to wrong diagnosis? Yes, specimen collection method as well as transportation and handling of specimen could have impact on the specimen quality and compromised laboratory results. While the use of quality products like BD Vacutainer helps the laboratory to reduce errors related to the devices, quality practices and processes play a key role in ensuring that good quality samples reach the laboratory. BD has been supporting the laboratories on all these aspects through training as well as process improvement engagements such as ‘May I Help You’ programs that help labs to assess the gaps in practices / processes and improve upon them.

Improper and unsafe (blood collection) practices coupled with the increasing burden of non-communicable diseases (e.g. HIV, hepatitis B, hepatitis C etc.) increase the risk of exposure of healthcare workers to these blood borne pathogens. How do you address this problem ? As mentioned above, blood filled needles used for blood collection pose a greater risk of infection to healthcare

january / 2014 ehealth.eletsonline.com

BD introduced several safety products that ensure minimized exposure to the healthcare workers after the needle has been withdrawn from the patient. During the last ten years, BD in India has put tremendous efforts towards increasing the awareness of laboratory personnel in better and safer blood collection practices workers than any other sharps injuries. BD has designed several safety devices in the last few years which help the users to activate specially designed safety-mechanism to protect them against needle stick injury. Besides these, use of puncture proof sharps containers and safe disposal practices would result in safer environment for healthcare workers.

Recently concluded CAP alliance is likely to impact and improve the Indian path lab landscape. Can you please summarise the scenario? Laboratories play a critical role in the diagnosis and treatment of disease

for the more than 2.5 billion people who live in China and India. The BD/ CAP Strategic Alliance will improve access to external quality assurance/ proficiency testing (PT) that can have a direct and positive impact on laboratory quality, and therefore, patient outcomes. Together BD and CAP will provide education to improve awareness of global practice standards and training that will help laboratories achieve their quality improvement goals. Additionally, BD will manage PT distribution, including sales, shipping, and first-line client service. This historic initiative brings together two of the leading global organizations that are ideally positioned to support laboratory improvement efforts around the world, particularly in India. BD offers extensive reach across the continuum of healthcare and laboratory testing operations, with a deep understanding of quality processes from both a technical and clinical perspective. CAP is the recognized leader in establishing quality pathology and laboratory standards and practices, and developing tools to guide and monitor lab progress on improving quality. Through this alliance BD and CAP will collaborate on providing laboratory quality improvement education that supports the entire spectrum of laboratory processes and procedures—from pre- to post-analytic requirements. The CAP/BD alliance integrates BD’s unique market reach and understanding and solutions that reduce pre-analytic error with CAP’s comprehensive quality improvement standards to bring more educational solutions that help labs accelerate their quality improvement. CAP and BD will collaborate to bring more innovative solutions to help laboratories achieve their goals of improved quality for better patient care, and global recognition and local differentiation for these efforts.

expert speak

Specialty care for Newborns Our top priority is newborn care and family comfort, therefore our NICU offers high-end quality, expertise and intensive care around-the-clock to each patient, says Dr Amit Jagtap, Neonatologist, Hinduja Healthcare Surgical

hat are the key unique facilities and services offered under NICU at your hospital? At Hinduja Healthcare Surgical, we have a Neonatal Intensive Care Unit marked with following unique facilities and services. These include a 4 bedded, state of the art, level 3 NICU strategically stationed right besides the labor and delivery room which also has cautiously been built on the same floor as the motherâ&#x20AC;&#x2122;s obstetric-post-natal ward. We provide a fully-equipped neonatal transport incubator which would aid the transfer of neonates, within the hospital premises e.g. from the O.T. to the NICU and vice-versa also between different hospitals. This transport incubator is capable of providing a controlled thermo-neutral environment to the baby it harbors; and prevent any adverse effect of the transport on the babyâ&#x20AC;&#x2122;s health. Once stabilized and received from the origin, the incubator provides a hassle-free transfer of the neonate to the destination. Once in our unit, the neonate is collectively looked after by NICU team which comprises of full-time dedicated and experienced neonatologist, pediatricians, neonatal fellows, NICU trained nursing staff, pediatric anesthetists and a lactation consultant.

allied faculties such as a cardiologist equipped with an in-house, bedside 2D echo facility, a pediatric surgeon, promptly available at any emergent occasions. Pediatric and Neonatal anesthetist, for specialized neonatal interventions are also available. In addition, an in-house 24x7 radiology support along with an efficacious and prompt laboratory support with respect to urgent hematological and biochemical evaluations or decisionmaking cytological and histo-pathological diagnoses is present. The NICU team alerts the concerned allied faculties as per any information that becomes available regarding high risk neonates diagnosed at birth or anticipated based on ante-natal detection.

