The Health Brigade: January 2012

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

volume 7 / issue 01 / january 2012 / ` 75 / US $10 / ISSN 0973-8959

www.ehealthonline.org

The Health Brigade Action heroes thrive to make a difference in the Indian healthcare industry

â&#x20AC;&#x192;7th Annual issue

volume

issue

contents

ISSN 0973-8959

special feature Catalysts of Change

A Manifesto for Growth

A rainbow like collection of vibrant innovations and sky-high investments are enabling the healthcare sector in India to grow at a scorching pace.

By Dhirendra Pratap Singh

eASIA 2011 report

Dr Jawahar Shah

Bishwajit Nayak

Col Sanjay Patole

Dr Akash Rajpal

Nivedan Sahani

Jasvant Prajapati

Ameera Shah

Gunjan Kumar

Rajendra P Gupta

Gp Capt (Dr) Sanjeev Sood

Dr Supten Sarabhadhikari

Annie Thakore

Nagarajan Ranganathan

Prof Dr AFM Rahul Haque Minister of Health and Family Welfare, Bangladesh

P K Taneja

Principal Secretary and Commissioner, Public Health & Family Welfare Department, Government of Gujarat

Shiban Ganju President of Atrimed Pharmaceuticals and Convener, iHIND

Vice President and Business Head, Tata Teleservices

Managing Director, Metropolis Healthcare

Chairman, Board of Directors, HIMSS Asia Pacific India

Founder of Supten Institute and an emissary of Health Informatics Standards

T S Y Aravindakshan

Lead, Public Sector Breadth, Microsoft

Bhudeb Chakrabarti

Senior General Manager and Region Head of National Institute for Smart Government

Dr Kishan Rawat

Consultant at Department of CT Scan and MRI, Sir Ganga Ram Hospital january / 2012 www.ehealthonline.org

14 16

30 34 35

Asiaâ&#x20AC;&#x2122;s Premier ICT Event Marks its Presence at Bangladesh

leaders speak

eindia 2011 report

Throws light on the work that Mind Technologies

Head of Health Claims and Networking, Future Generali

Head â&#x20AC;&#x201C; IT, Army R&R Hospital

MD & CEO, EKO Health Management Consultants

COO, GVK EMRI

Head IT and Automation, Sahara Hospital

Hospital Administrator and NABH empanelled Assessor

President of Atrimed Pharmaceuticals and Convener, iHIND

Vice President, ICICI Lombard

in conversation

Jay Culver

Thierry Zylberberg

Global Sales Director, Global Media

Executive Vice President, Orange Healthcare Division

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

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

coming up mumbai, june

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

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

hyderabad, august

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

For updates visit healthcareleaders.eletsonline.com

volume

issue

asia’s first monthly magazine on The Enterprise of Healthcare

President Dr. M P Narayanan

Editor-in-Chief Dr. Ravi Gupta

gm Finance Ajit Kumar

dgm strategy Raghav Mittal

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

Events Vicky Kalra

human resource Sushma Juyal

It’s all about personal gains over-weighted position over social accountability. Condition worsens day by day due to poor per capita purchasing power of rural India. By Sanjeev Kumar Saxena on “Rationalising Medical Care” A trauma related death occurs in India every 1.9 Min. The Majority of road accident victims are pedestrians, two wheeler riders and bicyclists, passengers by motor vehicles. Because of this tele-medicine concept we can make our ambulance on tele-medicine system and given a best of the best treatment on the way of hospital. On the other side of the hospital they use the telemedicine system and instruct the paramedical or junior medical staff. This mobile health tools system we can get best result of patient life from that critical golden hour. Jaimin Patel on “Demand for mobile health tools likely to increase”

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

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

inbox

january / 2012 www.ehealthonline.org

This is very good initiative and such type schemes must be

promoted for general public, health is very important aspect of life, many people due to lack of resources unable to access good health services, and some people by burden of expenditure due to health problem in the family get problem in day to day life. Dr Sanjay Gupta on “Vajpayee Arogyasri extended to BBMP areas” What is the need for another scheme when there is already such scheme the RSBY existing at national level? RSBY is by far the best ever social security scheme launched by the UPA at the centre at a national level. Is it just for the name of Vajpayee and political game? Raju Rathwa on “Vajpayee Arogyasri extended to BBMP areas” Thanks for the post. It was really helpful to solve my confusion. Heathrow Medical on “Aosta Software Technologies”

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

editorial

New Year: Great Expectations Healthcare has emerged as one of the most progressive and largest service sectors in India with an expected GDP spend of 8 per cent by 2012 from 5.5 per cent in 2009. At present the sector is estimated to be around US$ 40 billion and will grow to US$ 78.6 billion by 2012. The Indian healthcare sector is expected to become a US$ 280 billion industry by 2020 with spending on health estimated to grow 14 per cent annually. In this issue, we are putting the spotlight on the main leaders in the healthcare sector. A profound determination, spirit of working together, backed by the enthusiasm of a â&#x20AC;&#x153;can-doâ&#x20AC;? spirit, is a sure recipe for success. There are some personalities in the field of healthcare who have made the impossible possible through their vision and spirit. There are so many stalwarts who have proved themselves by carving for themselves a substantial niche in the industry. A number of new entrants have ventured in the recent past, striving to make their mark with innovative ideas, services and business models. Perhaps we can conceive of 2011 as a year of landmark technological and administrative advancements in healthcare. This is the year when the idea of using IT for bringing cutting edge healthcare facilities to the masses really took root. In the current issue we are featuring a year 2011 round up on innovation and achievements in healthcare. As the healthcare industry matures in terms of infrastructure and innovative technologies, the next goal of care delivery demands clinical excellence through evidence based medicine tools and benchmarks. Evidence based medicine is already being promoted globally and has been proved to be beneficial for all the stakeholders- clinical teams, hospital management, as well as the patients. The right amalgamation of modern infrastructure, innovative technologies and clinical skills guided by evidence based tools will go a long way in bridging the gap in the Indian healthcare industry. Last month, we organised the seventh edition of eHealth India, which was held in conjunction with the eINDIA 2011, in Ahmedabad. The event drew participants and visitors from across the country and worldwide. A plethora of activities ranging from keynote speeches, panel discussions, workshops and technology showcase made for an invigorating intellectual experience. eHealth India also recognised some of the best projects, initiatives and practitioners of healthcare through the medium of eHealth India 2011 Awards. The final encore to the event came in the form of the best healthcare technologies getting showcased at the eHealth India Expo. Hope you will find this issue informative!

Dr. Ravi Gupta ravi.gupta@elets.in

october january / 2012 2011 www.ehealthonline.org

special feature

Catalysts of Change A rainbow like collection of vibrant innovations and sky-high investments are enabling the healthcare sector in India to grow at a scorching pace By Dhirendra Pratap Singh, dhirendra@elets.in

january / 2012 www.ehealthonline.org

special feature

s George Bernard Shaw once said, “Progress is impossible without change, and those who cannot change their minds cannot change anything.” The last year, defined by innovations and new technology trends in healthcare, one word that dominated the global vocabulary was ‘change’. Healthcare has emerged as one of the most progressive and the largest service sector in India. The sector’s share in India’s GDP is expected to reach 8 percent by 2012. In 2009, it was 5.5 percent. At present the sector is estimated to be around US$ 40 billion and will grow to US$ 78.6 billion by 2012. The Indian healthcare sector is expected to become a US$ 280 billion industry by 2020 with spending on health estimated to grow 14 percent annually. The year 2011 can be considered a year of technology advancements. This was the year when innovative business models using IT ensured reach out of healthcare facilities to the masses. The year 2011 has been like no other for healthcare IT, not just in terms of the revolutionary and ground-breaking technology advancements, but also in terms of innovative business models. As Anthelio Business Technologies, Vishwanath Sivaswamy explains, “In 2011, Telemedicine - remote diagnosis, monitoring and treatment of patients via videoconferencing or the Internet - was seen as a fast-emerging trend in India. Telemedicine was supported by exponential growth in the country’s information and communications technology (ICT) sector, and plummeting telecom costs. Several major private hospitals have adopted telemedicine services, including those that have developed Public-Private-Partnerships (PPPs), such as the AIIMS. There are approximately 120 telemedicine centres across the country, and the government has pledged support for hundreds more.” He adds, “A booming healthcare insurance scenario is paving the way for hospitals to be able to afford use of technologies such as HIS and EMR. With the introduction of 3G, the possibilities of remote treatment and diagnosis of patients through mobile phones have been strengthened. In 2011, the number of cell phone users in India stood at approximately 600 million, with a projected increase of 20 million each month. In 2012, some telecom operators and value-added service developers are considering usage of mobile phones for diagnostic and treatment support, remote disease monitoring, health awareness and communication.” With the introduction of 3G ready devices like iPads, Samsung Galaxy Tab, Dell Streak etc., which have much bigger screen to facilitate content and application placement the mHealth space is poised to get even more expansive. The global healthcare IT market is forecast to exceed $24 billion by 2015 with a CAGR of 11 percent. The market is expected to be driven by governments’ financial incentives and regulations requiring automation in healthcare practices. The market growth is also expected to be driven by increasing need for hospitals to attain cost efficiencies and growing evidence of use of IT in healthcare practices.

“In 2011, Telemedicine - The remote diagnosis, monitoring and treatment of patients via videoconferencing or the Internet - was seen as a fast-emerging trend in India. Telemedicine was supported by exponential growth in the country’s information and communications technology (ICT) sector, and plummeting telecom costs.” Vishwanath Sivaswamy MD, Anthelio Business Technologies

The concept of Remote Diagnostics is picking up in India. More and more experts are interpreting digital images of MRI, CT scans, X-rays, etc and sending their interpretations to doctors practising not only in various parts of the country but also abroad. This innovative solution is simply a new paradigm of seeking medical expertise. Similarly, Telemedicine is fast becoming an integral part of healthcare services in several countries including Canada, Italy, Germany, Japan, Greece, Norway and now India. In India, Karnataka has become the role model for implementing telemedicine in all its districts. The market penetration of Picture Archiving and Communication Systems (PACS) in India is gaining momentum owing to the growing popularity of digitisation at the level of hospitals and healthcare delivery centres.

Medical Technologies Medical Technology over the past ten years has transformed the healthcare sector with several cutting edge technologies in the areas of molecular diagnostics, molecular imaging, minimally invasive therapies, implantable medical devices etc. The world today needs technology related innovation from the emerging world to ensure that the new technologies are affordable to a larger section of the population. The size of the Indian medical technology industry may touch US$ 14 billion by 2020, up from US$ 2.7 billion in 2008. The increased market share is on account of strong economic january / 2012 www.ehealthonline.org

special feature

With increase in awareness, growing income level, rapid increase in health infrastructure, gradual increase in state level reimbursement, and the enhancements of institutional and private medical insurances, India is now one of the fastest growing healthcare markets in the world.” Kaustav Banerjee Country Manager, India- St. Jude Medical Devices growth, higher public spending and private investments in healthcare, increased penetration of health insurance and emergence of new models of healthcare delivery. Kaustav Banerjee, Country Manager, India- St. Jude Medical Devices, says, “The medical technology space is diverse, and there are various therapies currently being offered for an array of diseases and ailments. This diversity makes it difficult to point towards one or two specific medical technologies.”

