Annual Special Issue 2009: January 2009 Issue

vo l u m e 4 | i s s u e 1 | J A NUARY 2009

w w w. e h e a lthonline.org

A Monthly Magazine on Healthcare ICTs, Technologies & Applications

ISSN 0973-8959

Rs. 75

8. Praveen Srivastava, Ministry of Health & Family Welfare, Government of India || 14. Anantharaman S Iyer, InterSystems || 20. Reynold O Bryan Jr., Extreme Networks || 22. Dr. Joseph Amuzu, Commonwealth Secratariat, UK || 24. Dr Mark Parrish, Microsoft || 28. Dr. Shariq Khoja & Dr. Hammad Durrani Agha Khan University, Pakistan || 32. Suresh Vazirani, Transasia Bio-Medicals Ltd. || 34. Brian Cohen, iSOFT || 38. Matt Harrison, Poornima, Texas instruments || 40. Dr. Rajat Agarwal, University of Southern California || 42. Aniruddha Nene, 21st Century Health Management Systems || 46. Dr. Paul Litchfield British Telecom || 62. Dr. Rob Neeter, VitalHealth Software Inc. || 64. Pradep Nair, HCL Technologies || 69. Madhukar Saboo, Avaya GlobalConnect || 74. Frost & Sullivan

CONTENTS

w w w . e h e a l t h o n l i n e . o r g | volume 4 | issue 1 | January 2009

NRHM gets the IT edge

Collaborating for Innovation

Praveen Srivastava Director, Ministry of Health and Family Welfare Govt. of India.

Matt Harrison General Manager, Medical Business Unit Texas Instruments

Engineering Bio-Medical Marvels

The ‘Blu-ray’ of Hope Long-term archive of medical images

Wellness at the Workplace

Intelligent IT solutions for healthcare

Revitalising & Reinventing

Malaysia to Host HIMSS AsiaPac09

Intelligent Communication

Lack of Medical Device Interoperability - is there a way out?

Achieving the Vision of Connected Healthcare Anantharaman S Iyer Regional Director - India InterSystems

Networks… to grow with Reynold O. Bryan, Jr. Global Healthcare Segment Leader Extreme Networks

Partnerships for a eHealthy future Dr. Joseph Amuzu Adviser, Social Transformation Programs Division - Health Section Commonwealth Secretariat, UK

A New World of Health Dr Mark Parrish Physician Executive Health Solutions Group Asia Pacific Microsoft Pty Ltd

Building Networks for eHealth Research Dr. Shariq Khoja Assistant Professor- Department of Community Health Sciences and Medical Director’s Office and Coordinator eHealth Program, The Aga Khan University, Pakistan

Key to good health - Sound Medical Diagnosis Transasia Bio-Medicals Ltd.

January 2009

Brian Cohen Chief Technology Officer iSOFT

On a mission to empower

Dr. Hammad Durrani Manager Research (eHealth) - Department of Community Health Sciences The Aga Khan University, Pakistan

Trending Enterprise Healthcare

Poornima Director-Business Development (Medical) Texas Instruments

eHEALTH Bureau (Dipanjan Banerjee & Susan Thomas)

www.ehealthonline.org

Dr. Rajat Aggarwal Assistant Professor of Ophthalmology and Co-Director of Intraocular Implants University of Southern California

Aniruddha Nene Principal Consultant-Imaging and Director21st Century Health management Solutions Pvt Ltd.

Dr. Paul Litchfield Chief Medical Officer, British Telecom

Dr. Rob Neeter Medical Director, VitalHealth Software Inc.

Pradep Nair Vice-President and Global Head Life Sciences, Healthcare and Chemical Practice HCL Technologies

Madhukar Saboo Head - healthcare & Life Sciences vertical Avaya GlobalConnect

Market Insight, Healthcare Practice, Frost & Sullivan

REGULAR SECTIONS

News Round-Up 49 Numbers 76 Events Diary 78

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

intelligence on all aspects of IT applications in the healthcare sector. Contributions to eHealth magazine could be in the form of articles, case studies, book reviews, event report and news related to e-Health projects and initiatives, which are of immense value for practitioners, professionals, corporate and academicians. We would like the contributors to follow the guidelines outlined below, while submitting their material for publication: Articles/ case studies should not exceed 2500 words. For book reviews and event reports, the word limit is 800. An abstract of the article/case study not exceeding 200 words should be submitted along with the article/case study. All articles/ case studies should provide proper references. Authors should give in writing stating that the work is new and has not been published in any form so far.

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

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

January 2009

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EDITORIAL

Volume 4 | Issue 1 | January 2009

president

Ringing in the New

Dr. M P Narayanan editor-in-chief

Ravi Gupta group directors

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

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

Susan Thomas Sarita Falcao Sales & MARK ETING

Arpan Dasgupta mobile: +91-9911960753 email: arpan@ehealthonline.org Bharat Kumar Jaiswal mobile: +91-9971047550 email: bharat@ehealthonline.org Sr Graphic Designer

Bishwajeet Kumar Singh Graphic D esigners

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

Zia Salahuddin subscriptions & circul ation

Manoj Kumar (+91-9971404484) manoj@ehealthonline.org editorial correspondence

eHEALTH G-4 Sector 39, NOIDA 201301, India tel: +91-120-2502180-85 fax: +91-120-2500060 email: info@ehealthonline.org is published in technical collaboration with Centre for Science, Development and Media Studies.

In the context of Indian healthcare industry, the year gone by has been truly phenomenal! With the announcement of tax holidays for new hospitals in non-metro towns, a record number of new hospital projects going live, a slew of PPP projects in the pipeline and some big-ticket investments coming into the market, the year 2008 witnessed substantial growth for healthcare industry. Taking into consideration the existing gap in demand and supply for managed healthcare services in India and growing importance of medical value travel in the West, we hope that the trend will somehow sustain in â&#x20AC;&#x2DC;09 as well - even in the face of ongoing economic slowdown. For long, our healthcare industry has been plagued with pressures of a large population, acute shortage in doctors and nursing staff, low levels of patient safety and poor service qualities. All these issues scream out for greater adoption of technology to speed up diagnosis, reduce medical errors and deliver quality services within limited human and financial resources. In the international circuit, the focus is towards increased adoption of evidencebased medicine through eHealth and better data sharing standards across interoperable systems. The European Union and the Commonwealth Secretariat are quite active in this domain - working through advocacy, R&D and awareness building for promotion of eHealth practices across the globe. In the broader view of things we need to recognise the fact that there is no end to innovation in technology per se, but the available technology needs to be implemented in the quickest and most affordable manner. This calls for a greater and stronger commitment on part of policy makers and healthcare institutions. According to a study by EU, 33% of research and innovation in developed economies worldwide is happening in ICT. We hope that the New Year brings to light innovations that allow greater reach and more effective implementation of ICTs for improving health outcomes. In this New Year we also bring you a new look for eHEALTH magazine - one that is more evolved, content rich, and re-designed to be reader-friendly. Let us know how you liked it. Wishing you and your loved ones a very Happy New Year.

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. Owner, Publisher, Printer - Ravi Gupta. Printed at Print Explorer 553, Udyog Vihar, Phase-V, Gurgaon, Haryana, INDIA and published from 710 Vasto Mahagun Manor, F-30, Sector - 50, Noida, UP Editor: Ravi Gupta

Ravi Gupta Ravi.Gupta@ehealthonline.org January 2009

ANNUAL SPECIAL ISSUE

National Rural Health Mission (NRHM) the flagship program under Ministry of Health & Family Welfare, Government of India, recently launched its ‘Health Statistics Information Portal’ - a webbased health management information system that will facilitate quick and efficient flow of information starting from the Facility-level, up to the District, State and finally the Centre. On top of all this, the system will provide an array of intelligent tools for advanced data analysis, reporting, monitoring, evaluation and overall program management. eHEALTH provides an insight into this novel initiative and finds out how it will impact efficiency and effectiveness towards improving rural health in India.

mproving health conditions in rural areas has always been the biggest challenge in India! With an enormous land area spread across a staggering 3.28 million sq. km. and having nearly 70% of its teeming billion living in rural areas, providing equitable and efficient health services is surely a herculean task by any scale of measure. Not only does it require a huge funding base, it also involves massive operations in terms of mobilising materials, medicines, human resources and physical infrastructure, required to deliver and administer health services. At the centre of all these lies an essential element - ‘information’.

January 2009

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NRHM Flow of information and management of resources is critical for the success of any program. Understandably, this is even more pronounced, when it entails the issue of public health. Starting right from policy makers, to program managers, to implementers and even for field health workers, information is a critical resource in understanding challenges, identifying gap areas and ensuring efficient implementation of the program. Even up till recently, health data collected at village level took some few months to reach authorities at the Centre. With manual and semi-automated systems in place, it was almost impossible to receive information in a short time. This resulted in delayed response time for authorities and a high rate of data redundancy in the system. In turn, this led to create lacunae in public health planning by way of creating difficulty in forecasting the accurate need for service provisioning, emergency preparedness and even resource mobilisation. In a project as crucial as the National Rural Health Mission, inefficiency of any form, not only escalates costs but often proves critical in terms of human life and health conditions. Since public health has a direct bearing on national productivity and consumption, it makes sense to plug all holes to bring efficiency in a project which will invest as much as INR 12,050 crores/INR 120.5 billion in the current fiscal, with scope for higher allocation in successive years till 2012. Keeping this in mind, The Ministry of Health and Family Welfare, Government of India in technical collaboration with iBilt Technologies (a

ANNUAL SPECIAL ISSUE

gets the IT edge SEI CMMI Level 5, ISO 9001:2000 and ISO 27001:2005 IT solutions company headquartered in New Delhi) recently launched the NRHM health statistics information portal - www.nrhm-mis. nic.in Built to serve as a one-stop-site for the entire NRHM program, the portal combines an array of cutting edge technologies that render superior data analytics, robust data warehousing and sharp business intelligence tools, which can allow decision makers to generate more frequent periodic reports and closely monitor the status of the health sector. Commenting on this initiative, Sri Pravin Srivastava, Director-NRHM, Ministry of Health and Family Welfare, Government of India said, “The NRHM portal is essentially meant to create a standardised single-point entry route for all field data and develop a centralised repository of all physical and financial information of the program, which can be easily-accessed and analysed online using a range of sophisticated software tools.” In addition to all this, the NRHM portal also aims to harness the power of information to bring quickest and fastest corrective action on ground for fighting any challenge in rural public health.

The idea is that, in the long-run, data collected at ground level can be made readily available for quick and immediate decision making at the local level. Reflecting on this issue, Srivastava says, “Traditionally, data collected at the local level bear no ownership among local people. Typically, the time lag for data to reach decision makers at higher levels; their subsequent aggregation and analysis into meaningful interpretations; and finally, execution of corrective action on ground is often too long, cumbersome

and in many instances, not effective. On the contrary, if local people are empowered to recognise the ownership of their data and are made capable of taking immediate action for potential threats, the benefits will be much better. This will lead to actual realisation of objectives of data-for-action. However, it’ll be a considerable time before we are able to create requisite capacities at local level and realise the true potential. The efforts have just begun.” The NRHM portal is also going

Screenshot of NRHM-MIS Portal (www.nrhm-mis.nic.in) January 2009

ANNUAL SPECIAL ISSUE

On a mission to empower

Praveen Srivastava Director

Ministry of Health and Family Welfare, Govt. of India

Q. What are the basic challenges that are meant to be addressed through the NRHMHMIS portal? A. When NRHM was launched in April 2005, there were a number of separate programs for different areas such as TB, malaria, maternal and child health etc. Under the NRHM, we tried to bring it all together as an integrated program for facilitating coordination among all of them. The reason for that was, whether one is suffering from TB, malaria or any other health problem, the person will go to the same institution or facility for his/her treatment. We had a similar problem regarding management of information across different programs. Each program had its own reporting channels built up over the years. Some programs had very elaborate reporting systems (such as in TB, where they monitor up to the most micro level) and for some the reporting systems were weak, which resulted in acute scarcity of data. This situation made it immensely

difficult for understanding exact problems at the district and sub-district levels, and magnified at the State and the Central level. We realised that if NRHM is itself integrated as a program, we need to integrate various monitoring and evaluation systems as well. Even our fund flow mechanism started to get integrated. We no longer send funds through separate programs, but rather through one single society in each state. In turn, state societies sign off funds to district societies and so on. To support all these activities, the medical officers were supposed to provide healthcare to people, which they were unable to. To address this problem, we established ‘programme management units’ in each state and district headquarters, where professionally qualified people were recruited for handling finance, program management and MIS. However, inspite of having people and equipment in place, data was not coming in on time. This was the actual genesis of the NRHM-HMIS portal. Q. How did you go about in developing the conceptual framework of the HMIS portal? A. About two years ago we created a task force on health management information system, under the Chairmanship of the Director General of Health Services (DGHS). The task force developed a blueprint for the system and defined various technical and functional aspects required for the portal. Once the blueprint was ready we went ahead for the tendering process. Criteria were laid in such a manner that it fit only those agencies with a certain level of calibre and credibility,

and not any fly-by-night operator. We built in a 5-year maintenance contract, so that the vendor stays with us even beyond the development period - share the pains and gains of the project, help us build stronger processes and see through its entire evolution. To begin with, we were thinking to have a state level reporting system. But soon we felt the need to make it more pervasive and decided to have it as district level. However, when we actually set out to develop the system, we found that the real need is to make it facility-level. Based on this realisation we developed the system with all requisite capability and scalability features to make it work even for facility-level reporting. However, we will roll out the facility-level system only after the districts start showing certain degree of stability in their processes. The biggest strength of this system lies in its ability to bring apparently disparate data sets and spatially distributed resources on one single platform. This has been achieved to the extent of even integrating the financial reporting system within the health information system. Getting both physical and financial information on the same portal is in itself quite unique and remarkable. Q. How much time do you think it will be before you can actually start realising the benefits of this system? A. Ideally, we should have started drawing the benefits yesterday! NRHM started in the year 2005 and is scheduled to terminate in 2012. We have crossed mid-way through the program and hence I think we’re already late. We Contd. on page no. 12 ...

to bring a paradigm shift in terms of overall program management and administration. Commenting on this, Ashok Tiwari, Chairman & Managing Director, iBilt Technologies said, “The NRHM portal is going to bring a substantial change in the management and operation of the entire program. It’ll provide health administrators with

January 2009

immense power to analyse field data like never before; monitor progress at every step of the work; and improve success levels and outcomes of program implementation.” The portal has been designed through an exhaustive consultation process with health officials, which brought out vital needs of administrators in terms of their

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MIS requirements, and also facilitated in making the portal more user-friendly, analytical and intuitive. Running on a SAS business intelligent platform, the portal is equipped with rich reporting tools that can take care of almost any and every reporting need of officers and administrators. In order to make the process more flexible, the

ANNUAL SPECIAL ISSUE ...Contd. from page no. 10 ...

need to put this on a fast track and ensure that we get data on a regular basis. However, it will take some time for the system to stabilise, as people need to be trained and sensitised. We have roped in ‘National Health Systems Resource Centre’ for training and capacity building at the district level. Considering that there are more than 600 districts across India, this is not an easy task at all. In addition, there is wide variation in technical and functional competence levels among district MIS teams, which can cause substantial difference in training outcomes in different places. Over last two months since the system started running, we’ve had a maximum of 329 districts entering data (out of 600+ districts) for a particular month. This squarely points to the huge amount of capacity building that is still required. Efforts are going on all around and even iBilt is helping us in some places. But for a huge number of people it’s something novel, requiring an entire change of mindset. This requires us to not only explain how and what to report but also generate a sense of accountability and ownership about their reported data. We need to make them realise that what they report today will bear profound impact on decisions about tomorrow. In the long run, our purpose is to make them capable of taking decisions based on their own data and information. The society system of public health management is trying to empower people so they can take decisions based on their

requirements. For example, at each facility levels, we now have something called ‘Rogi Kalyan Committee’ (patient welfare committee), which comprises of members from medical fraternity, public health, civil engineering, irrigation, water and sanitation departments, along with local elected representatives, who decide how funds can be best utilised to improve health services. The HMIS will play a vital role in all such local level planning and at the same time empower Central authorities with substantive evidence and data to rationalise fund allocation.

system has been endowed with custom reporting capabilities, which can match new data requirements of officials. A dashboard format of data representation gives complete control for officials to keep tab on key performance indicators (KPIs) and take immediate corrective action for any deviance and variation. If need be, the dashboard also provides for inclusion of new KPIs and custom analysis tools, which might be of relevance in future. Keeping in mind the pattern of information flow and existing organisational reporting mechanisms, the system has been structured to take care of hierarchical protocols with

appropriate checks and validations at appropriate levels. In addition, keeping in consideration low-bandwidth availability in non-metro and semi-rural areas, the portal has been built to run efficiently even on narrowband, dial-up connections. Furthermore, the portal allows for offline working mode, which gives users the liberty to carry out data entry jobs in spreadsheet files even in offline mode. Once connected, they can simply upload the spreadsheet file and the system will accept it as valid submission by automatically converting it into the relevant format. Moreover, in case of

January 2009

Q. What is the strategy being followed with respect to data that is already available in paper format? A. We have migrated most of the data prior to April 2008 in the consolidated form. While those before April ‘08 will be available only state-wise, we are trying to get those after April ‘08 district-wise. Once we have one full year of time-series data, we start can doing district-level trend analysis. Q. Even with the HMIS system in place, the quality of field data might still be questionable in some cases. How do you plan to address this challenge? A. The HMIS portal is equipped to handle data from multiple sources such as National Family Health Survey (NFHS), District Level Household Survey (DLHS), National Census etc. In addition, we will also get data from independent agencies, which will start flowing in from March-

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April ‘09 onwards. When all of these come together, we’ll have huge data sets – much more than what is humanly possible to analyse or disseminate. This will help in cross-checking and validating primary data, and finding possible discrepancies in reporting. The aim is to aggregate data from different sources within a common indicator framework and seeing how we can map it through data triangulation. Q. What is the ultimate outcome of this project? How do you foresee changes in the way public health is managed and delivered? A. The ultimate goal of this project is to put data for action at the local level. However, to make this happen, firstly we need data, secondly we need analytical capabilities, and thirdly we need the authority to use this analysis for action on ground. This calls for a huge amount of mindset change that has to go in for making people capable of making their own decisions. However, it is not at all easy to put this in practice - primarily because we have never thought in that direction. We are used to filling forms, collecting data and then forgetting all about it. But we need to stop forgetting and start using the data. The cutting-edge analytical tools of this HMIS portal will help consolidate data from different sources and facilitate timely action. It also requires talking to institutions, creating capacity by training and sensitising people who have never before thought about using data in such a way.

sudden connection breakdown, while working online, the system will revive all work stored till that point and resume from the same point where it left. Over next few years, the NRHMHMIS portal promises to bring a whole new paradigm in the way public health information is reported, analysed and understood. With the power of web technologies and cutting-edge IT tools delivered right into the hands of health officials, we can hope for a much better future for rural health in India. eHEALTH Bureau (Dipanjan Banerjee & Susan Thomas)

ANNUAL SPECIAL ISSUE

Achieving the Vision of Connected Healthcare

Anantharaman S Iyer Regional Director - India InterSystems

January 2009

any of the top hospitals, labs and healthcare providers around the world require mission-critical applications. Although, the term “mission-critical” is often misused while describing computer applications, the description is apt for healthcare industry. Healthcare applications often have life-or-death dimensions – a patient’s life can hinge on the instant availability and accuracy of information. It makes sense that professionals responsible for healing and saving people’s lives would only choose proven technology that meets the most stringent requirements for performance and reliability. Intelligent software products are being used by leading healthcare institutions around the world to turn the vision of ‘connected healthcare’ into realityimproving patient care, and safety while reducing costs. Innovative technologies offer fast ways to create and integrate electronic health records (EHRs). By enabling connected healthcare, it becomes

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possible for test results and other critical clinical information to be delivered instantaneously to healthcare professionals at every point of care. Doctors are able to send electronic prescriptions to pharmacies, and connected systems can flag potentially harmful drug interactions and provide clinical guidelines. Intelligent software solutions can eliminate the duplication of laboratory tests and other redundancies, expedite billing and payment, and maximise bed utilisation. Connected healthcare makes every process more efficient and reliable. InterSystems’ products offer the reliability, scalability, ease of use, and performance required to create connected healthcare environments. These are discussed as further.

InterSystems Platform

Ensemble

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ANNUAL SPECIAL ISSUE

InterSystems TrakCare™ is an advanced Webbased healthcare information system that rapidly delivers the benefits of an Electronic Patient Record. It is used by leading hospitals in 25 countries to bring exponential improvements to the care of every patient and to the productivity of every healthcare professional.

not a stitched-together suite of separate parts. We created it as a single, architecturally consistent technology stack. Ensemble seamlessly combines a rapid application development environment with messaging, integration, business process orchestration (BPO), and business activity monitoring (BAM) capabilities. Designed with service-oriented and event-driven architectures in mind, Ensemble excels at quickly building and deploying connectable applications – healthcare solutions that leverage the functionality of existing applications, orchestrate new business processes, and integrate data from across the enterprise. Ensemble offers unmatched performance because its technology stack includes InterSystems Caché, the leading database in clinical applications worldwide. Ensemble provides all the technology needed to create composite applications or to share data among disparate systems, without having to first integrate multiple development and integration platforms. This fusion of previously independent technologies has only a single, rapid learning curve and dramatically reduces time-

January 2009

Federal District Government of Brazil reaping quick benefits from InterSystems TrakCare implementation Brasilia, the federal district of Brazil, is in the midst of an ambitious three-year project to modernise the delivery and administration of healthcare in the city. They are implementing InterSystems TrakCare™ software and are already enjoying some of the benefits that come from having a state-of-the-art electronic patient record (EPR) system. When complete, the Integrated GDF (Governo do Distrito Federal) Healthcare System will connect all the healthcare centres, diagnostic laboratories, public pharmacies, and hospitals of the Federal District. It will also interface with national programs run by Brazil’s Department of Health. Each of the Federal District’s 2.5 million residents will be issued a “Citizen’s Health Card” that grants instant, secure access to all of their personal medical files.