What are the latest technologies installed at your NICU? Our NICU proudly displays the suc-

How do you ensure multidisciplinary connect and expertise at the NICU alongside Pediatrics? Apart from the above mentioned NICU team, we have an easy access to

january / 2014 ehealth.eletsonline.com

Dr Amit Jagtap

cessful use of the following cuttingedge technologies essential for the care of high risk and sick newborns. These include high frequency oscillatory ventilation (HFOV), use of Laminar flow for the sterile preparation of all medications and IV Infusions. We use neo-puff with air-oxygen blender to minimize iatrogenic lung trauma during resuscitation of the neonate and also have a trans-illuminator device that aids in neonatal intravenous access, in order to minimize the handling of the neonate and the degree of invasion of the babyâ&#x20AC;&#x2122;s skin integrity. What is the non-invasive management technologies adopted for newborns? Keeping in mind the need to be as less invasive as possible, in the management of neonates, we A.M.T. our NICU facility always strive hard to look for non-invasive therapies and interventions to be used in the NICU management of neonates. Some of these include trans-cutaneous bilirubin meter for non-invasive estimation of jaundice level in the baby. This is important as occurrence of jaundice is very common amongst new borns. Secondly, we have non-invasive ventilation in the form of both Continuous positive airway pressure (CPAP) as well as Nasal intermittent positive pressure ventilation (NIPPV). The hospital utilizes capnography for determining carbon-dioxide level in ventilated babies without the need of blood gas analysis. Advanced phototherapy options such as; LED panels and the Bili-blanket which has a definite advantage over the conven-

expert speak

attention is given to each patient to ensure complete guidance care and monitoring. Other than that for the NICU team, entry into the NICU, allowed only for parents, that too after a thorough understanding imparted regarding implementation of the NICU infection control strategies with vigilant supervision. Strict hand washing techniques has been laid down, also strict policies with respect to wearing of cap-masks and the liberal and appropriate use of hand-sanitizers prior to any handling of the baby are instructed to all. To ensure regular updates and feedbacks are included this is an ongoing activity with regular revision, discussion and improvisation tional modalities with respect to the neonatal outcomes are present A.M.T. our facility. Bili-blanket for hyperbilirubinemia ensures closed contact of the baby to the source of light without the risk of hypothermia as well as the ease of handling and nursing of the baby by the mother without interruption of the phototherapy.

What are the key steps taken by for infection control at NICU? Infection control is critical to the NICU facility and extensive caution and care guidelines are outlined for the same at the hospital. Key steps taken by our NICU for strict Infection

We provide a fully-equipped neonatal transport incubator which would aid the transfer of neonates, within the hospital premises to the NICU and vice-versa control includes strict adherence of the doctors, nursing staff, housekeeping staff as well as the parents to the universal safety precautions with continuous and ongoing earnest reminders regarding the same amongst the members of the NICU team. A 1:1 nurse: patient ratio ensures adequate

of the policies amongst members in order to find out any breaches in the prevailing system with prompt rectification of the same.

What are the trends in disease case at the NICU in percentage of cases? Trends in disease case at the NICU in percentage of cases have been that the total preterm births are around 40 percent out of which almost 50 percent were in the region of 33 weeks to 36 weeks of term. Prematurity with low birth weight and apnoea of prematurity accounted for almost 21 percent cases, followed by cases of Transient Tachypnoea of Newborn (TTN) and Respiratory Distress Syndrome (RDS) which were seen in 18 percent and 17 percent cases respectively. Cases of hypoglycemia, asphyxia and IUGR with low birth weight accounted for around 17 percent.

january / 2014 ehealth.eletsonline.com

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Zoom in

Prostate Cancer - Radiation

Therapy for Prostate Cancer Dr S Hukku, Chairman, Roentgen-BLK Radiation Oncology Centre, BLK CyberKnife Centre, in conversation with Shahid Akhter, ENN discusses the advent and advantage of Cyberknife in the treatment of prostate cancer What is the role of Radiation Therapy in urological cancers? Radiotherapy plays both a curative and palliative role in these cancers. The main cancers which benefit with the use of curative radiation are cancer of the prostate and cancer of the urinary bladder. In prostate cancer, modern dose escalated radiation therapy has shown results to be equivalent to surgery at a follow up of 10 years. Moreover, the complications are reduced drastically due to the use of organ sparing radiotherapy techniques. In muscle invasive cancer of the urinary bladder, a combination of radiotherapy and chemotherapy has opened a new possibility of bladder conservation. The palliative role of radiotherapy is in the treatment of bone, and brain metastasis.