He adds, “We offer technologies that help achieve cost reduction benefits, including our fractional flow reserve (FFR) PressureWire™ technology. FFR is a physiological index that helps physicians to identify the severity of blood flow blockages in the heart. This information helps guide decisions as to whether stenting or optimal medical therapy would be the best course of treatment for each individual patient. The FAME study demonstrated that use of FFR prior to coronary stenting resulted in superior outcomes for patients – including a 28 percent reduction in major adverse cardiac events – as well as a reduction in cost.” Dr Bhaskar Krishna Arumugam, Chief Executive Officer, Granules India Ltd., says “Over the next several years, companies will focus on generics for biotech products. This sector will become the next big growth driver for Indian healthcare companies. India’s biotech sector is relatively small, but it will continue to grow over the next few years as more companies focus on this space.”

Evidence based medicine tools As the healthcare industry matures in terms of infrastructure and innovative technologies, the next goal of care delivery demands clinical excellence through evidence based medicine tools and benchmarks. Evidence based medicine is already being promoted globally and has been proved to be beneficial for all the stakeholders- clinical teams, hospital management as well as the patients. Evidence based medicinal tools, like clinical protocols and clinical pathways, provide explicit and well defined standards of care for the clinical teams and support multi-disciplinary care planning. From a management perspective these tools reduce healthcare costs, reduce patient documentation, optimise management of resources and help continuous clinical audit. They improve clinical care by delivering superior outcomes, improved clinical effectiveness and patient satisfaction. These tools can also be integrated with the existing EMR for providing decision support to the clinical teams.

A study by Ernst & Young says that India will require another 1.75 million beds by the end of 2025. The public sector is likely to contribute only around 15-20 per cent of the required US$ 86 billion investment. Healthcare sector in India, at present is estimated to be around US$ 40 billion and will grow to US$ 78.6 billion by 2012 The size of the Indian medical technology industry may touch US$ 14 billion by 2020 on account of strong economic growth, higher public spending and private investments in healthcare The global healthcare IT market is forecast to exceed $24 billion by 2015 with a CAGR of 11 percent The government has proposed to step up the plan allocations in 2011-12 by 20 percent amounting to Rs 26,760 crore With a world average of 3.96 hospital beds per 1000 population India has only 0.7 hospital beds per 1000 population. The country will require another 1.75 million beds by the end of 2025

january / 2012 www.ehealthonline.org

special feature

Clinical protocols and pathways based on evidence available from the Indian sub-continent are now available and need to be adopted in healthcare settings to achieve the next level of quality. The right amalgamation of modern infrastructure, innovative technologies and clinical skills guided by evidence based tools will go a long way in bridging the gap in the Indian healthcare industry.

Government Policy The Government has proposed to step up the plan allocations in 2011-12 by 20 percent, amounting to ` 26,760 crore. This was announced by the Union Finance Minister Pranab Mukherjee while presenting Sixth Union Budget 2011-12. The boost provided to healthcare is welcome and shall continue to support the industry’s need to reach a larger population, including the people in the remotest districts. The reassurance shall provide the push for further growth. In India, the increased budget can further be fruitful as it will ensure good progress at the technological aspect. The Rashtriya Swasthya Bima Yojana (RSBY) has been extended to cover unorganised sector workers in hazardous mining and associated industries, like slate and slate pencil, dolomite, mica and asbestos. The Yojana has emerged as an effective instrument for providing a basic health cover to poor and marginal workers. Presently it is being extended to MGNREGA beneficiaries, beedi workers and others. Government of Maharashtra is using ICT as a tool to enhance their ability and bring more professionalism in healthcare services. Tripura has initiated Tripura Vision Centre Project, a Tele-ophthalmology project aimed at offering primary and preventive eye care services to rural citizens. The project has adopted the latest ICT related advances in medical sciences and bio-medical engineering. However, there are lot of challenges ahead. India faces the huge need gap in terms of availability of number of hospital beds per 1000 population. With a world average of 3.96 hospital beds per 1000 population, India stands just a little over 0.7 hospital beds per 1000 population. Moreover, India faces a shortage of doctors, nurses and paramedics that are needed to propel the growing healthcare industry.

Wish-list to the government Says Vishwanath Sivaswamy, “I believe that India can leverage its prowess in computer technology, along with its highly skilled medical fraternity, to enable and augment technology in healthcare. With spending in the industry likely to touch ` 200,000 crores by next year, policy initiatives by government will go a long way in ensuring effective penetration of healthcare technology.” To support and nurture the growth of healthcare technology, the Government should provide incentives to hospitals to seek NABH (National Accreditation Board for Hospitals) accreditation and IT enablement by allowing 100 percent tax exemption for expenditures related to accreditation and IT enablement. Such initiatives will not only pave the way for a sustainable fu-

“Over the next several years, companies will focus on generics for biotech products. This sector will become the next big growth driver for Indian healthcare companies. India’s biotech sector is relatively small, but it will continue to grow over the next few years as more companies focus on this space.” Dr Bhaskar Krishna Arumugam Chief Executive Officer, Granules India Ltd ture for healthcare, but will also give rise to a nation where advancement in technology can truly be leveraged for prosperity and change. Indian pharmaceutical companies will benefit if the government takes steps to modernise the infrastructure, including roads and ports. Modern infrastructure would reduce transportation time and costs, which and enable the healthcare leaders to create more value for customers.

Future A booming healthcare insurance scenario is enabling hospitals to afford technologies such as HIS and EMR. With the introduction of 3G, the possibilities of remote treatment and diagnosis of patients through mobile phones has been strengthened. In 2011, the number of cell phone users in India stands at approximately 600 million, with a projected increase of 20 million each month. In 2012, some telecom operators and service developers are considering to use mobile phones for diagnostic and treatment support, remote disease monitoring, health awareness and communication. In the healthcare sector, Electronic medical record (EMR) services have a high growth potential and is expected to become the most popular in 2012. According to Reuters, EMR growth is pegged at an estimated compound annual growth rate (CAGR) of 13.5 percent from 2009 to 2016. The spate of new private hospitals that accounts for more than 80 percent of the country’s total healthcare spend is likely to boost this further, with investment in EMR being seen as a necessity. january / 2012 www.ehealthonline.org

eindia 2011

A Manifesto for Growth Keynote speeches, panel discussions, roundtables, workshops and technology showcases led to a flowing of intellectual outputs at the eHealth India 2011

Narendra Modi, Chief Minister of Gujarat inaugurating eINDIA 2011

n the current era of globalisation, Information and Communication Technology (ICT) is performing the role of universal equaliser, enabler and integrator. Today ICT can help achieve the dream of a more just, inclusive and equitable world in the most peaceful way. We can see many examples of ICT-enabled empowerment and social inclusion achieved in the developing world over the last decade. Our country is mired by poverty, inequality, corruption, and social exclusion. ICT can be a solution to our woes. It has the proven power to shift the balance of power in the society, governance and economy. The common man gets empowered. The disadvantaged groups, the poor, the women and youth make their voice heard through ICT. With this vision and mission, Elets Technomedia and Centre for Science, Development and Media Studies organised the seventh ‘eINDIA 2011’, in Ahmedabad. The event was organised in association with Department of Health, Gov. of Gujarat, Department of Information Technology (DIT), Gujarat; Ministry of Communications and Information Technology, and Department of Science and Technology, Government of India. Acclaimed as one of the largest ICT events

january / 2012 www.ehealthonline.org

in India, the eINDIA 2011 drew participants and visitors from across the country and worldwide. eHealth India hosted many eminent policy makers, academicians, researchers, technology vendors as participants and delegates. The three-day conference threw light on the areas of IT and technology in eHealth, and provided a successful platform for sharing knowledge and having discussions on emerging issues in depth. The conference featured sessions on crucial eHealth issues such as - Telemedicine and Teleradiology; ICT innovations revolutionalising healthcare; Online and mobile healthcare and much else. eINDIA 2011 bestowed recognition, in form of eINDIA 2011 Awards, on some of the best ICT-driven projects, initiatives and practices of across government, education, healthcare, agriculture and rural sectors. With the purpose of bringing better transparency and fairness in the award process, the awards were given under two categories, namely, the ‘jury choice’ and the ‘public choice’ (through online voting). ICT being the powerful tool that can help achieve the Millennium Development Goals (MDGs), this forum has led to the evolution of a compendium of ideas that can further enhance the scope of ICT In our life.

leaders speak

A celebrated expert on healthcare, and a winner of many prestigious awards, Prof Dr AFM Rahul Haque, Minister of Health and Family Welfare, Bangladesh, talks to Shally Makin, about the government initiatives that have revolutionised primary healthcare in Bangladesh www.mohfw.gov.bd

january / 2012 www.ehealthonline.org

leaders speak

ICT Plays a

Vital Role in Reaching Out to

t is the policy of Bangladesh government to ensure that basic health services are available to the entire population, particularly the under-served population in rural areas. Easy availability of primary healthcare is of utmost importance when it comes to improving the health of the common man. The health indicators show that in Bangladesh, there has been improvement in life expectancy, recurrence of diseases have been curbed. Bangladesh has been awarded by United Nations for reducing child mortality rate by nearly two-thirds. Currently the child mortality rate in Bangladesh is around 2 percent. The death rate for neonatal tetanus has come down by over 90 percent in just over a decade. Mother and child health programmes have been in the priority list of government. There has also been improvement in the governmentâ&#x20AC;&#x2122;s financial allocation for health. Governmentâ&#x20AC;&#x2122;s commitment and support for a range of partnerships have led to a massive increase in tetanus toxoid immunisation coverage among women of childbearing age. This ensures that both mothers and babies are protected against tetanus infection. The main reason for the rise in life expectancy is the decline in infant and child mortality due to the successful implementation of the immunisation programmes, and of the various disease control programmes. The estimated adult HIV prevalence rate today is only 0.08 percent with just 445 new AIDS cases found last year. Various programmes have been initiated for improving the nutrition and family planning services in the country. We have many community clinics, which are manned by three trained technicians and

Rural Masses doctors to provide free medication to around 6000 villagers in the country. The roles of the individuals, families and communities are emphasised in the intensified action programme for PHC implementation, which involves decentralised system of planning. ICT has played a vital role in creating systems in rural areas through which data can be transferred in seconds to technicians and doctors about various diseases. Most of the network is developed through mobile connectivity and all the district hospitals are equipped with tel-

The community clinics are designed to provide free medication to around 6000 villagers in the country armed by three trained technicians and doctors ephone facility and broadband connectivity. We are trying to bring health benefits to every pregnant number and we have had considerable success in that. The government has plans to strengthen the HMIS through training, and also by developing and designing data collection tools and establishment of information networks. Bangladesh Health department looks forward to PPP initiatives as the government believes that it can prove better health services for the country in terms of well built infrastructure of hospitals, increased connectivity and better technology. Privatisation of medical care at the tertiary level, on a selective basis, is also being considered. The people in the country are very excited and happy to know that they will be able to consult specialists through systems like telemedicine and mHealth. january / 2012 www.ehealthonline.org

leaders speak

At the Cutting Edge The Gujarat Government is taking several initiatives to make the state a global healthcare destination