Rapid Return-on-Investment José Roberto Arruda, Federal District Governor, thinks the project will bring the public healthcare system out of what he refers to as the “Stone Age,” but acknowledges that it comes at a price. “For this to work, a large job needed to be done first. We invested R$6 million in systems alone, and that much again in equipment and training,” he says. Fortunately, thanks to TrakCare’s modular architecture, the district government is already seeing significant cost savings and improved quality of care from the portions of the project that have been completed.

to-deployment and costs. At the same time, it lowers management overhead by enabling one to rapidly tailor integrated systems, without coding, using business process definitions, business rules, workflows, and other configura-

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One prime example of this is the Test Portal, which allows patients and their doctors to access the results of laboratory tests over the Internet. So far, the Test Portal has been rolled out at the Base Hospital, several regional hospitals, and the Central Laboratory itself. Together, these hospitals account for 5.5 million of the over 8 million laboratory tests performed each year in the Federal District. According to José Geraldo Maciel, Secretary of Health for Federal District, “the old paper-based system resulted in 20% loss of test results even before they could be reviewed by a doctor. Moreover, when doctors ordered repeat tests, again 30% of results are reported to be lost.” Commenting on financial implications of such system inefficiencies Maciel further adds that, “the 8.4 million tests that we perform each year cost the system about R$60 million. This waste represents a minimum annual loss of R$18 million. The portal will cut waste to zero by allowing users and/or healthcare professionals to access, at any moment and in real time, the complete patient record, including all laboratory test results. Results are available much faster too, often ready in less than a day. With the old paper-based system, patients typically used to wait for 15 to 30 days to get their test results.” Significant savings are also being realised by efficiently managing the purchase of medicines, which costs the Federal District nearly R$220 million annually. According to Maciel, “about 20% of these resources are lost, and with them, another R$40 million.” By implementing

tion settings. Ensemble technology lets you rapidly enhance applications and systems with:  Rich Web interfaces  Adaptable workflow

ANNUAL SPECIAL ISSUE

month. We can set as a goal to double the occupation of each bed from 2.3 to 4.6 patients per month before the end of the Governor’s term, and hence effectively building 4,000 more beds in Brasilia without laying a single brick,” states Maciel. The Federal District Sub-secretary of Health, João Luiz Arantes de Freitas, predicts that in three years, when the Integrated GDF Healthcare System is completely operational, the total savings will reach R$100 million per year.

A Model for The Nation

TrakCare in healthcare centres, it will be possible to halt the distribution of medicine without a doctor’s prescription, or the distribution of the same medicine more than once to the same patient in different healthcare centres.” Bed management is another area that is yielding cost reductions. Currently, all of the 257 intensive care beds in Brasilia

   

Messaging via an extensible enterprise service bus (ESB) Data transformation Business Process Orchestration (BPO) Business Activity Monitoring

(in 17 hospitals, of which 10 are public and 7 are private) are being regulated by the new government project in real time. The system has already brought savings to the tune of R$1 million with the management of ICU beds contracted in private hospitals. “Brasilia has around 4,000 beds in all of the hospitals of the system and the occupation per bed is 2.3 patients per

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(BAM) Business rules processing Dashboards Out-of-the-box integration with the most popular applications, databases, and technologies

One of the most highly anticipated stages of the ‘Health Integration Project’ is the deployment of ‘Citizen Health Card’ system. A pilot project at the Gama Regional Hospital has issued health cards to approximately 100,000 inhabitants of the region. This program will gradually be rolled out to all of Brasilia’s 2.5 million residents, giving them instant, secure access to their personal electronic medical record. However, it just doesn’t stop there. Officials on the federal level view Brasilia’s health integration project as a model to be adopted by the national ‘Single Healthcare System’. Says José Carvalho Noronha, Federal Aide of Health Assistance and Attention, “here we are designing the structure that will guarantee every Brazilian citizen opportunities related to the care of their health. And, I am foreseeing, it is a short hop from here to implementing and having a user identification card, the national health card – starting with the Federal District.”

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High-performance data and metadata management Web services and other serviceoriented architecture (SOA) technology

January 2009

HealthShare is a comprehensive solution for aggregating and securely sharing clinical data across multiple organisations, enabling the rapid creation of an Electronic Health Record.

prise-wide clinical and administrative solution, and its application modules easily and seamlessly connect with existing legacy systems and other best of breed applications. In addition, with its unique ‘FastTrak to EPR’ methodology, TrakCare enables an Electronic Patient Record to be deployed in record time.

InterSystems TrakCare Web-based Healthcare Information System

InterSystems HealthShare – Health Information Exchange Platform

InterSystems TrakCare™ is an advanced Web-based healthcare information system that rapidly delivers the benefits of an Electronic Patient Record. It is used by leading hospitals in 25 countries to bring

When you work with InterSystems HealthShare™, you’re working with the leading software for connected healthcare - software that can help your organisation deliver better care while

TrakCare implementations range from single hospitals in numerous countries to a state-wide, fully integrated healthcare information system serving 6.5 million patients in Brasilia and its surrounding region. TrakCare can be readily adapted to varying public and private sector healthcare delivery approaches.

comprehensive solution for aggregating and securely sharing clinical data across multiple organisations, enabling the rapid creation of an Electronic Health Record. To address the unique requirements of each system, HealthShare has the flexibility to work with a variety of architectures, and includes a rapid development and customisation environment. With HealthShare, you’ll be able to take an incremental approach to deployment. You can preserve the separate systems that local healthcare professionals are accustomed to using, and rapidly transform them into connected regional or national systems. This means significant reductions in the cost, development time, and risk of creating and operating an electronic health record system.

Conclusion

Figure a: InterSystems at various level of HealthCare Value Chain exponential improvements to the care of every patient and to the productivity of every healthcare professional. TrakCare provides a complete enter-

January 2009

reducing costs. HealthShare is the only software product that provides a fast path for creating electronic health record systems on a regional or national basis. This is a

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Till the end of 2006, InterSystems was mostly known as a technology provider. Now with the inclusion of TrakCare™ HIS (Hospital Information System) into its product offering in May 2007 (TrakCare is not sold in the United States as part of our friendly policy towards our other partners) and HealthShare HIE (Health Information Exchange) framework, InterSystems addresses the needs at all levels in the HealthCare value chain as explained in Figure a.

IDMsys HealthCare ERP helps the Healthcare industry to streamline every aspect of their business from financial accounting, payroll, supply chain management, Patient Management, insurance and claims management and Services such as Lab management to EMR. In effect One ERP solutions for organizations connected with the healthcare industry. The CPA Technology Advisor has once again awarded Sage Accpac ERP with 5 out of 5 stars five years in a row. The bottom line is â&#x20AC;&#x153;Hospitals that have outgrown their present Hospital Information System (HIS) Software need to upgrade to IDMsys HealthCare ERP in order to achieve High End to End Performance - an investment that will pay for itself over time.â&#x20AC;?

Head Quarters: Vienna (Virginia), USA : 21351 Gentry Drive, Suite 265, Sterling, VA, 20166, Tel: 703 421 3170 Development Center: # 106/138, Nagawara Main Road, Bangalore - 560045. India Tel: 009180 22956827 Middle East Regional Office: Building 9, Office 322, Dubai Internet City, P. O. Box: 500143, Dubai. Tel: 0097143912350, 0097502732355 Souh East Asia Lot 119-1, Kelang Lama New Business Centre, 3.5 Mile, Jalan Kelang Lama 58000 KL. Tel: 603-79811363 Fax: 603-79811863 www.infdim.com www.idmedsys.com Email : sales@idbsonline.com

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Networks… to grow with Founded in 1996 and headquartered in Santa Clara, California, Extreme Networks provides network infrastructure equipment for corporate, government, education, healthcare enterprises, and metropolitan telecommunications service providers. Reynold O. Bryan, Jr., the Global Healthcare Segment Leader gives us an overview of Extreme Networks’ offering for healthcare industry.

Reynold O. Bryan, Jr. Global Healthcare Segment Leader Extreme Networks

January 2009

Q. Healthcare is known to be a unique sector whose needs, demands and dynamics are different in many ways compared to other industries. What is your perception in this regard? A. Healthcare is unique because of the nature of its core business of providing quality patient care, medication and related services to people of every age, race and gender, who are either sick presently or with a view to maintaining their health for the future. These services are mission-critical towards maintaining a person’s well being. Healthcare in the United States and other Western European countries is also highly regulated, requiring accreditation standards that can ensure patient safety and privacy. The healthcare industry is also rapidly changing from an industry where services were provided in a specific location, such as a hospital to now having expanded its reach significantly for patient care to be provided in several differing locations, including the physician’s office, ambulatory surgical suite, and various

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outpatient settings or even via remote mobile vehicles. Q. How does Extreme Networks take care of the typicality and challenges of this industry? What range of products and solutions are you currently offering for the healthcare industry? A. Extreme Networks provides Ethernet networking solutions, which serve as the foundation to supporting all applications and services crucial to the delivery of healthcare. Extreme Networks’ solutions provide converged wired and wireless Ethernet that are the backbone for these mission-critical healthcare applications and medical devices on a 24/7/365 basis. Extreme Networks also provides integrated network security solutions to further manage and protect information, to help meet mandatory regulatory requirements within healthcare environments. Extreme Networks’ security solutions provide integrated security features in its switching solutions to prevent QoS attacks and mitigates viruses, spam-

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ming and hacker attacks to increase network reliability. Q. With ever increasing costs, competition and disease complexity, healthcare providers are looking for even more intelligent and economical IT systems. What is your value-proposition for the industry in this regard? A. Extreme Networks healthcare customers choose our network solutions because they provide a better price/ performance ratio while lowering daily operational expenses. Extreme Networks’ solutions work to simplify the network architecture and make day-today management seamless, thus allowing the healthcare IT staff to implement and deploy solutions while reducing the amount of resources necessary to manage and maintain their networks. Additionally, Extreme Networks often lowers the overall power consumption by 30% - 40% compared to solutions from its major competitors, as illustrated through independent research analysis. Q. Emerging markets like India are currently witnessing faster maturity among healthcare providers towards adoption of IT driven systems and sophisticated technology applications. How do you foresee opportunities in such markets and what are your strategies to expand business in these markets? A. Extreme Networks provides wired and wireless LAN networking solutions to emerging markets including India and other countries globally countries experiencing faster maturity towards IT and Internet adoption. Extreme Networks partners are providing solutions in the areas of unified communications, VoIP, RTLS, RFI, flexible and mobile computing platforms and other leading technologies in the healthcare market. Extreme Networks strategy is to continue to increase and expand our partner eco-systems with applications, technology and medical device companies that are committed to developing solutions to improve patient care and safety.

and provide consistent features for its Ethernet switches promoting resiliency, security and automation of common tasks. Extreme Networks provides converged networking solutions for various western healthcare organisations as well as global customers who are leading the movement of IT and converged communications adoption throughout hospital facilities and related healthcare organisations. Extreme Networks is viewed as a visionary company in the converged networking arena with innovative approaches to help reduce hidden networking costs. This is in contrast to the practices of some LAN vendors, that work to shift expenses away from licensing fees into areas of device upgrades, maintenance services and support.

“Extreme Networks’ security solutions provide integrated security features in its switching solutions to prevent QoS attacks and mitigates viruses, spamming and hacker attacks to increase network reliability.”

Q. In what ways does Extreme Networks enjoy a leading edge over its competitors? What has been your standing in western healthcare markets? A. Extreme Networks enjoys a leading edge over its competitors by providing a uniform, end-to end network solution platform through its singular ExtremeXOS® modular Operating System (OS). This powerful OS foundation helps to lower operational expenses

Q. Which are your most successful implementations sites globally so far? Can you share some of the high points of testimonials/feedback received from your customers? A. John C. Lincoln Hospital, in Arizona, Hospital Authority in Hong Kong, St. Johannes Hospital in Germany, CH Valenciennes in France, Nuffield Hospitals and Basildon-Thurrock Hospital in the U.K are some of the most successful implementation sites for Extreme Networks globally. A common testimonial that we receive as direct feedback from our customers who have adopted our network solutions and migrated away from other vendors’ networking solutions’ platforms is that Extreme Networks provides a networking solutions platform that is “easier to design, implement, deploy and maintain while also providing improved flexibility, scalability and mobility to meet the increasing demands of providing quality patient care in remote locations.” Extreme Networks offers networks that can be relied on for maximising network performance and business resiliency, opening up IT to adopt required networked applications. Our Ethernet LAN switches are one of the most power-efficient. January 2009

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Partnerships for a eHealthy future The Commonwealth, an association of 53 independent states consulting and co-operating in the common interest of their people, has in an attempt to harness its member nationsâ&#x20AC;&#x2122; evidently extraordinary appetite for latest technologies, recently launched an international eHealth initiative across countries and continents. The Adviser - Health Section of the Commonwealth Secretariat shares the challenges and the way forward with eHEALTH.

Q. What are the issues the Commonwealth Secretariat is looking at, in the national policies of member countries to strengthen their practice of eHealth? A. The Commonwealth Secretariat is developing a guideline for the development of eHealth policy and strategy and accompanying tools for the assessments needed to provide evidence for the policy and strategy development.

Dr. Joseph Amuzu Adviser, Social Transformation Programs Division - Health Section Commonwealth Secretariat, UK

January 2009

Q. What are the measures taken by the Commonwealth Secretariat towards capacity building, knowledge exchange and financial support for developing country members to adopt eHealth in their health systems? A. The Commonwealth Secretariat is organising high-level dialogues for both Ministers of Health and Ministers responsible for ICT to share information on eHealth, towards the development of plans of action to address the gaps in eHealth policies and strategies at country and regional levels. We are also doing needs assessment in Commonwealth countries to identify the

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needs for standards, legislation, infrastructure and capacity building. The Commonwealth Secretariat plans to make a business case for new eHealth initiatives at both regional and country level for resource mobilisation to support the regions and countries. Q. You believe that partnerships are a way to increase access to health information. Could you give us some examples of successful partnerships from within the Commonwealth? Are there attempts to replicate these across regions? A. There was a successful partnership with the private sector in organising the first high-level dialogue of Ministers of Health and ICT in the East Central and Southern Africa region. The Commonwealth Secretariat coordinated the meeting and the resources for the meeting were contributed by the Commonwealth Secretariat, the countries and the private sector. The private sector participants made presentations at the meeting thus contributing knowledge.

Q. The penetration rate of mobile phones and the Internet is growing fastest in parts of Africa and Asia. How does Com Sec plan to incorporate these new channels for dissemination of information / as tools to improve health indicators? A. The Commonwealth Secretariat is advocating to member countries to take advantage of the simple technologies such as mobile phones and Internet to disseminate information, for referral of patients, for disease surveillance and data transfer. Swaziland for example is using mobile phones to trace AIDS treatment defaulters. The Internet is helping the Swazi Ministry of Health coordinate the health activities of physicians in the remote areas and also provides a means for healthcare workers to access information. Q. Do you see the lack of standards and interoperability as a major hindrance to the spread of eHealth within the Commonwealth? Are steps being taken to standardise medical and health data practices in the member countries? A. Standards and interoperability are two important areas that the Ministers at the ECSA dialogue identified as a hindrance to regional integration of eHealth facilities. The issues of lack of standards and interoperability are being addressed through the dialogues we are holding across the Commonwealth regions. These dialogues provide information and guidance for Ministers to take common decisions on regional and country policies, strategies, legislation, infrastructure, standards and interoperability. Q. The range and scale of implementation of eHealth varies greatly across various member states of the Commonwealth. What, according to you are the main achievements and challenges of such implementations? A. Countries have developed national ICT policies and strategies but there is generally a lack of specific policies and strategies on eHealth. eHealth projects have been implemented in countries but these are fragmented, small in scale and do not reach the ‘last mile’. The benefits of eHealth are generally known but the resources to scale up small projects are not available. As I said previously, legislation, ICT infrastructure, stan-

“The Commonwealth Secretariat plans to make a business case for new eHealth initiatives at both regional and country level for resource mobilisation to support the regions and countries.” dards and interoperability remain huge challenges. Donors are also unwilling to go into these areas as they stick to the traditional support for vertical disease specific programmes. There must be recognition of the fact that eHealth cuts cost and is a technological support for the effective and efficient delivery of services. Saving man-hours and saving costs by introducing Health/Hospital Information Management Systems for example; mobile phones for surveillance purposes; availability of the Internet for health information and virtual consultation with colleagues at the other end; eLearning - a lot of opportunities indeed. Q. Many countries outside the developed world do not have well-defined privacy laws. What are the ethical issues you face when proposing eHealth initiatives? A. The implementation of eHealth to improve the storage and use of medical records has raised ethical issues in most countries. The key ethical issues in most countries are related to i) consent; ii) confidentiality; iii) the secondary use of data; and iv) the acceptability of electronic signatures. In many countries legal frameworks are being revised or developed to address these concerns. Q. Up to 80% of expenditure in the health domain goes into administration. What do you think can be done to minimise this expenditure so that more funds are freed up for core medical services? A. I would suggest the use of more local expertise and knowledge and a reduction in the number of external consultants.

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January 2009

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A New World of Health In the current economic scenario no stone is being left unturned by organisations to increase efficiency and outputs with what little they have. Dr Mark Parrish of Microsoftâ&#x20AC;&#x2122;s Health Solutions Group gives an interesting example of how Microsoft is taking on the challenge of transforming the healthcare industry.

echnology has the power to transform industries. We see examples of this across a wide variety of businesses and organisations but less so in health. For example, two highly visible industries which affect many of us directly as consumers - the insurance and travel industries - have seen massive changes in business practices and productivity as a result of the effective application of Information Technology.

Dr Mark Parrish Physician Executive Health Solutions Group Asia Pacific Microsoft Pty Ltd

If we look at the insurance industry as an example of successful application of IT, we have seen a revolution in the way claims are processed. Mobile claims facilities can be triggered remotely and customers do not have to wait for inspectors to visit. The insurance industry can also better understand and more efficiently determine risk today, since the technology model assists in better forecasting and analysis. The result is more accurate underwriting of risks. Similarly, the travel industry has changed fundamentally. It seems almost impossible to remember a time when technology wasnâ&#x20AC;&#x2122;t an integral part of our travel experience. Today we make our bookings online, our tickets are emailed, we check in online and only need to interact with someone once we arrive at the airport and they need to stamp our passport. Travel companies use technology to run their

January 2009

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businesses, and there are a number of similarities to the healthcare industry. An airline has seats (beds) to fill with passengers (patients) 24 hours a day while rostering the right numbers and types of staff (pilots, aircrew, ground staff/doctors, nurses, administrators) to provide a safe and effective service while running support services of linen, laundry, food, cleaning, servicing; and buying and maintaining expensive pieces of equipment that need regular maintenance (aircraft/imaging modalities, healthcare facilities). You can only take this analogy so far, but it is remarkable how much healthcare does not use technology in such a coordinated manner - even though it embraced technology as a tool to help cure disease and to advance the science of medicine over many years. It has seemingly ignored the advances in information technologies and the value they can add in the delivery of care. At the same time, we know that healthcare is in crisis as a result of rising costs, inherent inefficiencies, and inconsistent delivery of care. So why is it so difficult to integrate information technology into our healthcare systems? There are some very real, long-standing barriers at the root of this issue. One reason is that healthcare is unlike the insurance and travel industries and has different drivers and market forces. But

this is only part of the story. The challenges in health services exist because of a vast, complicated and often unrelated ecosystem that is more like the world’s largest cottage industry, with a variety of levels of regulation, a mixed environment of public and private services, and a variety of business models (and sometimes no business models) that make the design, implementation and operation of integrated “patient centric” healthcare systems both difficult and expensive. But even this is only part of the story; complexities in relationships compound these issues. Effective healthcare is interdependent upon relationships between physicians and patients; between physicians, administrators and government; and between physicians, contributors and life sciences organisations. These relationships are frequently challenging to reconcile and can be compounded by political drivers. There are also global forces and challenges at work here. The World Health Authority has outlined the biggest challenges to universal healthcare. They include:  Financial constraints - healthcare costs have increased to over 10% of GNP in most developed nations, but there is a much lower number here in Asia.  Intellectual constraints - The belief in science holding the solutions to all healthcare problems is often no longer accepted  Medical constraints - Seventeen per cent of prescriptions and medical diagnostics are wrong  Operational constraints - In many countries, large segments of the population still have no access to quality healthcare. In the US, this figure stands at 45 million people and in Asia there is a massive discrepancy between rural and urban populations.  Administrative constraints Healthcare is often over - regulated by local authorities, with the industry often held between the limits of an administrative

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arena, rather than the open, competitive areas experienced by other industries. Workforce constraints - WHO estimates that there is a shortage of 4.3 million health workers around the world. Fifty-seven countries in the world do not have a health worker density sufficient to deliver basic services. Nine of these countries happen to be in Asia. Rise of chronic disease - Whilst there has been a dramatic improvement in Asia’s healthcare over time, new issues such as the growth of obesity, diabetes and cardiovascular disease create additional challenges. We have more medical issues along with fewer trained professionals, treating an ever-increasing number of patients.