What are the new radiation therapy techniques ? Intensity Modulated Radiation Therapy (IMRT) and Image guided Radiation Therapy (IGRT) have changed the way radiotherapy was given earlier. Use of these techniques have enabled us to escalate the dose to more than 80 Gy which has resulted in better cure rates. At the same time, the protection of normal tissues around the treated area has reduced the radiotherapy complications to a bare minimum. These techniques have become a standard of care in treatment of uro-

january / 2014 ehealth.eletsonline.com

Dr S Hukku logical malignancies, especially prostate cancer. These techniques are delivered by modern machines called Linear Accelerators and three dimensional treatment planning is done on the computers before the patient is taken up for treatment.

What is the role of CyberKnife in the treatment of prostate cancer? Radiotherapy delivered by using IMRT/IGRT takes approximately 7-8 weeks for completing the treatment. With the introduction of CyberKnife, this treatment time can be reduced to five days. This machine is a robotic linear accelerator through which a very high dose of radiation is delivered in a very short time. This is possible because of the real time imag-

ing possible with this machine which leads to a very high degree of precision in protection of surrounding normal tissues. This treatment can be offered as monotherapy (CyberKnife alone) in patients with low and intermediate risk prostate cancers. This can be used as a boost following IMRT/IGRT in patients with high risk prostate cancer. When used as a monotherapy, the treatment is over in five days. A three day treatment is required as a boost after five weeks of IMRT/IGRT. CyberKnife is also a useful tool for treating bone, brain, lung, and liver metastasis from cancer of the kidney, prostate, urinary bladder, and testis. The treatment is short (three days) and much more effective than conventional radiation.

Please share your experience at BLK CyberKnife Centre in treatment of urological cancers? We are offering CyberKnife radiosurgery as a treatment modality to all patients of prostate cancer. Over the last one year we have treated ten patients with this modality. At a follow up ranging from 2-13 months. All patients have a biochemical control. There have been no bladder or bowel complications n these patients till now. In addition we have treated bone. Liver, and brain metastasis in patients with this modality with excellent results.

  

Objective

 Scaling Up Best Practices in Healthcare  Major policy Gaps and Possible Solutions  Redefining Role of Private sector in healthcare including Hospitals/ Pharmaceutical/ Medical Devices and Medical Diagnostic Companies  Importance of Traditional Indian Health Practices  Utilization of ICT in enabling healthcare delivery and management  Pioneering models for increasing access to healthcare  Value of a Comprehensive Health Insurance Policy to serve health needs of the people TOPICS State of Indian Healthcare System Significance of private sector in healthcare delivery services Pioneering models of Healthcare Delivery Innovative ways to enhance the access to healthcare and Scaling up the best Practices PARTICIPANTS PROFILE  Government officials, Indian and foreign diplomats and healthcare policy makers  Well-informed speakers working on the various aspects of Indian healthcare industry  Hospitals representatives  Pharmaceutical, Medical devices and Medical Diagnostic companies  Business/ Research partners  Entrepreneurs in healthcare domain  Medical insurance / banking institutions  NGO’s functioning in areas of Indian healthcare     

Features & Opportunities Exhibition Stalls Poster Session Compendium Of Case Studies Of Best Practices Advertisement In Souvenir Partnership opportunities

KEY INVITED DIGNITARIES/ SPEAKERS Shri Ghulam Nabi Azad, Hon’ble Union Minister, Ministry of Health & Family Welfare, Govt. of India Smt. Santosh Chowdhary Hon’ble Minister of State, Ministry of Health & Family Welfare, Govt. of India Shri Rana Kapoor, President, ASSOCHAM and Managing Director & CEO, YES Bank Ltd Shri Keshav Desiraju, IAS, Secretary, Ministry of Health & Family Welfare, Govt. of India Padmabhusan Dr. B. K. Rao, Chairman – ASSOCHAM National Council on Healthcare and Hospitals Shri Bhaskar V Iyer, Chairman, ASSOCHAM national council on Drugs and Pharmaceuticals Dr. Mahesh Chandra Misra, Director, AIIMS Dr. H. K. Chopra –Co-chairman – ASSOCHAM national council on Healthcare and Hospitals Shri Umang Chaturvedi, Co-Chairman, ASSOCHAM National Council on Drugs and Pharmaceutical Dr. Naresh Trehan, Chairman and Managing Director, Medanta - The Medicity Shri Sushobhan Dasgupta, Managing Director, Johnson & Johnson Medical India, Vice President – Asia Pacific, LifeScan Shri Prabal Chakraborty, VP & Managing Director at Boston Scientific Company India Dr Nandakumar Jairam, Chairman and Group Medical Director, Columbia Asia Hospitals, India Shri Mukul Bagga, Managing Director, Quest Diagnostics in India Shri Aijaz Tobaccowalla, Managing Director of Pfizer Limited and Wyeth Limited

