eHEALTH 50th SPECIAL ISSUE: January 2011

The Monthly Magazine on Healthcare ICT, Medical Technologies & Applications

volume 6 / issue 01 / JANUARY 2011 ` 75 / US $10 / ISSN 0973-8959 www.ehealthonline.org

Special Issue

Dr Prathap C Reddy

Chairman Apollo Hospitals Group

Dr Devi Shetty

Chairman Narayana Hrudayalaya

Dr Krishnaswamy Kasturirangan Member Planning Commission

Babu A

CEO Aarogyasri Healthcare Trust

contents

Volume 6 | Issue 1 | january 2011 | ISSN 0973-8959 www.ehealthonline.org

24 Dr KK Aggarwal

Cover story

Snapshots of Change Pg. 15

Dhirendra Pratap Singh

spotlight

“The Indian doctor today stands tall”

Dr Prathap C Reddy, Chairman, Apollo Hospitals Group

“ISRO has taken key initiatives for telemedicine”

cover story

A Comprehensive Health Package at `10 Dr Devi Shetty, Chairman, Narayana Hrudayalaya

26 Medanta-The Medicity

Dr Krishnaswamy Kasturirangan, Member, Planning Commission

Changing Paradigms in Health Information Technology Dr Adam CHEE, Chief Advocate (Director), binaryHealthCare.com

Satellite Technology Bridging the Health Divide

Snapshots of Change

Max Healthcare

expert speak

in focus

Dhirendra Pratap Singh

www.facebook.com/ ehealthonline

32 National Rural Health Mission

Ramachandran Viswanathan,President and CEO,Devas Multimedia

www.twitter.com/ ehealthonline

38 Tamil Nadu Health Systems Project

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editorial

Volume 6 | Issue 1 | january 2011 www.ehealthonline.org

Celebrating eHEALTH 50 With the beginning of the New Year 2011, eHEALTH achieves yet another landmark of completing 50 successful issues. The journey has been extremely exciting with the Indian healthcare sector achieving greater heights in the past decade. Healthcare has emerged as one of the most progressive and largest service sectors in India with an expected GDP spend of 8 percent by 2012 from 5.5 per cent in 2009. At present the sector is estimated to be around US$ 40 billion, in size, and will grow to US$ 78.6 billion by 2012. The Indian healthcare sector is expected to become a US$ 280 billion industry by 2020 with spending on health estimated to grow 14 percent annually.

President: Dr. M P Narayanan Editor-in-Chief: Dr. Ravi Gupta Managing Editor: Shubhendu Parth VP - Strategy: Pravin Prashant Editorial Team: Dr. Prachi Shirur, Dr. Rajeshree Dutta Kumar, Divya Chawla, Sheena Joseph, Yukti Pahwa, Pratap Vikram Singh Sales & Marketing Team: Debabrata Ray, Arpan Dasgupta (Mobile: +91-9818644022), Bharat Kumar Jaiswal, Anuj Agarwal, Fahimul Haque, Rakesh Ranjan (sales@elets.in) Subscription & Circulation: Gunjan Singh Mobile: 9718289123 (subscription@elets.in) Graphic Design Team: Bishwajeet Kumar Mobile: Singh, Om Prakash Thakur, Shyam Kishore Web Development Team: Zia Salahuddin, Amit Pal, Sandhya Giri, Anil Kumar IT Team: Mukesh Sharma Events: Vicky Kalra Editorial Correspondence: eHEALTH, G-4 Sector 39, NOIDA 201301, India, tel: +91-120-2502180-85, fax: +91-120-2500060, email: info@ehealthonline.org ehealth does not neccesarily subscribe to the views expressed in this publication. All views expressed in the magazine are those of the contributors. The magazine is not responsible or accountable for any loss incurred, directly or indirectly as a result of the information provided. ehealth is published by Elets Technomedia Pvt. Ltd in technical collaboration with Centre for Science, Development and Media Studies (CSDMS) Owner, Publisher, Printer - Ravi Gupta, Printed at R P Printers, G-68, Sector-6, Noida, UP, INDIA and published from 710 Vasto Mahagun Manor, F-30, Sector - 50, Noida, UP, Editor: Dr. Ravi Gupta © All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic and mechanical, including photocopy, or any information storage or retrieval system, without publisher’s permission.

The eHEALTH 50th issue is dedicated to innovations in the health industry; it covers actions and action heroes in healthcare sector during last decade. Encompassing the length and breadth of the industry, eHEALTH 50 spans across innovative landmarks in health IT, medical technology, government initiatives, healthcare delivery centres, life sciences, surgical procedures, people who have made all this possible, and more. Through this issue, eHEALTH aims to acknowledge, appreciate and salute the initiatives and innovations that have helped bring the much requisite transformation in the Indian healthcare industry. Going further, in line with our commitment to offer you the latest in ICT applications in healthcare and medical technologies, this issue is a comprehensive compilation of perspectives and experiences of stalwarts of the healthcare industry. Dr Prathap C Reddy, in an exclusive interview, reflects upon his journey from a cardiologist to an entrepreneur to a leader in the vibrant Indian healthcare sector. Throwing light upon the applications of space technology in healthcare and the government’s initiative in this space, Dr K Kasturirangan, Member, Planning Commission, provides insight into the future of this industry in India. Dr Devi Shetty, Chairman, Narayana Hrudyalaya talks about Yeshaswani, the micro health insurance scheme for the poor farmers, which is very close to his heart. Once again, we express our deepest gratitude for every author, contributor, advertiser, reader and subscriber of this publication who have time and again reposed their faith and belief in our purpose, by being our biggest supporters and advisors. We wish all of you a very happy and healthy 2011!.

Dr. Ravi Gupta Ravi.Gupta@ehealthonline.org January 2011 < www.ehealthonline.org <

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SPOTLIGHT

eHEALTH 50th Issue Special

As a cardiologist, entrepreneur and leader, Dr Prathap C Reddy, Chairman, Apollo Hospitals Group is an inspiration for many. In an exclusive interview with Dhirendra Pratap Singh, Dr Reddy talks about his journey as a healthcare entrepreneur, his latest initiative—the GAPIO and the key issues that affect the Indian health industry today. Excerpts:

“The Indian doctor today stands tall”

January 2011 < www.ehealthonline.org <

interview

eHEALTH 50th Issue Special

“To bring about a change, one must be able to give others, what he gives himself and his kith and kin. Naturally, you would want to give best healthcare services to your kith and kin and this is how we evolved ourselves” How has the healthcare scenario in India transformed over the years? The healthcare services in India, today, are as good as anywhere in the world, and we must be proud of this fact. Moreover, healthcare in India is very much affordable. We are doing very well in medical tourism, and I have no doubt that India would be able to become a global healthcare destination, in future. We have the best doctors, the best nurses, the best technologies and the best managers coupled with great prices. I think we have the best talent in the country, not only in Apollo, but in other institutes, as well. These specialists are proving the best healthcare services in the world. I believe that an Indian skill is second to none. What prompted you to start Apollo like world-class affordable healthcare facility in India? When I came back from the US, India did not have any affordable and quality heart surgical programmes. So, I used to send

patients who could afford these services to the US, mostly to Denton Cooley in Houston. During that time, I lost a young man who couldn’t afford to pay US $ 50,000 to go to Houston. It was then that I realised that if Indian doctors and engineers are par excellence overseas, then we must have these facilities available here, as well. That was the birth of Apollo concept and today, I am glad that we are equivalent to any other institute in the world. We have done 94,0000 heart surgeries and our success rate is 99 percent. No hospital in world has such results. To bring about a change, one must be able to give others, what he gives himself and his kith and kin. Naturally, you would want to give best healthcare services to your kith and kin and this is how we evolved ourselves. We are not only the India’s best but also best anywhere in the world. As the Chairman of Apollo Hospitals Group, what are the major challenges in running hospitals in India and what are

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the best ways to overcome these challenges? I believe that to be able to excel at something one must have excellent leadership qualities. The healthcare field is as challenging as any other economic activity, perhaps much more challenging because multiple people are involved in this industry. I think that playing the leadership role in a hospital is much bigger. A hospital CEO must be powerful and at the same time have a heart. Is the public-private partnership model workable in the health sector? What do you think are the limitations? Apollo Hospital in Delhi is perhaps one of the best hospitals in the world. Apollo Hospital in Delhi was set up during the time Mr Rajiv Gandhi was the Prime Minister of India, in a joint venture with the government, which co-invested in setting up Apollo. The hospital, today, is the pride of our country. Apollo hospital in Bilaspur is also working on the PPP model. Even the Chief Minister of Chhattisgarh believes that it is the only hospital providing specialty care in the entire region of Chhattisgarh. Rahul Gandhi Hospital in Raichur, Karnataka is also based on a PPP model. So, I think the PPP model works and will sustain and grow.

eHEALTH 50th Issue Special

spotlight

“Indian Doctor today stands tall. It is time for the Indian doctor to influence not only the health of individuals and communities but, global health”

More than 27 percent people in India live below the poverty line and have no access to basic healthcare facilities. In such cases scenario, what should be the role of government as well as healthcare leaders like you? There are two ways to address this—to assess what is the situation and to outline the measures that are required to obviate this. In remote areas, my concept of Reach Hospital is working towards the goal of reaching people in the remote areas, districts and tier 2 and tier 3 cities. India was a very rich country in the 17th century and its time now to bounce back. What is your opinion about medical training in India? India needs to do a lot in this field. There is a huge divide, as far as medical training in India is concerned.