Add to this the fact that healthcare provisioning is increasingly driven by globalisation, consumerism and demographic shifts and one begins to realise that more pressure is placed on our health systems everyday in the midst of a difficult economic climate. Healthcare systems that don’t address this new environment will fail and this will put increasing pressure on their countries’ economies. There is hope however, in the form of Information Technology, which holds the promise of addressing many of these complex issues through creating new efficiencies and lowering barriers through effective communication and improved processes - just as we have seen in other industries. Whilst the traditional healthcare structure does not lend itself easily to integration, the good news is that there are some examples of success. In fact, we have already seen that the committed application of effective IT resources can enhance patient experiences, increase safety, manage workflow and boost capacity while reducing overall operating costs.

Bumrungrad: A case study for success A great example of information technology being adopted into a health system

Private Lounge, Bumrungrad Hospital Thailand and revolutionising the health experience can be seen with the evolution of Thailand’s Bumrungrad Hospital. In 1980, Bumrungrad Hospital opened its doors and became recognised as a premium private healthcare provider in Southeast Asia. The hospital serves over 1.2 million patients each year, including an average of 3,000 outpatients per day. Popular as an international medical destination, Bumrungrad also provides care for over 130 nationalities. As CEO Curtis Schroeder explains, Bumrungrad is “the world’s first truly international hospital.” While Bumrungrad enjoys a great reputation for quality care and professional service, its administrators were not always so positive. After several successful years, the hospital expanded its services by 554 beds. Before they launched the new facility, the management realised that they would not have the clinical or financial capabilities to meet the demands of patients and the hospital staff. Their predictions were correct and once the new wing opened, hospital administration could only manage at 45% capacity. Hospital management took an innovative view of the role of technology in increasing the productivity of the hospital. Schroeder explained, “We needed to create an environment that would allow our doctors to practice medicine in the best way and create the best relationships with their patients. We wanted clinical information at the fingertips of our doctors to enable them to make better decisions.” They knew they needed to implement these changes quickly. The hospital in Thailand was in a unique position. Senior leadership January 2009

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As Schroeder explains, “there is no conceivable way that a hospital could cope with 3,400 patients in one day, 80 percent without appointments, with a total treatment time of 45 minutes and an accurate demand bill at the time of service without a system like that provided by Microsoft’s Amalga.” But the savings in time and resources are only a small benefit when compared to the impact IT is having on improvement in care delivery. Success, as Schroeder explains, has been achieved because Bumrungrad has been able to bring quality healthcare to patients in a timely, effective and pleasant manner. While patients can choose to use public hospitals at a much lower price, the real differentiator is in the time and efficiency of services Bumrungrad can deliver. By ensuring a seamless information system, Bumrungrad has transformed the patient experience, improved efficiency, and positioned themselves as leaders in hospital care.

Bumrungrad Hospital, Thailand

A New World of Health

across the board. Not only were clinical systems, emergency departments, labs and radiology connected, but the back office functions such as billing, purchasing and inventory were also online and sharing information.

At Microsoft, we believe that health is a key ingredient to the stability and success of all nations. Healthcare is a critically important human endeavour, and Information Technology needs to play a fundamental role in helping to deliver better solutions, reduced costs, and better patient outcomes when properly utilised.

The results continue to speak for Bumrungrad, which today has expanded its patient volume to 3400 patients a day. Medical records are available instantaneously, and labprocessing time has been reduced from over 14 minutes per sample to only three minutes today. They have also seen a massive savings in radiology - film costs have been reduced from USD 294,000 to USD 26,000 through efficiencies gained from saving images to hard disk. The average wait in outpatients, even without an appointment, is 17 minutes - a figure unheard of in most other health organisations; and the financial records, which used to take 4 weeks to reconcile, now take only four days.

It may not be happening as rapidly as many desire, but slowly the healthcare community will embrace information technology as a core tool in resolving the complex challenges facing the industry. With committed leadership like that at Bumrungrad, healthcare systems can look to reform themselves to create positive experiences for healthcare workers as well as patients. It will be important in the current economic climate to realise what ongoing investments in effective healthcare systems can bring – reduced costs and complexities, increased workflow and capacity, and enhancements to patient safety and the quality of care. These are principles upon which all of us in the healthcare field can agree, as we prepare for a new world of health.

Reception, Bumrungrad Hospital, Thailand was committed to adopting technology, and the medical staff had already been accessing 17+ years of scanned records. Technology was not new to them and it was viewed as an opportunity. This allowed Schroeder and his team to search for a system that would satisfy the requirements of doctors, nurses, and radiologists. Administrative staff also needed integration of basic functions such as billing and inventory management. Keeping costs in mind, the team did not want to make significant changes to the layout or resources of the hospital, and did not want to increase administrative staff. The only thing that they wanted to change was the IT system. In 2000, Bumrungrad chose the Hospital 2000 solution. This enterprise software solution, now offered as Microsoft Amalga, was able to integrate every department in the hospital. For the first time, a hospital was integrated

January 2009

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Building Networks for eHealth Research PAN Asian Collaboration for Evidence-based e-Health Adoption and Application (PANACeA), a success story in the Asian context.

E Dr. Shariq Khoja MBBS. MSc. PhD (eHealth) Assistant Professor- Department of Community Health Sciences and Medical Director’s Office and Coordinator eHealth Program, The Aga Khan University, Pakistan Adjunct Assistant Professor Health Telematics unit. Department of CHS University of Calgary, Canada

Dr. Hammad Durrani MBBS. MSc (Health Policy and Management) Manager Research (eHealth) - Department of Community Health Sciences The Aga Khan University, Pakistan

January 2009

Health can be defined simply as the use of Information and Communication Technology (ICT) in healthcare. eHealth solutions can be applied in many domains including surveillance, prevention, administration, clinical settings, education and health research. The main uses of eHealth in developing countries have been to improve access to healthcare services, and enhance the quality of care by making patient data and other relevant information available to the healthcare providers at the point of care. In the context of developing countries there are specific challenges such as difficulties in communication between healthcare providers working in remote areas and those working in tertiary care hospitals, information transfers at different levels of care, and professional isolation of healthcare providers working in rural areas. eHealth can provide a medium to address these challenges by providing economically and socio-culturally appropriate technology solutions available at different points of care. But the problem at this point remains to be lack of scientific evidence to convince the decision-makers at the institutional and government levels about the benefits of eHealth in the local context, and to prove one technology is better than the other to address the same problem. The issue gets more complex with the lack of capacity of health researchers and the support available to design innovative eHealth solutions, which

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can be evaluated for their impact in the conditions of developing countries. These problems can be summarised in the following four points:

 Lack of demonstrated evidence of beneficial outcomes on health of individuals, communities and improvement of health systems.  Lack of evidence to ensure benefits reach populations without adequate access to health services.  Lack of demonstrated potential of new pervasive technologies (i.e. mobile phones/PDA) as tools for delivery of health services and/or information to positively impact health.  Lack of expertise and information on technologies/applications that are best suited to help prepare for or mitigate the effects of disasters, pandemics, and emerging and re-emerging diseases. In response to the above limitations, some key research institutions in Asia, such as Aga Khan University (AKU) Pakistan, Molave Development Foundation Philippines, Primary care Doctors Association, Malaysia, and Angeles University, Philippines with the support of International Development Research Centre (IDRC) and University of Calgary, Canada, planned a network of institutions, researchers, and experts in the developing countries of Asia. The

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initiative was named PAN Asian Collaboration for Evidence-based e-Health Adoption and Application (PANACeA), and was started in February 2007 with the goal of generating evidence in the field of eHealth within the Asian context. Key benefits sought from the network approach were as follows:

Kandy, Srilanka

A. Broaden sharing of knowledge: Since understanding of opportunities and implications of eHealth is still growing, it is important to learn from each otherâ&#x20AC;&#x2122;s knowledge and experience. The networks can emphasise on knowledge, rather than information, to reflect the process of translating data into thoughtful, relevant and meaningful parcels. These parcels of knowledge can then be shared among network members, other partners, and also a broader audience. Networks should help ensure greater knowledge sharing through its distributed nature, which allows its members to access a wide pool of knowledge to share at various levels within their immediate and extended programs.

Siddhi Memorial Hospital, Kandy Srilanka

Rural Health Unit, Quezon Quezon, Alabat Islands, Manila, Philippines

B. Increase scope for research activities: The network-approach realises that each research partner is limited in its own way. Therefore, programming through a network can enhance the scope for partnerships and resources. For example: i) the stable network structure can absorb funds to allow for more money to support new activities; ii) the distributed and fluid nature of a network is conducive to a diverse group of individuals whose collective knowledge and experience can lead to new programs; iii) the global nature of the network can increase the scope of eHealth activities to include additional partners, for whom the programs would be relevant and iv) the network can lead to spin off activities and projects that can be funded by other donors.

Primary Health Care centre, Mongolia,

C. Greater capacity building: It is generally agreed that capacity building is particularly strengthened through a broad network structure. This model is more self-sufficient in capacity building since the differential capacities in the network give rise to the potential

January 2009

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District hospital, Mongolia

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for resourcing each other. The different network members through communication and knowledge management, training and peer support, as well as mentoring arrangements can draw on these skills. Moreover, when certain issues are identified as areas where several members of the network could benefit from increasing their capacity, broad-based workshops or webinars can be arranged.

D. Administrative Resilience: eHealth Networks should be built on the principle of ‘Partnership’, and should involve members from a variety of institutions and backgrounds from all levels. Such an approach would strengthen administrative resilience within the network since it allows the team to be flexible and agile with respect to adding new components to the network and also freeing up the administrative and financial management role in-house. In addition, the network as a whole will likely have stronger capacity to raise funds and adapt to different scenarios and changes in the network membership and activities. It was decided that AKU will lead the network. Using the network approach, an initial meeting of eHealth researchers from 12 Asian countries was held to arrive at a consensus over the design strategy for the network. All the participants agreed to the concept and approach to developing PANACEA. The specific objectives agreed were:

 To support a set of multi-country research activities to address the four core research questions (given below);  To create a theoretical model for evaluating good practice in eHealth programs in Asia;  To build research capacity amongst Asian researchers to evaluate and adopt appropriate eHealth technologies and practices and influence policy and decision-makers;  To disseminate research findings widely in the regional and international research communities. PANACeA agreed to find answers to the following four core research questions: 1. Which eHealth applications and

Bandung Institute of technology, Bandung, Indonesia practices have had the most beneficial outcomes on the health of individuals, communities and the improvement of health systems? 2. What are the best ways for ensuring that beneficial outcomes can reach the segment of the population that still doesn’t have adequate access to health services? 3. What is the potential of using new pervasive technologies such as mobile phones / PDAs as tools to make the delivery of health services or information more effective? 4. What types of technologies / applications are best suited to help prepare for, or mitigate the effects of disasters, pandemics and emerging and re-emerging diseases? Achievements Partners were identified from countries in Central, South, and South East Asia, who worked together to identify eight projects to generate evidence for the adoption of technologically, economically and socio-culturally sound eHealth applications in multiple countries. These projects conducted a detailed needs and situation analysis in the first six months (Phase I), which will be followed by two years of project implementation and research (Phase II). Three workshops will be conducted during the course of the project to discuss project related issues and plans. Projects will be supervised and mentored by the Advisory and Monitoring team (AMT) comprising of a Project Manager from Aga Khan University (AKU), and three other eHealth

Primary Health Care centre, Mysore, Bangalore, India

experts from Asia. Regular communication, reporting and mentoring of the projects is done through online-discussion forums and visits by the network lead and project managers from AKU, and the members of AMT. Another important aspect of this project is the crosscutting issues, named PANACeA Common Thematic Activities (PCTAs), which are being investigated in the Asian context, to support the eHealth initiatives. The PCTAs will not only impact the implementation of the research projects, but also influence the development of eHealth in the participating countries. The PCTAs are communication; change management/readiness; systematic review of telehealth in Asia; systematic review of health informatics in Asia; open source standards; outcomes; and policy. Evidence generated from these projects will be disseminated to policy makers and decision makers at the institutional and government levels in all Asian countries. Conclusion PANACeA offers a unique way of developing evidence in a local context, yet involving a large number of countries and developing new partnerships that may last beyond the duration of this project and would generate communities of practice within Asia. The knowledge generated from these projects and PCTAs will also be disseminated widely so that it benefits healthcare providers, managers of healthcare institutions, researchers and policy-makers in advancement of eHealth in the region. January 2009

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Key to good health Sound Medical Diagnosis Total healthcare spending in India is expected to grow at a CAGR of 17% between 2007 and 2012. Added to this the large-scale prevalence of both infectious and lifestyle-related diseases has created a big opportunity for the In Vitro Diagnostics (IVD) market in India. The following article with inputs from Transasia Bio-Medicals Ltd. gives an overview of the importance and scope of technological advances in IVD.

“Transasia’s mission and philosophy is to serve the doctors and patients worldwide by meeting their needs for reliable, affordable and innovative medical diagnostic systems. The spirit is the “spirit of India” where we want to make a mark in this very important diagnostic field and make Transasia a formidable force on the diagnostic world map.” Suresh Vazirani CMD, Transasia Bio-Medicals Ltd.

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ndia’s rapid growth has brought about a health transition in terms of shifting demographics, socio-economic transformations and changes in disease patterns. Healthcare industry in India is booming. India produces the largest number of doctors, nurses and technicians in the world. This puts us in an ideal position to be the ideal healthcare providers to the whole world. The major factors driving the In Vitro Diagnostics (IVD) market in India are an increase in healthcare awareness levels amongst the people, as well as an increase in disposable incomes and lifestyle diseases leading to higher frequency of testing. Penetration by the insurance sector in the medical field, corporatisation of health services and opening up of the rural sector are also playing important roles. On the one hand, the Indian middle class, with its increasing purchasing power, is more willing than ever before to pay more for quality healthcare. On the other, the supply of healthcare services has grown steadily, as the private sector becomes more involved in owning and running hospitals. The medical equipment market is the direct beneficiary of this boom in health-

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care industry. There are many growth drivers for this industry like: • New laboratories and corporate hospitals coming up • The fully automated segment is continuously growing due to increase in sample workload • Path Labs are going for quality certification and accreditation • Nearly 70% of patients are being treated on the basis of lab diagnostic tests

How critical is the laboratory? The laboratory plays a central role in healthcare. By one estimate, 70% of all medical decisions are based on laboratory results. And now all the laboratories strive to use the latest in technology. However, technology is a means to an end and not the end in itself. Optimising performance means that workflow and technology are integrated to yield an operation that best meets the clinical needs and financial goals of the organisation. High quality at low cost is another concern. Updates in technology must lower capital and operating costs and also improve turnaround time. The measurement of samples using automated instrumentation has undergone an evolutionary process since early

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times. It began with a manual processing using basic techniques of colorimetry or manual slide preparation and moved on to single channel analyser using continuous flow analysis and measured one analyte on a batch of samples, i.e., one sample, one test. These samples were measured in a sequential fashion, i.e., one sample after another. The specimen throughput rates were also very low. It then evolved into multiple channel instruments. One major disadvantage to this type of instrument configuration was that all testing was performed in a parallel fashion. This resulted in the measurement of every analyte configured on the system for every sample. This inflexibility in testing led to the development of more evolved, fully-automated, random access analysers. In recent years, the workload on laboratory personnel has increased two to two-and-a-half times. An increase in the capacity and directions of laboratory investigations should be reflected in the quality of the work, or in the accuracy and reliability of the acquired data. But this is possible only when laboratories are equipped with modern technology, permitting a sharp rise in production and in the reliability of investigation results.

Need for Automation of Labs Experience has confirmed that full automation is a very gradual step toward efficiency in laboratory work and lab automation still continues to evolve. The drive or thrust for smaller, faster, and more-accessible devices is increasing. Emerging markets have different needs with respect to the test menus, technologies used and operating procedures. Thus, made-to-order solutions need to be developed for these markets. Lab automation has also taken on a new level of importance in the ability to actually get instruments interfaced to various laboratory information systems (LIS). Information technology has taken a giant leap in the IVD industry, thereby reducing the dependence on a technically qualified individual to be present at all times during the analytical procedure without compromising on established levels of care. Delivering the right data in a timely and cost effective manner while improving the sensitivity and specificity of the test

is the need of the hour and the industry needs to gear up for single workstations that can carry multiple workloads. Today the diagnostics business is mainly based on technology. The Indian companies with their state-of-the-art R&D facilities have developed a range of good quality products for the local market with fierce competitiveness. Technology has stepped in to play facilitator to improve healthcare delivery. Issues such as systematised capture, storage and sharing of patient information, allowing faster but error free operations are now achievable.

Role of Transasia in the Diagnostic Value Chain Transasia Bio-Medicals Ltd. offers ‘Total Solutions for Clinical Diagnosis’ whether it is Biochemistry, Haematology, Immunology, Critical Care, Coagulation, Urine Analysis, Liquid Handling systems or Blood Transfusion medicine. It has a complete suit of semi auto to fully automated instruments, which are indigenously manufactured at its state of the art manufacturing units or through its alliances with global leaders in the respective segments.

Partnerships Biochemistry: Transasia is equipped to manufacture Instruments, Reagents and Consumables conforming to IVD Directives and it has manufacturing facilities at Daman, SEEPZ (Mumbai), Baddi (Himachal Pradesh) and Mannheim (Germany). Haematology: Transasia and Sysmex, Japan have formed a joint venture, which is involved in conducting scien-

tific activities like CME programmes, scientific seminars and quality control programmes. Sysmex is a world leader in Hematology and Hemostasis. They have a comprehensive range of instrumentation, lab automation and software to cover the entire portfolio of haematology testing. This company also manufactures reagents in India for the Indian market. Immunology: Transasia is exclusively representing GRIFOLS, Spain for their product Triturus – A 4 plate, multibatch, fully automated ELISA analyser. Critical Care: Medica is a Boston, Massachussets based organisation involved in manufacturing of critical care products like electrolyte analysers and Blood gas analysers. Transasia has been representing them since 2000 for their range of electrolyte and blood gas analysers as well as their reagents and controls. Liquid Handling: Transasia has an exclusive agreement with Biohit, Finland for their wide range of liquid handling systems. Transasia. also has a licensing agreement with Erba Biohit for assembling of PROLINE range of pipettes at its ISO 9001:2000 certified manufacturing plant at Daman, India.

Conclusion Transasia Bio-Medicals Ltd. is one of the leaders in the clinical diagnostics segment of the Indian healthcare sector. With an enviable 29-year track record in the Industry, the company is the largest Indian manufacturer and exporter of diagnostic instruments and reagents. The company has successfully developed and manufactured hi-tech In-Vitro Diagnostic (IVD) instruments and reagents and has become a name to reckon with, in India and about 55 countries across the world. The company is ISO 9001:2000 and ISO 13485:2003 certified and has also been rated as India’s largest In-vitro Diagnostics Company (2006) by McEvoy & Farmer, U.S.A. (International Experts on IVD Markets). CLEARSTATE International, Singapore survey has revealed Transasia’s market leadership over international players specifically in the Clinical Chemistry and Haematology segments. It also mentions Transasia’s Erba Chem series as the most placed clinical chemistry (CC) analysers in all types of facilities. January 2009

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Trending Enterprise Healthcare The Chief Technology Officer of iSOFT tells us about LORENZO - The newly launched innovative service oriented software from iSOFT.

t is widely accepted that healthcare is a fundamental right for every individual, however, today some important questions about patient infomation, its accessability and ownership are being raised. The questions being asked are s “Has the ownership of health information transformed from care institutions to individuals?” “Do the caregivers and the patients have a say in the structuring and delivery of healthcare?” “How is the relationship between the care receiver and provider made more legitimate?” “Can a patient govern his / her own care and the associated information?”

Emerging Trends in Healthcare Economics Brian Cohen Chief Technology Officer iSOFT

January 2009

In the world market economics of healthcare, there are major transformations occurring. The question now is no longer whether or not to computerise a healthcare entity, rather how much to computerise and by when. Gone are the days when the caregivers were averse to using computers and other such devices, leaving it to the more tech-savvy professionals. Today, the latest technological innovations are adopted quickly and the resistance is fast declining due to the ease of use and obvious benefits. In this era of fast changing lifestyles, quick buildup and dissemination of information, ubiquitous Internet access, the paradigm shift towards healthcare information being owned by the individuals rather than institutions is gaining momentum and

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the awareness of preventive and wellness approach is replacing the hitherto slow curative approach.