Interested participants please send your nominations to the undersigned. Attractive Speaking Slot / Branding Opportunities available For further details, please contact: Dr. Om. S Tyagi Direct Line: 011-46550584 ombeer.tyagi@assocham.com

Mr. Vipul Sharma Mob: 09013078036 vipul.sharma@assocham.com

Ms. Shikha Singh Mobile: 09990690325 shikha.singh@assocham.com

The Associated Chambers of Commerce and Industry of India (ASSOCHAM) ASSOCHAM Corporate Office: 5, S. P. Marg, Chanakyapuri, New Delhi – 110021 Phone No: 011-46550555, Fax No: 011-23017008/09, Website: www.assocham.org

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Most CVD sufferers in India

are in their productive age

Extensive experience in the field of Cardiac Interventions and Electrophysiology, Dr Viveka Kumar, Director-Cath Lab, Sr Consultant-Max Super Specialty, Saket, talks with Ekta Srivastava, ENN, about the Cardiac disease scenario in India

ow technology is improving the cardiac related issues in India?

Technology has made life easy both for the cardiologist as well as the patient. New inroads have been made in the field of non invasive diagnostics as well as invasive therapeutics. Latest CT coronary angiography 256 and 320 slice machines are giving unparalleled resolution and insights into the coronary anatomy with much lesser contrast volumes and radiation exposure. Biplane cathlabs and hybrid labs are a reality and expanding the range of interventional and hybrid procedures to an unprecedented level. Aortic surgery, once the cornerstone of aortic valve disease management is gradually being challenged by percutaneous treatment modalities like TAVI. For the first time, the dreams of the interventionists have been realized in the form of the “ideal stent” i.e Bioabsorbable stent.

Maybe there’s a medication in heart disease that comes into play. But that’s all part of good management that you can do, right? Yes, you are right. It’s all about managing the disease efficiently. Being aware of the risk of heart disease is important because it’s the first step in taking action to lower risk. Being aware of personal risk and treatment options can empower a woman to live a long and healthy life. Female patients can make

january / 2014 ehealth.eletsonline.com

Dr Viveka Kumar lifestyle changes and better select the right medications to help them avoid or treat heart disease. They can do a regular exercise for atleast 30 minutes every day and eat a heart healthy diet that includes fruits, vegetables, grains, low-fat or nonfat dairy products.

Maybe talk for a minute about heart disease in women who are diabetic? If you have diabetes you are two to four times more likely to develop cardiovascular disease than people without diabetes. Hypertension, abnormal blood lipids and obesity, all risk factors in their own right for cardiovascular disease, occur more frequently in people with diabetes. Uncontrolled diabetes causes damage to your body’s blood vessels making them more prone to damage from atherosclerosis and hypertension. People with diabetes develop atherosclerosis at a younger age and more severely than people without dia-

betes. Hypertension is more than twice as common in people with diabetes as in people with normal blood glucose levels. People with diabetes are more likely to have a heart attack or stroke, than people who do not, and their prognosis is worse. If you have diabetes you can have a heart attack without realizing it. Diabetes can damage nerves as well as blood vessels so a heart attack can be ‘silent’ that is lacking the typical chest pain. Premenopausal women who have diabetes have an increased risk of heart disease because diabetes cancels out the protective effects of estrogen.

What is the future of India in heart disease? Cardiovascular disease (CVD) is the leading cause of death and disability worldwide. It is expected that by 2020, CVD would prevail as the leading cause of death and disability over infectious diseases globally. In recent years, demographics and health surveys have reported increasing malaise of CVD among individuals of all socioeconomic strata. According to recent statistics, incidences of CVD-related death and disability in low-income countries have grown at an alarming pace. The seriousness of current scenario could be gauged by the fact that most CVD sufferers in India happens to be in their productive age which may potentially impose huge socioeconomic burden and devastating consequences over the coming years.