P K Taneja Principal Secretary and Commissioner, Public Health & Family Welfare Department, Government of Gujarat www.gujhealth.gov.in

january / 2012 www.ehealthonline.org

leaders speak

ujarat Government is trying to improve the skewed child sex ratio by effective implementation of PC and PNDT Act, which envisages increased roles for ICT based applications in the state, and by bringing about substantial improvements in immunisation. The state government is determined to address malnutrition related issues and has decided to set-up a state nutrition mission for convergence, integration, monitoring and evaluation of targeted interventions. The state has set-up an autonomous society for Sickle Cell Anemia (SCA) related state interventions for full and faster coverage of tribal population in 12 tribal districts and plans are afoot for online tracking of beneficiaries through ICT initiatives. We expect a substantial increase in budgetary outlays in the health sector in the next plan period. We also hope to integrate various initiatives taken under NRHM with state health systems, and to sustain these initiatives for all times to come. The state is providing primary, secondary and tertiary healthcare services through reasonably good infrastructure of SCs, PHCs, CHCs, DHs, medical colleges and super specialty institutions. The state is providing comprehensive maternal and child health services like ANC care, institutional delivery, PNC care and immunisation services with Mamta Abhiyan package and through private institutes’ involved in schemes like Chiranjeevi and Bal Sakha Yojana. The Mamta Taruni Abhiyan for comprehensive healthcare services was started to take care of adolescent girls. Gujarat government’s e-Mamta scheme is a ‘motherly’ system that remembers a child’s needs — even if the mother forgets. This project, which even the Union government is now considering to replicate in other states of the country, tracks and monitors the health of pregnant women and children of up to six years. Everything about a child, from his very conception to education, is tracked and monitored under this system. Also, for parents, who have provided their cellphone numbers, vaccination alerts will be delivered via SMS on specific dates. The programme has improved reporting of maternal deaths from 589 to 702 over previous year and reporting of infant deaths from 4732 to 7263 over previous year. The state’s success in controlling sickle cell anemia has been feted with the prestigious Prime Minister Excellence award for administration in Public Health Programme. Gujarat is associated with many high-end super-specialty institutes for heart, kidney and cancer treatment.

The state government is determined to address malnutrition related issues and has decided to set-up a state nutrition mission In the current year 2011-12, the Rastriya Swasthya Bima Yojana (RSBY) policy in 26 districts of Gujarat is being renewed. In addition to the already eligible rural BPL families, the scheme is being extended to all the eligible 9.5 lakh urban BPL families of the state. More than 3.0 lakh BPL families have been enrolled till date. The state is deploying more than 100 mobile Health Units and Mobile Medical Units in remote and difficult areas. It is absolutely necessary to monitor and track these units through a tracking system; GPRS technology based tracking services are being outsourced for the purpose. The health department has a few projects lined up, such as 104 (Non-emergency Health Help Line). Government has framed policies that make it mandatory for every employee to get certain level of IT knowledge for promotion. A separate entity, namely Gujarat Informatics Ltd (GIL), has been set up to support all Government departments in ICT initiatives. january / 2012 www.ehealthonline.org

leaders speak

“iHIND Builds a Health Information

Network” Shiban Ganju, President of Atrimed Pharmaceuticals and convener of iHIND, has plans to develop and integrate end-to-end electronic healthcare informatics network in India. iHIND is a national interoperable health information network, which enables various stakeholders to have access to healthcare information

HIND (Indian Health Information Network Development) is a national volunteer lead initiative for creation of a HIN (Health Information Network). It takes account of India’s 626 districts and uses a hub-and-spoke model to connect various healthcare entities and aggregate data. The initial 20 member team has rapidly grown to 41. iHIND has expertise in various fields, including drug surveillance , improved healthcare quality, healthcare finance and technology, secure access to data on demand, reduction of duplication and errors, fraud and abuse prevention, public health and planning. A pilot for rural health IT has been conducted to connect 16 Rajiv Arogya Yojna clinics in Amethi, UP. The collaborators in the project being IAMI, CDAC, SAI Tech, Asia Heart Foundation and Save A Mother Foundation.

Policy Matters The government health department, insurers provide need based access, which is revenue neutral data. This is minimum data created to merge into clinical UID and UHID. Policy framework is important to facilitate the data to access issues pertaining to healthcare. The national autonomous (neutral), governing council looks after the accountability issues, and ensures appropriate participation, policy and legal consistency and transparency. The draft policy work was submitted to the Ministry of Health in April 2010 for the start of a pilot in rural and urban districts. In the meanwhile Health Secretary formed a team to identify EMR standards for India with a six month mandate. The team is working on this and making good progress and we expect to complete the work in March 2011.

Futuristic Models The iHIND foundation designs, develops and integrates an end-to-end electronic healthcare informatics network in India to improve public health, health research and the delivery of healthcare. The healthcare department needs to identify standards necessary for India and comply with international standards. Establishment of open source, open architecture, tools and components that support standards-based development and operations of the healthcare systems is equally important. The initiative ensures systems interoperability across all platforms and mediums and aims to assess potential privacy and security issues and set up guidelines for its compliance. It also helps to develop methods of certification and accreditation process for all healthcare stakeholders. . The work is primarily focussed on empowering the rural in India with improved healthcare infrastructure. With the successful implementation of Telehealth programmes, an initiative taken up by UNICEF and Bill Gates Foundation, the maternal mortality rates have fallen by 93 percent in 1000 villages in 39 districts. The cost of this IT project is also quite low.

january / 2012 www.ehealthonline.org

leaders speak

A pilot for rural health IT has been conducted to connect 16 Rajiv Arogya Yojna clinics in Amethi, UP. The collaborators in the project being IAMI, CDAC, SAI Tech, Asia Heart Foundation and Save A Mother Foundation

Shiban Ganju President of Atrimed Pharmaceuticals and Convener, iHIND www.atrimed.com

january / 2012 www.ehealthonline.org

leaders speak

The Bandwidth of Growth

Nivedan Sahani, Vice President and Business Head, Tata Teleservices believes that healthcare industry has been exchanging information, such as medical images and more recently electronic medical records, through local networks www.tatateleservices.com

t used to take weeks, months, or even years to plan, procure, and deploy IT infrastructure for connecting embedded medical devices to the network and capture valuable data. Healthcare organisations use ventilators, heart monitors, ultrasound wands, and countless other portable medical devices. Cloud computing solutions can allow emergency room doctors to quickly access a patientâ&#x20AC;&#x2122;s history and make better and faster diagnosis. Technology infrastructure and medical devices are expensive to deploy in the healthcare industry. The diversity of regulations and existence of myriad life-saving outcomes make the cloud a bit more complicated to embrace than it is in other industries. However, outsourcing bits and pieces of healthcare data services can still be cost-effective solution, one that also leads to improved patient care. We at the Tata Teleservices are also

Bridging the Healthcare Gap

Ameera Shah, Managing Director, Metropolis Healthcare says that ICT bridges the gaps in healthcare by bringing about automation in the process of testing and diagnosis

www.metropolisindia.com

iagnostic laboratory industry, which is estimated to be of about 10,000 crore in India, is largely fragmented and unorganised. According to estimates, there are about 100,000 pathology laboratories in India of which hardly 200 are accredited. But ten years from now we see this industry consolidating and health insurance industry will drive the growth. About 75 percent of the revenue of Metropolis Healthcare Ltd. comes from Indian markets, while the remaining 25 percent of the revenue comes from international markets. ICT bridges the gaps by automating the process of testing. The role of ICT starts

december/ 2012 january / 2011 www.ehealthonline.org

from the on-line patient booking to the registration of the sample and then the report gets digitally signed in after the analysis of the sample. Had the entire process been done manually, the possibilities of human errors would have been higher. In Metropolis, we try and avoid manual intervention in the testing process. In future, ICT will play an important role in data mining of information in pathology and diagnostic industry, which is already growing by leaps and bounds. Diagnostics is an important part of healthcare and thus proper regulations need to be in place.

working on various mobile-based applications that will improve life of rural citizens, and at the same time enable the state government to collect all the relevant data and take faster decisions. Automation at FPS - GPRS based solution consists of a Blackberry device/Pos with GPRS connectivity and a bluetooth printer. The handheld device can also be customised with the finger printing option, smart card swipe and barcode reader-writer. The solution, on a handheld device, aims to provide an integrated framework for streamlining the day-to-day activity in National Health Rural Mission (NRHM). Online data capturing, on a handheld device, is done by ASHA/ANM workers in a local language. This data is collected at the block and district level again and sent to state headquarters where appropriate reports get prepared.

Zoom In speak leaders

“Telemedicine

Industry Craves for

Strong Policy Makers” Rajendra P Gupta, Chairman, Board of Directors, HIMSS Asia Pacific India Chapter, foresees a contest between Tablets and SmartPhones, between Windows, Apple and Android, rather than one between a ‘user’ and ‘non-user’ of mHealth by 2015. He talks about the challenges faced by the industry www.himssindia.org

january / 2012 www.ehealthonline.org

leaders Zoom speak In

elemedicine needs to be thoroughly understood by the healthcare professionals, experts and leaders to create sustainable business models. Telemedicine growth story can be studied with an evolution cycle which follows the path of advocacy—policy— infrastructure— issues of capacity building—funding—financial models— research—adoption and mass deployment. Telemedicine in India is still in the policy phase where the year 2011 has been a breakthrough year in terms of developing new policy. The biggest challenge lies at the government level and policy makers who do not understand the concept of ICT in health. So far the Directorate General of Health Services, Ministry of Health & Family Welfare, Government of India, and the WHO Country Office in India have jointly formulated policy 2.12. Promoting use of information technologies like TeleMedicine to improve access of NCD services, National Policy on Information Technology, (NPIT) 2011 was thus introduced to focus on application of technology-enabled approaches to overcome monumental developmental challenges in education, health. The policy helps to leverage ICT for key social initiatives like education, health, rural development and financial services to promote equity and quality. The policy determines to undertake implementation of Mission Mode Projects (MMPs) in Health, Education, Financial Services, PDS etc. to improve the quality and accessibility of such services. There are few challenges before Telemedicine takes over and there is improvement in health parameters in the country. The country has 900 million plus mobile phone users, over 8500 medical applications are available on cell phones. The number of internet users has increased to 100 billion and few hospitals have dedicated telemedicine facilities. A major area of concern is to initiate human resource development for eHealth and mHealth. Medical Council of India is willing to push for Telemedicine courses, but MBBS is already cramped with too much teaching material in the current 5 year curriculum. The council needs to create regional training centres along with specialised short term courses for healthcare professionals in telemedicine. Another challenge faced by the telemedicine programmes is funding. All major projects - notfor-profit and ‘Trust run’ like Apollo telemedicine - need to be encouraged. Government run projects have not gone ‘Beyond the Pilot phase’. Government should showcase success stories for adoption especially in three issues - infant mortality, chronic diseases, early diagnosis and prevention. The industry needs to start doing projects that are financially viable. The data shared during the research should be transparent. It is also observed that unless we invest in research, we will not be able to convince the medical fraternity to use telemedicine. A joint initiative of MCIT, DMAI & TSI— ‘ Project iHope – Improving Healthcare Outcomes by practicing eHealth’ –needs to be spread around the country. Legal and regulatory issues should be sorted out to ensure provider / user adoption. Telemedicine has to become an important component of rural health, EMRs needs to be adopted in clinical practice, tablets should be used for medical education and this is the best