There are both good and not so good institutes in the country. I think that the Medical Council of India (MCI) is doing a lot in this field now and we must compliment them. However, a tremendous amount of work still needs to be done. The MCI is transforming medical education in country in due course of time. What are your views on preventive healthcare in India? I think preventive healthcare is a crucial issue. India is still facing the so called infectious diseases burden, tuberculosis is reappearing and life style diseases are catching up. We are the diabetic capital, the heart capital and the cancer capital of world. Indians, today, are getting heart attacks at a very young age. There is no way to tackle this than to attack the problem. Every single family must take a pledge to leave smoking, do some exercise and do yoga and meditation. This will control diabetes and hypertension and incidentally cancer to the master level. These are the preventive measure that everybody must take. You have initiated the Global Association of Physicians of Indian Origin (GAPIO). What are its objectives and vision? It is estimated that there are 1.2 million physicians of Indian origin working not only in India, but also, in most of the countries

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around the world. This strong Diaspora of Indian doctors needs a common professional platform. There is a need for greater visibility and cohesion of these physicians. It is with these objectives that the society, Global Association of Physicians of Indian Origin (GAPIO) has been formed. GAPIO has the vision of improving health globally. A Google search for ‘Indian Doctor’ yields 35.7 million results in 0.1 seconds. ‘Indian Doctor’ today, stands tall. It is time for the Indian doctor to influence not only the health of individuals and communities but, global health. There is a plethora of physicians of Indian origin working globally who have their roots in India. Their combined intellectual and technical strength can also be a vital force in the development of the Indian healthcare sector. How GAPIO will work for quality healthcare with affordable access for all? Indian physicians both in India and abroad excel in their fields and have a passion to provide quality care. GAPIO will bring their collective power on one platform to help shape healthcare in underserved areas and work towards quality healthcare for all, especially in India. The society would work towards providing a platform to empower physicians of Indian origin to achieve highest international standards and act towards engaging with policy makers in order to highlight the challenges faced in the healthcare system not only in India but across the globe. It will serve as a forum and an advocate for the clinicians to mobilise their collective experience and expertise to help address global health issues with focus on India, assisting development of quality health care with affordable access for all. The most important thing is that how a doctor could work towards inclusiveness and take healthcare to the last mile. It is also important to involve them with society. Doctors still work very hard and it must be able to be visible to the society.

Photo: Joginder

IN FOCUS

Dr Krishnaswamy Kasturirangan Member, Planning Commission

January 2011 < www.ehealthonline.org < > www.ehealthonline.org > January 2011

in focus

eHEALTH 50th Issue Special

â&#x20AC;&#x153;ISRO has taken key initiatives for telemedicineâ&#x20AC;? Dr Krishnaswamy Kasturirangan, Member, Planning Commission, has steered the Indian Space programme for over nine years as Chairman of the Indian Space Research Organisation (ISRO), Space Commission and as Secretary to the Government of India. In an exclusive interview with Dr Rajeshree Dutta Kumar, Sheena Joseph and Pratap Vikram Singh, Dr Kasturirangan provides insights into the various applications of satellites and information and communication technologies in healthcare

What are the specific initiatives that have been taken under your leadership in the Planning Commission? How are you guiding and driving these programmes? In the Planning Commission, I am involved in the areas of science and technology, environment and forest, climate change and agriculture research. Space is one of the key areas within the science and technology segment that I am looking after. We have recently tried to complete the mid-plan review of various projects and programmes under the 11th Plan to look at how we have fared in these areas and also to identify the things we are supposed to do in the remaining two years left of the 11th Plan. By and large the programmes under various scientific departments like Department of Science & Technology (DST), Council for Scientific & Industrial Research (CSIR), Department of Biotechnology (DBT), Department of Space, Department of Atomic Energy and Ministry of Earth Sciences have been progressing to different levels based on certain targets that have been set for them. There have been significant developments in terms of our publications, as well. India has now gone to the 9th place in terms of overall publications. DBT is a very unique institution in terms of promoting innovations in biotechnology and recently it has organised Stanford India Biodesign to promote tech fellows or graduates from IITs or other areas of engineering, science and medicine. These fellows identify good and innovative ideas in the area of medical instrumentation. This is crucial

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as India imports medical instruments worth ` 15 crore and hardly 5% of the overall requirement today is indigenously manufactured. These youngsters are given a holistic view of the entire issue or dimension involved in creating medical instrumentation. This also involves opportunity and idea identification, converting that idea into prototype product, testing, evaluation, questions of business practices, financial management, ethical issues and intellectual properties. Is DBT, through its initiatives, being able to bridge the gap between indigenous and imported medical instruments? Yes. However, what is more important is the fact that it is trying to create cadres in the country, which can be the foundation for developing India as a biomedical instrumentation hub of the future. Can you elaborate on how science and technology and Indian remote sensing satellites contribute towards health? How specifically will these initiatives affect the social development sector? In health, specifically the Indian Space Research Organisation (ISRO) has taken some key initiatives for telemedicine. In India, there is a dearth of doctors and specialists in rural areas, whereas the density of doctors in urban areas, which have super specialty hospitals is much higher. Of the total number of doctors in India, hardly 2% practice in rural areas. So at doorstep of rural population, India does not have that kind of specialty support for treatments and diagnostics. Further, to transport every patient of rural area to

in focus

eHEALTH 50th Issue Special

“Today more than 300-320 hospitals in rural India have been connected to some 30-40 specialty or super specialty hospitals in urban centres and nearly 300,000 patients have been treated in through telemedicine. ” the city to get specialist medical attention will be a huge task and probably impossible. Many of the patients who come to cities should be guided as to how to treat a disease and have right diagnosis by a specialist. These are the considerations that prompted us to see whether we can install equipments in rural/district hospitals like electrocardiogram or chest x-rays to monitor everything electronically and send it via satellite to some urban hospitals, which has a telemedicine centre, so that the reports can be analysed by specialist doctors stationed thousands of kilometers away. So there is enormous potential of ICT in the context of healthcare system in the country. Nearly 300,000 patients in the recent past have been treated in through telemedicine. Today more than 300-320 rural hospitals have been connected to some 30-40 specialty or super specialty hospitals in urban centres like Apollo Hospitals, Ramachandra Hospital, Mata Anandmayi Hospital, AIIMS and Sanjay Gandhi Post Graduate Institute. All these hospitals are connected to the rural areas and doctors in urban centres provide services to the rural folds by providing timely medical advice which is of specialist nature. They have also built mobile vans, which can not only penetrate at the levels of district hospitals but can go to

other places and screen patients/population for their health problems and so on. These mobile vans can again transmit these reports using ICT for monitoring to specialty hospitals. Many of these scientific departments, particularly atomic energy, as a byproduct of their nuclear research programme have developed number of isotopes such as Cobalt 60 and CCM-137, which are available today for cancer treatment for radiation therapy. This is one class of development that scientific department has contributed to. But there are potentials for cancer detection and treatment where ICT can be brought in. Various types of processing which has gone into and newer softwares that have been brought into can reduce the complexities of hardware systems by judiciously complementing the hardwaresoftware interfaces. For example, ECG developed in CSIR laboratory costs only around `10,000. It is quite affordable and being installed at many locations in the country. ICT can further be used to send these ECG reports to various parts of the country. ICT can also be used for information processing and information improvements for image processing. The space department has developed as part of remote sensing system, a number of image processing algorithms. These

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image processing algorithms if suitably adopted could be used for looking at the images that are normally for the nuclear magnetic MMR, CT scan, gamma ray cameras, etc. All of them need variety of image processing techniques which is found in the realm of information technologies because these are all signal processing and signal analysis. The National Innovation Council promotes innovations which could actually cater to the need of grassroot people. What is the broader objective of this and what is the roadmap for addressing the needs of common people? National Innovation Council has now formed three scientific departments or consortiums. We will bring them together and they will exchange their experience. Many of them have built their equipments for nuclear applications, medical applications and educational programmes. But then they will exchange their experiences, look at all technologies and analyse the potential for mapping these technologies for rural development or social applications. However, this has not been organised in a manner which is both sustainable and which can make an impact so far. This is where National Innovation Council’s relationship with other scientific departments is going to make a difference. Three departments—Atomic energy, Space and DRDO have already set up headquarters called the Innovation Directorate. Ultimately they are going to work together but initially it is going to be a linked system, which will exchange information and work with people in social areas, health areas, etc. to find out their requirements and transform these technologies to meet their demands. The ultimate mission is to see whether we can even create an institute where all the three could pool in their knowledge and then try to create solutions which become a kind of a gateway to find inroads into societal applications or health applications by appropriate institutions that specialise in it.

cover story

eHEALTH 50th Issue Special

Snapshots of Change A rainbow collection of stories in the field of healthcare that track the life of India growing fast, and how! By Dhirendra Pratap Singh

s Joel A Barker once wrote, “Vision without action is merely a dream. Action without vision just passes the time. Vision with action can change the world.” The last decade defined by innovations and new technology trends in healthcare, one word dominated the global vocabulary: change. Healthcare has emerged as one of the most progressive and largest service sectors in India with an expected GDP spend of 8 per cent by 2012 from 5.5 per cent in 2009. At present the sector is estimated to be around US$ 40 billion and will grow to US$ 78.6 billion by 2012. The Indian healthcare sector is expected to become a US$ 280 billion industry by 2020 with spending on health estimated to grow 14 per cent annually.