The new way forward In this context, LORENZO is a groundbreaking, next generation healthcare software application built on the Service Oriented Architecture (SOA), which is considered to be the current industry trend worldwide. The service-oriented approach facilitates development of highly flexible generic products, which can then be used to create market specific solutions. LORENZO is truly scalable and can cater to the entire gamut of healthcare services across the complex model of healthcare delivery covering GPs to tertiary care hospitals to myriad care settings in a health economy. LORENZO being web-enabled adds to the advantage of its being able to address the needs of all participants in the supply chain.

Longitudinal EHR & care continuity The functional map of LORENZO product services covers the entire spectrum of care activities, which can be a combination of administrative and clinical information. Coupled with inherent highly flexible configuration tools and engines, it enables the healthcare enterprises to maintain the electronic health record for the entire life history of the patient in the “Journey from Cradle to Grave.” It also supports continuity of care across

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Service Oriented Architecture (SOA) for today and tomorrow

multiple episodes spanning multiple geographic locations and addressing different diagnostic conditions. This ensures elimination of duplicate data and timely availability of accurate information thus enabling cost optimisation and savings.

Powerful yet flexible LORENZO consists of a powerful set of information processing tools promoting governance, quality, efficiency and consent in healthcare. It is extremely flexible and can be tailored to meet local

needs through rich configuration tools. LORENZO can be deployed across a community in such a way that the existing investments are protected by integrating with existing applications, equipment and devices towards inter-connecting January 2009

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Traditional IT Models • • • •

Designed for processing & Optimised for speed Requirement for integration consideration as an afterthought Decades spent reverse engineering architecturally compromised solutions 40 per cent IT spend is backward looking: Gartner

the information silos, thereby removing the hurdles in the patient journey.

Standards based LORENZO has been designed to support modern and emerging international healthcare standards. This will enable build-up of enormous healthcare data that can in turn enable accurate and comprehensive statistics. It can facilitate data mining to address the needs of national and regional healthcare bodies. Statutory and regulatory reports relating to epidemics can be generated.

Designed by healthcare professionals LORENZO has been designed by healthcare professionals from different health economies through a rich user experience. iSOFT has strategically employed and nurtured a good number of healthcare subject matter experts including doctors (with different specialties), nurses, pharmacists, laboratory technicians, radiologists, etc.

Development strategy LORENZO was envisaged several years ago and one can say that the concept, approach and strategy for the product

Contemporary IT Models

January 2009

• • • •

Designed for integration Optimised for modern computing paradigms web, mobility, personalisation, collaboration Supports and enables modern concepts of virtual organisations Empowers individuals, facilitates workflow and process re-engineering

development was pioneering and ahead of its time. This was one of the reasons for its selection as one of the software solutions for the prestigious National Program for Information Technology (NPfIT) in the National Health Service (NHS) UK, which is considered to be the largest civilian projects in the world.

Architecture LORENZO’s architecture provides for Solution-based approach covering systems and services. It supports “Pick & Use” approach from a comprehensive catalogue of information, thereby eliminating redundancy and achieving normalisation of data. This kind of architecture enables continuous change through process design and management from a stable platform. It protects the delivery of core business with an ability to integrate and co-exist with a variety of existing systems, applications, devices and tools based on international standards for information exchange. It has the potential to promote business changes whilst minimising the impact on the existing workflow and processes.

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LORENZO deployment options LORENZO can be deployed in a small GP to a large multi-tier, multi-site healthcare organisation that may span across a nation. Its scalability and versatility provides for deployment in different possible models suiting different infrastructures including resilient or semi-resilient environments, centralised or distributed databases, etc. The performance of the application has been tested and proven for terabytes of data with several thousands of concurrent users. Considering the mission critical nature of healthcare requiring 24 X 7 availability with a need for high level of data integrity, and at high speeds, the application can be deployed in the most optimised environments that can evolve and grow from basic infrastructure onwards.

Conclusion LORENZO can ensure lowest cost of ownership while providing early and high return on investment. The next few years will see a revolution in healthcare in which LORENZO will play a central role, improving the quality of life for millions of people worldwide.

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Collaborating for Innovation eHEALTH had the opportunity to meet with innovators and facilitators of innovation together at the recently concluded Texas Instruments Developer Conference held on November 2008 in Bengaluru. The well attended conference showcased research and development being undertaken by TI and its partners. In interviews with two representatives of TI and a medical doctor (co-director of the Bionic Eye project), eHEALTH took stock of the development and partnership strategy of TI, specifically in the biomedical field. The following are excerpts from the interview.

Matt Harrison General Manager, Medical Business Unit Texas Instruments

Poornima Director-Business Development (Medical) Texas Instruments

January 2009

Q. What are the innovations TI is bringing into the market along with its partners? And how do you propose to market these products? Matt: Texas Instruments has been a supplier to the medical electronics industry for 20-30 years, but it was only at the end of 2006 that we decided to dedicatedly focus on this market. We have dedicated resources to end equipments such as ultrasound machines, blood glucose metres, ECGs, etc., for which we are offering a broad range of semiconductor components from our catalogue offering as well as application - specific parts. Our marketing efforts are typically aimed at the manufacturers of these products. We hope that our customers think of TI first if they’re developing medical electronics devices. An example for a future innovation is a gastric pacemaker; it mainly targets the patients suffering from obesity. In a the lap-band procedure, they put a band around the stomach to make it smaller. The challenge with this kind of surgery is the 1-2% mortality rate associated with it. As opposed to this, the gastric pacemaker is a device that is non-invasively implanted in the stomach. It has sensors, which can calculate the calorie intake. So the devise can tell how many calories have been taken in and it will automatically stimulate the stomach to mimic the feeling of being full, or satiated, so that the patient does not over-eat.

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Poornima: A unique thing about the medical field is that it requires a medical device company to work with a semiconductor company to develop the product and also have healthcare service providers as a consultant or as a reviewer, because it is not a purely technical problem that we’re trying to solve. TI’s contribution at the end of the day would be semiconductors. Matt: We need to try and get people out of hospitals sooner but still monitor their condition, so you’re going to see a lot more activity in wireless monitoring. This requires that we have intelligent devices in homes, which could be wirelessly connected to the hospitals, so that the doctor can check on the patients remotely in the comfort of their homes. Another area that wireless plays into is what we call ‘ageing in place.’ It’s been observed that many people face this problem – as they get older, it becomes more and more difficult to live in their own homes, to maintain the house, so they move into an assisted care living facility. But most people don’t like to do that. They like to stay in the comfort and familiarity of their own homes. This is one place where wireless technology can help. For example, there are devices that an elderly person can wear, which make sure that they did the things that they were supposed to in the course of a day and monitor, for example, how they walk. This was

developed keeping in mind the fact that Orthopaedists have come up with conclusive evidence that before elderly people take a fall and break a hip, they start walking differently, their gait changes. Such monitoring of eventualities may prevent the fall and fracture if timely evaluation and precautions are taken. Q. While wireless technology for home care is catching up in a big way in the US, in large, developing countries such as India, this same technology can be used for telemedicine. Does this varied use require much customisation? How different is the experience of developing such similar technology for the two very different regions? Matt: Using similar technology in different locations or for even slightly different purposes would require some customization. The available infrastructure would be one reason for that. However, the base technology would be the same. That will make it easier to deploy, make it more affordable, allowing for leveraging on economies of scale. Let’s say if people watch television in High Definition (HD), you can also deploy the same technology in remote places, linking it to hospitals, and a doctor could very well diagnose the patient almost as if the patient were in front of him. Eventually we could envision a kiosk where people could come in, be identified by biometrics and take their blood pressure, respiration levels and other basic vital signs. I don’t think the base technology will change that much but how it is deployed will be different. Poornima: The driving factors are different in India, implementation-wise also. If you look at the ageing factor,

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India is not among the first 15 countries with the most ageing population. So that won’t be India’s biggest problem, but we too want care at home, or in the familiarity of the location we are based in, instead of travelling far to a city, in which case, the patient requires another person to travel with him/her and the subsequent cost of care also shoots up. Q. Where is most of this R&D and manufacturing happening? Is it still relegated to the US or is it shifting to other parts of the world? Matt: Yes historically, much of the activity has taken place in the US, but in fact, one of our most important teams in the medical group has been in India, designing high profile analog front ends for things like ultrasounds and other applications. So some of the R&D is done here in India. Ultimately we look at where we have the best talent and entrust the right projects to those teams. And the team in India is one of the best we have; they’re in fact, leaders on the design front. Q. What role, if any does TI play in bringing about innovation in the medical device segment by marrying two different technologies developed by different customers of TI? Poornima: This issue came up many times in our TI Developer Conference and involves the whole ecosystem. TI as a semi-conductor company has many partners, universities, design houses, medical device manufacturers, healthcare service providers - and we try to play an active role in connecting these different sets of people depending on the problems. And we of course work with the interest of maximising the use of TI technology. Matt: The challenge of doing this is also a very real one. We are after all trying to bring together two very different and complex sciences together - the science of medicine and the science of electronics. And typically our custom-

ers are experts on the medical side, and we’re experts on the electronics side. We are also trying to bridge the gap between the two. We are trying to get more knowledge on what those challenges are and how we can tailor our technology to meet those needs. It may take some time to get there, but as long as we are working very closely with our customers on it, we are on the right way. Q. What is your view on the role India can play in this environment? Matt: India for me is really interesting because there is so much talent here. Historically speaking we’ve always looked at India, in say, the outsourcing situation – we bring in a challenge, solve the problem and export the solution. But on the medical front I think there’s a real opportunity to provide solutions to the Indian population where many people live in remote places and can’t get to a hospital quickly. Q. Is there a big number of homegrown medical devices manufacturers developing solutions for India and asking for technical support from TI? Poornima: Absolutely. Not only are there big multinationals, but also multiple start-ups are working with us in India on projects. Universities too, nowadays, have what is called an incubation centre, so we have multiple startups within Universities and otherwise, who are working on medical products. So it’s a big spectrum of big and small companies we are looking at. Matt: A lot of the intellectual property associated with some of these technologies has resided with the US and Western Europe but this trend seems to be changing. I’m encouraged by seeing more and more activity here in India and even China where also, people have started to develop some of their own solutions. I think we’re going to see an entirely new category of medical devices that is more affordable and will have a broader reach - and that, in fact, might find its way into some of the more established markets. Poornima: Another reason why one probably doesn’t hear much about indigenous manufacturing is because the entire process from manufacture to January 2009

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Dr. Rajat Aggarwal MD, Assistant professor of ophthalmology and co-director of Intraocular Implants, University of Southern California

Engineering Bio-Medical Marvels In addition to the routine clinical work, Dr. Agarwal is involved in the Artificial Retinal Implant project, being carried out in collaboration with Texas Instruments, which aims at developing a complex artificial epiretinal device in patients with advanced retinitis pigmentosa and age-related macular degeneration, which will help these patients see again. He is also involved in developing techniques for using stem cells in retinal degenerative disorders and development of nano-drug delivery devices.

Q. Would you kindly elaborate on the research areas that you are working on in the biomedical area, most specifically the work on ‘Bionic Eye’? Dr. Agarwal: The work with artificial or bionic eye has been going on for almost 20 years now and TI has been partnering with us on it. This work is finally maturing – so we hope that in the next few years we can come out with a commercial product that the physician might be able to suggest to patients to buy. Besides that, we are developing a lot of innovative implants. Many patients with ailments like diabetic retinopathy or glaucoma require medication over a long period of time. Currently there are these injections we give directly into the patients’ eye every 6 weeks to treat such people; to have a needle poked into your eye is not a very pleasant experience for anybody, not even doctors who inject. So we are developing a drug delivery implant device that will sit on the eye. It’s a minor procedure that we do to fix the device on the eye. There will be certain parameters that control it and it will inject a controlled amount of the drug into the eye, at regular intervals. So through this device we can both monitor the disease

the time it is qualified and tested, the required clinical trials are done and it is actually available in the market, is a lengthy procedure. In India, there are two challenges for the medical devices industry today. One is that the duty structure is not supportive of it. And the other is the lengthy certification process. These two also contribute to the higher import of medical devices from abroad which turns out cheaper. There are no labs in India for clinical trials and certification of medical devices. But at the same time a lot of innovation is happening and the government is also actively involved in it. But acceleration in certification process is still a major issue. Q. Do you interface with vendors of health IT or related software developers while developing solutions for medical devices? Poornima: Increasing efficiency in various processes can help bring down healthcare service costs. And one way to do this is by digitising patient records. There is a very critical role that

January 2009

and take necessary action as well. Q. How exactly does the implanted device work? Does it have to be activated or does it work independently? Dr. Agarwal: One way is to have a constant infusion at a regular interval, let’s say once a day. But we have to look at it from various angles. When the pressure of the eye increases it causes damage to the optic nerves at the back and that causes damage to the neuron, which leads to a visual deficit. The intra-ocular pressure in such patients keeps fluctuating. We are therefore developing intra-ocular pressure sensors, which allow us to monitor the pressure in their eyes. If we can bring down the rising pressure we can keep the nerves from getting damaged. Matt was talking about wireless technology-in this context we’ve developed this little device that goes into the eye and monitors intra-ocular pressure and can then relay information through an optical reader to the physician’s office via the Internet. A message can in turn be sent to the device that tells it to inject a certain amount of the drug to control the pressure. All this can be done without the patient knowing

ported to our DSP or hardware platform for acceleration, so we are constantly looking at software to understand which piece will help increase efficiency, and make sure that it’s happening. We are also looking at the other piece of software that can be ported to hardware, so that it runs much faster. For example we talk about the ultrasound and x-ray devices becoming portable. This could result in a huge amount of image data resulting in the need for compression technology.

software can play in this ecosystem. To that end we do keep an eye on software and make sure that the software partners are in the loop. But since TI doesn’t really work on software, our role is limited. However, we are looking into how some pieces of the software can be

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Q. From the business perspective, which are the 5 major countries you’re looking at, at this point? Matt: Asia is an exciting area of the world with China for example, which is moving in very quickly. Also Korea. Taiwan is one place where I’d like to see more activity, because they’ve got all the right technology and infrastructure, but they still seem a little more focused on the consumer space. Clearly, India is one. And finally, Japan, which is a major player in the healthcare space.

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anything about it. At the University of Southern California, where I work, we have an Engineering Research Centre funded by the National Science Foundation. It’s the only engineering research centre in the US focused completely on biomedical devices. There are two other very interesting projects we are working on. One of them is trying to use glucose in the blood for power generation - the excess glucose in a person’s body can power biomedical devices. Another notes that for the blood to flow through the body the heart has to pump very hard and there is a huge pressure with which this blood flows, so we are trying to develop a hydro-turbine kind of device that can harness this hydro energy. Q. How long would it take to have something like this available in the market? Dr. Agarwal: Its going to take some time, since the FDA requirements are really stringent. First of all we need to prove the safety, then show the efficacy part, which involves animal trials, then try to get the approvals for clinical trials - this itself is a long procedure. So it really depends

on the complexity of the technology or device involved. The Bionic Eye project was conceived in 1988 or so, the first implant was done in 2001. And even now, after so much work and data we’ve made available, we’ve still not finished. But of course, the FDA is right in being so cautious. Q. You are trying to bring the clinical trials of the bionic eye to India; will you elaborate on the current status of this news? Dr. Agarwal: A key problem is that the device is hand-made and it takes as long as about 6 months to make one. It’s also quite expensive, currently costing about USD 50,000, since it’s made of gold and platinum. So it is difficult for any company to produce that many devices. At this point of course we don’t charge the patients anything since we’re doing the clinical trials. But the reasoning is that over time we will be having more patients getting this implant and we’re hoping that the cost is going to come down to about 10% of its cost now. Another reason is lack of data. This is one of the biggest challenges in India even for common diseases, let alone spe-

cific diseases like this. So we’re compiling the database right now, for which Dr. Rajini Battoo from Narayana Nethralaya is helping us. Also the FDA will have to clear the export of the device. Next is logistics, the company needs to bring their people over to conduct the clinical trials. We have to be very thorough with the paperwork; we have to document every tiny detail. So we need to get everything right and in place before we can actually start with the clinical trials. But we are still hoping to bring in the clinical trials to India by the end of next year. Q. Final messages for our readers? Dr. Agarwal: We don’t want to raise false hopes, because it’s but natural that the message that people take home is that it’s magic, which it is not! It involves a lot of hard work on both sides. A patient has to train for long periods with the clinical trials team to start figuring out things through the minimal sight she/he gets. Also different patients will respond differently to the same treatment. We even conduct a psychological evaluation of patients before we put them on the trial.

International Institute of Health Management Research (IIHMR) Plot No. 3, HAF Pocket, Sector 18A, Phase-II, Dwarka, New Delhi – 110075 Management Development Programme (MDP)

Topic of MDP Resource Date Fees (Rs.) Monitoring and Evaluation for Health Projects Sambodhi Jan. 21 – 23, 09 Rs.17,000/- (Non-Res.) Rs.19,000/- (Twin Share Accom.) Rs.21,000/- (Single Room Accom.) Data Analytics for Health Research Professionals Sambodhi Feb. 16 – 18, 09

Rs.17,000/-(Non-Res.) Rs.19,000/- (Twin Share Accom.) Rs.21,000/- (Single Room Accom.)

Open Source Database Management System Indian Assoc. for Medical Feb. 23 – 27, 09 for Health Care Informatics (IAMI) Training of Trainers on design and delivery Sambodhi Mar. 4 – 6, 09 of training on health initiatives

Rs.15,000/- (Non-Res.) Rs.22,500/- (Twin Share Accom.)

Telemedicine CDAC, Mohali Mar. 12 – 13, 09

Rs.6,000/- (Non-Res.) Rs.9,000/- (Twin Share Accom.)

Rs.17,000/- (Non-Res.) Rs.19,000/-(Twin Share Accom.) Rs.21,000/- (Single Room Accom.)

International Training Programme on Sambodhi Mar. 23 – 27, 09 US$ 1450 (Twin Share Accom.) Logical Framework Analysis for Designing Health Projects US$ 1650/- (Single Room Accom.) Note: Programme subject to cancellation due to unavoidable circumstances. Health Insurance Administration & Informatics** HealthSprint & 3 Mar.,–2 Jun.,09 Rs.15,000/- per month for 3 months. TTK Healthcare (Part Time) Total Rs.45,000/- (Non-Res.) **Demand for trained professionals in this area has been felt assessed by market survey. Trained personnel in this field are likely to be absorbed by industry immediately. Web based online course “Certificate in Project Management (CIPM)” Specialisation in Health is optional with no additional fee || Course Fee : India & SAARC Countries = Rs.10,000/- || Outside SAARC Countires = US$1200/Body of Knowledge: Project Life Cycle Phases – Conceptualize, plan, organize, implement, control, integrate, deliver & close out. Project Management Certification envisages to provide healthcare professional to perform their functions and duties more effectively & efficiently. URL://http:www.cepm-iihmr.org For more information kindly visit: www.iihmrdelhi.org, Contact: Training Officer, Mob.9313346882, digamber@iihmrdelhi.org

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The ‘Blu-ray’ of Hope

Long-term archive of medical images

edical imaging, today is at the core of modern medicine. Digital image availability at the point of care depends largely on how well the data is stored. It is important to understand the subtle differences in storage and archive first. When one talks of storage of any data, mainly two aspects are of highest concern - high availability and efficient retrieval.

Aniruddha Nene Principal Consultant – Imaging and Director 21st Century Health management Solutions Pvt Ltd.

High availability Availability is an on-going battle against ‘Murphy’s laws’. It is not uncommon to have a hi-tech device failing when it is needed the most. Most architects of highly available systems tackle it with redundancy! They get more hard discs to duplicate the data, use redundant network switches or cabling or even make the entire server hardware redundant too. So if one component fails, another redundant counterpart takes over. All this happens automati-

Precision of Blu-ray technology

January 2009

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cally, without the user actually getting to know about the failure in one of the components. Of course, software designed to achieve this plays an equally important role. Efficient retrieval In the healthcare environment, it is not enough to have the data available at any given time. How quickly this data reaches the Consultant, Surgeon etc. when requested, will make the difference between life and death at times. Thus, efficient retrieval means the data has to be intelligently prioritised - anticipating the need. The system should utilise the best technology available to communicate data at multiple points of care without delay. High availability and efficient retrieval together, is referred to as on-line data. When we talk of archiving of digital images, the main focus is on longevity

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and permanence of the record. Stringent legal guidelines in the West require all the records of the patient to be preserved. Even in case of a catastrophe and destruction of online storage, the data has to be kept intact physically at another place. A clinician would ideally desire that all the data should be available online as well as stored as a back up permanently and separately, so that both requirements are met. Storage on Google is one such example where users have all their data on-line, always! But intelligent archive is the best bet for the healthcare industry. The online data can be restricted, balancing clinical requirement and affordability. Typically 3 to 12 TB online space, gradually upgraded over 3

to 5 years meets requirements of most of the hospitals ranging from 100 to 700 beds. But archives are faced with ever growing data, and it needs to be planned carefully. Conventional methods of Archiving and Blu-ray technology Information Technology in healthcare lags behind its counterparts in banking, manufacturing etc. Most of the other industries have long implemented and optimised archival methods to suit their own requirement. But the requirements of healthcare data archival are totally different from other industries. The sheer size of data is the key differentiator. Conventional methods used are hard discs (other than online archival tools), tapes, tape libraries, CD / DVD, juke,

Blu-ray archive arrives in India

Backward compatibility of Blu-ray

Blu-ray Disc (BD) Structure

AIIMS, New Delhi has become the first site in India for implementing Blu-ray technology based archive for Philips BIG BORE CT scanner installed in Dr B R Ambedkar-Rotary Cancer Hospital. This scanner is aimed at routine radiology studies as well as radiation therapy simulation. 21st Century Health Management Solutions provided Advanced Imaging System for Blu-ray archival and DICOM communication. The archive is scalable and can address larger archival requirements. Aniruddha Nene, Principal Consultant and Director- Imaging, 21st Century Health Management Solutions remarks that Blu-ray technology is the optimal choice for permanent archive with life of the media exceeding 50 years and size exceeding 50GB per media.