Event Report

Montek suggests independent discussion for reforming Health Care The 10th India Health Summit with a concept of ‘A Transparent and Integrated Health System for the Next Decade, was organised by Confederation of Indian Industry (CII) on 17-18 December 2013 at Hotel The Lalit, New Delhi

(L to R) Rahul Khosla, MD, Max India Ltd; Aditya Vij, Chairman, 10th India Health Summit and CEO, Fortis Healthcare (India) Ltd; Dr Naresh Trehan, Chairman, CII National Committee on Healthcare & CMD – Medanta - The Medicity, Dr Montek Singh Ahluwalia, Deputy Chairman, Planning Commission, Shivinder Mohan Singh, Executive Vice Chairman, Fortis Healthcare (India) Ltd., Chandrajit Banerjee, DG, CII

unique forum, designed to bring together, Indian and overseas players with a multi stakeholder to interact and discuss the best practices and ideas shaping the healthcare landscape of the globe, the two-day event provided a platform for all key themes and issues in Healthcare services to be deliberated extensively among stakeholders. Dr. Montek Singh Ahluwalia, Deputy Chairman, Planning Commis-

sion, said that a discussion consisting of independent experts and stakeholders in healthcare should be set up for generating ideations for the mid - term appraisal of the 12th Five Year Plan, due for next year. The discussion should, among other things, objectively take stock of the gaps in the existing infrastructure, mismatch in the talent pool and the reasons that held back public –private partnership in the health value chain.

While giving the keynote address at the 10th India Health Summit organized by CII and Ministry of Health and Family Welfare in the capital today, Dr Ahluwalia observed that the panel should consist of general medical practitioners, NGOs, health activists, pharmaceutical companies etc. along with other stakeholders. The document produced by these stakeholders should highlight the differences in the perception of the different players

january / 2014 ehealth.eletsonline.com

Event Report

rather than the commonalities of their views. â&#x20AC;&#x153;There is already a consensus on the priorities that have to be assigned to the health segment but what that holds back is the differences in the perception as to how to go about it and implement themâ&#x20AC;?. Dr Ahluwalia said that the mid term appraisal of 12th Five Year Plan would be due next year. By that time a new Government and Planning Commission would be in office. A lot of preparatory work had already been done in this direction, he said. He wanted CII to give a presentation about the outcome of the Health Summit, which would go as the organizationâ&#x20AC;&#x2122;s viewpoints for the mid-term appraisal. Dr Ahluwalia observed that the ongoing dialogue on health should be made more participatory. â&#x20AC;&#x153;We have to involve the pharmaceutical companies, which play an important part in rolling out the health infrastructure in terms of pricing of medicines and making them affordable to the common manâ&#x20AC;?. â&#x20AC;&#x153;We have to hold discussion general medical practitioners apart from hospitalsâ&#x20AC;?, he added. Mentioning that public - private partnership was critical in rolling out a strong health infrastructure in the country, Dr Ahluwalia said that only very little progress had been made for making this concept work effectively in the health eco system. It was mostly because of the complex nature of the health segment. â&#x20AC;&#x153;It is easy to lay down critical strategic plans for partnership for others industries, but when it comes to health care, there are social issues that have to be addressed to, making an effective PPP model difficult to achieveâ&#x20AC;?, he added. Rising medical cost had been a concern both in the private and public segments. In the public sector segment, though the patients need not have to bear the cost, there had to be considerable governmental expenditure in providing free health services to the common man. Also, healthcare was interconnected and not purely in

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The Plenary Sessions include: Physical Infrastructure Gap â&#x20AC;&#x201C; Future Demand and Integrated Solutions Medical Workforce Gap â&#x20AC;&#x201C; Solving the Problem in a Decade Public Private Partnerships â&#x20AC;&#x201C; Collaborating to Meet Countryâ&#x20AC;&#x2122;s Need Rising costs, Dropping prices â&#x20AC;&#x201C; Living with margin squeeze Big Data in Health â&#x20AC;&#x201C; Leveraging What Exists Rising Medico Legal Liability â&#x20AC;&#x201C; Implications for the Healthcare Sector Trust with Patients â&#x20AC;&#x201C; Bridging the Deficit

the domain of the Health Ministry. Issues like sanitation, water etc. impact the health landscape of a country. Dr Naresh Trehan, Chairman, CII National Committee on Healthcare, in his address, urged the Planning Commission to play an increasingly important role in bringing all stakeholders across the table to discuss about the way forward. India had to address multiple health challenges emanating from communicable and non-communicable diseases, which entailed huge budgetary allocations. He said that private sector could play a crucial role particularly in the secondary and tertiary sectors and for making existing national assets in healthcare to function effectively and efficiently. Shivinder Mohan Singh, Executive Vice Chairman, Fortis Healthcare India Ltd, underscored the need for building trust with the patients to roll out an effective healthcare system. Innovation, technology and grooming up of a talented group of medical practitioners and para medicals were critical for developing a sound healthcare system. Highlighting the importance of innovation in healthcare, Singh observed that India, with the inherent strength in IT, could devise cheaper technology that could reduce the cost of treatment. He suggested setting up of quality institutions and hospitals in India as a next step for adding value to the healthcare chain.