In eHealth 50th issue we are covering actions and action heroes in healthcare sector during last decade. Our segments are-Health IT, Medical Technology, Government Initiatives, Innovators, Healthcare Delivery Centres, Life Sciences, Procedures and more… If we consider year 2010, then it can be considered a year of technology advancements and innovative business models in Healthcare using IT to ensure reach-out to masses. Says Gaurav Mundra, Director & Chief Operating Officer, Truworth Infotech Pvt Ltd, “The year 2010 has been like no other for Healthcare IT not just in terms of the revolutionary and groundbreaking technology advancements in Healthcare but also in terms of innovative business models in Healthcare using IT

to ensure reach-out to masses.” He adds, “This was the year of the cell phone but the greater excitement is about the next year which will be the year of the tablets – iPads, Samsung Galaxy Tab, Dell Streak etc. which provide 3G data transfer, much bigger screen to allow content and application placement better.” Aniruddha Nene, Principal Consultant & Director, Dr 21st Century Health group considers India’s IT integration of evidence based protocols and pathways as the most innovative IT solution of the year 2010. The global Healthcare IT market is forecast to exceed $24 billion by 2015 with a CAGR of 11 percent. The market is expected to be driven by governments’ financial incentives and regulations requir-

January 2011 < www.ehealthonline.org <

Cover story

eHEALTH 50th Issue Special

“As the healthcare industry matures, the next goal of care delivery demands clinical excellence through evidence based medicine tools and benchmarks” Alam Singh Assistant MD, Milliman India

ing automation in healthcare practices. The market growth is also expected to be driven by increasing need for hospitals to attain cost efficiencies and growing evidence of use of IT in healthcare practices.

New Paradigms The concept of Remote Diagnostics is picking up in India. More and more experts are interpreting digital images of MRI, CT scans, X-rays, etc and sending their interpretations to doctors practising not only in various parts of the country but also abroad. This innovative solution is simply a new paradigm of seeking medical expertise. Similarly, Telemedicine is fast becoming an integral part of healthcare services in several countries including Canada, Italy, Germany, Japan, Greece, Norway and now India. In India, Karnataka has become the role model in the country implementing telemedicine, networking all districts. The market penetration of Picture Archiving and Communication Systems (PACS) in India is gaining momentum owing to the growing popularity of digitisation at the level of hospitals and healthcare delivery centres. Says Dr.G.S.K.Velu, Managing Director, Trivitron Group of companies and Vice Chairman Metropolis Health Services, “Medical Technology over the past ten years have transformed the healthcare sector by several cutting edge technologies

in the areas of Molecular Diagnostics, Molecular Imaging, Minimally Invasive Therapies, Implantable Medical devices etc. Anyhow the world today needs technology innovation coming from the emerging world to ensure the new technologies is affordable to the larger section of the population across the world.” He adds, “New technology should not mean expensive technology and MT segment should take the clue from IT and Telecom Industry and come out with cutting edge technologies affordable and accessible to larger section of population across the world.” The size of the Indian medical technology industry may touch US$ 14 billion by 2020 from US$ 2.7 billion in 2008 on account of strong economic growth, higher public spending and private investments in healthcare, increased penetration of health insurance and emergence of new models of healthcare delivery. Says Alam Singh, Assistant MD, Milliman India, “As the healthcare industry matures in terms of infrastructure and innovative technologies, the next goal of care delivery demands clinical excellence through evidence based medicine tools and benchmarks. Evidence based medicine is already being promoted globally and has been proved to be beneficial for all the stakeholders- clinical teams, hospital management as well as the patients. Evidence based medicine tools like clinical protocols and clinical pathways pro-

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Fact files Healthcare sector in India, at present is estimated to be around US$ 40 billion and will grow to US$ 78.6 billion by 2012 The size of the Indian medical technology industry may touch US$ 14 billion by 2020 on account of strong economic growth, higher public spending and private investments in healthcare The global Healthcare IT market is forecast to exceed $24billion by 2015 with a CAGR of 11 percent In the last Union Budget, Government increased the plan allocation for Ministry of Health and Family Welfare from US$ 4.2 billion in 2009-10 to US$ 4.8 billion in 2010-11 With a world average of 3.96 hospital beds per 1000 population India stands just a little over 0.7 hospital beds per 1000 population. India would require another 1.75 million beds by the end of 2025

Cover story

eHEALTH 50th Issue Special

“This was the year of the cell phone but the greater excitement is about the next year which will be the year of the tablets which provide 3G data transfer and much bigger screen”

vide explicit and well defined standards of care for the clinical teams and support multi-disciplinary care planning.” He further says, “From a management perspective these tools reduce healthcare costs, reduce patient documentation, optimise management of resources and help continuous clinical audit. They improve clinical care by delivering superior outcomes, improved clinical effectiveness and patient satisfaction.”

Gaurav Mundra

Action heroes A profound determination, spirit of working together backed by the enthusiasm of a “can-do” spirit can assure the success of mission. There are some personalities in the field of healthcare who have made the impossible possible through their vision and spirit. Renowned cardiac surgeon and social entrepreneur Dr Devi Shetty founded Narayana Hrudayalaya because he believed that no child should be deprived of best healthcare because the parents cannot afford it. He has immensely reduced the cost of heart operations making heart surgery affordable to the common man. He along with the Government of Karnataka also initiated a health insurance scheme with an aim to provide cheap coverage to the poor farmers of Karnataka. Another example is that of Dr KK Aggarwal who is bringing about a movement by creating health awareness among

Director & Chief Operating Officer, Truworth Infotech

masses. His Perfect Health Mela is a mix of health education for people from all walks of life from all strata of society using all pathies incorporating the principles of fun and entertainment under one roof. In the last Union Budget, Government increased the plan allocation for Ministry of Health and Family Welfare from US$ 4.2 billion in 2009-10 to US$ 4.8 billion in 2010-11. The Government launched the National Rural Health Mission (NRHM) in 2005 to provide quality healthcare for all and increase the expenditure on healthcare from 0.9 per cent of GDP to 2-3 per cent of GDP by 2012. Government of Maharashtra is using ICT as a tool to enhance their ability and bringing more professionalism in healthcare services. Tripura has initiated

“New technology should not mean expensive technology and MT segment should take the clue from IT and Telecom Industry and come out with affordable technologies” Dr GSK Velu Managing Director, Trivitron

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Tripura Vision Centre Project, a Teleophthalmology project aimed at offering primary and preventive eye care services to rural citizens adopting advances in medical sciences, biomedical engineering and its convergence with Information and Communication Technology. But, there are challenges ahead. India faces a huge need gap in terms of availability of number of hospital beds per 1000 population. With a world average of 3.96 hospital beds per 1000 population India stands just a little over 0.7 hospital beds per 1000 population. A study by Ernst & Young says that India would require another 1.75 million beds by the end of 2025. The public sector however is likely to contribute only around 15-20 per cent of the required US$ 86 billion investment. The corporate India is therefore, leveraging on this business potential and various health care brands have started aggressive expansion in the country. So, we are featuring Max Healthcare and Medanta medicity, the hospitals with the mantra of star facilities and bleeding-edge technology and writing a new chapter in India’s healthcare services. Thus, in this special edition, eHealth has tried to capture the most dramatic actions and action heroes that have influenced and changed healthcare scenario around us. It is, most tellingly, a reflection which is remembering. It can be a rainbow collection of stories that track the life of India growing fast, and how!

Chiranjeevi Yojana

2000 â&#x20AC;&#x201D; 2010

Birth of Hope Health initiative undertaken in Gujaratâ&#x20AC;&#x201D;Chiranjeevi Yojanaâ&#x20AC;&#x201D;ensures better care of a pregnant woman and her child

hiranjeevi means long life and with the same meaning Chiranjeevi Yojana is working towards long life of mothers and babies in Gujarat. Implemented by the Government of Gujarat, this scheme aims at encouraging the BPL families to improve access to institutional delivery. This is done by providing financial protection to these families and covering their out-ofpocket costs incurred on travel to reach the healthcare facility. The scheme also provides for financial support to the accompanying person for loss of wages. This scheme empowers the poor to seek skilled care and emergency obstetric care. It is estimated that in the state of Gujarat about 1.2 mil-

lion children are born each year and 4600 mothers of these children do not survive at the time of delivery because of several reasons. The maternal mortality rate for the state is 389 per 100,000 live births. Primary reason for these maternal deaths is that majority of deliveries are domiciliary and are conducted by untrained persons in unhygienic conditions. The Chiranjeevi Yojana uses several mechanisms to target the BPL family. Among them, the main mechanism being used is the BPL card. When the scheme was initiated the pilot districts were selected based on remoteness and included regions facing highest infant mortality and maternal mortality. The private medical practitioners (mainly gynaecologists) in these regions were empanelled

in the scheme to provide maternity health services. These providers are reimbursed a fixed rate for deliveries carried out by them. Under the scheme, the health department has empanelled and contracted private practicing gynaecologists who had their own small hospitals in rural areas using a few selection criteria. Based on the experience of Gujarat state, other states where private providers are available and where government services are non-functional or of poor quality, the state governments can explore the option of PPP to provide comprehensive emergency obstetric care services to poor women in India. It will pave the way to save 117,000 maternal deaths and large portion of neonatal deaths which happen every year in India.