January 2009

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Magneto Optical Discs (MOD). Blu-ray is an emerging technology in optical storage. The precision of Bluray burning is depicted below:

ď&#x201A;&#x;

Blu-ray media discs referred to as BD have a life expectancy of 50 years and are expected to go beyond 100 years as technology matures. It is environment friendly with the least consumption of power for archive libraries / robotics owing to large data size per media. Currently 50GB discs are commercially available. The size is expected to reach 100 GB per media soon.

Blu-ray advantage over other archival systems Blu-ray drives/Jukes are typically backward compatible to CD / DVD. Right choice of the solution Blu-ray based archive has the least cost of ownership of all other types. Please refer to the chart of technology comparison.

Relative Total Cost of Ownership - Archival Storage Systems *12 TB capacity over 3 years

Conclusion Indian healthcare industry has been witnessing Information Technology transformation in recent times. We do not have large legacy systems to be migrated to the latest technology. Indian healthcare industry can leapfrog to adopt the latest archival technology easily and quickly. Blu-ray technology appears to be a clear winner among the other technologies. Until the next avatar of technology, the holographic storage becomes practical Blu - ray will dominate the archive market.

Read articles, interviews and news online at

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January 2009

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1 2 3 4 5 6 7 India : Mumbai • Delhi • Kolkata • Bangalore • Hyderabad Overseas : Kuwait • Dubai • Kenya • Singapore • Kuala Lumpur

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ANNUAL SPECIAL ISSUE

Wellness at the Workplace

Dr. Paul Litchfield Chief Medical Officer British Telecom

The main role of Occupational Medicine is to provide health advice to organisations and stakeholders, to ensure high standards of health and safety at the workplace. The Chief Medical Officer at British Telecom, speaks about his work at the largest telecom company in the UK. 46

January 2009

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Q. Given your background in clinical medicine, could you give us a brief overview about your career? How did you move to the corporate sector? A. When I first qualified, like most young men, I didnâ&#x20AC;&#x2122;t know what to do with my life. I ran away to sea and joined the Royal Navy. I was working at a shipyard, looking after mainly the civilian workforce that repaired ships. I saw then the real problems that the workers had in terms of injuries and diseases. There was a new case of asbestos disease every couple of weeks! It ignited in me a passion to work in occupation medicine/workplace health. I then trained for it in my clinical speciality. When I hit 40, I decided that Iâ&#x20AC;&#x2122;d had enough of the Royal Navy and the Armed Forces, and I first joined as Medical Director for the Occupational Health Service for the UK civil service, where I was

ANNUAL SPECIAL ISSUE

see some of our suppliers, particularly our BPO suppliers, Accenture – because they do a lot of back-office work for health in BT. I was in Bangalore about a month ago on a trade mission on diabetes led by a minister from UK.

“I think anybody in the NHS and also in BT if asked to reflect on the last 5 years would say that sometimes we’ve made things more complicated than they need to be.” looking after about half a million people in the UK from a wide variety of jobs traditional civil servants and others like customs, prison offices. Then NHS got privatised, and I found myself in the private sector, delivering services to a whole range of clients in the private and public sector. In 2001, the company I was working for won a contract for the outsourced work that British Telecom (BT) was doing in terms of occupational health. BT liked the product so much, that they bought the doctor! So I joined BT in 2001 as Chief Medical Officer. Q. Do you come to India often? What brings you here now? A. I’m here as part of the work we are doing with the World Economic Forum. I’ve been to India before, partly to see some of our own people in BT, partly to

Q. Diabetes is a big issue here in India. You must be dealing with people from all across the globe. What are the specific health and safety issues that come up according to region? A. I look after health, safety and well being in BT. We outsource most of the service delivery, but we have a small group working on it in the company. My role is to advise the chief executives of the different divisions, and the Board, on health strategy. We have a three - pronged strategy around health. First is preventive health, next, if health problems do occur, intervening early so that the effects are minimised, and lastly, if people have become ill, rehabilitating them back into the workplace as quickly and effectively as possible. In terms of preventive care we look at the health risks for our employee population and then try and target interventions to counter those risks. In the UK, our biggest issue is mental health. When we look at other parts of the world though, other diseases and health problems become more important. One certainly has to be blind to come to India and not see that diabetes and cardiovascular disease are huge issues. The focus around the world this year in the company is diabetes. In fact, we launched a campaign just last week to raise awareness about diabetes, attempting to get the message across that small changes in lifestyles can make a big difference to an individual’s health. We have produced this online tool, where one can answer a few questions and it tells them their risk of developing diabetes. If they come back and tell us that they’ve got themselves checked, we’ll put them in a competition and they can win something. It’s part of encouraging people to look after themselves. Q. I believe you have started a ‘Work Fit’ program. Could you tell us more about it?

A. When we were looking at what to do 5 years ago in terms of prevention, there was a lot of pressure to implement traditional health screening such as we had done in the 1980s and 1990s. In the UK it would have been largely nurse – based, not something that has worked very well in the UK. When one does the evaluation – and not enough people evaluate the programs they do (that’s a big issue) - that type of program actually has a very limited effect. What we tried to do was to construct something different, using BTs own products and services. We used IT and communication to get across the message instead of relying on health professionals. We worked with an NGO and our trade unions to construct a targeted program. What we did was send simple messages about nutrition and exercise. Our target was to try and engage about 4000 people. We actually engaged over 16,000 people. We were surprised by our own success. A. Are these programs optional? A. Entirely optional. We could implement a compulsory program, but we would lose the support of groups like the Employee Representatives. But we’ve got about 25% of the population to engage with the program. In our evaluation we found that these people had lost weight and were exercising more, and had maintained it for at least over a year. We could demonstrate that we had changed attitudes and behaviours in the group who participated in the program. We also found that just as many people, who had not formally enrolled in the program, had also made changes to their lifestyle. That’s what we call the collateral effect. That for me was a surprise. Q. BT is one of the first large companies to ban smoking in its offices and vans. How tough was it to do that? A. One of the biggest challenges today is to alter peoples’ behaviour around smoking. You have to make sure though, that the timing is right for that sort of change. The whole societal attitude in the West has been swinging towards making it harder for smokers January 2009

ANNUAL SPECIAL ISSUE

to practice their habit. So, we thought the timing was about right. We’ve already had limitations on smoking for 10-15 years. The time was right to close all the smoking rooms on BT premises and stop smoking on BT vehicles. To counter that harsh message, we also ran a programme for helping people to give up smoking. We got about 1200 people engaged in that program with considerable success - 25-30% have managed to remain off cigarettes for a year. This is not just philanthropy. By improving the health of the workforce, one improves the health of the balance sheet, and this can be done by reducing absenteeism and healthcare costs. In the US, healthcare is a direct cost to employers. In Europe, since there is insurance or the state provides health cover, it’s harder to make the economic case, however, there still are lots of other benefits, in terms of higher productivity when employees are healthy. Another example is that the resale value of a vehicle, which has never been smoked in, is significantly higher, at least in the UK. BT has the biggest vehicle fleet in Europe with over 50,000 vehicles. Even if you only save £100 per vehicle, that’s a lot of money. It’s to do with thinking about the benefits to the company, rather than just saying, like many, “You must do this because our people are dying”. In business, you need to talk the language of business to get across your message. Q. Do you use telemedicine in your daily work? If yes, how? A. Telemedicine is something I first came across when I was working down in the Antarctic. When I first went there, the nearest medical facility was over 3000 miles away and I had with me someone who was acutely ill. But 25 years ago, all we had was a radio. In a later job, I again got involved with the British Antarctic Survey, and we set up a contract for proper support with an NHS unit in Plymouth. Telemedicine was just developing then and much of the unit was based on providing support to remote communities through telemedicine. Today, its not something I use in my day to day practice, but as a company,

January 2009

its certainly something we are interested in because even in a place like UK which is very compact, access to the correct specialist expertise is often quite difficult. Coming back to diabetes for example, looking at retinal changes in diabetics, but doing it remotely can benefit people. Digital imaging too is developing fast, partly because it is transportable and always available to the clinician to get opinions from a long distance in real time. I see it as a fabulous advance for healthcare and I see it developing even more in future. In India, telemedicine gives you the real chance to bring high quality healthcare to rural communities where otherwise it would be quite difficult. Q. Spanning your entire career, what do you think would be the top three technologies that you think have made a big difference to the medical community? A. I think one naturally starts out by thinking about specific medical technologies, such as imaging. If I think back 30 years to when I first qualified, imaging was essentially just x-rays. When you look at what you can now do in terms of MRI and ultrasound, it has transformed diagnostics greatly. Again, in terms of treatment, if somebody had gall bladder disease 30 years ago, then they were looking at a major abdominal operation, which, if they were working, would keep them from work for 3 months. With endoscopic operations these days, such patients can be up and about in a few weeks time. The pure medical technologies have been fantastic. That said, I think some of the possibilities come from other areas of technological advancement. The big one is in terms of using communications to enhance healthcare. Part of that is getting the messages across by using a multimedia approach and using modern communications to deliver a higher quality of healthcare. This

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could mean, getting results analysed in a centre of excellence and feeding that to other areas, instead of having many sub-standard laboratories, all of them struggling to improve their standards. This brings down the cost of healthcare, while upping standards. Q. Can you tell us something about your experience working with the NHS in UK and possible replication of such work in India? A. India would be an immensely complex project. It was so even in a small country like the UK with a population of about 50 million. If one is thinking of rolling that out outside the UK, one must try to make things simpler and less complex. I think anybody in the NHS and also in BT if asked to reflect on the last 5 years would say that sometimes we’ve made things more complicated than they need to be. Having a clear understanding of the client and what they need and planning up front is well worth the investment. If you’re introducing something like this in India, which no doubt in due time you will, these simple messages will save you a lot of time and money. Historically, one of the mistakes often repeated, is that we develop something for one part of the world and replicate it in another place because it worked well in the first case. Initially when you start off you’re naive, and think the barriers are things like language and culture – but they’re not. And so, what we’ve tried to do over the past couple of years is to make sure we fully engage with the local people to make sure what the business and health priorities are. We try to understand their perceived needs and the best channels of communication. What works for people in London or Manchester, doesn’t necessarily work for people in Bangalore or Delhi. We all want to get things done quickly, but the danger is that if you just impose things on people, you don’t make any progress at all.

NEWS ROUND-UP 2008 CORPORATE UPDATES

Trivitron, Siemens will take care of govt healthcare Trivitron has formed a strategic arrangement with Siemens Healthcare in India for providing sales and after sales support to the selected segment of customers for all Siemens product line. Now, Trivitron will also be responsible for taking care of exclusive Government Segment apart from the 90 selective private customers across India. This union of multinational Diagnostics giant - Siemens and a true Indian diagnostics company - Trivitron, is pertinent for the requirements of customers in India. Trivitron has a large customer base for Immunoassay analysers and RIA in the last 10 years with high customer satisfaction.

Germany’s GEK picks Atos for e-health card German health insurer, Gmünder ErsatzKasse (GEK), has signed a five-year deal with Atos World line, to implement and operate the new German electronic health card (EHC) on its behalf. During 2009, GEK plans to issue 30,000 cards per day.

Due to be rolled-out nationally in 2009, the electronic health card is one of Germany’s most important public sector IT projects. The card is designed to guarantee the secure exchange of data between insured parties, doctors, pharmacists and health insurance companies and will serve to validate patient’s identity, rather than hold their electronic medical record.

Airtel launches alert services for vaccination Airtel announced the launch of ‘VacciDate’ service which enables parents to keep track of the vaccine dates of their infants on the occasion of Children’s Day. Available in Karnataka the services can be subscribes to for free of cost. Venkatesh V, CEO, Mobile Services, Bharti Airtel Ltd, Karnataka, said, “Every parent is responsible for his / her kids’’ immunization. In today’s fast paced world, it has become even more pertinent for parents, specially working couples, to keep track of their child’s vaccination dates.”

Ramky to invest INR 500cr in health, education Hyderabad-based Ramky Group is planning to invest INR 500 crore for setting up hospitals and educational institutions over the next three years. The group is into consultancy and real estate business among others. Group director M Goutham Reddy said they would construct two 200-bed hospitals in Hyderabad, a 100-bed hospital in Bangalore and a 50-bed hospital in Warangal. Each building will involve about INR 25 crore excluding the land costs. Similarly, it plans to construct a school each in Hyderabad, Bangalore and Chennai. The schools will come up on about 4 acre each at an investment of about INR 25 crore.

Perot Systems Buys Tellurian To Expand Health-Care Services Reach Perot Systems will significantly bolster its healthcare interests after acquiring Tellurian Networks, a managed services provider of electronic medical records (EMR) and practice management (PM) applications. The acquisition was announced recently, though financial terms were not disclosed. “We are pleased to welcome Tellurian’s associates to the Perot Systems global team,” said Peter Altabef, Perot’s president and CEO, in a statement. “With its demonstrated expertise and commitment to operational excellence, Tellurian will enhance our expanding worldwide healthcare IT services capabilities.”

iSoft India gives shape to world’s largest health project Healthcare software provider iSoft has said that its Indian R&D team is developing a solution that it described as the world’s largest civilian IT healthcare project. The Lorenzo software application, which will link nearly two-thirds of the hospitals in the United Kingdom, will also be launched in Europe, Australia and Germany in November, iSoft executive chairman and CEO Gary Cohen said at the opening of the company’s global product development centre here. Hospitals will also be connected to general practitioners, allowing patients in the UK to get themselves treated at any clinic in the country without the need for re-entering data.

January 2009

NEWS ROUND-UP 2008 HOSPITAL NEWS

Karachi medical institute embraces Digital Healthcare with IBM IBM has announced that Memon Medical Institute (MMI) in Karachi will implement IBM BladeCenter and IBM System Storage to store electronic medical records for the very first time to provide the availability of critical information and a manageable storage infrastructure in time for the hospitals grand opening next year. One of the Memon Medical Institutes

Christ Hospital implements eICU The Christ Hospital, Cincinnati, is to implement an eICU program designed to improve critical care delivery and save lives. The eICU program, patented by VISICU, combines early warning software and remote monitoring to connect off-site critical care physicians and nurses to ICU patients around the clock. The Christ Hospital’s eICU program, called Critical Connections, supplements existing ICU bedside care, allowing eICU and ICU teams to work together to provide an enhanced level of proactive care. The combination of early warning software and remote monitoring is proven to reduce unnecessary complications, shorten the hospital length of stay, and improve mortality rates.

Balco to build INR 300 cr cancer hospital in Chhattisgarh The Bharat Aluminium Company Ltd (Balco), which is a part of the Vedanta Group, will spend INR 300 crore in building a cancer hospital and research centre here, officials. “The state government has given a 41 acre plot of land free of cost to Balco at village Saddu in capital Raipur to build the cancer hospital,” an official said. The land has been given to the company for a 30-year lease period. Balco will develop the hospital, the first of its kind in the state, within 18 months of the beginning of construction in November this year.

ESIC to set up med college in Mumbai goals is to provide a state of the art paperless IT infrastructure for its brand new 300-bed tertiary care teaching hospital. The MMI aims to provide accessible and affordable quality healthcare and education in Karachi.

Narayana Hrudayalaya plans health city in Mexico Indian hospital major Narayana Hrudayalaya plans to set up a health city in Mexico that will also cater to patients from the US. “Our next project will be a health city in Mexico. We may tie up with some American hospitals for this project,” said Devi Shetty, eminent cardiologist and chairman of the Narayana Hrudayalaya group of hospitals. Shetty was addressing a news conference to announce the setting up of a health city - a multispeciality hospital with research facilities - in Hyderabad on the lines of the group’s famous facility in Bangalore.

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Mumbai city will soon get a new government medical college, thanks to the ESIC (Employees’ State Insurance Corporation)— a much-ignored wing of the city’s healthcare network—making a foray into medical education. For the first time, the corporation will open a medical college attached to its 300-bed hospital in Mulund, with the first batch of 50 MBBS students to be enrolled in 2009. “A recent Planning Commission report pegged the shortage of doctors in India at 6 lakh and nurses at 10 lakh. As we already have infrastructure by way of hospitals, we thought we could produce quality doctors,’’ Prabhat C Chaturvedi, director-general of ESIC, said during a visit to Mumbai recently.

SoftLink Intnl bags the HMIS installation at JIPMER SoftLink International, a leading software product company with core focus on Hospital Automation and Medical Imaging, has bagged the prestigious order for implementation of Hospital Management Information System at JIPMER, Pondicherry. With more than a decade of indepth experience in the field of ‘Healthcare Information Technology’ (HIT), Softlink has garnered 150 plus installations globally that span across 12 countries. The core strength of SoftLink lies in its product portfolio, which comprises of a fully integrated suite of HIS/CIS/RIS/ PACS, making it a “one-stop shop” for an end-to-end solution approach for any Hospital. JIPMER with a current bed strength of around 1050 and a daily OPD load of around 4500 patients is ranked among the top 10 teaching hospitals in India. JIPMER offers high quality sophisticated diagnostic and therapeutic facility to all patients free of cost. The institute runs under the direct administrative control of DGHS, Ministry of Health and Family Welfare, GoI and is on par with similar institutes like AIIMS, New Delhi, PGIMER, Chandigarh etc. Recently, JIPMER was declared as an Institute of National importance by way of a legislation approved in Parliament by the GoI.

NEWS ROUND-UP 2008 RESEARCH

Multiple-media alert to locate endangered children

system missing

The Dutch police are using an innovative, cross-media alert system, AMBER Alert Netherlands, for locating missing and abducted children whose life or health is thought to be endangered. AMBER Alert Netherlands is a joint initiative of software company Netpresenter and the Netherlands Police Agency (Klpd). It enables the whole of the Netherlands to be immediately alerted when a child goes missing or is abducted, by means of pop-ups on PCs, large advertising (digital signage) screens, email, SMS text messages, instant messenger, RSS newsfeeds and website alerts (Flash). To engage with the system software can be downloaded from the AMBER Alert website. (www.amberalertnederland.nl).

Should you trust health advice from internet forums? Certainly, health consumers are not blind to the net’s problems. Blatant commercial agendas which present opinion as fact, the downright barking bonkers, the health conspiracist - the net has them all. Six out of ten of us say in surveys that we know the net to be full of misinformation. But we love it on so many counts. Immediacy, confidentiality, the linking with others, and most can navigate round its faults by more exhaustive searching and comparing of sites, for instance. And an overarching reason for the existence of these sites is the gap between what health professionals think we ought to know and our actual health information needs.

Asian HIV/AIDS database launched A new UN-backed website has launched providing details of HIV/AIDS prevalance in the Asia Pacific region, bringing together a host of resources on the disease for researchers, healthcare providers and government officials. The site, described as a hub for information on HIV/AIDS, is endorsed by the UNIADS programme, Unicef, World Health Organisation and Asian Development Bank. Data included on the website (www. aidsdatahub.org) site includes coutry HIV/AIDS profiles, maps and other resources for health professionals and policy makers. Profiles are listed for 25 Asian countries, ranging from Vietnam to Afghanistan.

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CSIR launches collaborative research for anti-TB drugs India recently launched a unique collaborative programme to discover drugs for infectious diseases common to the developing countries. The ‘Open Source Drug Discovery’ (OSDD) programme, launched by the Council of Scientific and Industrial Research (CSIR), aims to build a consortium of global researchers and bypass the patent regime, which makes drugs expensive. To begin with OSDD, a brainchild of CSIR Director General, Samir K. Brahmachari, has taken up research on discovering new drugs for treatment of tuberculosis, a field in which no major advancement in treatment has emerged since 1960.

PwC backs PPP in healthcare Paramedic students trained using Second Life Paramedic students in London are being trained in how to deal with emergency situations using the virtual world of Second Life. The Second Life training system uses online avatars of patients in Second Life, in a series of different scenarios, to teach future paramedics how to respond to different situations. Students work in groups of three or four to treat the virtual patient. Emily Conradi, e-Projects Manager said, “The advantage of Second Life is that it feels more real. Students get a sense of being there together and can decide what to do from what they can see in front of them.”

The huge investments required to bridge the gap between the demand for healthcare and the existing supply could only be met through public private partnership, points out a recent study by PricewaterhouseCoopers (PWC). Health was a state subject and governments were actively courting private industry in healthcare. The PPP experience in India and other developing countries in Asia suggested five common models, based on social marketing, social franchising, contracting in, contracting out and equity arrangements. However, the Asian experience revealed challenges in the healthcare sector, like the need to have an appropriate policy framework backed by an appropriate institutional mechanism.