Aditya Vij, Chairman, 10th India Health Summit and CEO Fortis Healthcare India Ltd, referred to the challenges that were being thrown up by the healthcare system in India. He suggested that more doctors and para medicos should be enrolled in the medical institutions. Presently, there was a mismatch between the demand and availability. He suggested non-traditional approach to healthcare system whereby some of the government - run schemes like Ayush etc. became more accessible to the common man. These schemes should have more linkages with the private sector to make them sustainable and to increase their reach. Rahul Khosla, MD, Max India Ltd, suggested pricing and standard protocols to be evolved in the healthcare to build trust with the patients. He underscored the need for evolving self-regulation among players in the healthcare value chain. Chandrajit Banerjee, Director General, CII, informed that CII is working on areas such as bridging the demand supply gap in healthcare infrastructure and medical talent. â&#x20AC;&#x153;While bridging the gap between the Government and the Private Sector has been one of the major achievements over the last decade, robust models for PPPs in healthcare delivery are yet to be evolved and this is one of the thrust areas of CII â&#x20AC;&#x2DC;s workâ&#x20AC;?, he added.

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Product Launch

Innovation + Quality in Mammography

The latest technology with dual mode tomosynthesis powered by direct conversion detector promises faster and low dose examinations for women

By Amit Pednekar, National Manager, Fujifilm India Pvt Ltd

o to cherish smiles neeeds: of Attune patient’s every p

patient’s ne eeds: Attune to every p women, the mammography device manufacturers have pursued innovation in its proprietary technologies, yielding the evolutionary imaging system. Every examination process today has been optimized, realizing a more Amit Pednekar, effective and less stressful examNational Manager, ination process for technicians Fujifilm India Pvt Ltd and patients. Breast screening technologies have always aimed for radical changes in the product to offer unmatched specifications and unchallenged AMULE ET Harmonyy incorpora ates a rang ge of mamm mography solutions s sp pecifically designed d to o features giving a new dimensionmaintai to progress of nious healthcare n a harmo exam mination envvironment and a foster an atmosp phere of tru ust between n for women. Amulet Innovality offers twoographers powerfuland aspain a tools their atients. mammo dual mode tomosynthesis and stereo biopsy in one system. Dual Mode Tomosynthesis dle: More cHarmony is achieve ed with pain. reduces do ose levels. 1. Sweet Pad AMULE ET compression y nincorpora ates a less rang ge ofAlso mamm mography s solutions sp pecifically 2. Mood Light tings: Furth her reduces s the fear w while screen ning and makes m and thefoster e environment t maintain a harmo• nious exam mination env vironment amode an atmosp phere of tru u Dose performance for 2D and ST tomosynthesis friendlier. Hexagonal Close Pattern(HCP) detector ographers and a is their pa atients. mammo almost the same k Paddle for re emoval: One e hand attacchment of compression c n paddle. 3. Single Click In its journey to offer cutting-edge technologies dedicated Sharp detector Sweet Pad• dle: Moreimage c quality with compression n is HCP achieve ed with less pain. Also reduces do o women, 50µ pixel is the benchmark achievement by1.Fujifilm 2. Mood Light Furth her reduces s the fear w while screen ning50 and makes m the • tings: Intelligent exposure control with implant detection Corporation, Japan, for a true Digital Mammography friendlier. AMIT PEDNEKAR P R micron pixel image and now further improved with Hexagonal Close Pattern NATIO ONAL MANA AGER R emoval: One e hand attac chment of compression c – DR n paddle. 3. Single Clickk Paddle re (HCP) detector design. The new detector efficiently collects • Optimised for user & patientFUJ ergonomics JIFILM INDIA PVT LTD D 5888 088 96 6 +91 85 electrical signal converted from X-rays to realize both high Email:: amit.pedne ekar@fujifilmindia.com m resolution and low noise. This unique design makes it Image Spectrum Conversion Technology AMIT possible to realise a higher Detective Quantum Efficiency The image spectrum conversion (ISC) technology makes it (DQE) than with the square pixel array of conventional possible to process an image acquired with W anodeNATIO withONAL MAN panels. With the information collected by the HCP detector, an appearance like obtained from MO anode. This resultsFUJ inJIFILM IND 5 +91 85 the device creates high definition images with a pixel size of improvement of contrast with 10 per cent reduction in dose. ekar@fujifi Email:: amit.pedne 50 μm - the finest available with a direct-conversion detector. This low-noise and high-speed switching technology allows Amulet Harmony (more patient friendly) tomosynthesis exposures with a low X-ray dosage and short With a range of mammography solutions specifically designed acquisition time to be performed. to maintain a harmonious examination environment and foster an atmosphere of trust between mammography and their patients. The design incorporates a sweet paddle that Intelligent AEC The unique feature of Automatic Exposure Control (AEC) has offers more compression with less pain and also reduces advantages in defining the optimal dose for an examination dose levels. In addition, there are mood lightings that further compared to conventional AEC systems where the sensor reduce the fear while screening and makes the environment friendlier thus calming the patient. position is fixed.