Fact File n Launched in: December 2005 n Target population: BPL families n Target region: Initially launched in five districts viz., Banaskantha, Dahod, Kutch, Panchmahals, and Sabarkantha; now extended to entire state n Key technology used: Smart Cards

January 2011 < www.ehealthonline.org <

2000 — 2010

Cloud Computing

Virtual Reality As healthcare providers gear up to adopt IT-enabled services in a big way, cloud computing has much in store for both providers and patients

he concept of computation being organised as a public utility, was till a few years back, only a far-fetched dream. By the turn of the millennium, with faster internet speeds and advanced computing equipment in place, cloud computing became a reality. Going further, cloud computing will offer enormous benefits to the healthcare industry including improved patient care and newer delivery models at lower costs. For smaller healthcare organisations, who do not have the required IT staff, cloud computing will offer cost-effective ways of managing information on a cloud and only pay providers for what is being used. The technology is equally beneficial for larger organisations. Max Healthcare, one of the best hospital chains in the country converted their entire IT infrastructure on a private multi-protocol label switching (MPLS) cloud running remotely from their vendor Dell’s data centre facility in Noida. As Max plans to start new facilities, a significant advantage that the cloud will offer is the capability to add more hospitals/ networks as and when required without any hassles. Ultimately, once the EHR system is in place, Max plans to have all patient data on the cloud. With so much happening in this field, the future has many opportunities in store as cloud computing penetrates deeper into the field of healthcare.

“Each patient will have his/her own URL, which will work through a cloud, and provide the entire clinical history”

Dr Pervez Ahmed CEO and Managing Director Max Healthcare

Robot-assisted Urological Surgery

Fiction Turned into Reality Indian surgeon Dr Prem Nath Dogra has performed robot-assisted urological surgery of a 50-year-old woman with cancer of the urethra and bladder

Fact File n This was first robot-assisted urological surgery in India. n Conducted at AIIMS n Earlier, this type of surgery was confined to the field of cardiology. n The robotic system used in such surgery costs $ one million

t looks like a scene out of a Hollywood scifi flick. But fiction has turned into reality at AIIMS operation theatres. This was the country’s first robot-assisted urological surgery and conducted at the All India Institute of Medical Sciences in New Delhi. The surgery called the ‘Anterior Pelvic Exenteration’ involved removal of the urinary bladder, uterus, fallopian tubes, ovaries, anterior vaginal wall, urethra and pelvic lymph nodes of a 50-year-old woman with cancer of the urethra and bladder. Earlier, this type of surgery was confined to the field of cardiology. However, the doctors soon discovered that robotic surgery was much more useful for other surgeries. The robot consists of a set of four arms, two to operate, one to hold the camera and the fourth one for assistance. These arms are mounted on a platform and are controlled by the doctor sitting at the control panel. The robotic arm is designed in such a way that it can reach the interior part of the organ curvature, which is not possible in the traditional surgery without damaging the normal tissues. The robotic system used in such surgery costs $ one million, however, experts say that with the introduction of indigenously manufactured systems, the cost will come down.

> www.ehealthonline.org > January 2011

2000 — 2010

Bioresorbable Vascular Scaffold

Hope for Heart The successful treatment of a heart patient with the groundbreaking bioresorbable vascular scaffold marks another milestone in the field of interventional cardiology

atients with coronary artery disease have lesser reasons to worry now with the launch of a revolutionary bioresorbable vascular scaffold. Dr Ashok Seth, Chairman and Chief Cardiologist at Fortis Escorts Heart Institute has successfully treated the first patient in Asia with this device, which has been launched by Abbott Vascular. This bioresorbable vascular scaffold performs the function of restoring blood flow by opening a clogged vessel and providing support while it heals and once the vessel can remain open without extra support, it is designed to slowly metabolise and eventually dissolve and disappear from the body. Talking about the revolutionary technology, Dr Ashok Seth said, “Treatments for coronary heart disease have come a long way from the days of balloon angioplasties and metal stents. With the launch of bioresorbable vascular scaffolds, physicians are intrigued by the concept of being able to effectively open up and support a blocked artery without leaving a permanent implant behind in the blood vessel.”

Fact File n 30 million heart patients in India n Less than 300,000 coronary heart disease patients undergo procedures n Approximately 250 patients implanted with bioresorbable vascular scaffolds so far n Fortis Escorts first in Asia to use the technology bioresorb

Dr SMS

Health on Fingertips Kerala empowers its citizens by delivering health information directly to their mobile phone

Fact File n The system has complete information about the health infrastructure of Kozhikkode, Kannur, Kasaragod, Trissur, Ernakulam and Alapuzha (90%) districts n To avail facility the user has to send an SMS to a predesignated number (9446460600) website

r SMS is a key project of the Kerala State IT Mission, the technology implementation wing of the Government of Kerala in India, launched on 29th May 2008 with the aim to increase the common people’s accessibility to healthcare services through simple and innovative use of mobile telephony. The project is probably the largest initiative of the government in the mobile healthcare space. Dr SMS facilitates quick information delivery on the nearest medical service centre to the concerned person. The fact that Kerala ranks as one of the leading states in India in terms of mobile penetration was also one of the key factors that prompted the Kerala government to launch this mHealth project. The project provides users with a comprehensive list of medical facilities available in a particular locality including hospitals with infrastructure and expertise in various medical specialties such as cardiology and gynaecology, specialised doctors in the locality, through the simple facility of an SMS. This is where the project also derives its name from. The pilot of the project in Kozhikode district turned out to be a huge success and approximately 200 transactions happened on a daily bases during this phase. January 2011 < www.ehealthonline.org <

2000 — 2010

Dual Source CT Scanners

Cardiac Imaging Redefined The dual source CT scanners offer faster scans at lesser radiation exposure

ntroduced in 2005, the dual source CT scanners are the latest revolution in the field of CT imaging. The technology effectively uses two x-ray tubes and two corresponding detectors arranged at 90° to take a scan. Dual source CT scanners have revolutionalised the way cardiac imaging is done. Cardiac CT imaging has now become a very robust CT modality owing to a marked improvement in temporal resolution. Dual source CT scanners have made dual energy CT feasible in a routine way, creating wider avenues in CT imaging and creating new hopes for radiologists. As per reports, dual source CT scanners are capable of imaging full cardiac detail with as much as 50 percent less radiation exposure than traditional CT scans. Dual source CT thus offers the unique possibility to facilitate the increased speed and power of two X-ray tubes allowing for better imaging of high-end applications like coronary artery imaging and CT angiography. Besides these, all standard protocols of the head, thorax and abdomen are performed with higher speed, less or equal radiation dose and, above all, improved image quality. Dual source CT scanning thus marks a new beginning in the field of radiology.

“Dual source CT scanners are capable of imaging full cardiac detail with as much as 50 percent less radiation exposure than traditional CT scans. Cardiac CT imaging has now become a very robust CT modality owing to dual source imaging”

Emergency Management Research Institute

First Window to Emergency A free emergency service handled by GVK EMRI reaches the emergency victims in 22 minutes on an average

It is Gandhian innovation for synthesising multiple technologies (telecom, IT, medical, fleet) for serving poor people 24X7 at International standards.

Venkat Chengavalli CEO GVK EMRI

he toll-free 108 has emerged as a popular free ambulance service for medical, police or fire emergencies in Andhra Pradesh, Gujarat, Uttarakhand, Goa, Chennai, Rajasthan, Karnataka, Assam, Meghalaya and Madhya Pradesh. This is a free Emergency service and handled by GVK EMRI (Emergency Management and Research Institute). This service is delivered through state- of -art emergency call response centers. It responds to 11,500 emergencies with 2,626 ambulances every day and reaches the emergency victims in 22 minutes on an average. In India, at least four of every five deaths take place in the first hour of admission to hospital. A McKinsey study reveals that India witnesses three lakh emergencies daily. Thus, there is a desperate need of such emergency services in India, cannot be disputed. In Andhra Pradesh, this service has become a state-wide emergency management system with 700 ambulances taking victims to 3,500 registered hospitals in all 23 districts of the state. Venkat Chengavalli, CEO GVK EMRI says, “GVK EMRI has responded so far 10 million emergencies and saved 268,000 lives. It is Gandhian innovation for synthesising multiple technologies (telecom, IT, medical, fleet) for serving poor people 24X7 at International standards.” Really, it is Gandhian innovation and India needs it.

> www.ehealthonline.org > January 2011

2000 â&#x20AC;&#x201D; 2010

Portable Ultrasound

Small is Better Portable ultrasound scanners, in the past decade, have effectively taken diagnostic imaging to patientsâ&#x20AC;&#x2122; bedside

ver since its inception, ultrasound imaging has come a long way, from bulky machines to portable hand-carried ultrasound to pocket ultrasound. Benefits of portable ultrasound technology were not realised and the market did not evolve until the beginning of this decade. In emergency situations and places where there is limited space, mobility and portability are key requirements. Hence, the evolution of portable ultrasound became inevitable. Initially, obstetrics and gynaecologists were the only ones using this technology as it could be brought bedside or were affordable enough to be purchased by a private practice. Now, as the market has matured, various specialities including Cardiac, Vascular, Radiology, Endocrinology and Paediatrics are making use of portable ultrasound for diagnostic imaging. The technology is also being widely used by EMS personnel across various countries are leveraging on portability of ultrasound machines in the field. In India and the world over, SonoSite is one of the leading vendors of handcarried ultrasound. The company specialises in manufacturing portable ultrasound scanners of high quality. In addition, GE Healthcare launched VScan, a pocket-size ultrasound scanner, last year, which created much excitement in the entire healthcare industry.