India is the IT Hub for the world, it has technically capable manpower, EMR industry is growing tablets and phones are cheaper, 3G is available, 4G is expected in 2012, and mobile health applications are growing at a fast pace

way to get doctors to use latest technology. If 100 million consumers used health related applications on mobile phones, the country would have reached the threshold of going ‘Mass scale’ on Telemedicine. We need to encourage innovative ideas and promote initiatives like EMRI– Innovative emergency response model, HMRI – Remote advice and mobile Solutions, Aravind Eye – Low cost eye-care model leveraging Telemedicine and mobile based high risk expectant mothers tracking system – Maternal Mortality dropped by 93 percent after the launch of the programme. We believe that it is time to prioritise ‘Inclusive Health care’ as a key component of the Healthcare policy and delivery. But without Telemedicine the aim of providing inclusive healthcare will remain a distant dream. january / 2012 www.ehealthonline.org

leaders speak

â&#x20AC;&#x153;Need for Training Medical Professionalsâ&#x20AC;? Dr Supten Sarabhadhikari, Founder of Supten Institute and an emissary of Health Informatics Standards, talks about creating a vibrant health network through e-learning. www.hl7india.org

ealth informatics, which is also known by terminologies like healthcare informatics medical informatics, nursing informatics, clinical informatics or biomedical informatics, is a discipline that stands at the intersection of information science, computer science, and cutting edge healthcare. It deals with the resources, devices, and methods required for optimising the acquisition, storage, retrieval, and use of information in health and biomedicine. Health in-

january / 2012 www.ehealthonline.org

formatics tools include not only computers, but also clinical guidelines, formal medical terminologies, and information and communication systems. It is applied to the areas of nursing, clinical care, dentistry, pharmacy, public health, occupational therapy, and bio-medical research. Supten Institute offer courses intended to introduce the basics of healthcare informatics. At the end of completion of this course, the students are skilled in various learning techniques. The course teaches basic health informatics including electronic health / medical records (EHR/EMR), tele-health (ehealth and telemedicine), medical imaging, evidence-based medicine (EBM), and healthcare interoperability standards. The students are made aware of the role of hardware, software and networks that are used in healthcare. They are able to acquire skills in querying medical databases (including literature) relevant to clinical management and medical research. The students need to learn and understand basic skills required to develop databases relevant to healthcare and use of hospital information system. Supten Institute intends to become a centre of excellence for empowering professionals to effectively use Information and Communications Technologies (ICT) applied to healthcare practice, education and research. The institute is committed to capacity building, for informed healthcare delivery in the 21st century, through the Internet, social networking sites and faceto-face classes i.e., Blended Learning. It shares the values of its founder whose commitment is to offer high quality education across time and space barriers to enable all human beings in asking for and delivering informed healthcare through informatics tools. The institute will offer courses through the programmes and examinations offered periodically at external locations. The programmes are in hybrid model, with one day of four courses being offered as a pre-conference or post-conference, the remaining six to eight courses are offered online. The certification exams are also conducted online.

national conference on ict in Public safety & security march 1, 2012 The Claridges, New Delhi

Focus Areas

• • • •

Disaster Management Public Safety and Security Information and Cyber Security Infrastructure Security; Interstate Cooperation; Border Management; Police Reforms • ICT in Policing/Traffic Modernization

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Ministry of Home Affairs Ministry of Defence Border Security Force CRPF, CISF, DRDO, CBI State Police/Home Ministry • CCTNS Nodal Officers • NATGRID, Indian Army, National Crime Records Bureau and State Crime Records Bureaus ..and more

For Sponsorship Enquiries: sales@elets.in | For Programme enquiries: events@elets.in

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eindia awards 2011

eINDIA 2011 Award Winners

Hall of Fame OASIS receives the award for Best Government to Business Initiative of the Year in the Jury Choice Category

ICDS-GMIS (Geo-Graphical Management & Monitoring Information System for ICDS) receives the award for Best Government to Citizens Initiative of the Year in the Jury Choice Category

e-Governance of Mineral Administration (Geology and Mining) receives the award for Best Government to Business Initiative of the Year in the Public Choice Category

AISECT Financial Inclusion Model for Rural India receives the award for Best ICT in Financial Inclusion Initiative of the Year in the Public Choice Category

HORTNET receives the award for Best Government to Government Initiative of the Year in the Public Choice Category

january / 2012

Online Scholarship Management System receives the award for Best ICT-Enabled eGov Initiative of the Year in the Public Choice Category

january / 2012 digitalLEARNING www.ehealthonline.org www.digitallearning.in

Community Public Private Participation through Community Knowledge Centre Model receives the award for Best Telecentre Initiative of the Year in the Jury Choice Category

eGov Strategies and ICT enabled Initiatives at Chief Ministerâ&#x20AC;&#x2122;s Office (IT), Gujarat receives the award for Best Government to Citizens Initiative of the Year in the Public Choice Category

eindia eindia awards awards 2011

IKen Library receives the award for Best ICT Enabled Content for K-12 Education in the Jury Choice Category

Eureka.in receives the award for Best ICT Enabled Content for K-12 Education in the Public Choice Category

Integrated Housing Lottery Management System (IHLMS) receives the award for Best Urban ICT Initiative of the Year in the Jury Choice Category

TeachNext receives the award for Best Assessment Tool Providers in the Public Choice Category

Online Voting System receives the award for Best Urban ICT Initiative of the Year in the Public Choice Category

Extra Marks receives the Special Mention award for Best ICT Enabled Content for K-12 Education

Shodhganga receives the award for Best ICT Enabled Higher Education Institute of the Year in the Jury Choice Category

LK Singhania Education Centre, Gotan receives the award for Best ICT Enabled School of the Year in the Public Choice Category

Gulbarga University Library receives the award for Best ICT Enabled University of the Year in the Jury Choice Category

Lovely Professional University receives the award for Best ICT Enabled University of the Year in the Public Choice Category

january / 2012 january / 2012 www.ehealthonline.org www.digitallearning.in

digitalLEARNING

27 27

eindia awards 2011

Xcelerate receives the award for Best Open and Distance Learning Practices in Higher Education in the Jury Choice Category

LearningWare receives the award for Best Technology Solutions for Education Institutes in the Jury Choice Category

Community Development Programme using ICT: JNV DAVANAGERE receives the award for Best Technology Solutions for Education Institutes in the Public Choice Category

AMR APARD eLearning Project receives the Special Mention award for Best ICT Enabled Skills Development Initiative of the Year

DigiClass receives the award for Best Use of Technology for Teaching/Learning Practices in Schools (Private Sector) in the Jury Choice Category

SevenHills Health City receives the award for Best ICT-enabled Hospital of the Year in the Jury Choice Category

108 Emergency Response Service receives the award for Best Civil Society Development Agency Initiative of the Year in the Jury Choice Category

january / 2012

january / 2012 digitalLEARNING www.ehealthonline.org www.digitallearning.in

Tripura Vision Centre Project receives the award for Best Govt Policy Initiative of the Year in the Jury Choice Category

3D Technology in Education receives the award for Best Use of Technology for Teaching/Learning Practice in Schools (General) in the Public Choice Category

leaders speak

Leveraging Digital Technologies in

Healthcare

Technology needs to be secure, stable and scalable, and it is equally important that it should be supported internally and externally

uring the last decade the health spend has been rising and the quality of healthcare has been declining. Digital technologies are having an impact in every walk of life, but not much improvement has happened in the healthcare sector. The cost of quality healthcare continues to spiral. At Microsoft we believe that we’re on the cusp of a pivotal change. Within the coming decade, we expect to see a number of innovations that will actually equip consumers to improve their health and manage risks. One of the primary reasons that digital technologies have not delivered on the promise is that, up until recently, the vast majority of health information technology solutions (HIT) on the market today have targeted our existing, acute care delivery system - the hospitals, clinics and emergency departments - that are in the business of caring, but not preventing acute conditions and complications of chronic diseases. Acute care is, of course, an information-intense business, so it’s no surprise that most of the solutions to date have focused on digitising, organising, and moving health record information around the ecosystem. The problem is, our existing acute care delivery system is mired in its own inertia around reimbursements, cost shifting, low primary care to specialist ratios, and local turf wars and is now so consumed with acute care that it doesn’t even have the capacity to refocus on health. At Microsoft , our focus is to collaborate and innovate with industry, business, academia, government, and consumer leaders to bring innovative, scalable and higher leverage solutions that bring about improvements in healthcare at lowest cost per capita to the environments where we live, work, learn and play. With reimbursements falling and medical loss ratio minimums rising, hospitals, physicians, and health plans are under unprecedented pressure to drive down operating costs while still improving the quality and safety of patient care. The economic advantages of cloud-based productivity solutions to drive down operational costs and complexity are well understood. Clinical teams--doctors, nurses, pharmacists, and care coordinators--spend about 80 percent of their time communicating. The ability of facilitating communication on the move

january / 2012 www.ehealthonline.org

T S Y Aravindakshan Lead, Public Sector Breadth, Microsoft www.microsoft.com

between patients and departments and the office and hospital can make the difference between a rapid recovery and a life threatening complication. Technology needs to be secure, stable and scalable. It needs to be supported both internally and externally. It’s not enough to have a system in place internally if the clinical trial partners you work with can’t use it. If life sciences companies are ever going to ditch paper and move towards an integrated content management system, there needs to be industry-wide agreement on the technologies, standards and protocols and business processes that need to be in place. Basically, there is some risk in going 100 percent paperless. In order to improve data exchange and foster collaboration, solutions should integrate with other applications, and seamlessly aggregate data from disparate sources into common, accessible formats.