January / 2014 ehealth.eletsonline.com

In Person tech trends

Smart Global

launches Smart Living Smart Living is the flagship initiative of Smart Health City. Smart Global plans to invest about $250 million in the healthcare initiatives and make Saket City Hospital a 1,000-bed unit by 2016 Smart Global, a US$ 2 billion diversified conglomerate announced the launch of ‘Smart Living’, a unique and holistic initiative that aims to provide comprehensive curative, regenerative and preventive solutions. The launch witnessed discussions by distinguished panelists including Dr Pervez Ahmed, Vice Chairman & Lead Director, Saket City Hospital; Dr Roger J. Howe, PHD, Executive Chairman, Stemedica USA and Chief Executive Officer, Stemedica International; Dr JeyaPrakash, Director, Medical Park and Aesthetic Surgeon & Age Management Consultants and Sameer Maheshwari, Founder CEO, HealthKart. Singer Ms Carlyta Mouhini gave a scintillating live performance on Senorita song from the blockbuster movie ‘Zindagi na milegi dobara’ at the launch event. Commenting on the launch, Dr. B.K Modi, Chairman, Smart Global, said “As India continues to advance and raise its benchmark of development, the need for a modern, proactive and sensitive healthcare ecosystem is most immediate. Smart Living will offer the best expertise and the highest quality

January / 2014 ehealth.eletsonline.com

of services. By 2016, we aim to invest about $250 million in the healthcare initiatives and make Saket City Hospital a 1,000-bed unit. Smart Health City is a $3-billion project and we are confident that we will contribute significantly to the growth and development in this segment. Delhi will be the first Global City coming out of India.” “We see a tremendous opportunity in our Smart Living initiative which is set to revolutionize the healthcare sector. Our main vertical for growth in India will be healthcare segment. We have already invested $100 million in developing the healthcare facilities in India, which includes refurbishing of the Saket City Hospital in Delhi as well as the Smart Living initiative”, he further added. Smart Health City is based on the concept of adopting a holistic and mindful approach to wellness through curative and preventive intervention. Smart Health city represents the healthcare vertical of the Group comprising Saket City Hospital and Smart Living. Smart Health city will consist of facilities of-

fering premium, multi-dimensional services in wellness in the fields of Yoga, Meditation, Age Management, Stress Management, Assisted Living, Vipassana, Stem Cell Therapy, Wearable Health Devices, Wellness Spa, Aesthetic Medicine, etc. All these services will be offered through experts with whom Smart Health City have exclusive tie ups and partnerships. Smart Health City shall also house facilities like Alternative medicine block, convention centre, medical office building, research & testing centre, medical recuperation, serviced apartments, education & training block and residential block. Smart Health City will be located at Saket in South Delhi, spread over an area of 15 acres and is expected to be completed in a phased manner by FY 2016/2017. Jones Lang La Salle has been appointed as the infrastructure partner for Smart Health City. According to industry estimates, Indian Wellness Industry is worth INR 490 Bn and shall grow at a CAGR of 20% of reach INR 875 Bn in the next three years.

launch pad

First Life Sciences Solution

AKTA start brings automated and reliable protein purification affordable to wider Life Sciences Community. GE Healthcare Life Sciences, a business unit of GE Healthcare (NYSE: GE) announces the launch of AKTA start, a compact, affordable and easy-to-use preparative chromatography system for laboratory-scale protein purification. AKTA start is the latest addition to GE’s new generation of AKTA systems and the first product designed and developed by the company’s research and development center in India, for the world. AKTA, in Swedish, means true, genuine or real. GE pioneered the design, development and manufacture, through reverse innovation, of medical imaging technologies in India for India and the world and is focused on developing technologies that make healthcare more accessible and affordable around the world