Fact File n As per latest reports, the handheld ultrasound market in the US alone is expected to exceed US $1.2 billion by 2016 n Leading manufacturers include SonoSite, GE and Siemens n Adoption in emergency medicine is a key driving factor for this growth

Maharashtra/ HMIS Project

Going All the Way Government of Maharashtra is using ICT as a tool to enhance their ability and bringing more professionalism in healthcare services

Fact File n The project became operational since October 2008 n Unique Health ID generated by HMIS has been issued to approximately 25 Lakh patients that have come to the 4 hospitals which have gone live since Oct 2008.

ealising the challenges of dealing with providing healthcare services to a huge population, Government of Maharashtra decided to use ICT as a tool to enhance their ability to deal with this complex delivery model. Through this project, the entire patient registration and front office management of patients and casualty services was outsourced with an objective of bringing more professionalism in government hospitals. Absence of a unique patient ID and leveraging on the technology innovations in the field of bio-medical engineering by interfacing with medical equipment and gadgets for seamless flow of information were the precursors for the initiation of this program. Objective of the project was to create unique health ID for the patients visiting state government run hospitals which will be used as a number for the patient reduction in the waiting time at registration and consultation for patients. Automatic generation of cash collection and inventory reports has improved efficiency and reduced scope for malpractices and pilferages. This is a model that can work for healthcare providers having large volume of patients with varied geographical spread. January 2011 < www.ehealthonline.org <

2000 — 2010

DR K K Aggarwal

Keeping the Flame His Health Mela concept is a successful low cost module and unique opportunity for creating health awareness among masses

e is a product of India who is bringing about a movement by creating health awareness among masses. An MBBS from Nagpur University, Dr KK Aggarwal realises that for creating health awareness one need to use all the principles of social adverting, marketing and PR. He says, “In 1991, I was called by the then secretary medical and asked to design a module which can attract the crowd for the health exhibitions organised by the Govt of Delhi. In the evening, I saw children Mela at the India gate and saw the ground was full of people. I just coined the idea of combing the two and the concept of Perfect Health Mela was born in the country.”

The first Mela was organised in December 1993 which was declared as the best event in Asia for creating health awareness and the government of India released a postal commemorative stamp on the occasion. Ever since it is a yearly feature. The Mela is a mix of health education for people from all walks of life from all strata of society using all pathies incorporating the principles of fun and entertainment under one roof. It’s a mix of health exhibitions, competitions, workshops, lectures, checkups under one roof. Sharing his perspective on the benefits of such events, Dr Aggarwal says, “Health mela is a successful low cost module which can be adopted even at a village level. One should use

> www.ehealthonline.org > January 2011

the principles of “hit the iron when it is hot”, and involve the people who counts, with health messages in the form of one line sutras which are made by experts, filed tested and based on facts and not myths.” Dr Aggarwal has also conceptualised events like: Health Darbar, Perfect Health Parade, Health Playing Cards, Miniature Health Books, Health Games, Mr. Tobacco - an anti-tobacco campaign and Delhi Ministers’ Pledge to boycott tobacco promoting functions. The WHO estimates that chronic diseases would account for over 65 per cent of deaths in India compared to 53 per cent in 2005. Keeping this view, such type of health awareness campaign could be revolutionary for a healthy India.

One should use the principles of “hit the iron when it is hot”, and involve the people who counts, with health messages in the form of one line sutras which are made by experts, filed tested and based on facts and not myths.

Dr KK Aggarwal Chief Cardiologist, Medanta Medicity, Gurgaon

2000 — 2010

Max Healthcare

Setting the Standard Star facilities and bleeding-edge technology are the Max Hospital Mantra

massive boom in private hospitals has changed the nation’s health delivery landscape beyond recognition in the last decade. And Max Healthcare with the mantra of star facilities and bleeding-edge technology is writing a new chapter in India’s healthcare services. Max Healthcare commenced operations in 2001. Currently, it has six hospitals and two diagnostic centres, which are all located in the national capital region, comprising of over 1,000 beds, 225 ICU beds, 3,000 support staff and most advanced technologies. It is currently in the process of building four new hospitals at Shalimar Bagh, New Delhi; Bhatinda, Mohali and Dehradun. Says Dr Pervez Ahmed, CEO, Max Healthcare,

“At the end of our horizon of growth, we expect to have around 4000 beds in another five years, most of which will be in the NCR or the Shatabdi region. We want to concentrate our growth in North India because logistically it is a more scalable model.” Max Healthcare has also partnered with Nova Medical Systems, which is an ambulatory surgical product for Northern India. In today’s world, information has been considered as a strategic source of power – empowerment to make timely informed decisions. This fact cannot be overemphasized in healthcare, where an informed decision can be the difference between life and death (or disability) for a patient. Max Healthcare has continuously invested in Information

Systems, from the Hospital Information System (HIS) to Accounting and Financial System, Picture Archiving and Communication System, Telemedicine and Business Intelligence. To be able to deliver quality care consistently, Max Healthcare has opted to install an Electronic Health Record (EHR), along with which comes business and Management Information System. Says Dr Pervez Ahmed, CEO, Max Healthcare, “To allow customers and insurance companies to choose the highest quality clinical provider, the outcomes need to be measurable, reportable and reproducible. We, therefore, realised the need to move from a simple HIS to an EHR, which coupled on top of the HIS can give us the ability to have a true MIS and help us take strategic decisions.”

At the end of our horizon of growth, we expect to have around 4000 beds in another five years, most of which will be in the NCR or the Shatabdi region.

Dr Pervez Ahmed CEO, Max Healthcare

January 2011 < www.ehealthonline.org <

2000 — 2010

Medanta-The Medicity

Care with Compassion Medanta-The Medicity is working with highest standards of medical care, state-ofthe-art infrastructure and cutting edge technologies

edanta is one of I n d i a’s largest multi-super specialty institutes located in Gurgaon. Founded by eminent cardiac surgeon, Dr. Naresh Trehan, the institution has been envisioned with the aim of bringing to India the highest standards of medical care along with clinical research, education and training. In 1988, despite a successful career in United States Dr Naresh Trehan returned to India and started Escorts Heart Institute and Research Centre - a pioneering state-of-the-art heart institute in India. Dr Naresh Trehan says, “We have built an institution which matches the highest standards of healthcare delivery

across the world, where care is provided to patients at an affordable cost. Medanta - The Medicity will offer not only the best technical facilities, but also clinical research, education and training.” Dr Trehan was awarded Padma Bhusan in 2001, Padmashri Award in 1991 and Ernst & Young Entrepreneur Award in the services category for yeoman services to the healthcare industry. He has been president of the International Society for Minimally Invasive Cardiac Surgery. Medanta brings together state-of-the-art infrastructure and cutting edge technology-256 Slice CT, Brain Suite, Intra-Operative Imaging Operating Theater, Da Vinci Robot for Minimal Invasive Surgery, Artis- Zeego Endovascular

> www.ehealthonline.org > January 2011

Surgical Cath Lab, 4 Linear Accelerators (provision for IGRT/ IMRT) (radiation surgery), Tomotherapy, Integrated Brachytherapy Unit with remote controlled HDR, 3.0 Tesla MRI, PET CT, Gamma Camera, Digital X-Ray, Fluoroscopy, Bone Densitometry, 3D and 4D Ultra Sound, Digital Mammography. Its arm Medanta Vattikuti Institute of Robotic Surgery which will initially cover cardiac, urology and gynaecology surgeries have joined the US-based Vattikkuti Foundation. It is the country’s first multi-specialty, multi-modality institute for robotic surgery. The institute aims to be a hub for robotic surgery in the Asia Pacific region. The institute will also develop a large database on robotic surgery.

Medanta - The Medicity matches the highest standards of healthcare delivery across the world, where care is provided to patients at an affordable cost. It will offer the best technical facilities, clinical research, education and training.

Dr Naresh Trehan

2000 — 2010

NABH

Wake up to Meet Norms An autonomous body set up by the Government of India is operating accreditation programme for healthcare organisations

n the modern age of marketisation, hospitals create an image of themselves that need not provide the true picture and this can result in a wide gap between the actual position and the expectations of the patients. To bridge this gap, the Quality Council of India has introduced the concept of accreditation. National Accreditation Board for Hospitals & Healthcare Providers (NABH) is an offshoot of the Quality Control of India (QCI), an autonomous body set up by the Government of India, with industry support, to establish and operate accreditation programme for healthcare organisations. NABH is doing a yeomans’service for the country through various accredita-

tions like NABH (for secondary and tertiary care, large hospitals), SHCO (for smaller hospitals/single specialty hospitals), NABH for blood banks, NABH for radiology diagnostic centres and NABH for dental. It has also been involved in setting standards for AYUSH hospitals, wellness centre and some basic primary care services as well. Accreditation seal bestows on the hospital a “badge of recognition” that the hospital fulfills the essential parameters that result in better quality care. From registration, admission, pre-surgery, peri-surgery and post-surgery protocols to discharge of patients from the hospital to follow-up consultation after discharge, the standards cover everything.

NABH also conducts regular inspections on the premises of the hospitals accredited to it. It even has norms covering aspects such as how to clean the floor, quality of linen used in the hospital. “Unfortunately the ultimate consumer, the patient, is not much aware of its existence. Just as agmark, ISI and hallmark are recognition of the quality of the product they respectively serve, NABH must become of the same, if not better, recognised symbol of healthcare quality,” says Dr Narottam Puri, Chairman, NABH. He adds, “A lot of work has been done and is continuing….creating awareness amongst the consumers of healthcare must remain an important point on the agenda.”