Conclave of Global Leaders in Education Thematic Sessions Confluence of Thinkers, Innovators, Experts Expositions on Digital Technologies Interactions with School and College Leaders

Awards: Recognising global innovation and excellence in education

Where Education Takes Centre Stage highlights • Power tracks on > School Education > Higher Education • Ministers’ Conclave • Secretaries’ Conclave • Industry Leaders’ Conclave • Education leaders’ conclave

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

Organisers

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Featured Product

A Tête-à-Tête with Pankaj Vaish, President-HealthFore Congratulations on the launch of Mediphone Pankaj. Thank you. So, mHealth is a buzzword today? How much do you think is hyped and how much of it is pragmatic? What else is HealthFore doing in this space besides Mediphone? Yes, it is a buzzword and high on the hype cycle, but so were ‘Cloud’ and ‘SaaS’ a few years back. I think that very much like them, mHealth, is now here and making a difference in people’s lives. We’ve had a number of callers from Rajasthan, who were very appreciative of the service during the doctor strike there. Last week we had a caller from a remote village in Madhya Pradesh at 2 in the morning whose son had suddenly fallen ill and vomiting continuously, no local doctor or chemist was available. Our doctors and health officers were able to help guide the parent to stabilize the patient using home care and standard medicines available in the household. Each such call is a testament to the value mHealth brings to the people. At HealthFore we have an entire business unit looking at bringing Tele-Health solutions to the Indian subcontinent and expanding to points in South East Asia and Africa. We’ve grouped ourselves to address three core business points in tele-health, encompassing Tele-Triage, Tele-Medicine and Health Concierge. You have already read about our Mediphone services which branches out of our Tele-Triage services; what we also have, is our HealthLine 24x7 health concierge service, which is primarily a free of cost, health guidance and medical directory service that runs 24x7 and is accessible through 33006666. In the tele-medicine area, we run a teleclinic for our remote employees where the systems monitor and transmit patient data in real-time to the doctors for advice. Great! But Tele-triage has existed in the US markets for more than 20 years now but there was not even a single success in India, What made you think that this is an area of interest and how you planned to approach and scale it? There are several ways in which one can map success. The programs with India’s National Rural Health Mission (NRHM) and the Ministry of Health & Family Welfare (MOHFW) have got tremendous success in establishing connectivity amongst primary, secondary, and tertiary centers.What we have realized as the reason for not having stellar success stories in the private sector was primarily because most initiatives in tele-health

were launched as point or partially integrated solutions. That is why most of these solutions do not make it beyond the pilot stage. We paid heed to this lesson before we forayed into this business and ensured that we have the right partners who not only had the ability, scale and network to support such models, but also understood the dynamics of a growing industry and shared our commitments. So if you take a quick look at our partners, we have Airtel (India’s largest telecom operator), Fortis (India’s largest private healthcare provider), SRL labs, Religare Wellness, Religare Health Insurance, RenKare (Dialysis Solutions), C-Doc (Diabetes & Chronic Disease Solutions) and HealthCursor Consulting who is helping us build our mHealth practice globally; to get the reach of them bringing their experience to the table ishelping us enable an ecosystem that can be deployed on demand. Do you feel that the whole array of solutions you provide including Hospital/Labs information systems, practice management software, Enterprise solutions can change the way healthcare is being delivered today? Short Answer, yes. But as great man once wrote, “Vision without action is merely a dream. Action without vision just passes time. Vision with action can change the world.” Healthcare is the case in point, where we have no shortage of vision, but an acute lack of enablers. Our strategy has been based on three pillars, our B2B enablers, our B2C enablers and our ecosystem which constitutes of our people, partners and promoters. I’ve already talked about our B2C enablers like Mediphone and HealthLine 24x7 and our ecosystem. Our B2B business constitutes of next gen enterprise enablers under the aegis of our Magnum suite of products which is a comprehensive hospital information management system where we have feature rich solutions for Patient Administration System, Diagnostics, Back Office, Billing, Radiology and PACS. We are currently serving customers across India, Middle East, Africa and South East Asia where we are very happy to see difference being made where it’s needed both for healthcare practitioners and patients. Tell us something about your future endeavours. Our tele-medicine group is working on our Live Consult platform, which we envisage would form to be a de-facto model for corporate and educational community health service. The Tele-Triage group’s Tele Consult platform is already garnering a lot of interest… And of course, with our upcoming Infinity product range, we are aiming to bring the health care providers of the developing markets to the exacting efficiencies of the western market within the developing market budgets. january / 2012 www.ehealthonline.org

leaders speak

“Streamline Key Processes through Business Process Re-engineering” Bhudeb Chakrabarti, Senior General Manager and Region Head of National Institute for Smart Government, envisions to integrate and rationalise the information processing work so that there can be an optimisation of the dispersed resources. www.nisg.org

s defined by Hammer and Champy, business process reengineering is the fundamental rethinking and redesign of businesses for achievement of dramatic improvements in vital parameters like cost, quality, service and speed. The core issue is the value of healthcare delivered. In our country the extent of medical errors is largely unknown. There are unnecessary deaths attributed to medication related errors, and to unneeded or ineptly performed surgeries. The issues are aggravated due to heavy reliance on paper based patient records in medical institutions and untimely or mistaken diagnoses. There are problems related to duplicate data and management errors. The poor healthcare processes are due to reasons such as long queues at OPD and air of mystification about patient’s status. There is no system to conduct a need-based assessment of requirement of “Admission to Hospital” or “Days of Stay.” At times patients are forced to make multiple visits to hospitals for the same treatment. There is poor quality of service. Patient information is often, neither evidence based nor easily accessible, as there is no way of accessing critical care data. 60 percent of clinician’s time is spent searching or waiting for patient information. We need to streamline key processes through business process re-engineering (BPR), capture information at source, identify key performance indicators and evaluate the performance accordingly. The reporting formats need to be simplified. Clinical Decision Support systems (CDS) must be carefully designed so that they are reliable and accurate. An integrated collection of data is needed to track and monitor each process on regular basis. Identification of all the processes in an organisation and prioritising them in order of urgency

january / 2012 www.ehealthonline.org

National Knowledge Commission (NKC) recommends initiating development of Indian health information network and establishing national standards for clinical terminology and health informatics is the need of the industry. We also look forward to link parallel activities in the workflow instead of just integrating their results. National Knowledge Commission (NKC) recommends initiating development of Indian health information network and establishing national standards for clinical terminology and health informatics. We need to create a common electronic health record (EHR), frame policies to promote use of IT in healthcare and create appropriate policy framework to protect health data of citizens. Medical informatics should become a part of medical and paramedical curriculum. The industry needs to widen the area health network, reconfigure laboratories so that they can perform the most frequently requested tests faster.

leaders speak

“Radiologists are Exploring

Feasible

Teleradiology Models” Dr Kishan Rawat, Consultant at Department of CT Scan and MRI, Sir Ganga Ram Hospital (SGRH) talks about the challenges that the teleradiology industry is facing. He dwells upon the few feasible models, which can encourage exchange of medical imaging data for better diagnosis www.sgrh.com

he teleradiology systems involved in the exchange of medical imaging data basically deals with three issues - data privacy, authenticity and integrity. It is important to make patient-specific data quickly available and usable to many specialists at different geographical sites. We look forward to integration of audio and videoconferencing with collaborative virtual reality images. A tele-immersive radiological system has been developed for remote consultation, surgical preplanning, postoperative evaluation and education. There are various tele-immersive devices such as Personal augmented reality immersive system (PARIS), Configurable wall (C- Wall), Physician’s personal virtual reality display and ImmersaDesk. Such devices provide augmented reality and avoid an important stereo vision depth perception conflict. A tracking system with two sensors has been installed on the PARIS, which can generate stereo images from the viewer’s perspective and let the user interact with the data directly in three dimensions. It allows superior interactive visual display of medical data and also facilitates ability to interact over networks with collaborators in remote locations. A web-based teleradiology system called MITIS records all the necessary medical information, patient data, examinations, operations and advanced image-processing tools for the manipulation, processing, and storage of ultrasonic and mammographic images. Web-based collaborative clinical teleradiology is recently introduced to eliminate the radiation dose by continuous physical presence in the catheter lab. Digital images from

imaging modalities can be transferred without any loss of information and remote experts involved in surgical interventions or preoperative planning sessions. The radiologists are now looking at feasible models such as Nighthawk Model and Indian Model. The Nighthawk Model relocates fully licensed domestic radiologists to a country in eight to 12 time zones ahead of the home country. The existing licensure systems are compliant and hospitals doing business with Nighthawks do not need to fear being sued for negligent hiring or supervising of their radiology staff. The only disadvantage the model bears is that the domestic radiologists are relocated overseas. This leads to labour shortages in the home market. The model is not a price-competitive alternative to traditional radiology. On the other hand, the Indian providers hire unlicensed indigenous radiologists who are willing to work for one tenth the wages of radiologists in developed countries. The country has scarcity of quality radiologists in tier 2 and tier 3 cities, remote diagnostic centres want quality reporting to increase revenues, reduced time and cost of travelling is required to increase healthcare penetration in remote area. The infrastructural limitations such as network functionality and bandwidth availability are a major reason for failure of teleradiology in the country. The teleradiology system developed for combat support is also suitable in humanitarian and disaster-relief operations performed by armed forces. The industry needs skilled medical care to patients who are isolated from the specialised care. january / 2012 www.ehealthonline.org

leaders speak

Building

Trust in Telemedicine Dr Jawahar Shah throws light on the work that Mind Technologies, a company that he founded, has done for connecting rural and urban specialty centres through telemedicine, and by offering quality preventive and curative services in Homoeopathy www.mindtechlive.com

ural India desperately needs Telemedicine. Poor Indian villagers are often forced to spend comparatively large sums of money on travel to the cities for treatment in speciality hospitals. According to a study done by the Indian Institute of Public Opinion, 89 percent of rural Indians are forced to travel more than 8 kms to receive basic medical treatment. AYUSH (Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homoeopathy) was undertaken by the National Institute of Homeopathy in Kolkata in partnership with a private firm, Infrastructure Leasing and Financial Services Limited (IL&FS), both of which were working under the Union Ministry of Health and Family Welfare, Government of India. The team at Mind Technologies sought to harness this power of remote communication and combine it with homeopathic treatment, which is cost effective, has no side effects, and shows tremendous ability in combating a wide array of diseases. The project was implemented at 11 centres in Tripura. A patient living in remote area of Tripura can approach any one of these centres and consult a doctor sitting in a nearby dispensary. If a doctor is not available in the dispensary, a link will be established with the NSS hospital in Tripura or with the National Institute of Homoeopathy, Kolkata, or to the expert consultation end at Mind Technologies, Mumbai. Upon making a prescription, a trained attendant in the centre dispenses the medicine to the patient. The project is a massive success. More than 14,000 patients have been treated since the project began; more than 60 percent of the patients are women. In future, the team also sought to reduce isolation of rural medical practitioners by upgrading their knowledge through tele-education and tele-CME (Continuous Medical Education), and facilitating full access to medical information through remote

january / 2012 www.ehealthonline.org

technology. This has enabled emergency and critical care situations to be managed in the rural areas itself. The project will overcome all geographic, economical and social barriers faced by the rural citizens and help them in obtaining quality preventive and curative services through homoeopathy. Embarking on a first of its kind telemedicine venture, Mind Technologies has meaningfully touched the lives of more than 14,300 people in rural Tripura. Not only has this initiative provided healthcare to the poor and needy, it has also opened new avenues in the health industry, the government authorities, and the masses. It has already started the process of acceptance of homeopathy.

leaders speak

Technology that

Secures

With innovations and developments in the technology, we have smooth electronic data flow from insured to insurer

Bishwajit Nayak Head of Health Claims and Networking, Future Generali www.futuregenerali.in

january / 2012 www.ehealthonline.org

ealth Insurance is one of the fastest growing business line in general insurance. This business involves various stake holders and voluminous data capture and transfer takes place between the stake holders. This includes the client, intermediary, the insurance company, the TPA (if involved), the hospital, doctors, diagnostic centers, etc. All the stake holders require excellent IT infrastructure in terms of hardware as well as software. The process of reimbursement presently takes around 20 days and we plan to shorten it up to 3-4 days to hold the customersâ&#x20AC;&#x2122; interest.â&#x20AC;? The company focuses on web insurance of policies, web enrolment of members in corporate, eCards and eEnrolment of members and dependents. Customers can access their policy coverage information online as well as seek information online. Future Generali has 18 percent of share in the health insurance sector. The role of technology in insurance is used for distribution of health insurance, customer service and data flow and capture. For the rural population, they have incorporated web enabled common kiosks which are a single window concept for financial products. Future Generali is a joint venture between the India-based Future Group and the Italy-based Generali