NEWS ROUND-UP 2008 TELEMEDICINE

SMS for the nearest healthcare facility in India

Telemedicine could solve India’s healthcare woes says UN official

India: ONGC to extend telemedicine project in its entire work base

If you happen to be anywhere in Kerala’s Kozhikode district, emergency relief is just an SMS away. A government project named ‘Dr SMS’ has implemented a system allowing citizens to obtain information on the nearest healthcare facility anytime of the day by sending an SMS. Anyone seeking medical attention anywhere in the district has to SMS a prescribed format including his pin code to 9446460600, the same number which returns information on government files in the district collectorate. The system extracts information from a database prepared by the government machinery under the district medical centre. Within seconds, a message containing the nearest hospital’s whereabouts will be sent back to the user.

With the growing cost of healthcare becoming a major headache for governments across the world, telemedicine could provide a solution to India and other countries grappling with the problem. Listing the advantages of telemedicine, Alice Lee, the chief of the UN programme on space applications said that developed countries too were now relying on telemedicine. “In Germany, officials expect to save 300 euros (INR 19,000) on each patient through telemedicine. In the US, specialists are not able to reach the patients residing in rural areas” and telemedicine has been effective in such cases,” Lee said.

The Government-run Oil & Natural Gas Corporation (ONGC) is planning to extend its telemedicine project with Bandra-based Lilavati hospital. ONGC is also planning to incorporate the project to cover all the rigs and platforms at Bombay High Offshore. The piloted telemedicine project will provide medical care to over 100 personnel present on a platform and another 80 at the rig at any given time. According to Dr R H Kewalramani, general manager of ONGC, Mumbai, there is a plan to tie-up with Nanavati Hospital also.

Indian Railways to expand telemedicine network

Satellite monitoring can predict cholera outbreaks in India Scientists have found that cholera outbreaks can be predicted using satellite monitoring of marine environments, especially in India and Bangladesh where such epidemics occur regularly. Professor Rita Colwell, from the Institute for Advanced Computer Studies at the University of Maryland, says that she has studied cholera outbreaks for over 30 years, and found that they follow seasonal increases in sea temperature. She points out that the number of tiny animals increases following a rise in sea temperature, and they bring the cholera pathogen into the drinking water supply.

The Indian Railways has decided to expand telemedicine network across the country. Currently, the facility is available in 18 places including Rangia, Badarpur, Guwahati, Sonpur, Ratlam, Bhavnagar, Ahmedabad, Mumbai, Chennai, Vadodara and Rajkot.

Soon, the telemedicine facility will be accessible in about 20 more places in Maharashtra, Jharkhand, Orissa, Karnataka and Goa. Implemented by Konkan Railway, telemedicine project is the use of electronic communication and information technologies to provide healthcare when distance separates medical specialists from the patient. It also includes educational use of these techno logies such as distance learning of health subjects.

Satyam launches mobile healthcare for rural Indians Satyam Computer Services Ltd., a leading global consulting and information technology services provider, announced recently that it has embarked on a revolutionary program to deliver world-class healthcare to remote villages in India. The public/private partnership between the government of the Indian state of Andhra Pradesh and Satyam provides a fleet of healthcare vans - mobile health units (MHU) - that visit villages on designated days to deliver healthcare services to rural Indians, many of whom have never been seen by medical professionals before.

January 2009

NEWS ROUND-UP 2008

HEALTH FINANCING/INSURANCE

India needs INR 60,000 cr by 2013 in healthcare India needs an investment of up to INR 60,000 crore (INR 600 billion) over the next five years to meet demands in the healthcare sector alone, according to a consultancy firm Feedback Ventures. “Currently, there are 1.5 beds available for every 1,000 people, while the global average stands at 3.3 beds per 1,000 persons. An investment of INR 40,000 to INR 60,000 crore (INR 400-600 billion) will be required over the next five years to maintain the Indian average looking at the population growth,” FeedBack Ventures President (Infrastructure Advisory Division) Monika Sood told reporters in New Delhi.

Financial and Demographic Crises to spur eHealth deployment The global financial crisis as well as the growing demographic crisis that is affecting Europe could be the catalyst for European governments to finally embrace electronic healthcare reforms, according to Esko Aho, former Prime Minister of Finland and leading thinker on innovation. Mr Aho, who was delivering the closing keynote presentation at the World of Health IT Conference and Exhibition in Copenhagen, said that he believed the substantial cost savings to be recouped from investment in electronic health records could provide the stimulus that is needed for European governments and healthcare bodies to start investing

seriously in eHealth.

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USD 350k MacArthur grant for India’s public health inst

World Bank announces USD 520 m Malaria project for India In a bid to help combat Malaria and other fatal diseases in India, World Bank has announced a USD 520 million scheme, the largest such project by the international body in any country. Over 100 million people in India will be provided prevention services and treatment under the scheme designed by the Indian government, the UN, World Health Organisation (WHO) and the Global Fund to Fight AIDS, Tuberclosis and Malaria. Welcoming the scheme, UN Secretary-General’s Special Envoy on Malaria congratulated both the World Bank and the Indian Government for their “tremendous commitment” to combating malaria and like diseases.

Insured losing access to healthcare: US study About 20 percent of the US population delayed or were unable to get access to medical care when they needed it in 2007, up from 14 percent four years earlier, a study released recently found. About 9.5 million more people went without medical care in 2007, compared with 2003, the nationally representative survey released by the Center for Studying Health System Change, a nonpartisan policy group, found. In a striking finding, the survey said although those without insurance were more likely to report going without care, those with insurance had a greater percentage increase in unmet medical needs.

Sangath, a Goa-based public health institution focussing on 350 million children and youth, is one among eight organisations in six countries that has won the MacArthur Award for Creative and Effective Institutions. Announcing the award recently, Chicago based John D. and Catherine T. MacArthur Foundation said Sangath would use its USD 350,000 grant to build a new centre for its clinical, training, and research work. Foundation president Jonathan Fanton said, “From its founding, the MacArthur Foundation has sought out people and organisations that have the creativity, energy and breadth of vision to change the world for the better.”s

SKS launches health insurance for rural India Hyderabad-based SKS Microfinance Pvt Ltd, the new generation microfinance company is all set to roll out its health insurance product, ‘’Swayam Shakti’’, for the poor in semi-urban and rural areas. SKS Microfinance will cover its members in Andhra Pradesh, Karnataka and Orissa by March 2008 under the health insurance program. SKS Microfinance has tied up with ICICI Lombard General Insurance for this initiative. ‘’Swayam Shakti’’ is a tailor-made health insurance product, which covers the SKS member, member’s spouse and two children against pre-existing illnesses, maternity, more than 24-hour hospitalisation and personal accident for a period of one year.

NEWS ROUND-UP 2008 PRODUCT WATCH

iPhone telemedicine application for heart patients RS TechMedic BV, a Dutch based company with eight years experience in medical device development, has announced the release of their iPhone Telemedicine Application. With this iPhone Telemedicine Application physicians can monitor vital signs of ambulant and home-care patients at any time from anywhere. This product offers a significant increase of patient comfort, fast recognition of heart problems and a reduction of hospital and healthcare cost. Dyna-Vision® is a small and portable device, with the dimensions of a PDA. This reliable and sophisticated device monitors up-to 10 clinical parameters through non-invasive sensors attached to the skin.

New software cuts waiting at hospitals A new software package, developed by researchers, helps hospital or emergency staff anticipate the rush of patients hour by hour for the day or the next week, even on holidays with varying dates, such as Easter. The Patient Admission Prediction Tool (PAPT), designed by Australian e-Health Research Centre (AeHRC), can predict accurately how many patients will be present at emergency departments, their expected requirements and the number of admissions. The software was developed by clinicians from Gold Coast and Toowoomba Hospitals and Griffith University and Queensland University of Technology, collaborating with AeHRCe.

India’s first web portal for the disabled launched Punarbhava.in, India’s first interactive web portal for the disabled, was launched recently, along with a screen reading software that will enable the visually challenged to use computers. An effort of the Rehabilitation Council of India (RCI) and Media Lab Asia, a part of the communications and information technology ministry, the web portal and the software are aimed at enabling the disabled to get more connected to the rest of the world. Punarbhava. in will also have a National Disability Register that will give statistical information about the disabled population in India (http://www.punarbhava.in/).

CompuMed previews telecardiology EMR Medical informatics company CompuMed has previewed its new CompuBRIDGE telecardiology electronic medical records (EMR) solution. The CompuBRIDGE EMR is designed to capture and integrate electrocardiogram (ECG) results and over-reads into an existing EMR system. Integration does not require additional software, hardware or specialised servers. For facilities without a general EMR system, CompuMed offers hosted solutions that provide access to ECG data via any Internet enabled computer. CompuMed expects to release its CompuBRIDGE EMR system after testing with beta customers.

IBM’s new data sharing technology for critical public health info IBM, in collaboration with the Nuclear Threat Initiative’s (NTI) Global Health and Security Initiative and the Middle East Consortium on Infectious Disease Surveillance (MECIDS), has created a unique technology that standardises the method of sharing health information and automates the analysis of infectious disease outbreaks, in order to help contain diseases and minimise their impact. The secure, Web-based portal system, the Public Health Information Affinity Domain (PHIAD), is being deployed in the Middle East first, and the partners are pushing for international deployment.

Transasia launches Erba Den-Go to detect Dengue To provide a user-friendly and rapid diagnostic method for detection of dengue infection, Transasia Bio-Medicals Ltd has launched its brand new product, Erba Den-GO (CE marked). The key advantages of this new test are that it is a 15 minute procedure. The test allows presumptive differentiation between primary and secondary dengue with an overall accuracy of 99.3%. Transasia Bio-Medicals Ltd has a 100% subsidiary in Germany, Erba Diagnostics Mannheim GmbH, which is playing a stellar role in bringing worldclass products within reach of laboratories across the globe.

January 2009

NEWS ROUND-UP 2008

POLICY WATCH

EU internet access reaches 60 per cent

ECIL and 21st CHMS set up Centre of Exellence

Bharat Biotech wins Orissa government’s first PPP project

60% of households across the EU had internet access in 2008, according to a survey. Across the 27 countries within the EU, household internet access ranges from 25% in Bulgaria to 86% in the Netherlands. Searching for health information remains a popular online activity, accounting for 28% of usage across the 27 countries surveyed. This ranged from 51% in Finland and 46% in the Netherlands, to 6% in Bulgaria and 11% in Romania. The countries with the highest levels of household internet access were the Netherlands, 86%; Sweden, 84%; Denmark, 82%; Luxembourg,80%; and Germany, 75%. The lowest levels were registered in Bulgaria, 25%; Romania, 30%; and Greece, 31%.

Electronic Corporation of India Ltd and 21st Century Health Management Solutions signed an MoU to jointly set up a Centre of Excellence for Healthcare ICT and Medical Electronic Solutions to address the very large healthcare projects in the govt sector in India. This CoE, to be set up in Hyderabad, will have state of the art infrastructure for IT enabling of Hospitals and applications of Telemedicine to reach out to remote and rural India.

The Orissa Government has selected Bharat Biotech International (BBIL), www. bharatbiotech.com the multidimensional biotechnology company specialising in product-oriented research, development and manufacturing of vaccines and biotherapeutics as the ‘Developer’ for its first Public-Private-Partnership (PPP) “Biotech Pharma IT” project in the state. The park to be located at MouzaAndharua, Bhubaneswar is estimated to cost about INR 100 crores and it is slated to be completed in 8 years.

Rockefeller Foundation calls for support for eHealth

Minister calls for strict norms on import and export of drugs

The Most Reverend Desmond Tutu discusses eHealth as “the great equalizer” and its ability to improve the human condition at the Global Ministerial Forum for Research on Health in Bamako, Mali. This is in continuation to the Rockefeller Foundation sponsored conference series at its Bellagio Center from July 12-August 8, 2008, titled “Making the eHealth Connection: Global Partnerships, Local Solutions.” eHealth is the use of information and communications technology to improve health systems performance.

Calling for stringent regulations on the import and export of drugs and food items to meet the global competition, External Affairs Minister Pranab Mukherjee has said the items people consume should be of the highest quality. Mr. Mukherjee said it was important for the industry to adopt the good manufacturing practices if India had to compete in the international trade that had been speeded up by the World Trade Organisation regime. For this, the Indian industry may require global pharmacy and hence it is important to harness the potential of the scientists and scientific institutions, he said.

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India leads the way for personalising medicine in developing countries India is playing a major role in raising the standard of personalised medicine across the world, especially developing countries. Though the idea of personalized therapeutics based on individual variation has existed for more than 4,000 years in India’s traditional practice of Ayurveda medicine, the country has created a new national databank of genetic samples from about 15,000 unrelated individuals from its diverse geographic and linguistic subpopulations. A case study involving Dr. Mitali Mukerji of the Institute for Genomics and Integrative Biology and Dr Samir K Brahmachari of the Council of Scientific and Industrial Research has revealed that life-sciences company, Avesthagen Ltd, has announced a five-year, USD 32 mn project to genotype the country’s entire Parsi population - about 69,000 people.

NEWS ROUND-UP 2008

EHR/EMR

Holland aims for electronic child records All child healthcare providers will have to introduce electronic patient records by the end of 2009. André Rouvoet, the Dutch minister for youth and family, has said all institutions and bodies dealing with the healthcare of children must be using electronic patient files by the end of 2009. The minister set out the requirement in a letter to the Dutch parliament last month. The new electronic patient files will contain information on the child, his or her family situation and circumstances. Once the system is up and running, every new child will receive an electronic file during their first contact with a health institution.

C-DAC software to aid healthcare sector If the new software developed by the Centre for Development of Advanced Computing (CDAC ) is accepted by medical equipment manufacturers and service providers, patients with medical history will no longer need to worry about maintaining their records and its compatability with different softwares. Through the medical informatics standards software development kit (SDK), the C-DAC aims to achieve globally maintained standards as defined by international and national organisations. The software development kit was officially unveiled at C-DAC’s new campus in Aundh recently.

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US-wide EHRs priced at USD 150 billion

Award for open source application for analysing health data

The full implementation of a digital US healthcare system, with integrated networked electronic health records (EHR) in all U.S. doctors’ offices and hospitals, has been estimated as costing around 97 billion (USD 150 billion) over eight years. The figure was suggested by Robert Miller, a professor of health economics at the University of California, San Francisco, according to a report by Government Health IT. Prof. Miller called for hospitals to spend GBP 22.6 billion (USD 35 billion) to acquire and expand EHR systems and USD 55 billion in new operating costs over eight years. In 2005 the Rand Corporation reported that the total cost over 15 years would be GBP 74 billion (USD 114 billion), with EHRs paying for themselves.

Health Atlas Ireland, an Open Source application to analyse health related datasets using geographical information systems (GIS) and statistical software, was one of twenty projects that were given the ‘Prime Minister Public Service Excellence Award’. The awards were handed out last month by Irish Prime Minister Bertie Ahern. Health Atlas Ireland is based on the Open Source content management system Plone and the Open Source application server Zope. It was selected for the Award because of its capacity to innovate and its technical perfection, writes Zeapartners, a network of companies involved in Plone and Zope.

HIMSS investigates global EHR implementation Recognising common threads that affect all EHR implementations in 15 countries, the Global Enterprise Task Force of the Healthcare Information and Management Systems Society (HIMSS) has released the white paper Electronic Health Records: A Global Perspective. The extensive study reviewed healthcare IT progress in Europe, Asia Pacific, Middle East and North America. The 16-member task force looked at various EHR components within each country, including, security, quality, financing sources and barriers to adoption. Amid many variations, four common factors emerged that affect implementation of the electronic health record throughout the world - Funding, Governance, Standardisation and interoperability, Communication.

Google launched

Health

Internet search giant Google recently unveiled Google Health, its online personal health record service, which enables consumers to manage their health records, use online health tools and get health advice online. In February Google announced a pilot project with the Cleveland Clinic to provide hundreds of clinic patients with tools to collect, manage and store personal health records online. Having created a record users can decide who they subsequently make it available to. The service also provides detailed searchable health advice, based on a series of health topics.

NEWS ROUND-UP 2008

WIRELESS/MOBILE APPLICATIONS WiMax market to touch INR 52,000 cr by 2012

NHS Direct text message details of local health services

Wireless broadband market is estimated to touch INR 52,000 crore with an estimated subscriber base of 19 million by 2012, WiMax Forum has forecast. The projected market includes broadband wireless products as well as services, said WiMax Forum, said the advocacy group which promotes broadband connectivity through wireless mode, in a statement. The forum makes this projection keeping in mind the wireless technology’s performance capabilities, early availability, cost advantages, government support and the upcoming auctions relating to the 2.3/2.5 GHz frequency bands, it added.

NHS Direct has launched a service that allows users to obtain details of local health services by text messages. Anyone wishing to find their nearest GP, dentist, pharmacy, optician, walk-in centre, A&E or hospital in England can text the name of the service required, followed by a postcode, to 61121. A text message is sent back in reply, with details of the closest services to that postcode, and further results can be obtained if needed. Results contain the service name, address and telephone number (where available) plus the distance from the postcode.

Better health through your cell phone In many Third World and developing countries, the distance between people in need of healthcare and the facilities capable of providing it constitutes a major obstacle to improving health. One solution involves creating medical diagnostic applications small enough to fit into objects already in common use, such as cell phones - in effect, bringing the hospital to the patient. UCLA researchers have advanced a novel lens-free, high-throughput imaging technique for potential use in such medical diagnostics, which promise to improve global disease monitoring, especially in resource-limited settings such as in Africa.

Smoking cessation campaigns via SMS in London Pharmacies in London will launch a text messaging service to validate smoking status and invite ‘quitters’ for smoking cessation services in addition to using the system for ‘follow-up’ over the next year. The adoption of the Patient Care Messaging service, provided by iPLATO, has been driven by the successful use of the system for similar campaigns in GP surgeries across 34 PCTs. The pharmacies using iPLATO’s Patient Care Messaging for Pharmacies service, will receive support via best practice techniques for launching the text messaging service, enabling them to fulfil their growing role in Public Health.

Social network site may help fight malaria The British entrepreneur who sold a soccer Web site at the age of 17 for USD 40 million has switched his attention to help launch a social networking site designed to fight malaria. Tom Hadfield set up Soccer.net in his bedroom before selling it to US Sports network ESPN, but now hopes the power of sites such as Facebook can curb a disease that kills an estimated one million people a year, many of them in Africa.

iPhone could soon become a tool for doctors Experts say version 2.0 of the popular iPhone’s firmware, which is due to be launched in June this year, could turn the device into an indispensable medical tool in hospitals. Doctors are quite optimistic about the new version of the mobile phone as it could serve as an electronic alternative for the old-fashioned clipboard and X-ray light box. According to Adam Flanders, director of informatics at Thomas Jefferson University and an expert in medical imaging, “If you could use the gesture-based way of manipulating images on the iPhone and actually manipulate a stack of X-rays or CT scans, that would be a huge selling point.”

January 2009

NEWS ROUND-UP 2008 PHARMA/DRUG

Protest over govt-funded pharma research incentive Bill The government’s plan to boost research and development using public funds has raised sharp reactions from public interest groups on the commercial rights of the products that would reach the market at the end of such research. Healthcare activists fear the taxpayer who paid for developing medicines under the scheme may not be able to get them at a fair price if such products are allowed to be patented by its developers. Granting monopoly rights to anyone for products developed using public money is unfair, they say.

Himalaya Drug gets ready for rural play

Blogs new window to the world for Pharma industry

Himalaya Drug Company is set for a bigger push into rural markets with the launch of a new strategic business unit (SBU) for expanding into smaller towns and hinterland districts. The development at the INR 600-crore herbal healthcare major comes as the rural share of India’s pharma market, pegged at INR 31,000 crore, has risen from 18% to 21% in 2005. A McKinsey report published last year suggests that small towns and rural centres will be contributing as much as metros and top-tier cities in pushing the domestic pharma growth by 2015.

Pharma blogs are playing an important role in shaping the future of the pharmaceutical industry in India. Many Indian online financial portal and investment firms as well as research organisations have provided a blogging platform for the pharma industry to keep itself updated with the development in the pharma world through open and uncensored discussion. Sample this: The pharma blog from moneycontrol.com has a range of topics for discussion for the investors, pharma experts and intellectual property attorneys. Another blog analyses all Indian pharma companies and serves up some potent potions.

Cellworks in collaboration with Orchid on drug discovery Cellworks Research India Ltd, the R&D wing of California based company Cellworks Group Inc and the first company in Asia to build Systems Biology based drug discovery solutions has successfully helped Orchid Chemicals & Pharmaceuticals Ltd., a leading Indian Pharma company in its ongoing New

Centre plans drug stores in all districts in India The government has decided to set up a retail network of drug stores across the country in public-private partnership that would sell 350 essential medicines at half the rate of its branded substitute. The project, being launched in 15 states in the first phase, would ultimately ensure at least one such store in every district of the country. The move aims at ending company-chemist nexus which tries to push costlier branded medicines to customers in the name of substitutes.

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ALERT project looks to ICT for drug safety A new EU-funded information and communication technology (ICT) project is tackling issues of safety in newly developed drugs. Over the next three and a half years, the ALERT (‘Early detection of adverse drug events by integrative mining of clinical records and biomedical knowledge’) project partners will work on an innovative computer system for a better and faster detection of adverse drug reactions (ADRs). Currently, so-called spontaneous reporting systems are used when side effects are discovered in a drug that is already on the market.