Just as agmark, ISI and hallmark are recognition of the quality of the product they respectively serve, NABH must become of the same, if not better, recognised symbol of healthcare quality.

Dr Narottam Puri Chairman, NABH

January 2011 < www.ehealthonline.org <

2000 — 2010

Mobile Healthcare

Changing the Face of Healthcare Mobile Healthcare is quickly emerging as a channel that drives accessible, real time and efficient healthcare delivery

fter taking the telecom sector by storm, mobile phones are set to change the way healthcare is delivered. Be it sending an SMS to track down the closest healthcare facility, or an attempt to track truant government doctors who neglect their official duties by practising privately on the side, or even a more evolved form of a cell phone that can monitor the condition of HIV and malaria patients and test water quality at disaster sites and undeveloped areas. Mobile Healthcare or mHealth is a term for medical and public health practice supported by mobile devices, such as mobile phones, patient monitoring devices, PDAs, and other wireless devices. mHealth appli-

cations include the use of mobile devices in collecting community and clinical health data, delivery of healthcare information to practitioners, researchers, and patients, real-time monitoring of patient vital signs. Last year, Bihar State Government has announced to give free mobile phone services to its doctors in an attempt to reduce truancy. Many government doctors neglect their official duties by practising privately on the side. The main purpose of the move is to be able to get in touch with the doctors at any time. Their movements will also be tracked by a system. Similarly, for the first time in India, a mobile phone doctorto-patient service called ‘Doctor on Call’ was launched. The 9 to 9 service that provides

> www.ehealthonline.org > January 2011

live interaction was pioneered by BPL Mobile, Mumbai’s leading mobile service. “The role of the stakeholders in mHealth will play a major role in the success of efficient healthcare model. The Government is interested in leveraging this model due to the penetration of mobile phones in rural and inaccessible areas. The way forward is to shift the focus to driving medical value – mHealth solutions should build efficiency and must cut costs in healthcare delivery. A successful mhealth model should have a cross-carrier approach for the infrastructure, solutions should be handset independent and should work with a variety of connectivity standards (Bluetooth, GPRS) with minimal switching costs.

The role of the stakeholders in mHealth will play a major role in the success of efficient healthcare model. The Government is interested in leveraging this model due to the penetration of mobile phones in rural and inaccessible areas.

Dr Ruchi Dass Vice President, Lifetime Wellness Rx International

2000 â&#x20AC;&#x201D; 2010

Medical Robots

Surgery sans Experts Medical robotics and computer-assisted surgeries mark the beginning of a new era in healthcare

he launch of medical robots marked the beginning of an era, which has ever since been experiencing development of several systems and technologies being marketed by various companies. Research and development of robots and robot enhancements are taking place throughout the world. Systems with enhanced capabilities are being developed to offer surgeons with cutting-edge technology. Technological advances and the incorporation of robotics into the operation theatre has been mainly via the use of microscopy, navigation, instrumentation, optics and imaging. As more and more institutions acquire robotic surgery as a tool to perform various surgical procedures, the number and types of surgeries being performed by robots is increasing rapidly. Robotic surgeries practically eliminate the need of multiple surgeons and assistants in an operation theatre; a single surgeon can perform the entire surgery by controlling the robotic arms through the computer console of the surgical robot. In future, this will also serve as a scope for the emergence of telesurgeries, where a surgeon sitting miles away would be able to perform a surgery via a computer console that is connected to the surgical robot placed at the site of the surgery.s.

Fact File n The global market of medical robotics and computer assisted surgical systems was estimated to be less than USD 1.30 billion in 2008 and more than USD 1.30 billion in 2009 n The major contributor in this market is the US, which accounts for almost 52 percent share

NABL

Powering Laboratories This accreditation is a formal recognition of the technical competence of a testing, calibration or medical laboratory for a specific task

Fact File n The laboratories seeking accreditation are assessed in accordance with ISO, IEC 17025:2005 for testing and calibration laborator n Must have a Quality Manual on its Quality System satisfying the requirements as described in ISO/IEC 17025

ational Accreditation Board for Testing and Calibration Laboratories (NABL) is an autonomous body under the aegis of Department of Science & Technology, Government of India. Its objective is to provide Government, Industry Associations and Industry in general with a scheme for third-party assessment of the quality and technical competence of testing and calibration laboratories. Government of India has authorised NABL as the sole accreditation body for Testing and Calibration laboratories. NABL provides laboratory accreditation services to laboratories that are performing tests and calibrations for medical laboratories. NABL accreditation is a formal recognition of the technical competence of a testing, calibration or medical laboratory for a specific task following ISO, IEC 17025:2005, and ISO 15189:2007 Standards. This is based on third party assessment. WTO recognises non-acceptance of test results and measurement data as Technical Barrier to Trade (TBT). Accreditation is considered to be the first essential step towards removing such technical barriers.

> www.ehealthonline.org > January 2011

2000 — 2010

National Rural Health Mission

On a Mission to Empower The National Rural Health Mission has provides accessible, affordable and accountable health services to the poorest households

s healthcare is now one of the thrust areas for the Government of India, there is an increased focus on primary healthcare coupled with increasing health spend, every fiscal year. The National Rural Health Mission (NRHM) has been the main vehicle for giving effect to the above mandate. The Goal of the Mission is to improve the availability of and access to quality healthcare by people, especially for those residing in rural areas, the poor, women and children. Launched in 2005, NRHM is an overarching umbrella initiative which subsumes the existing programmes of Health and Family Welfare and seeks to be the omnibus vehicle for sector wide reform. The NRHM programme is now rapidly spreading across the entire country and has achieved overwhelming success. It has achieved it all--reduction in infant mortality and maternal mortality rates; universal access to public health services such as women’s health, child health, water, sanitation & hygiene, immunization, and nutrition; prevention and control of communicable and non-communicable diseases, including locally endemic diseases; increasing access to integrated comprehensive primary healthcare; achieving population stabilisation, gender and demographic balance; revitalization local health traditions and mainstream AYUSH and promotion of healthy life styles.

Fact File n Around 8 lakh ASHAs selected n Health and sanitation committee in 4.95 lakh villages n 1,589 specialists, 8,648 MBBS doctors, 25,790 staff nurses, 46,351 ANMs, 17,575 paramedics

Online Healthcare

Virtual Health Healthcare adopts internet as one of the latest technology tools that can enhance the delivery and reach to the masses

Fact File n There are around 1.734 billion internet users across the world n Asia accounts for almost 43 percent of the total internet users, which is the highest compared to any other region

ealthcare has readily adopted internet as one of the latest technology tools that can enhance the delivery and reach of healthcare to the masses. Just at the click of a button, a user can have access to a gamut of healthcare services being offered by various online healthcare providers, now-a-days. As traditional healthcare delivery models make way for alternate resources, online healthcare has unlimited scope, considering the widespread usage of internet services. Although healthcare needs still require visiting a doctor, it is still worthwhile to have minor issues sorted out virtually. Allowing patients to access online healthcare services can become a new conduit for exchange of health information. Online healthcare is equally beneficial for physicians as they can put in extra hours and make themselves available from their homes, as well. For insurance companies, the benefit lies in the fact that online healthcare is able to shift health delivery from the more expensive sites, the hospital or clinic, to a cheaper online option. All in all it’s a win-win deal for all.

> www.ehealthonline.org > January 2011

knowledge for change

2000 - 2010

Picture Archiving & Communication Systems

Filmless Future The evolution of picture archiving and communication systems has allowed for image access anytime, anywhere

he field of radiology and the concept of Picture Archiving & Communication Systems (PACS) have undergone tremendous technological growth over the last decade. Imaging procedures such as CT, MRI and PET scan have become more complex over the years, leading to generation of a huge amount of medical imaging data that is simply impossible to interpret, if available in printed films format. The application of PACS today is not limited just to the field of radiology. Rather it encompasses various clinical disciplines including cardiology, pathology, orthopaedics, ophthalmology and dental. PACS has been effectively able to fulfill all needs of the medical imaging world. It not only saves the time spent on film processing and handling, but it also eliminates the need for physical storage space required for storing imaging reports. Moreover, it saves the huge sum of money spent on offsets films and chemicals. PACS is equally beneficial for patients as it helps in faster diagnosis and treatment plan. It also eliminates the need for repeated procedures due to lost films and reports as everything is available in digital format. More features and advanced visualization techniques are the future of this exciting and vibrant segment.

Fact File n PACS market is on the cusp of high growth in India n As per eHEALTH research, the total PACS market in India is valued at USD 6 million n The market segments bundled PACS and modular PACS are valued at USD 4.2 million and USD 1.8 million respectively

Rajiv Aarogyasri Health Insurance Scheme

Power to Poor The Rajiv Aarogyasri Scheme has given the BPL population of Andhra Pradesh the promise of a healthy future

“Use of ICTs for monitoring the scheme has been a success and the enthusiasm of the government can be observed by its growing financial allocations”

Babu A CEO, Aarogyasri Healthcare Trust

he Andhra Pradesh based Rajiv Aarogyasri health insurance scheme has been one of the most successful government endeavors for providing health cover to the BPL population. According to Babu A, CEO, Aarogyasri Healthcare Trust, “the scheme started with a `50 crore budget in 2007, which was further increased to `450 crore in 2008-09 and and more than `1000 crore in fiscal year 2009-10.” He further added that “Covering majority of the state population and most importantly including the lowest strata of human society, the scheme has proved to be inclusive in real terms.” A web-based solution has been designed for the scheme, which provides real time information about every individual patient, right from the moment somebody comes to a primary healthcare centre to his/her admission into a city hospital and till the time he/she is discharged after the medical treatment. Further, medical reports of every single patient are available online, which makes requirement of hard copy reports unnecessary at the time of follow-up. The scheme also runs a 24x7 operational call centre manned by doctors and paramedics and telephonic medical counseling is provided through toll free numbers—104 and 108.