Group. Future Generali is present in India in both the Life and Non-Life businesses as Future Generali India Life Insurance Co. Ltd. and Future Generali India Insurance Co. Ltd. The capabilities of each of the stake holder in capturing data effectively and transferring the data across are very important. Health Insurance involves personalised services and the efficiencies required are of a much higher level. Extensive quality data, analysis and inference are very vital for a viable health insurance portfolio. Health insurance underwriting as well as claims processing system capabilities play a pivotal role. The extent and quality of data captured by an insurance company helps in more efficient product designing and pricing. Fraud detection is another important area in health insurance where IT has a major role to play. New regulatory initiatives such as portability require quick retrieval and exchange of data within insurers and would require the insurance companies to have excellent IT systems. With innovations and developments in the technology, we will have smooth electronic data flow from insured to insurer, diagnostic centre to insurer, hospital to TPA/ Insurer and insurer to insured. It will help better fraud detection as well as fraud management.

easia 2011 report

Honorable Prime Minister H.E. Sheikh Hasina Government of the Peopleâ&#x20AC;&#x2122;s Republic of Bangladesh and Architect Yeafesh Osman, Honorable State Minister, Ministry of Science and Information and Communication Technology, Government of Bangladesh releasing a postage stamp on eAsiA 2011 to mark the 40th year of independence

Asiaâ&#x20AC;&#x2122;s Premier ICT Event Marks its Presence at Bangladesh www.e-asia.org

The eASiA initiative was introduced to facilitate a common space for all the stakeholders allowing them to share their experience through face to face consultation, online consultations, discussions and communications. This forum provided an opportunity to reach out to the appropriate community with adequate knowledge resource materials. It became an effective forum for a quick knowledge exchange which would be instrumental in preserving and adding on to the knowledge as well as resources while keeping it dynamic in order to meet the changing needs.

nformation and Communication Technologies (ICTs) have transformed the very concept of development and growth, bringing disparate communities together in virtual interactive communities of shared experiences and understanding. This revolution has shaped social changes that necessitate a rethinking of what it means to be part of a community since lack of access to the knowledge society invariably means exclusion from the social, economic and political decision-making process. The 5th eASiA 2011 provided for a knowledge platform to gather thought leadersips, scholars, practitioners, policy makers and government functionaries, academia from across Asian

countries and beyond to exchange, collaborate and become engaged in a continuing dialogue ultimately leading to appropriate, innovative and ground-breaking policy solutions. It provided for a platform for strategic knowledge building community aiming at developing, identifying, and sharing emerging practices on the integration of ICTs in various facets of growth and development in governance, education and health. The 5th eASiA 2011 was organsied at Dhaka, Bangladesh to commemorate the 40th birth anniversary of Bangladesh and celebrating Digital Bangladesh agenda of the government from December 1-3, 2011 at Bangabandhu International Convention january / 2012 www.ehealthonline.org

easia 2011 report

The audience attending the inaugural function in the ‘Hall of Fame’, BICC

Key Sessions:

Architect Yeafesh Osman, Honorable State Minister, Ministry of Science and Information and Communication Technology, Government of Bangladesh (left) felicitating Chief Guest HE MD Zillur Rahman, Honorable President, People’s Republic of Bangladesh

Centre (BICC). Bringing more than 200 international leaders as speakers from across the globe, the event kicked off successfully with the inauguration by Honourable Prime Minister, Sheikh Hasina, Government of People’s Republic of Bangladesh. The Prime Minster, in her inaugural speech, emphasised that the government wants to build the new generation as technology-friendly human resources by providing skills in ICT in different sectors of development such as governance, education, healthcare, agriculture, outsourcing, among others. Releasing a postage stamp on eASiA 2011 to mark the 40th year of independence, the Prime Minister also highlighted the need for a global cooperation to build an eco system around the drive for ICT for Development.

In line with the four key strategic pillars of Digital Bangladesh vision, eASiA 2011 comprised of unique thematically inter-related conferences: Building Capacity, Connecting People, Serving Citizens and Driving Economy. The conference spanning over three days with more than 35 sessions, witnessed a footfall of more than 25,000 visitors and participants.

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Co-creation: Citizens in the role of service providers An appropriate Telecommunications Regulatory framework to maximize citizen’s benefits Telecentres Sustainability to bridge digital divide Cost effective Healthcare services using ICTs ICT enabled Future Classrooms to increase learning outcomes Redefining pedagogy: Teachers as mentors and guides ICT enabled Agricultural Services to be accessible, available and cost effective Application development for mobile platform Best practices in safeguarding digital content

The exhibitions provided a great platform for knowledge sharing, showcasing projects, programmes and initiatives of government and private sector agencies and corporations, as well as for demonstrating innovative ICT products, solutions and applications for various domains, which were covered under the scope of the event. There were also pavilions of the countries like Thailand, Malaysia, Sri Lanka, China and Japan along with two special pavilions from Nordic countries. eASiA 2011 Awards night was witnessed by the distinguished guests including the Honorable Minister for Planning and Honorable Minister for Science and Information and Communication Technology. The eASiA Awards were instituted with the primary aim of felicitating and acknowledging unique and innovative initiatives in the use ICT4D. The award categories were chosen in alignment with the five themes of the conference: Building Capacity, Connecting People, Serving Citizens, Driving Economy and Breaking Barriers. Among 38 finalists, 17 awards were given in the gala event held on the second day of the conference. The valedictory session was presided by the HE Md Zillur Rahman, Honorable President, People’s Republic of Bangladesh.

leaders speak

“Standardise Nomenclature of Medical Information” Col Sanjay Patole, Head – IT, Army R&R Hospital, believes that HL7 version 3.0 can be a potential solution for creating medical information database

mproper data and non-availability of medical information often results in extraordinary hardship for many serving exservice personnel, whose records get lost, and who are unable to get their benefits processed in a timely fashion. We need a different approach in the healthcare domain. The problem is that a modern information system does not exist in all hospitals. Many sections of the industry uses ICD 10, which has 10,000 terms. HL 7 already uses a Reference Information Model (RIM), which includes ICD 10, SONMED (Systematised Nomenclature in Medicine) and has every clinical term included in it. The Department of Defence (DOD) is working with the Department of Veterans Affairs (VA) in USA to create a new electronic-health record (EHR) system, which will have healthcare information on veterans from the time they enter military service. The Joint Virtual Lifetime Record will standardise the

way the agencies share electronic medical information. In our case we have to focus more on patient centricity than on institutional centricity. If we look at the IT budget, only 2 percent is spent on Health IT. The Indian army is planning a hospital system that will have 30,000 beds and 4-5 million dependent personnel. This is in line with what the US Veteran Society has. GAO Report, US DOD - Department of Defence reports the lack of an integrated system perpetuated the reliance on paper-based records, leading DOD to pursue a comprehensive electronic healthcare record. HL7 version 3.0 is a system that can deliver the solution to us. It’s called the medical logical module (MLM) that can effectively work to integrate services in an organisation. We need something in our country which gives us a certified EHR that we can use and the data will be updated automatically.

“IT is the Future”

Dr Akash Rajpal, MD & CEO, EKO Health Management Consultants, aims to deliver affordable healthcare by improving patient awareness

www.ekohealth.in

KO Health Management Consultants facilitates discounts for patients who are in the uninsured or unsecured segments and who have diabetes or hyper tension or lie under the 50 plus age group. Use of Hospital Management Software is becoming essential in hospitals, as it contributes to faster turnaround times and reduces paperwork. RFID, bar coders and even use of mobile phones for remote patient monitoring is a trend. All postings when done in software automatically adjusts central/ sub stores accountability, reorders can be placed as appropriate, re-order levels can be set depending on usage trends and high risk alerts can be popped up. Central monitoring system is conducive for better patient safety. Blood samples can be quickly transported from vacuum chutes to lab for quick communication and transcription. No matter how sophisticated the technology is or how good the software is or it can store your information till eternity, if it reduces the productivity, it is a complete failure.

The computer can store standard nursing care plans in a format determined by the institution, to be used by nurses as the basis for developing individualised client care plan. Nurses’ notes can be entered quickly by choosing statements, appropriate for a particular client from multiple preprogrammed choices. Computer is a useful tool in Education because it allows an individual self paced learning. Computed Assisted Instruction (CAI) is a method of teaching that involves interaction between the learner and the computer. The technology cannot replace the human element nor undermine the values that define nursing. On the contrary, I have come to believe that informatics and technologies would in fact secure the future of the profession. It would hardly be a time when IT use would not be considered as an effort and will be part of routine. january / 2012 www.ehealthonline.org

Featured Product

Capillary Electrophoresis Technology A Novel Method for Hemoglobinopathy and Thalassemia Detection

emoglobinopathies is a severe problem in our country. Prevalence of sickle cell anaemia and thallasemia is higher in some of the geographical regions and communities. If parents have hemoglobinopathies and are carriers, then children born to such parents have 25 percent chance of being affected by severe forms of the disease. In such cases, parents have the right to be informed and to make a free choice regarding primary prevention. Several countries are offering primary prevention programme for populations where carriers are routinely diagnosed in childhood, before marriage, in early pregnancy or at birth.

Hemoglobinopathies can be diagnosed by detecting and quantifying various haemoglobin fractions like HbF (α2γ2), HbA (α2β2) and HbA2 (α2δ2). In healthy adults, haemoglobin comprises of HbA (~97%) and HbA2 (~2.7%), with only trace amounts of HbF.

january / 2012 www.ehealthonline.org

Newborn babies show higher concentrations of HbF. Sebia, France is the single largest company with dedicated product line for Clinical Electrophoresis with Agarose gel Electrophoresis and Capillarys Electrophoresis. Trivitron Healthcare represents Sebia, France in India. Capillarys Electrophoresis is the recent most advanced technology which provides walkway convenience for electrophoresis. This FDA and CE approved method offers quantitation and detection of normal and abnormal haemoglobins, as an aid in the diagnosis of hemoglobinopathies and thalassemias. Sebia’s fully automated system speeds and simplifies processing because it’s completely hands free from bar-coded sample tube to final results also it includes a robust database that can store up to 100,000 capillarys electrophoresis result curves and data and the system can automatically delimit curves and identify the fractions, reducing the need for operator editing. Capillrys Hemoglobin also provides very enhanced resolution and foculisation in the separation of Hb A2, F and S especially useful in Sickle Cell anemia diagnosis and very clear detection of Hb Bart’s and Hb H which are indicators of alpha- thalssemia. The capillarys system also features an onboard dropdown Hb variant library and stored control reference curve overlay visible on the screen. Sebia Capillrys’s electrophoresis used for other types of analysis including: serum / urine protein electrophoresis, Immunotyping (automated immunofixation alternative), and CDT (a marker for chronic alcohol abuse) Sebia offers Capillrys 2 Flex Piercing system which uses whole blood analysis for hemoglobin electrophoresis with no pre-analytical preparations.Also capillarys 2 Neonat Fast for Newborn Screening. The HbA1c analysis will be available soon on Capillarys by using the same technology.