Paradigm Veo System

Cushion Massagers Ergonomically designed, Omron Cushion Massagers can be used on head, neck, shoulders, back, lumbar region, feet and calves. A combination of heat and vibration simulate the actual massage experience - working as an elixir for physical and mental relaxation. It also has straps so that it can be conveniently used at home on a sofa, an office chair, recliner, or even the bed. The massager is light and portable, making it convenient to carry for an easy, all- time-available massage. The range of the massager is Omron HM -300 and Omron HM-340 and the specific features include acupressure massage, ergonomic design, gentle heat (in OMRON HM-340),removable washable cover, easy positioning, temperature for protection.

JANUARY / 2014 ehealth.eletsonline.com

The Paradigm Veo is the world’s first insulin pump equipped with a Low Glucose Suspend (LGS) function, designed to help protect you from severe hypoglycaemia day and night. Hypoglycaemia is a particular problem if you have a busy work and social life, with stress, alcohol consumption and exercise all contributing to the risk. LGS is therefore perfectly suited to young adults with hectic lifestyles.With its CGM technology, the Paradigm Veo can anticipate a bad hypo and issue a warning. If no action is taken, the pump responds quickly by halting insulin delivery for two hours you can even intervene manually at any time if you want insulin delivery to begin before this two-hour shut-off period is complete.This added protection will give you the peace of mind you deserve – and will help you to continue living life to the full.

Electronic Nerve Stimulators Omron Electric Nerve Stimulators are used to relieve muscular aches, spasms, stiffness and to improve blood circulation. With presence of diverse therapy modes, the products provide customised soothing and reliving therapies as per the requirement of the user. The stimulation is provided through two pads which can be placed on the affected areas of the body. The range of the electronic nerve stimulators is Omron HV-F127 and Omron HVF128 and the features include LCD Screen, auto therapy modes : Soothe (Low frequency stimulation – in HV-F128) , Relieve (high frequency stimulation at the joints and lower back) , Region ( designed for different areas of the body), Massage (Tap, Knead, Push Rub) – of 9 and 12 types in Omron HV-F127 and Omron HV-F128 respectively, special modes: Hyper, Soft, Repeat, Point & Wide, ‘R’ & ‘W’ (for adjusting intensity on the right and left side) – 4 types in Omron HV-127 and 5 types in Omron HV-F128,Durable and washable pads.

‘uAngel’

OSIM India, a leading brand for a healthier lifestyle and overall well-being launches the World’s 1st SofaTransformer, OSIM uAngel. OSIM uAngel, a lifestyle sofa transforms from a small sofa into a full-body massage chair. With just one touch of a button, it doubles the pleasure of a modern and elegant looking lifestyle sofa. With strong massage from neck down to the toes, the OSIM uAngel presents a suite of 5 professionally designed massage programmes such as Neck & Shoulders- this massage programme helps the body and mind to achieve a heightened sense of alertness using invigorating massage techniques at higher intensities; Lumbar-A popular massage programme to loosen lower back tension, for a healthier, stronger back; Relax-A pampering massage programme to loosen the overall body when it is tired; Energize-A high-energy massage programme designed to charge up the body and mind and De-Stress-this programme targets very busy ladies who typically feel great amount of stress and this massage programme uses low intensity massage technique to gently stimulate the body to keep you healthy and relaxed.

JANUARY / 2014 ehealth.eletsonline.com

ClearPath introduces 3D Aligners ClearPath Orthodontics an American company, introduces a breakthrough technology which revolutionizes the way we treat malocclusion (irregular teeth and bite). ClearPath provides new improved quality 3D aligners through its unique proprietary, patented process which provides a hygienic, convenient and a clear solution for the correction of malocclusion without having to wear brackets and wires. ClearPath Aligners are removable, almost invisible, US-FDA approved medical grade plastic appliances which fit snugly onto patients teeth instead of wires and brackets to correct malocclusion. ClearPath Aligners are a modern alternative to braces for straightening teeth. People aged between 13 years to 60 years are making aligners their first choice of treatment for malocclusion.

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Veritable : Unique diagnostics with second opinion on every test

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Actionable: Precise disease stratification and therapy selection

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Reliable: Definitive diagnosis within the shortest turnaround time

Core Diagnostics Private Limited 406, Udyog Vihar, Phase III, Gurgaon 122016

Core Diagnostics, Inc 2458 Embarcadero Way, Palo Alto, CA

Phone: +91 124 4615 615

Phone: 650-532-9500

info@corediagnostics.in