> www.ehealthonline.org > January 2011

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2000 — 2010

Remote Diagnostics

Doctor - anytime, anywhere With the help of remote diagnostics, the technical problems can be solved remotely and it is not required to call the technicians for a visit

his innovative solution is simply a new paradigm of seeking medical expertise. The diagnosis that saves a patient’s life in some remote areas of the country and abroad is being made by doctors sitting in their consulting rooms. The concept of Remote Diagnostics is picking up in India. More and more experts are interpreting digital images of MRI, CT scans, X-rays, etc and sending their interpretations to doctors practising not only in various parts of the country but also abroad. Usually the service of remote diagnostics is carried on with the help of a VPN which communicates with the main server where the support team meets virtually to resolve the issue. Says Vishwa Chandra, from Singularity Ventures: “In India, there is a service gap that needs to be met and a number of companies such as Max, Fortis are looking at this. However, while each of these companies will look to grow significantly in the coming years, I do believe that there will still be a significant portion of the population in rural, semi urban, tier III towns that will remain underserved. Technology companies involved in remote diagnostics can help bridge this gap. Such technologies will be key in providing scale to our limited resources that we have to deploy.”

I do believe that there will still be a significant portion of the population in rural, semi urban, tier III towns that will remain underserved. Technology companies involved in remote diagnostics can help bridge this gap.

Vishwa Chandra Singularity Ventures

Rasthriya Swasthya Bima Yojana

Blessed with a Smart Card Rasthriya Swasthya Bima Yojana empowers the BPL population with the best-inclass healthcare services

Fact File n Beneficiary pays `30 for a family of five n Insurance amount `30,000 n Hospitalisation as well as 727 surgical packages covered n More than 5000 empanelled hospitals n Currently provided more than 17 million smart cards to more than 70 million people

ealthcare in India, driven primarily by the private sector, had little to offer to the BPL population unless the Rashtriya Swasthya Bima Yojana (RSBY) was launched in April, 2008. The scheme completely redefined the scope of healthcare delivery, taking quality health services to the poorest of the poor population at a meager cost of `30 per year. Launched by the Ministry of Labour and Employment, Government of India, RSBY is the first ever paperless health insurance scheme in the world. The scheme leverages IT on a massive scale to empower the rural population of the country, which makes it paperless as well as cashless. “The idea behind the conception of RSBY was to design a health insurance scheme based on a world class model that avoids the pitfalls of all health insurance schemes launched in the past”, says Anil Swarup, Director General Labour Welfare, Ministry of Labour and Employment. “As RSBY is a Government sponsored scheme for the BPL population of India, majority of its funding, almost 75 percent is done by the Central Government, while the respective state governments invest the remaining 25 percent”, says Anil Swarup. Being one of the fastest scaling schemes, RSBY will soon cover majority of the BPL population of the country.

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2000 â&#x20AC;&#x201D; 2010

Vaxiflu-S

Breathe Easy This vaccine has created a platform in the country which can be used for production of any pandemic influenza vaccine

t is considered a major scientific advancement in India-Vaxiflu S is Indiaâ&#x20AC;&#x2122;s first vaccine against H1N1, which is manufactured by Ahmedabad based pharma major, ZydusCadila Healthcare. Launched in June 2010, this egg based inactivated vaccine is based on conventional technology. H1N1 swine flu has killed more than 18,000 people and affected some 214 countries since the virus emerged in Mexico and the US in April 2009. In India, over 1,500 have died, since the country reported its first influenza A (H1N1) case in May 2009. This technological breakthrough in the indigenous manufacture of Influenza Vaccine has created a platform in the country which can be used for production of any pandemic influenza vaccine besides seasonal influenza vaccines at short notice to safeguard public health. In November 2010, Tamil Nadu government decided to administer free vaccines for the poors following a spurt in H1N1 deaths in the state. Research and development of vaccines have also emerged as a major focus area in recent times. The worldwide vaccine market is predicted to increase at a compound annual rate of 9.7% during the next five years. Thus, the vaccine market is also re-emerging as a key revenue generator for the Indian pharma companies.

Fact File n In India, over 1,500 have died, since the country reported its first influenza A (H1N1) case in May 2009 n Vaxiflu S is Indiaâ&#x20AC;&#x2122;s first vaccine against H1N1 n Zydus-Cadila is producing this H1N1 vaccine using the seed given by the WHO

Tamil Nadu Health Systems Project

Health for All After adopting TNHSP, the maternal mortality rate in Tamil Nadu witnessed a considerable drop from 145 in 2001-02 to 79 in 2008-09

Fact File n Funded by the World Bank at a total cost of INR 597.15 crore, the TNHSP was implemented in January 2005 for a period of around five years. World Bank has approved the second phase funding for next three years till 2013

he centres have done extremely well in improving the maternal and infant mortality rates with Tamil Nadu now has much lower rates of infant and maternal mortality as compared to most of the other states. The rising concern for reducing maternal and infant mortality, the Tamil Nadu Health Systems project began in 1990, with a plan to cover the entire state over three expanding phases, the 51 centres of the first phase were designated in 2004 . Targetting to improve the health of the people of Tamil Nadu, especially the poor and the disadvantaged, the TNHSP covers various other aspects that are aimed at improving the overall status of health in the state. Improvement of infrastructure in district and sub-district hospitals, maintenance of medical equipment, building up a comprehensive health management information system, promotion of publicprivate partnerships and preventing risk factors for non-communicable diseases are some of the major aspects that the project looks into. After adopting this project, the maternal mortality rate in Tamil Nadu witnessed a considerable drop from 145 in 2001-02 to 79 in 2008-09, while the infant mortality rate fell from 49 in 2001 to 31 in 2008.

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Organisers

Presenting Publication

2000 — 2010

Telemedicine

Rationalising Medical Care Telemedicine is a potentially miraculous method that promises improvements to healthcare delivery systems, bettering quality and access

ele is a Greek word meaning “distance” and Mederi is a Latin word meaning “to heal”. Telemedicine is a method, by which a patient can be examined, investigated, monitored and treated, with the patient and the doctor located at different places using Information Technology i.e. computer and telecommunication technology. A major goal of telemedicine is to eliminate unnecessary travelling. acquisition, storage, display, processing and transfer of images represent the basis of telemedicine. Patient’s records can be sent via text, voice, images or even video and medical advice offered from a remote location on Internet or off-line as digital content.

Says Shivaram Malavalli, President, TeleVital India Pvt. Ltd, “Only 25 percent of India’s specialist physicians reside in semi-urban areas, and a mere three percent live in rural areas. As a result, rural areas, with a population approaching 700 million, continue to be deprived of proper healthcare facilities. Further the availability of hospital facility is very low in rural areas. Thus, the early successes of telemedicine pioneers have led to increased acceptance and proliferation of telemedicine.” Telemedicine has various aspects including TeleConsultation, TeleDiagnosis, TeleEducation, TeleTraining, TeleMonitoring and TeleSupport and incorporates complete information about patients’ medical record (in the same

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hospital or any virtual hospital online). Telemedicine system is well suited for disaster management as it is even more reliable, than the physical system. Remote patient monitoring uses special devices to remotely collect and send data to a monitoring station for interpretation. This could include checking vital signs, such as blood glucose or ECG. This is usually accomplished with speciality hardware devices and with integrated/fixed communications capabilities. Specialist referral services usually involve a specialist assisting a general practitioner in rendering a diagnosis. Telemedicine can open a world of healthcare delivery by building clinical bridges between patients and available healthcare.

Fact File n Karnataka has become the role model in the country implementing telemedicine, networking all districts n Telemedicine is fast becoming an integral part of healthcare services in several countries including Canada, Italy, Germany, Japan, Greece, Norway and now India

2000 â&#x20AC;&#x201D; 2010

Tripura Vision Centre Project

Vision for All A Tele-ophthalmology project undertaken in Tripura ensures primary and preventive eye care services to rural citizens

HO estimates blindness rate in the rest of the world is about 0.3% while in India it is 1.1 percent. The report says that 80 percent of diseases that causes blindness are curable or preventable by nature. Keeping in view, Tripura has initiated Tripura Vision Centre Project from November 21, 2006, itâ&#x20AC;&#x2122;s a Teleophthalmology project aimed at offering primary and preventive eye care services to rural citizens of Tripura adopting advances in medical sciences, biomedical engineering and its convergence with Information and Communication Technology. The Vision Centre is a comprehensive model for providing primary and preventive eye care in a decentralized manner using the benefits of ICT integrated with the medical eye care solutions. The model empowered trained paramedics or ophthalmic assistants to provide eye care services at the grass root level. All patients visiting the vision centre are completely examined by the ophthalmic assistant and the medical record is uploaded electronically for doctorâ&#x20AC;&#x2122;s live tele-consultation from the base hospital in Agartala. This project enables quality healthcare in the existing system and can serve as a model that can be replicated or adapted by other states in India.