leaders speak

“A Model Service that can be Replicated Across the Country” Jasvant Prajapati, COO, GVK EMRI, talks about creating a historic landmark in healthcare delivery system, in which there are increased institutional deliveries and the maternal mortalities get reduced by 20 to 25 percent through its ambulance service www.emri.in

nformation technology is changing the face of government hospitals, as the services provided today are user friendly and efficient. GVK EMRI is working in 11 states and 2 union territories. The vision of 108 was to respond to 30 million emergencies and save 1 million lives annually by 2011. We deliver services at global standards through leadership, innovation, technology and research and training. It has now covered the whole state with 400 ambulances within one year. 108 services were started due to the fact that 75,000 emergencies occur per day in the country, of these 80 percent are at the bottom of the pyramid, 80 percent deaths occur in hospitals in the first hour and 4 million deaths p.a. (Cardiac, Road Accidents, Maternal, Suicidal attempts/ Neonatal / Infant/ Pediatric) The EMRI services have synergised processes for efficiency and effectiveness in performance delivery. The team needs to create awareness and offer community education and capacity building through media support. The integration of technology with the communication, IT, fleet and medical is really important to hold the base of EMRI services. Integrated Emergency Response Services are offered for medical, police and fire emergencies with single universal toll-free number ‘108’. It is a service delivery model to provide free Emergency Response Services at one / Citizen / Month. The Public Private Partnership (PPP) frame-

january / 2012 www.ehealthonline.org

work conducts research and builds capability in Emergency Medicine and Management. The 108 model of providing emergency services maintains all information related to emergency in Patient Care Records (PCRs).Patient information is shared with the hospital on arrival. There is 48 hour follow up even after the the patient has been admitted to hospital. State of the art ambulances are equipped to tackle any type of emergency which are furnished with basic and advance life saving equipments and medications. It provides appropriate care and transport within “Golden Hour” of Emergency. 108 ambulance is equipped with “Extrication kit” to rescue victims involved in high energy collisions. Emergency Medical Technician (EMT) are trained to provide prehospital care and manage emergency situations. EMT gets support over phone from qualified medical practitioner called ERCP (Emergency Response Centre Physician) located at the ERC. EMRI services has covered 433 million population in 11 states, trained 47,441 people, handled 12,000 plus emergencies per day (6.2 Million cumulative), 3,006 Ambulances - 5 trips a day across the country managed by 16,596 plus GVK EMRI Associates. Responding to 2200 Emergencies a day with 506 ambulances GVK EMRI serving 6.03 crore people across Gujarat, GVK EMRI has built in expertise in emergency care.

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Paras Hospitals

Born to Care A super specialty hospital with the mantra of state-of-the-art facilities and bleeding infrastructure. The hospital was accredited with NABL & NABH in the year 2009

aras Hospitals is Gurgaonâ&#x20AC;&#x2122;s first comprehensive healthcare service provider with an ever growing passion for excellence under one roof. After achieving operational breakeven in very short time; the hospital was accredited with NABL & NABH in the year 2009. Paras Hospital began its project in the year 2005 and became operational in 2006. It is a 250 bedded multi â&#x20AC;&#x201C; specialty hospital that is designed by German architects RRP architects along with RSMS architects led by Manu Malhotra. The endeavor is to become the leading professional healthcare company in superspecialty tertiary care in the region, with a range of products, services and quality consistent with the highest customer expectations at affordable cost. Paras Hospitals started with its focus on neurosciences, joint replacement and mother and child care. The department of renal sciences was started in November 2006 with six dialysis machines, uroflowmetry etc. Interventional cardiology and oncology with radiotherapy started in early 2008. There are 55 specialty departments including internal medicine, minimal invasive surgery, gynecology and obstetrics, ophthalmology, dermatology

january / 2012 www.ehealthonline.org

and cosmetic surgery and plastic surgery and a dedicated IVF centre. After establishing its footprint in Gurgaon, in April 2009, the group has taken a step ahead with opening of Paras Spring Meadows in East of Kailash, Delhi. Paras Spring Meadows mainly focuses on mother and child, cosmetic and skin centre and minimally invasive procedures. The hospital provides surgeries like joint transplants and other basic specialties like general surgery, internal medicine, psychiatry, non intervention cardiology etc. In the second half of 2011, Paras Healthcare announced two projects in Bihar with a 350 bedded hospital at Patna and a 75 bedded facility at Darbhanga. This Endeavour will enable Paras Hospitals to provide state of the art healthcare facilities encompassing cardiac care, neuro surgery and oncology as well all other super specialties to the state of Bihar and making Paras Healthcare single largest private healthcare provider. The hospital will treat cases of oncology, neurology, nephrology, urology with the facility of kidney transplant and cardiac care, including open heart surgery. This hospital will provide efficient nursing facility and will follow norms of medicare

as laid down by the National Accreditation Board for Hospitals (NABH) and Healthcare Providers and National Accreditation Board for Testing and Calibration Laboratories. This will be the first hospital in the state to have these accreditations The hospital shall install state of the art linear accelerator with computerised planning facilities and PET scan. The hospital will have all modern diagnostic facilities such as MRI, CT scan and a modern pathological laboratory. For the first time in this region, a hospital will provide a wide range of medical services under one roof in the most professional manner. For the first time in this region, Paras HMRI will provide high-end services such as linear accelerator, PET, MRI, CT in addition to a wide range of medical services under one roof in the most professional manner. The institution would cater to all sections of society, the stress will be on bringing international standard healthcare at an affordable rate and ensure that patients from the state will not require go to Delhi and other metro cities. A large number of eminent doctors hailing from the state but working abroad have expressed willingness in returning to Bihar and working in the Paras-HMRI Hospital.

Patna

The ignition for Bihar's health care transformation has just begun.... PARAS HOSPITALS Coming Soon in PATNA & DARBHANGA

Gurgaon

New Delhi

leaders speak

Connecting India Gunjan Kumar, Head IT and Automation, Sahara Hospital believes that synchronised integrated healthcare delivery systems are evolving and leading to better clinical data management www.saharahospitals.com

ealthcare IT is an enabler. Most organisations around the world have envisaged ‘Business Visibility’ through adoption of Information Technology and have gone to the extent of restructuring and re-aligning their operations around new age technologies. The healthcare sector may be lagging behind in IT adoption initially, but in recent past there has been a phenomenal spurt in IT spending by healthcare organisations. Synchronised integrated healthcare delivery systems are evolving and resulting in better clinical data management and consistent clinical information across the healthcare enterprise. There is an analytical tool with capability to record complete vital-parameters data of all the patients in the critical care area on a central database server for online analytics of each patient. Through the same web login the doctor can view all past critical and non-critical events and have further insight into the vital-parameters trend of his patient. This database server has an inbuilt tool, which analyzes each and every second of the patient’s vital parameters. Almost 150 bed side

patients can be covered at the same time; the system keeps the data ready to be used by the technicians or doctors in any part of the world.

Advanced Fire Detection System It comprises of a network of Fire Detectors (both above and below false ceiling), all linked to microprocessor based fire panels and these are further networked to Centralised Management Server Console (CMSC). Management console is equipped with maps and location plan of all the areas of the entire hospital campus. Each detector in the campus is demarcated with a unique address with details of location where it is installed. The art is to strike a balance between optimum data throughput by use of appropriate transmission medium and switching technology while ensuring the network security by deploying firewalls, content filters, intrusion detection/protection system and network admission controls.

“Vista Flavour on the World” Dr Dinesh Jain, Max Healthcare, shares his experience that Vista has enriched the system with its clinical features, which many other proprietary products lack www.maxhealthcare.in

ax healthcare operates eleven hospitals in North India and it is the second hospital chain in the country to adopt VA Vista. The Max hospitals have recently gone live with the implementation of VA Vista, which is the product of VA organisation based in USA. VA develops the VA Vista system and releases it under Release of Information Act because it is the tax payer who had paid for its development. Subsequently VA Vista was taken over by an open source community called World Vista, which made it available to the world. Since the product positioned itself in the market, we integrated the product with our own Hospital Information System (HIS) to make it compatible with the way we are working in this country. The challenges while using such system led to the development of a hybrid model. We encourage our physicians to use the system at the point of care; we enable them by providing computers on wheels, at the OPD’s, IPD’s, every area where

january / 2012 www.ehealthonline.org

there can be an interaction between a patient and a physician. Dictaphones are used for transcription services. Helpers or assistants help them in feeding data. When we look at the data generated in last four months, it comes out as being quite substantial. When a patient comes back for new round of checkups and a new physician starts the system, he is pleasantly surprised to find that the system already has some data available from earlier checkups. The journey so far I believe has been challenging and very interesting in using the system, which we choose to go with. Being an open source system, it provides lot of flexibility. We want to carry forward with our Hospital Information system (HIS), which took care of patient management requirements of typical Indian hospitals. We were able to adapt to the system, which were not designed for Indian healthcare industry and we used them effectively in Indian context.

leaders speak

AADHAAR Opening Up of New Vistas in Healthcare ‘Aadhaar,’ a unique identification system for providing ID (a digital signature) to citizens, is based on the personal bio-data and biometrics (ten digit finger printing and iris scan)

EHRs-The game changers in Healthcare

Gp Capt (Dr) Sanjeev Sood Hospital Administrator and NABH empanelled Assessor

he project is based on the diversified architecture of the cloud and is the first online ID of its kind in the world. 125 million people have already been enrolled for UID and the figure is expected to grow to 600 million in the next two and a half years. According to Mr Nilekani, once completed, Aadhaar will be the largest database anywhere in the world.

january / 2012 www.ehealthonline.org

The UID scheme has opened up new vistas for the healthcare sectors. Since the UIDAI implements an open-system, plug and-play approach, entrepreneurs can develop applications in numerous areas in healthcare. The medical industry could build up a database using ‘Aadhaar’ as base for seamless use by various healthcare providers. The government and regulatory agencies have a major role in how EMRs/EHRs are developed and implemented by HCOs. The Ministry of Health and Family Welfare and bodies like National Knowledge Commission, CDAC have constituted an EHR Standards committee that is already seized of this matter. The Government needs to enact suitable legislation and policies to encourage adoption of EMR, legally accept digital signatures, and provide guidelines to standardise records formats, nomenclature, and communication protocols to enhance interoperability of IT applications across healthcare spectrum.

Defining Regulatory and Legal Framework In USA Health Insurance Portability and Accessibility Act (HIPAA) addresses some of the relevant issues, a lot remains to be done in India. The government may also educate care providers and public at large about benefits of EHR and may also mandate compliance. These EHRs can be linked to each citizen’s UHID and health data can be filed and retrieved from National Data

Record System based on cloud. The issues of capturing, storage, standardisation (ICD-10,SNOMED-CT,LOINC) and interoperability (HL-7 version 3.0, DICOM) of health information, billing formats, authenticity, privacy and security of sensitive data, can also be ensured through laws similar to HIPAA. The most commonly used interface standards in healthcare are Continuity of Care Record, or CCR and Continuity of Care Document, or CCD. CCD is a joint effort of HL7 and ASTM to foster interoperability of clinical data to allow physicians to send electronic medical information to other providers without loss of information. Once these regulatory norms and standards are put in place, various HCOs, ISVs (independent software vendors) and stake holders shall come forward to develop and implement EHRs. The linkage of EHRs linked to the UID of the patient will ensure achievement of ultimate objective of ‘one EHR for each patient, accessible anywhere, anytime’. Also, automated transactions shall create a trail that permits medical audit thereby increasing accountability. In addition, adhering to standard treatment guidelines and clinical pathways shall enable clinicians to practice evidence based medicine. Notwithstanding the immense benefits offered by UID linked EHRs, the journey to their implementation is not going to be smooth. But the gains at the end of journey are worth the efforts. The parliamentary standing committee on the matter has also expressed some reservations on the role of UIDAI.

leaders speak

“ICT is a Boon to the Hospital Industry” Annie Thakore, Head Administrator, CARE Hospitals, says that ICT has changed the way in which medical research is conducted; ICT can model the effects of new drugs, and can be used to conduct clinical trials in collaboration with international teams www.carehospitals.com

ealthcare Information and Communication Technology is the use of information technology to improve the process of healthcare delivery. It is concerned primarily with streamlining administration and putting information into the hands of point-of-care professionals. IT can be used in various departments; in administrative tasks it can bring much needed efficiency. Automated Medical Records System (AMRS) can facilitate more efficient process of care. Infrastructure that supports the administrative and clinical applications, administrative billing, electronic materials management, clinical and computerised provider order entry for drugs, lab test procedure, gets streamlined by IT. Picture archiving and communication systems for filmless imaging, laboratory results and clinical decision support systems also use ICT for better synergy.