Chemical Entity research program. Orchid Chemicals & Pharma-ceuticals Ltd., is the first India based Pharma to adopt System Biology technology from Cellworks in order to improve its Drug Discovery efficacy.

ANNUAL SPECIAL ISSUE

Intelligent IT solutions for healthcare

Dr. Rob Neeter Medical Director, VitalHealth Software Inc.

The only way to cope with more chronic disease patients with better quality of treatment in the face of limited personnel and funds is to use IT to transform the practice into a more efficient one.

January 2009

Discussions regarding the quality of healthcare today mostly focus on the availability of qualified personnel and effective and safe drugs. Qualified personnel are scarce and their professional education is expensive and time consuming. The cost and time factor is true for the development of effective and safe pharmaceutical treatment also. This situation has led to (and rightly so) to measures being taken to utilise precious resources in the most efficient way possible. The two most important areas the healthcare and life sciences industry has focused on, in this respect, are business process reengineering to organise the business/organisation/practice more efficiently and installation of intelligent software solutions, which should both support the more efficient organization, as well as the quality of outcomes. Software solutions are less expensive and more dependable than people and drugs, and therefore, it may be expected that apart from improvements in efficiency and quality of healthcare, it may be expected that this should be possible at a limited additional cost. Case study: The Netherlands In The Netherlands several dedicated healthcare software development companies have been founded to contribute to this important, though ambitious goal; and this region also serves as the test-bed for implementation of the new software. These companies meticulously try to develop software that will support the goal of improving efficiency and quality of outcomes at acceptable costs. One amongst these enterprises is VitalHealth Software, founded by the Mayo Clinic of the United States and a social venturing fund of a Dutch IT entrepreneur in The Netherlands. This company has been the subject of a prospective comparative

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study in order to investigate the clinical benefits and cost-effectiveness of such a software supported approach. VitalHelath Software, acquired for this reason the leading disease management company in The Netherlands, Diagnosis4Health, who had been developing and implementing practice and clinical support software for over 10 years. It was investigated whether the combination of the practical clinical experience and the superior Information Technology of both companies would be able to deliver the promise of a software support solution that will make the necessary contribution to the healthcare system. Prospective comparative study of usefulness of IT This project appears to be more than just a dream. This has been demonstrated by the first reports from the reputed Julius Center of the University Medical Center, Utrecht in The Netherlands. In a prospective comparative parallel study, a group of 55 matched practices were randomly organised into two groups, of which the active group (29 practices with 1699 patients) would get the opportunity to use the practice and clinical support software related to care for patients suffering from diabetes type 2 and the control group (22 practices with 1692 patients) would continue with practice as usual regarding the care for a similar patient set. The control group would get to work with the software one year after the start of the study. This pilot test, about which has been published in several journals1, 2, studied not only clinical outcomes, but evaluated the costeffectiveness also. The clinical investigators FGW Cleveringa, M van den Donk, KJ Gorter and GEHM Rutten from the Julius Center for Health Sciences and Primary Care, University

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Medical Center Utrecht, were supported by the health economics experts LW Niessen and WK Redekop from the Institute for Medical Technology Assessment, Erasmus Medical Center, Rotterdam, to assess the clinical outcomes in terms of their effect on the patients lives and to translate these effects into costs for the community. This analysis was conducted with the objective to prove whether or not practice and clinical support software would improve the health condition in patients with a chronic disease – in this case diabetes type 2 – and whether this improvement could be achieved at an acceptable cost. The outcomes would help in the discussion whether or not this type of software should indeed be applied in daily medical practice, and whether or not we could close the discussion on the subject by rigorously implementing it or by forgetting it for good. In the randomised trials, it was already shown and published that the so-called Diabetes Care Protocol (DCP, also known as Vital for Diabetes) is able to reduce the cardiovascular risk of type 2 diabetes patients.1 The DCP intervention consists of an organisational aspect, a software tool and repeated reporting. The organisational aspect means that a diabetes consultation hour is set up and run by a qualified practice nurse. The software tool consists of a computerised decision support system, a recall system and three monthly feed-back information. Study parameters In both groups patients were seen at baseline and after 1-year for their annual diabetes check-up. Among other things HbA1c, blood pressure, cholesterol, medication, diabetic complications were registered. Data of individual patients in both groups after a year were used to compute average lifetime disease outcomes, direct medical costs and quality adjusted life years (QALY) per patient. A validated probabilistic Dutch diabetes model and the UKPDS risk engine were used to extrapolate the results.2 This model included health states for cardiovascular disease (CV) and other severe DM2 related complications (blindness, end stage renal disease, lower extremity amputation). Costs of medication use and implementing and maintaining DCP were included. Incremental costs per QALY were calculated. Since 50% of the population had a history of cardiovascular disease

(CV+), the model assumes for 60-64 year old patients with CV+ an increased risk of a cardiovascular event (i.e., relative risk of 1.47 in men and 2.95 in women). Results Table 1 summarises the effectiveness results from the cluster-randomised trial. There were statistically significant differences in cardiovascular parameters at the end of the 1-year follow-up. These differences resulted in a reduction in 10year UKPDS coronary heart disease risk estimates. Table 2 shows the lifetime QALYs and costs for DCP and control treatment. Patients in the DCP group live 0.63 years longer than patients in the control group, and experience 0.38 more QALYs. Patients in the DCP group incur slightly higher medical costs than patients in the control group (EUR 130). These differences (EUR 130, 0.38 QALYs) result in an incremental cost-effectiveness ratio of EUR 342 per QALY gained. DCP would cost about EUR 300-400 per patient over a lifetime. However, it would reduce the risk of CV events and thereby reduce CV event costs.

Table 1. DCP trial outcomes of clinical parameters within and between groups (N = 3391) * The 10 year United Kingdom Prospective Diabetes Study (UKPDS) coronary heart disease (CHD) risk (%) was calculated using: date of onset of diabetes (age – duration of diabetes), sex, ethnicity, smoking, HbA1c, systolic blood pressure, total cholesterol and HDLcholesterol † generalised linear model ‡ for percentages the OR is given § Improvements of intervention group compared to control group significant (p<0.05)

Table 2. Costs and effects of the DCP compared to usual care: Base-case results

Conclusions One-year results show that DCP is improving the quality of outcomes and reduces cardiovascular risk in patients with diabetes type 2, resulting in a extension of life of 0,63 years of which 0,38 years are spent in good quality (0,38 QALY’s). With costs of EUR 342 per QALY gained DCP is very cost-effective as compared to usual care in The Netherlands. Based upon these results health authorities, health insurers and medical professionals are increasingly interested in implementing this type of IT supported care systems. In The Netherlands this is expected to lead to structural improvement of the quality of medical care. In countries where healthcare has not yet reached the quality standard of The Netherlands, the DCP approach offers a big chance to make tremendous developments towards quality care. The other countries do not have to make huge investments now in R&D, and they don’t have to go through the long, painful and expensive journey of trial and error. They can take advantage of these results, minus the original investment and with a much shorter time-to-market, which may just be very suitable for countries, which are in the process of their development. Acknowledgement The author is grateful to Dr. Frits Cleveringa c.s. for allowing him to cite from his published data and presentations. References: 1. Cleveringa et al. Combined task delegation, computerised decision support and feedback improve cardiovascular risk for type 2 diabetes patients. A cluster randomised trial in primary care. Diabetes Care 2008;10.2337/dc08-0312. 2. Dijkstra et al. A Patient-centred and professional-directed implementation strategies for diabetes guidelines: a cluster-randomised trial-based cost-effectiveness analysis. Diabet Med. 2006 Feb;23(2):164-70. January 2009

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Revitalising & Reinventing HCL’s Life Science, Healthcare & Chemical practice has emerged as the fastest growing practice amongst Indian IT Service providers, and now seeks to revitalise it’s clients’ business enterprise using vertical applications and integrating them with ERP using middleware and SOA. Pradep Nair, Vice-President & Global Head of the Life Sciences, Healthcare & Chemical practice discusses with eHEALTH the growth strategy and vision of the three micro-verticals.

Pradep Nair Vice-President and Global Head Life Sciences, Healthcare and Chemical Practice HCL Technologies

Q. How do healthcare and life sciences verticals differ in terms of technical challenges and demands as compared to other industry segments? How do you propose to tackle the unique challenges that these two segments throw up? A. The healthcare segment consists of Payer (Health Insurance) and Provider (Hospitals, clinics etc), while the life sciences vertical consists of Pharmaceutical, Clinical Research Organisation (CRO), Bio Technology industry and Medical Devices Industry. This segment is an emerging vertical as it started to adopt IT and outsourcing services much later than other verticals like financial or retail vertical. The healthcare and life sciences vertical focuses on the well being of people and is very sensitive to the impact of services offered to the general population. Thus, regulatory compliance becomes extremely important to ensure that all required precautions and regulations have been followed. Also, due to the increasing pressure to have life changing patented solutions, the Life Sciences vertical invests heavily in R&D. The spiraling R&D costs, in turn increases the cost of healthcare. The sharp increase in costs in the healthcare sector and the growing demand caused by an aging population too exercise great pressure from insurers on healthcare providers. Healthcare providers are being forced to reduce costs among

January 2009

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others by increasing productivity. Also, APAC countries like China and India have vast, geographically dispersed populations, and the limitations in communications infrastructure may impede their efforts in setting up efficient healthcare infrastructure. Life sciences industry looks for outsourcing partners who can provide solutions for a complete product that can address the entire value chain, so as to optimise the R&D spending on innovation for new product introduction. Over the past five to ten years, healthcare providers have moved from seeing IT exclusively as a billing and scheduling tool to accepting that technology can help make their clinic practices more efficient and safer. As per Health Industry Insight, an IDC company, even the billing aspects of IT have undergone transformation as P4P and new insurance vehicles such as high-deductible and consumer-directed health plans (CDHPs) put more focus on the revenue cycle and the cost of care that require provider attention. In medical device companies, technological advancements that combine improved therapeutic effects (such as better clinical outcome) with lower overall costs (such as shorter hospital stay) has become of prime importance. Another interesting area is

the emerging markets. Medical devices companies are strategising to explore with low cost products in emerging markets. The BRIC countries’ medical device and equipment markets are currently valued at USD 10.4 billion, as per “Medical Device Markets of the Future?”- a report published in January 2006 by Espicom Business Intelligence, Chichester, UK. And as per Datamonitor, Pharmaceutical industry will lose nearly USD 80 billion in revenue by 2008 due to patent expiration. The largest 50 pharmaceutical companies in the world spent more than USD 100 billion on R&D in 2006. For Pharmaceutical companies, reducing operating costs and streamlining, automating and/or integrating key business processes are key drivers for offshoring work. Safety and pharmacovigilance risk management will be one of the fastestgrowing application development areas in the life science market. Driven by growing interest among regulators, consumers, and the medical community, drug safety is rising in both importance and visibility to drug manufacturers. HCL works with some of the top pharmaceutical and medical devices companies along with global, large and cluster hospitals. The company provides business aligned IT solutions to healthcare providers and pharmaceutical companies, which address the pain points of CIOs. These solutions focus on reducing the process cycle intensity and create revitalised enterprise by integrating ERP with custom applications. We have developed custom products along with Intersystems, SAP and Oracle especially for healthcare and pharmaceutical industry. We also provide business aligned R&D services for medical devices companies, which address the pain points of CTO and Head R&D. With therapeutically aligned, end-to-end concept to manufacturing services, HCL enables medical devices companies to create innovative, low cost and reliable products. HCL also partners with leading research institutes across the globe to enable medical device companies to launch medical devices for emerging markets.

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Q. What IT products and services does HCL currently offer in the two micro-verticals of Medical Devices and Healthcare? A. HCL has the largest dedicated medical devices practice amongst Indian outsourcers and works with 19 of the top 40 medical device companies in the world. With a team of 900 plus domain experts and consultants, HCL provides therapeutically focussed, business aligned R&D offering end-to-end ‘concept to manufacturing services.’ HCL provides concept development, design, protyping, validation, regulatory and manufacturing. HCL works for Cardio, Ortho, Renal, Diabetic and bed side equipment industry segments and has worked on 89+ products with Zero product recall. HCL is the 1st Indian service provider to be ISO 13485 certified, and has compliance lab, which is certified for ISO/IEC 17025. HCL has also been delivering significant value for its Life Sciences customers through the integrated package of process management, software services and infrastructure management; and works with 10 of the top 20 Pharmaceutical companies. With a team of 1600+ domain experts, regulatory consultants, clinical trial technicians, biostatisticians, software engineers and consultants, HCL provides business aligned IT offering with drug discovery to sales and marketing services. The company provides IT services, infrastructure and BPO services for Life Sciences conglomerates; and is working with SAP and Oracle to create custom solutions to address the needs of the industry. In the field of healthcare, HCL is the first Indian IT services company to be the early adopter Solution Partner using InterSystems Technologies. With a team of 200 medical doctors and consultants, HCL provides business aligned IT services to healthcare industry. It also provides ERP, Middleware and SOA, EMR and Hospital Information System implementation, maintenance and support services Q. What is HCL’s strategy for strengthening its healthcare and life sciences vertical, in India?

A. The Indian economy with a healthy economic growth rate is certainly a lucrative market for HCL. The company already works with most of the large healthcare providers in India. We are also engaged in enabling the top medical devices companies to launch medical devices for emerging markets like Brazil, Russia, India and China. We also invested in the first private Test Lab in India, with an investment of USD 5 million. This ensures that all devices, from Class I to Class III are safe and meet all required quality standards. HCL has also designed many medical devices for emerging markets like a low cost, multilingual, portable renal therapy device to be launched in India in the next three months. To better understand the needs of the Healthcare, Life Sciences vertical, we conduct an annual study. Last year, we launched a joint survey with Knowledge@Wharton to understand the predisposition of ‘envisioning the medical device company of the future’. This year, we have initiated a joint research with School of Medical Science and Technology, IIT Kharagpur and Doctor Kares Hospital to understand the needs of ‘Launching Medical Devices for Emerging Markets’ and has with them created low cost, custom and innovative solutions. We spoke with over 283 Senior Executives of medical Devices companies, Medical Doctors, analysts and various thought leaders in the industry. We met them face-toface, used online polls and telephonic conversations to gather inputs. Three different sets of survey queries were created. Each was designed to understand the market trends, requirements of end users as well as capture the insights of thought leaders in this industry. The interactions and further analysis provided many striking insights into their plans and the problems faced while launching medical devices for emerging markets. Based on its vast experience working in this vertical and these periodic research, HCL has come out with3 innovative models that reduce process cycle time, democratise innovation and create a fixed process to apply innovation to business problems. January 2009

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Q. What do you think are the key issues the medical devices manufacturers and healthcare providers are struggling with and need to resolve immediately in India? A. In India, the majority of hospitals are extremely small as compared to U.S. and European standards. These facilities more closely resemble clinics, rather than full-service inpatient facilities, often having well under 50 beds. Government plays an active role in providing healthcare services in the Asia/ Pacific region. However, the healthcare industry in India has come a long way from the days when those who could afford it had to travel abroad. Today patients from neighbouring countries, Middle East, and the UK are flocking to India for specialised treatment. In India, the public healthcare system provide services free of cost or at subsidised rates to low income group in rural and urban areas, and with the recently passed healthcare bill by Government of India, a substantial improvement can already be perceived in health infrastructure. The Government is upgrading and increasing the total number of hospitals, clinics and clinical laboratories in urban and rural areas. According to a recent trade report by the Royal Danish Embassy, New Delhi and Trade Commission of Denmark, Bangalore, this is expected to drive growth in medical devices sector. The report says that the medical devices segment is expected to witness considerable imports of medical imaging equipment, cardiac care equipment, and medical laboratory equipment during the forecast period. Telemedicine services in India are also expected to grow, which, in turn, should create demand for diagnostic medical equipment such as X rays, CT-scanners, dopplers, ultrasound, electrocardiographs, and so on. However, medical device firms may soon be facing what big pharmaceutical companies have come to live with for several years now - less cash to spend, and ultimately fewer dollars to invest in essential R&D. Though the India and China markets are growing at 4.7% to 6.5% a year respectively, (Espicom

January 2009

Business Intelligence, UK) to tap that market, will require substantial changes in product design, user interface and cost structure. The biggest would be learning to build medical equipment at the right price. In the U.S., a dialysis machine might cost USD 1,400, whereas in India, the market will only bear a machine priced below USD 600. Similarly, there are also certain basic socio-economic differences that need to be kept in mind while developing medical devices for the emerging markets. These are countries where electricity is a major issue, and hence it is important that the devices have a longer battery life. Also, unlike in developed countries where disposable devices are preferred, in the emerging market, the users want their devices to be reusable and rugged. These are insights that came out of the joint research with School of Medical Science and Technology, IIT Kharagpur and Doctor Kares Hospital to understand the needs of emerging markets. Manufacturers in the medical device market thus face the challenge of maintaining profitability despite slumping average price per unit. According to analysts, while growth in unit sales increased by more than 15.6% from 2007, the average price per unit reduced by 8.9% per year from 2007. Q. What role is HCL playing / what stake does HCL hold today in the arena of clinical trials in India? A. A comprehensive Clinical Trial Supply Management Solution is key to accelerating clinical trials and gaining the

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competitive advantage. HCL enables IT Services for Clinical Trials for leading medical devices and life sciences companies. The services include Hosting, Investigators and Site Management, Patient Life Cycle Management, Adverse Event Monitoring and Management, Clinical Trials Supplies Management, COTS Implementation, Application development, maintenance and support and Data Integration. HCL also provides Clinical Data Management and Data Analysis services including Paper and EDC, CRF Design, Data Management Plan, Database Design and Build, Data Entry, Data Validation Plan, Data Review and Validation, Query Management, and Medical Coding AERS/SAE Reconciliation, Database Lock, Quality Control, Review for Protocol Adherence, Clinical Data Migration, Standards Adoption, Application development, maintenance and support and COTS implementation/ validation. Q. How do you plan to grow in this field in next 5 years? A. HCL Life Sciences Practice has been growing at 65% year on year since its inception in 2001, and is the fastest growing vertical in HCL Technology and seeing the market trends HCL is extremely bullish about its growth. But as a policy, HCL doesnâ&#x20AC;&#x2122;t give any forward-looking statements. Q. Please comment on the scope, importance, and current market share of HCL in India and other countries in the Asia-Pacific region, with respect to the medical devices and healthcare segments. A. With 65% year on year growth, HCL Life Sciences, Healthcare and Chemical Practice contributes to 6% of HCL Technologies revenue. HCL is the largest medical devices practice amongst Indian outsourcing company and works with 19 of the top 40 Medical Devices companies in the world. These medical devices companies are also present in India or are in the process of entering emerging markets. HCL also works with 5 of the top 10 Pharmaceutical companies in APAC. HCL also works with multiple leading hospitals in India and APAC region.