NABH accredits hospitals which have relevant ICT technologies / functionalities facilitating that are in line with standards laid by Access, Assessment and Continuity of Care (AAC) Criteria Group, Patient Rights and Education(PRE), Continuous Quality Improvement (CQI), Facilities Management and Safety (FMS), Human Resource Management (HRM) and Information Management System (IMS). Robots have been used to perform very accurate operation, such as those on the brain. Teleconferencing has been used to share expertise; surgeons in one country can help those in the other; wireless transmission can serve as a link between hospitals and doctors. But the process of implementation must take into account the needs of the end-user and it must be scaled up carefully.

“Providing Cashless Treatment to Artisans”

Nagarajan Ranganathan, Vice President, ICICI Lombard, has created a mark in the industry with his efforts to provide cashless treatment through an IT based Rural Point of Service model www.icicilombard.com

he product from ICICI Lombard was initiated through the Ministry of Handlooms and it targeted 26.2 lakh artisans and their family members living in clusters spread across 29 states and 605 cities in India. It was a comprehensive health coverage plan, which offers cashless treatment for OPD patients for only `15,000. Cashless treatments for IPD patients and reimbursement of medical expenses (OPD/IPD) are also provided under the plan. The set up of cashless health facility network of 1,040 OPD Centres and 2,721 hospitals and clinics was envisaged. 91 percent beneficiaries made claims in first year itself. On an average 65 lakh claims are intiated per annum. It is decentralised paper based claim intimation and processing model and it works through manual procedures. This resulted into a lot of concerns of late payment and provider grievance due to tons of claim papers received with no synchronicity in the billing pe-

january / 2012 www.ehealthonline.org

riod. At times there was late intimation, loss of documents in transit and delayed processing. The changing computer literacy and availability of internet bandwidth led to the development of applications built on Oracle .NET platform and SQL based server. Such a web based application integrated simple dropdown menus, user authentication modules for exclusivity, automated invoice generation for the specified billing period and served as tool for seamless BSI tracking. The Rural Point of Service (Rural POS) was further developed to address speedy claim intimation and regularly monitored claim process and trends. This resulted in ready access to treatment and claim history in a scenario where average claim hit for OPD is between 500-2000. The data loss was prevented as the activity of a provider can be tracked on real time basis. There is least amount of paper work and this is something that enables bulk claim processing and 67 percent reduction in the cost of backend operations.

Medical Technology Special 2012

healThcare Technology reSource guide 2012

in conversation

Telemedicine is a Democratic Technology GlobalMed is the premiere telemedicine design and manufacturing company, manufacturing and selling visual assessment telemedicine solutions that provide superior image quality, unmatched versatility and unsurpassed simplicity. With passion to improve the delivery of global healthcare through innovative technologies, Jay Culver, Global Sales Director, Global Media, elaborates on the pillars of success of the tele-medicine in USA and his outlook towards Indian healthcare markets www.globalmed.com Tell us your views on the Indian telemedicine market and how do you see it changing in the near future? In USA, the challenge is that the insurance companies have included most of the healthcare services in their coverage and most of the patients rely on them for payments, in India the current GDP spend on healthcare is low, although there is a commitment from the government on investing more to make healthcare affordable and at the same time reach out to more people. Hence, we observe that the future technologies that will play a key role in the Indian healthcare market will have tele-medicine as an effective component. Of our innovations has been, to take the medicine and extend its reach beyond the last mile has become possible in the USA, in addition with the IT infrastructure and high quality streaming in video-conferencing to support the consultation â&#x20AC;&#x201C; we are optimist that we can come up with creative solutions that can meet the diverse needs of practioners of tele-medicine in India. Flexibility is a key component in our product designs as we know one size cannot fit all in tele-medicine, and to extend our reach in India, we are open to learning the needs and challenges to customise our products and make appropriate and user-friendly for the Indian tele-medicine market. In the process, we had been

january / 2012 www.ehealthonline.org

associated with Presto Infosolutions Pvt. Ltd., a â&#x20AC;&#x153;Value Added Distributorâ&#x20AC;?, is committed to provide Quality Services. With a clear vision and focus on emerging technologies they represent us exclusively here in Indian and SAARC region as a value added distributors to GlobalMed. What are the main changes that have been done so far in the tele-medicine technology? Our technologies enable leading pathologists, dermatologists, pediatricians, neurologists, surgeons and other caregivers to be more effective in providing patient care and more productive and efficient in managing patient information. Our innovations and patented technology provide medical professionals with unmatched capabilities in delivery of quality of care. The major changes is the transportable examination station, usually for remote areas we can have more consultations, besides this we have also done extensive work on power supply, battery life that play crucial role when operating in these remote areas. We are also working on the various modalities of telemedicine as a practice; in some villages they are so remote that unless you have a Satcom one cannot transmit images, so we are working on the connectivity and quality of images. Also,

in conversation

we have worked on software aspects that allow the practioners to store images on offline as proprietary information as a confidential and secure file storage system, the same set of images can then be whenever connectivity is available. What were the key drivers of bringing tele-medicine solutions in mainstream healthcare services? It was a national scale project and was supported with federal funding. It took time for the project to get started in US, and started with two cameras, and then it was followed with many scaling-up action. The approach was to identify the problem point or the challenges and explore solutions around them. We did multiple-customer preference tests, and as it was a national roll-out so it was federally funded with a mandate to service a certain ratio of population. There were more than every 3000 veterans, and each would have a clinic, and their aim was to improve the reach of healthcare. In addition, they were to ensure not only tele-medicine service provider satisfaction but also patient satisfaction and ensure that they received the same level of care as in a one-to-one interaction. Today, using metrics, we are seeing more veterans are using the technology platform and taking advantages of the features and benefits of it. There were clinical champions of tele-medicine who would then convince other to follow and practice tele-medicine, and we had administrative champions who looked at just at logistics of set-up and running a tele-medicine centre. Training and education of the stakeholders was an integrated component, and it is the heart of the project.

Training and Education has been key to success, tell us your views on the same? We have a Tele-medicine University that is our training facility where one in tele-medicine can come learn and best practices and train on our technology and platforms. It helps them equip themselves to make the optimum use of all the tele-medicine facility, to optimize the equipments. The technology is there, but the real benefits come only when we integrate the technology in healthcare practice, and this integration has to be not only from the hardware and software but also from the operational level. The human element and operational processes are critical for the success of any tele-medicine project as is technology, and the same will be important for its success in India. Our representative, Presto being associated with other related OEMs from this field such as Video Conferencing, Wireless Microphone, Wireless, Secure Data Center etc. & deals with supply, training & support; is going to be very useful. Tell us your future outlook for the Indian tele-medicine market? We are here to share our experiences, successes, challenges and to learn and adapt to the Indian market. No one has yet launched a large scale tele-medicine in India, although there have been pilots that have taken place and shown positive results for the deployment of tele-medicine technology for healthcare in India. Tele-medicine is a democratic technology and is actually a bridge to healthcare divide anywhere in the world including India.

january / 2012 www.ehealthonline.org

in conversation

â&#x20AC;&#x153;3G is

Creating Wonders in

Healthcare Domainâ&#x20AC;? O

Thierry Zylberberg, Executive Vice President, Orange Healthcare Division, speaks to Shally Makin about the drivers for mHealthcare in developing markets. He believes that mobile technology is responsible for bringing health services to larger sections of the population www.orange.com

january / 2012 www.ehealthonline.org

range is seeking to innovate in order to deliver solutions and services like eHealth to its customers. The company seeks to develop a system through which all kinds of information can be stored, safeguarded and disseminated with seamless efficiency. 3G is creating wonders in healthcare domain, and there is cloud computing that helps share medical information with anyone who has access to internet. The bring-your-own-phone model could really work in modern hospitals, as it will lead to better communication between patients and doctors. Healthcare is one of the areas that can benefit hugely from mobile technologies, much like transport. It is an industry with highly mobile workforce and clientele. mHealth majorly deals with gaining trust and delivering efficiency to the consumer. It can be achieved by managing health databases. More than 50 percent of mHealth revenues are spent on health management services like tele-assessment and remote monitoring. In case of developing countries, we need business models that can help reduce the economic and health divide. Health costs are rising around the world at around five percent per year. In Europe, healthcare amounts to 10 percent to 11 percent of the GDP, and in USA it is 16 percent. In Africa, 50 percent of the population owns mobile devices and telecom operators have opened avenues to expand the scope of mobile usage. A lot has to be done in case of chronic diseases, as the ageing population is now looking for a solution to curb rise in expenses. In the task of bringing healthcare services to the masses, mobile technol-

in conversation

ogy is proving to be a wonderful tool. The consultation fees can be reduced to just US$ 2 with the use of mHealth. This will lead to the rise of affordable healthcare services in developing countries. After Bhutan, a health line will be launched in Kenya. Africa has villages, which lack primary healthcare centres (PHCs). At times it takes people up to 24 hours to reach the nearest PHC. On the other hand, first aid can be provided at the earliest with the help of telemedicine. Itâ&#x20AC;&#x2122;s meaningless for a doctor if you provide medical information to him without any protocol prescribed by him. Technologically, the industry is 20 years ahead; a lot of people are going a wrong way and thus the confusion leads to a mismanaged infrastructure. There are devices being launched to benefit patients suffering from chronic ailments. Every night the information can be transferred through a small box, which can be kept near your bedside, and will serve the purpose of informing the doctor about the condition of your heart. Since most of the information today is available on the internet, the educated can challenge the doctor at any stage. We need to take care of the legal issues, as lot of responsibility lies on doctorâ&#x20AC;&#x2122;s shoulders. The government needs to host medical data and lay high standards to regulate the medical fraternity. There are also questions of mHealth privacy. The industry can gain trust for maintaining medical data on cloud only if we offer secure solutions. The digitising of all the records is being done; the x-ray images are scanned, archived and transferred to health professionals through a server. A virtual PAC has been so designed to create effective analysis and encourage tele-radiology tools to make space in the industry. The demographic of doctors can be a key factor in transforming the healthcare. We have to make endeavours for making mHealth a reality as this can lead to a vast improvement in the number of patients a doctor can examine. This in turn will allow larger sections of the population to benefit from improved healthcare. january / 2012 www.ehealthonline.org

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