Malaysia

to Host HIMSS AsiaPac09 24 - 27 February 2009

ealthcare and healthcare IT experts from around the world will converge in Kuala Lumpur from 24-27 February 2009 for HIMSS AsiaPac09 organised by HIMSS, the Healthcare Information and Management Systems Society, a not-for-profit and non-governmental, international healthcare membership organisation. This follows the successful staging of HIMSS AsiaPac08, held in Hong Kong, which united over 1500 healthcare and healthcare IT leaders across the region to share best practices, gain insights and discover the latest innovations to advance quality healthcare through IT. Steven Yeo, Vice President and Executive Director, HIMSS Asia Pacific, said, “HIMSS AsiaPac09 is an ideal platform for healthcare IT stakeholders to connect and exchange ideas and get the latest updates on worldwide healthcare IT trends. We chose to hold HIMSS AsiaPac09 in Malaysia because Kuala Lumpur is the gateway for healthcare organisations and is easily accessible from many major cities in the Asia Pacific region, which makes it the perfect location to host next year’s event. “HIMSS AsiaPac09 comes at an opportune time as the Malaysian government considers its healthcare industry as one of its top priorities and many initiatives are in place to boost the country’s Healthcare sector. This includes improving existing hospitals’ quality care through use of Health IT, upgrading facilities and improving training for its healthcare professionals,” said Yeo. Tan Sri Dato’ Seri Dr. Haji Mohd. Ismail Bin Merican, Director General, Ministry of Health, Malaysia is scheduled to deliver the opening keynote address at the HIMSS AsiaPac09 conference which will offer more than 30 education sessions covering topic areas by speakers representing over 14

countries. These experts and high-level representatives will provide a variety of perspectives and unique insights into the latest trends and issues facing the healthcare industry today. Other notable keynote speakers include Professor Emeritus William Edward Hammond, Chair, Health Level Seven Inc. at Duke University, Enrico Coiera, Director, Centre for Health Informatics, University of New South Wales and John J. Nance JD, John Nance and Associates. “Healthcare is facing fundamental issues in costs, accessibility and quality of care. Together with the aging population across the globe and especially in the Asia Pacific region, the healthcare sector will need to focus on reducing cost of care delivery and the administrative cost as well. Another issue facing healthcare is ensuring that quality of care is achieved through effective diagnosis, patient compliance and avoiding medical errors. Improving access to care in remote communities or emerging and underdeveloped economies with enough hospitals and care professionals is another area that needs to be addressed. It is thus imperative that healthcare organisations recognise the issues and respond with effective processes and technologies for delivering superior care, and this includes the widespread adoption of healthcare IT systems to deliver improvements in the quality and accessibility of care and also lowering costs,” said Yeo. In addition to the keynote addresses, the HIMSS AsiaPac09 Conference will offer almost 25 education sessions, covering topic areas by speakers representing over 12 countries. The conference offers a practical solutions-oriented educational programme covering three main tracks in eHealth; EHR/EMR/EPR/PHR; and IT Strategy & Innovation. Additional sessions will explore

topics in Clinical Leadership & Governance, Business Case for Sustainable IT and Communication - Connection for Care. The HIMSS AsiaPac09 exhibit hall, featuring over 50 companies showcasing their latest products and solutions in a hands-on, interactive and dynamic environment, will provide visitors with an opportunity to explore the latest in healthcare IT solutions, emerging technological advances and interoperability standards. The HIMSS AsiaPac09 will also offer two purposefully developed, full-day symposia and one regionally targeted workshop to provide clinicians, care providers, government personnel and leaders the opportunity to hear from experts in their fields on the most prominent issues in healthcare in the Asia Pacific Region today. The Physicians’ & IT Leadership Symposium will focus on solutiondriven approaches, healthcare IT issues, and IT as a foundation for innovation, integration and expansion of care delivery. Participants will also have the opportunity to tour Serdang Hospital, a government-funded multi-specialty hospital. The Nursing Informatics Symposium will provide an opportunity for nurses, clinicians and managers to discuss key issues on how to effectively integrate IT tools to improve processes and workflow at the point of care, and approaches for enhancing patient care and quality outcomes. The Developing Countries Workshop at HIMSS AsiaPac09, created specifically for providers, leaders and government officials from emerging nations is designed to give insights on healthcare IT advances within the Asia Pacific region and provide an environment of knowledge sharing in capacity building for developing countries. Registration is now open at www.himssasiapac.org

January 2009

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ANNUAL SPECIAL ISSUE

Intelligent

ommunication An integrated approach to IT and communication systems for better patient care and higher operational efficiencies.

ealthcare workers live in a very dynamic environment where they constantly gather, communicate and analyse information to take clinical decisions and to monitor the effect of the decisions made. All healthcare workers will vouch for the fact that timely intervention based on real-time evidence saves lives everyday. The importance of collaboration and communication in healthcare delivery is exceptionally high as the industry deals with issues of life and death where time lost could result in the loss of life. Madhukar Saboo Head - healthcare & Life Sciences vertical Avaya GlobalConnect

While information sharing and collaboration is definitely required, there is always a danger of information overload, more so for caregivers. Multitasking in a mobile working environment is true for all of them and information overload can reduce efficiencies. The need of the hour is not simply communication but intelligent communication of information. Intelligent Communication is about dealing with information end-to-end. It is about evaluating whether information is relevant, if it is relevant to whom it should be conveyed, how it should be conveyed, and once conveyed, help the person take appropriate action. Intelligent Communication solutions utilise advancement made in communication technology in conjunction with IT systems to manage information dissemination and collaboration require-

ments in different business contexts effectively, reducing unwarranted delays and human effort. Consider a scenario which is very often seen in hospitals. A doctor orders the blood sugar test of a diabetic heart patient who has just undergone surgery. The test result is released on the IT system. The sugar level is out of limit and requires intervention; the doctor needs to be consulted. The responsible doctor is busy in another operation, so the information needs to be conveyed to another doctor. The other doctor is not in the hospital so the information has to be communicated on his mobile. Once the information is conveyed to the second doctor, he wants to talk to the floor doctor to alter the amount of insulin being given to the patient. What we see here is involvement of multiple people through which information is analysed and communicated to the decision maker. Automating all the above steps so that there is no human or system latency, and the communication solution along with IT systems take care of: ď&#x201A;&#x; Evaluation of information and deciding whether it has to be communicated or not. ď&#x201A;&#x; Communicating information to the right person based on availability Enabling the right person to take action based on information.

January 2009

ANNUAL SPECIAL ISSUE

is mapped to his mobile whenever the system detects he is not in hospital, hence his mobile rings simultaneously and the contact between nurse and the doctor is established. In case the doctor is not available on his mobile, the system can check who is next in line to take a decision and match the next doctor with the nurse. The benefits are for all to see. The nurse is free to attend to other patients instead of spending time hunting for the mobile number and then dialing it. The doctor is reached anyway and connected with the nurse. The overall responsiveness of the organisation increases.

Intelligent Communication reduces human latency and makes organisations more responsive, thus increasing the overall quality of patient care while reducing information overload on caregivers and bringing in process efficiencies. Healthcare providers have been investing in Hospital Management Systems (HMS) and clinical decision support systems (CDS). These help in capturing information and directing it to the right persons on desktop or tablets. But given the mobile, non-desktop nature of the healthcare delivery and the fact that generally doctors are attached to multiple healthcare organisations, the challenge remains to provide the right information to the right person in time. The solution lies in having an integrated approach towards IT Systems and Communication Systems so that together they are able to better serve business requirements.

Challenges before Healthcare Stakeholders Patients, doctors, nurses, paramedics support staff and hospital management are four major stakeholders in any healthcare system. The primary challenges faced by each one of them are different. While the patient is mostly worried about the responsiveness of an organisation (given that he has chosen the organisation based on clinical expertise), for the doctors, access to the right information at the right time is the major concern. The nurses are occupied in coordinating between different departments for getting information, though by design they should spend maximum time in patient care. Hospital Management aims to increase operational efficiencies while providing good environment for best possible patient care and for practicing medical specialties. If you look at the overall picture, all the above challenges have genesis in how information is being generated, handled, communicated and acted upon. IT systems like HMS and CDS do improve the process of information

January 2009

capturing and communication but do not go the entire length to solve the problem. Take for example, a nurse during her rounds notices some symptoms and registers the same in her notes in CDS. Based on the symptoms, she intends to consult the doctor immediately. The CDS sends an email to the doctor. The doctor if out of hospital remains unaware of the patient symptoms. The nurse does not receive any response and she realizes that probably she needs to personally call the doctor. The nurse calls doctor’s extension but no one picks the phone. She searches around for the mobile number and is able to reach the doctor on phone after encountering busy network problem a couple of times. The delay in reaching the doctor is systemic and no one can be held responsible for the same. How the above scenario can change by the appropriate utilisation of communication technology can be seen as follows. As soon as the nurse notes her observations in CDS and her intention to consult the doctor is made clear, an e-mail is sent. Simultaneously, the communication system checks for the ‘presence’ of the doctor and notes that he is not available in the hospital. The system dials the nurse as well as the doctor’s extension number simultaneously. The doctor’s extension number

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The scenario described above requires a number of IT and communication technology components to work seamlessly. As we stand today, these components are all available in enterprise portfolio but are working in silos. Enterprise Communication System specialist companies like Avaya help healthcare organisations implement the right communication technology components and integrate them with existing IT systems to maximise business benefits out of investments made in both IT and communication systems.

Internet Protocol (IP) makes Intelligent Communication Solutions possible Communications technology has evolved over centuries from beating drums, smoke signals to modern smart phones and embedded communications. Numerous technologies are now available for transmitting information from the sender reliably over any medium to the receiver. For decades we have been using TDM technology, which has served us well till the evolution of smarter solutions such as email, video, text messaging etc. Moreover, voice over IP technology has helped in converging traditional voice on desk phones and combine the same with video and other communication platforms enabling unified communication. Unified Communications helps users to use their preferred device when they are on the desk, mobile or working from home, without compromising on

ANNUAL SPECIAL ISSUE

functionality. It also allows customers or patients to reach doctors and nurses without worrying about their location. The presence of users is available which allows you to communicate with your peers in the preferred mode as you are aware of their status. Since different channels of communication viz voice, video, email, instant messaging etc. have converged on IP technology, this provides a unique opportunity to use these communication tools in conjunction with IT systems - laying the foundation of Intelligent Communication Solutions. From a user perspective, one is least bothered about the bifurcation of underlying tools or systems being used. At the end of the day, the users want simplified processes to meet their business requirements and the same is achieved by integrating communication and IT platforms to devise Intelligent Communication Solutions.

Intelligent Communication Solution Examples Technology investments need to be closely scrutinized for their business

benefits. Communication solutions together with IT Solutions can provide following benefits:  Deliver faster access to critical information – push relevant information to the right person on right device or allow easy access to information on the phone.  Enable mobile working - manage the process of reaching right person on right device

January 2009

economically. Promote collaboration- enable joint decision making or expert consult (second opinion) remotely and on the fly increasing decision making speed. Increase process efficiencies -trigger alerts and notifications based on business rules decreasing human latency and optimising information delivery process.

done immediately. In such a scenario, as per American College of Cardiology, there are two bottlenecks.  The team to undertake the procedure is not ready  The facility to undertake the procedure is not ready Communication Solutions can expedite the process of contacting affiliated heart surgeons as well as support staff so that the procedure can be done in the least time.

Better patient care, lower average length of stay, higher staff satisfaction and retention, higher operational efficiencies, lower fatality rates, higher patient satisfaction and growth in top line as well as bottom line are business benefits accruing out of deploying communication technology intelligently with IT systems. Some of the examples of Intelligent Communication Solutions provided by Avaya are described in following paragraphs.

Disease Management: Less average length of stay (ALOS) is beneficial to hospitals as well as patients. Less ALOS increases average revenue per day of hospitals and for patients it means less expenditure as well as reduced probability of catching Nosocomial infections (hospital acquired infections). Disease Management Solution helps healthcare organisations to remotely collect, monitor and analyse key health parameters of patients.



Emergency Management: In emergency situations time is of great essence. Time taken for information dissemination and analysis, decision making and execution, needs to be compressed based on type of emergency. Quick action within golden hour can save lives. Communication Solution can dial out predefined groups of people (based on therapeutic area, skills, time of the day etc.) on their preferred device / number depending upon time of the day to apprise them of the emergency situation. These people can be brought into an audio conference to discuss their availability and finalise action plan. For example: suppose a patient is brought into emergency department and a blockage is diagnosed. An angioplasty needs to be

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Patient-Doctor Connect: Patients like to spend more time with doctors and doctors are pressed for time as they have to manage multiple patients. Doctors generally also operate from multiple healthcare facilities and sometimes have to travel only to meet recuperating patients. Patient-Doctor Connect Solution allows doctor to remotely meet patients through video conferencing. While doing video conferencing with the patient and enquiring about his health, they can access latest reports of the patient on Hospital Management System. In case the doctor wants to get second opinion, the solution can be used to have video conferencing with the expert and patient information can also be shared real time. Patient-Doctor Connect solution can also be used for providing telemedicine on large scale wherein a virtual Out Patient Department (OPD) can be created and all specialties can simultaneously provide their services at multiple remote patient points. Laboratory Test Reporting: Getting laboratory results in time to validate and further align line-of-treatment is one of the most common challenges that doctors face. The Laboratory Test

ANNUAL SPECIAL ISSUE

Reporting solution integrates with the Laboratory Information Management System (standalone or a module of HIS) to deliver laboratory results intelligently through a Voice Call or SMS in case so desired by the doctor. Intelligent Signage: Unavailability of information is one of the major pain points for out-patients. Intelligent Signage solution integrates various sources of information and displays the same in real time. The solution can display the queue status of patients (provided that is being captured in HIS) along with live television, advertisement and disease education related information from separate databases. Patient Feedback Management: Hospitals thrive on word of mouth. The customers who walk out of the hospital are most prevalent, least expensive and most influential source of advertisement. Generally all hospitals have a feedback collection and analysis system (mostly paper based) with a view to keep a track of quality of their services. The major drawbacks of such paper-based systems are:  The system is reactive to the point of no recourse – If a patient is dissatisfied with hospital services and rates the hospital bad on some parameters, the hospital is not in a position to address his/her grievances since the system is paper based and till the time it reaches responsible people, the patient has already left the premises.  Manual process of analysis – the feedback forms have to be manually analysed. Real time information is not available. Patient Feedback Management Solution allows patients to give feedback on the phone. The patient can rate different services provided by the hospital. Business rules can be configured to take immediate remedial action (the call can be directed to a patient relationship executive or a mail can be triggered) in case the rating is bad. Automatic reports presenting statistical data on ratings can be configured. The patient can record his/her qualitative

feedback. The top management can have a look at ratings in real time and can listen to qualitative feedback given by patients. The above solutions only showcase some business scenarios during healthcare delivery where judicious use of communication technology can give good results. There are umpteen scenarios which can be thought of, which requires information dissemination to relevant people and management of communication/collaboration of people after information dissemination for decision-making and activity closure on the ground. The technology infrastructure components can be used in different scenarios, which not only increase utilisation of infrastructure but also provide higher returns on investment due to business benefits on multiple accounts.

Execution Approach

Communication Technology has progressed leaps and bounds. Given the role Communication plays in Healthcare delivery, Healthcare organisations need to have overall strategy for leveraging communication technology to the maximum by having an integrated approach towards IT systems and Communication systems. A phased approach towards execution of overall strategy should be taken for better adoption of technology by users. First step in overall strategy should be to have basic building blocks of communication and their inter-operability in place. Multiple device and

channels of communication is fact of life. Telephony, Video, E-mail, Instant messaging, Voice messaging, Paging, Cellular, SMS and Application alerts are some of channels being used for communication while Desktop, Laptop, Cell-phone, Desk-phone, Pagers, PDAs etc are devices commonly in use. The goal of unified communications involves breaking down barriers between different communication channels so that people using different channels of communication, different media, and different devices can still communicate to anyone, anywhere, at any time. The users should be comfortable utilising unified communication tools before any further step is taken. Once unified communication tools are used extensively, embedding communication applications in dayto-day processes by integrating IT and Communication systems needs to be done. Intelligence has to be built and business rules need to be defined on IT systems to enable seamless usage of unified communication capabilities in different business context. Organisations need to fully leverage already established IT and Communication platform to meet business requirements. The goal of intelligent communication of delivering right information, to the right person, at the right time and on the right device can be achieved. Whereas IT systems help in filtering right information, the communication systems help in narrowing down the right person at that time and ways to pass on the information on the right device. In conclusion, Indian healthcare provider industry is in the midst of unprecedented change. The demand for better healthcare services has increased tremendously and the entry of corporate players in healthcare and the booming insurance industry is redefining the way healthcare services are delivered and paid for. Taking an integrated approach towards utilisation of communication and IT technology can substantially increase quality of patient care through increased responsiveness of and collaboration between healthcare workers. January 2009

ANNUAL SPECIAL ISSUE

Lack of Medical Device Interoperability -

is there a way out? Market Insight, Healthcare Practice, Frost & Sullivan

he fact that patient monitoring is not a new concept in healthcare is apparent. Santorio did the first patient monitoring in 1625 by measuring body temperature and blood pressure. Rapid advancements in technology took place post World War II that has led to the development of different types of monitoring till date.

Patient monitoring today To a large extent computer based monitoring and high acuity care systems have become affordable enough to be deployed on a large scale in many intensive care units around the world except for a few regions in

January 2009

It is hard to digest that keeping aside the IT enabled data transfer, the healthcare industry has minimally benefited from standards based interoperability.

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Asia Pacific and Eastern Europe. With bedside becoming an imperative site of displaying data, bedside monitors have started functioning with multiple capabilities like efficient monitoring, intelligent alerts, plug and play modules, Ethernet networking and many other features that provide easy, integrated monitoring in any facility. Most bedside monitors available today can incorporate data from clinical laboratory and bedside laboratory systems. The drawbacks of these features are that they usually have proprietary communications protocols and data acquisition schemes usually governed by the respective manufacturers.

ANNUAL SPECIAL ISSUE

Gaps in the system - medical device interoperability The most common problem with patient monitoring systems has always been their interoperability. Not all systems can be interfaced with other devices unless and until they are from the same manufacturer or from the

ones with whom strategic alliances exist. It is tough to debate whether industry conglomerates employ this strategy to improve their market share or to maintain the brand reputation that they have been enjoying thus far. Single vendor device integration looks achievable, whereas disparate devices from multiple vendors, assembled by end users or system integrators, run into interoperability barriers.

Interoperability - today’s scenario It is hard to digest that keeping aside the IT enabled data transfer, the healthcare industry has minimally benefited from standards based interoperability. Device connection established through leads and cables may result in electric shocks. A hazard report published by Medical Devices Safety Reports [MDSR] says patients received electric shocks when they were inadvertently connected to line power (120 VAC). These incidents occurred when electrode lead wires, which should have been attached to the patient cables connected to ECG or home apnea monitors, were instead plugged into energised detachable power-line-cord plugs. Reasons for lapses during device connectivity could be (i) device factor in the form of design error (ii) user error in the form of improper connection and (iii) support system failure due to use of inappropriate devices.

Is anything being done to address the problem? There are multiple reasons why medical devices do not have proper interoperability when compared to many non-medical devices, which can be easily integrated. (i)There is no incen-

Perfect interoperability is not a mere physical connection of two systems where one device provides data to a second device, but also a functional bridge where the second device understands what it is receiving from the first and thereby respond the way it is expected to.

second device, but also a functional bridge where the second device understands what it is receiving from the first and thereby respond the way it is expected to.

Is the job done? Establishing a perfect interoperability amongst medical devices is not that easy a task. The interoperability package should ideally have simple and user-friendly hardwares that are capable of physically integrating devices from different manufacturers. These hardwares should be governed by a versatile algorithm in order to put all the data into a single platform. This being a new approach, companies should collaborate to manufacture it.

An ideal interoperability platform Amidst all the difficulties, it is possible to create a “customised one-off solution” to integrate all the monitoring systems.

tive for medical device manufacturers to interoperate with other manufacturers’ devices. (ii)The medical devices industry also runs short of interoperability standards and the ones that exist are too complex. (iii)The healthcare sector, in general, has been lagging behind other industries with respect to computerisation and networking. (iv) Interoperability solutions face complex technical and social problems, including liability and regulatory issues. Several consortia are addressing the issue of medical device interoperability. The Medical Device Plug and Play program (MD PnP), Continua Health Alliance (Continua) and Integrating the Healthcare Enterprise (IHE) are groups focusing on interoperability. MD PnP is a multidisciplinary, multi-institutional program committed to simplifying and standardising medical device connectivity in support of improving patient safety and healthcare efficiency. In the regulatory arena, FDA is reopening discussion regarding the issue of a unique device identifier (UDI), which is one necessary ingredient for medical device interoperability. Perfect interoperability is not a mere physical connection of two systems where one device provides data to a

But it is complicated, expensive and could be possible only if manufacturers and the end-users join hands to bring

International Health Informatics Standardization

a permanent solution for a perennial problem. January 2009

UMBERS

NUMBERS

The diagnostic market has been growing at 15-20% each year, and by all indications shall continue to do so in the next 10 years.

India has 500,000 new cases of cancer every year.

There are 325 million current mobile phone users in India.

Healthcare spend of US Government is estimated to exceed US$ 2.7 trillion by 2009.

Tier I hospitals in India spend approximately 2% of their revenues on IT.

January 2009

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EVENTS DIARY

7 – 11 January 2009 21 - 23 February 2009 62nd Annual Conference of Indian Ra- Meditec Clinika 09 diological & Imaging Association ‘09 Hyderabad, India

6 – 10 March 2009 European Congress of Radiology 2009

Patna, Bihar

Vienna, Austria

http://www.meditec-clinika.com

www.iria2009.com

http://www.myesr.org/cms/website.php

9 - 11 January 2009 Medical Technology India 2009 New Delhi, India

23 – 26 February 2009 Global Healthcare 09 Singapore

1 - 3 April 2009 Med-e-tel 2009

http://www.magenta-global.com.sg/healthcare/

Luxembourg, Luxembourg

http://www.medicaltechnologyexpo.com/site/in-

http://www.medetel.lu/index.php

dex.html

12 - 14 January 2009 Strategic Healthcare Marketing & Management Conference & Workshop

24 - 27 February 2009 HIMSS AsiaPac 2009

16 - 19 June 2009 CommunicAsia 2009

Kuala Lumpur, Malaysia

Singapore, Singapore

http://himssasiapac.org/

http://www.communicasia.com/main.htm

Singapore, Singapore http://www.conferences.com.sg/S1322-HCM55V-E.pdf

25 - 28 February 2009 2nd International Conference on Advanced Technologies & Treat19 January - 20 February 2009 Pan-India Private Equity Investment ments for Diabetes Forum 2009 Athens, Greece Ahmedabad, India

16 - 19 June 2009 Enterprise IT 2009 Singapore, Singapore http://www.goto-enterpriseit.com/main.htm

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31 July - 02 August 2009 Medicall 2009

http://www.vcindia.com/

Chennai, India http://www.medicall.in

12 - 13 February 2009 Map World Forum

27 - 29 March 2009 Medical Fair India

Hyderabad, India

New Delhi, India

www.mapworldforum.org

http://www.mdna.com/shows/medfairindia.html

4 - 6 August 2009 eHEALTH India 2009 India Expo Centre, Greater Noida (Delhi NCR), India http://www.eIndia.net.in/ehealth

January 2009

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5th

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INDIA

2009 4-6 August, 2009 India Expo Centre, Greater Noida (Delhi NCR), India

...the definitive event on healthcare ICTs, technologies and applications

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Hospital Automation & Management Systems Clinical Information Systems HMIS & ERP EMR & Medical Informatics Medical Imaging, RIS & PACS Communication & Network Solutions Tele-medicine & Tele-health

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