Fact File n This initiative is first of its kind in the country particularly in the North Eastern India n The project serves a rural population size of 3,432,000 people in remote areas spread across 40 blocks of four districts in Tripura

January 2011 < www.ehealthonline.org <

2000 — 2010

Dr Devi Shetty

Making of a Miracle He has conceptualised the world’s cheapest health insurance programme that covers three million beneficiaries in Karnataka, at five rupees a month each

ur population is our strength and we can do lot of things using this unique strength of ours,” says Dr Devi Shetty. Renowned cardiac surgeon and social entrepreneur Dr Devi Shetty founded Narayana Hrudayalaya because he believed that no child should be deprived of best healthcare because the parents cannot afford it. The Narayana Hrudayalaya Group performs the largest number of heart surgeries on children, across the world, providing cardiac care to children from over 73 countries. In addition to providing healthcare services, Dr Devi Shetty has also initiated a health insurance scheme with an aim to provide cheap coverage to the poor farmers of Karnataka. Dr Shetty has an incredible list of achievements—being the first heart surgeon in India to venture into neo-natal open-heart surgery, performed the first open-heart surgery in the world to close a hole in the heart with the help of a microchip camera, used an artificial heart for the first time in India and performed the first surgery in India using the blood vessels of the stomach to bypass the blocked arteries of the heart. He has immensely reduced the cost of heart operations making heart surgery affordable to the common man.

Fact File n He has performed than 10,000 heart surgeries n Introduced the concept of assemble line heart surgery that aims at reducing the cost of surgery n Facilitated with Padma Shri, Dr BC Roy award, Sir M. Visvesvaraya Memorial award

Yeshaswini Farmers Healthcare Scheme

Targeted Development A Farmers Healthcare Scheme undertaken in Karnataka provides cost effective quality healthcare facilities to the co-operative farmers

Fact File n Launched in November 2002, and operationalised with effect from June 1, 2003 n The International Labour Organisation has showcased the scheme on its website and has also constituted a study of this scheme backed by expert actuaries

s India moved to an inclusive democracy in the years since Independence, we now have the chance to enable a similarly inclusive economic culture, one which encourages initiative, participation and growth for the many, across India, rather than the few. Yeshaswini Co-operative Farmers Healthcare Scheme is a landmark initiative towards inclusive growth for the farmers of Karnataka. Today, any farmer who is a member of a co-operative society in Karnataka can get the necessary treatment and have access to expensive medical procedures by becoming a member of this scheme. Initiated by Dr. Devi Shetty of Narayana Hrudayalaya, Bangalore, and implemented by Government of Karnataka the scheme aims to provide cost effective quality healthcare facilities to the co-operative farmers spread across the state of Karnataka. The scheme is offering a low priced product for a wide surgical cover, (covering over 1600 defined surgical procedures) to the farmer cooperators and his dependent family members. The latest government data show that in India access to hospitals for every 100 poor persons is just 1.70. Thus, India needs such type of micro healthcare scheme desperately, can’t be disputed.

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expert speak

eHEALTH 50th Issue Special

A Comprehensive Health Package at `10 Yeshaswini is the largest micro health insurance scheme launched in the world with three million farmers as subscribers By Dr Devi Shetty

ive years ago, we produced a concept of micro health insurance programme, which was quickly adopted by the Karnataka State Cooperative Societies and converted to Yeshaswini Micro Health Insurance scheme. In the name of Yeshaswini, the Karnataka State Government has proved that with `5 a month

from a farmer and `2.50 a month from the government, it is possible to run a health insurance scheme, which pays for every possible operation on the human body starting from cataract surgery to major heart surgery. In five years Yeshaswini has grown and now it is covering nearly 3 million farmers who are contributing `10 per month. All farmers are eligible for treat-

ment at 300 network hospitals across the state of Karnataka.

Conceptualisation to Implementation Yeshaswini micro health insurance scheme was conceptualised by our team. However, launching such a massive programme to help billions of people was not possible

January 2011 < www.ehealthonline.org <

eHEALTH 50th Issue Special

expert speak without the assistance of the government. So, Karnataka State government through cooperative society is managing the scheme through the Yeshaswini Trust in which some of the leading doctors of Karnataka state including me are the trustees. The Trust is responsible for deciding the policies of Yeshaswini and now we have about three million farmers subscribing `10 per month. Yeshaswani is a joint venture with the Karnataka State Government. This programme is now extended to about 65% of the states population. When we launched Yeshaswini micro health insurance programme, we coined the term micro health insurance over regular health insurance. Idea of micro health insurance is to collect a small amount from the farmers every month and with that money run the health insurance.

The Model Yeshaswini is a model, which proved to the government that with five to ten rupees a month poor people can get even a heart operation done and this is the beauty of micro health insurance and also this shows the benefit of our numbers. Our population is our strength and we can do lot of things using this unique strength of ours. As we went along, we realised that just building a hospital is not sufficient. We need to look at how to organise all the poor people together under a programme for jointly buying a health insurance programme. This was the genesis of Yeshaswini Micro Health Insurance Programme, which was the largest micro health insurance programme launched in the world with 1.7 million farmers as the subscribers. In fact our group took the credit of coining the word called Micro Health Insurance for the first time in the world. More than 3 million farmers are getting benefited by this scheme in Karnataka and similar programs are launched in states like Andhra Pradesh, Rajasthan, and Tamil Nadu etc.

Replicability Based on the success of this model, the Andhra Pradesh Government has

More than 3 million farmers are getting benefited by Yeshaswini Healthcare scheme in Karnataka and similar programs are launched in states like Andhra Pradesh, Rajasthan, and Tamil Nadu launched a programme called Aarogyasri to provide health insurance cover to all people living below poverty line. West Bengal Government is also in the process of launching a health insurance programme for primary teachers of the state in association with the National Insurance Company. These are just the eye lens of successes and the beauty of the entire exercise is that governments have realised that it is better to be a health insurance provider than a healthcare provider. Recently during the closely fought elections of Karnataka State, all the political parties in their manifesto added a very important agenda of offering health insurance to the masses. This shows that the politicians have realised the power of micro health insurance. Recently, the Karnataka State Government has also requested Yeshaswini Trust to manage health insurance for all the BPL card holders.

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The best way government can transform the way healthcare is delivered in India is by being a healthcare promoter than a healthcare provider. Typical example is Yeshaswini of Karnataka State and Arogyasree in Andhra Pradesh. Yeshaswini Micro Health Insurance proved that it is possible to offer healthcare with five rupees a month and get even a heart operation done and Arogyasree of Andhra Pradesh proved that 80% of the state population can afford to undergo any major operation totally free by the government sponsored health insurance.

About the Author

Dr Devi Shetty Chairman Narayana Hrudayalaya

expert speak

eHEALTH 50th Issue Special

Changing Paradigms in

Health Information Technology The changing perspectives about health information technology over the last ten years

By Dr Adam CHEE

he year 2011 holds many promises for healthcare information technology professionals around the world as governments of various countries issue budget and mandates to implement national-wide healthcare information technology initiatives. The talk of the town is, without doubt, the electronic medical records (EHR). From the meaningful use of EHR in the United States of America to the eHealth Programme in Hong Kong, the EHR initiatives in Taiwan and Singapore to the Personal Health Record initiative down in Australiaâ&#x20AC;&#x201D;these are just some of the multi-million (if not billion) programmes that are taking place as we speak. While the quest towards the intended is still a

long arduous journey ahead, the healthcare information technology industry has come a long way.

The need for effective health informatics So what happened during the last decade that fuelled the current demand for adoption of nation-wide eHealth or EHR programmes? These initiatives are by any standards, neither cheap nor easy to achieve and no government will devote to such causes if it does not benefit their people and nation. The drivers point to a common indicatorâ&#x20AC;&#x201D;a rising demand for healthcare services but an inability to meet these demands. Further, looking at things to come, there will be a continual

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increase in demand due to rising affluence and changes in diet, life style leading to increase in the aging population, changes in disease patterns as well as epidemiological changes.

Enabler in the past decade Health information technology can serve as an enabler by bridging the gap arising from healthcare systems due to an inability to keep pace with the increasing demands but this only made sense if the cost of the enabling technology is kept affordable. While the cost of the average workstation 10 years ago was relatively affordable (as compared to 15 years ago), the cost of broadband and storage was not. It is only during the last 10 years that faster

and cheaper broadband and storage were made available and this served as an important catalyst in enabling the adoption of health information technology. The other important catalysts are the convergence of standards within the healthcare information technology industry, which enables interoperability between the disparate silos of data to converge and utilisation of data, which transforms them into usable information to enable better diagnosis and patient care. The consolidation of data also allows research and trending to take place, which further fuels the acceptance and demand for healthcare information technology. Most important, is the improvement of communication between both clinical professionals and IT professionals, the ability to work hand in glove with clinicians understanding the underlying need and the ability to fulfil those individual needs (clinical specific) while keeping focus on the grand scheme of things. Great improvements have been made during the last decade with the emergence of healthcare information technology professionals.

Formula for success From understanding the role technology in healthcare (as an enabler) to cheaper but technologically superior workstations, servers, broadband and storage, healthcare enterprises were able to obtain a Return on Investment (ROI) from their healthcare information technology initiatives. These ROI range from operational efficiency, workflow improvement, lower operating cost, manpower reduction to most importantly, increased patient safety and quality of care. However, the process in convincing clinicians to adopt healthcare information technology has been an uphill task, mainly due to unfamiliarity with computers and expectation management. When the concept of healthcare information technology was first introduced to clinicians, it was held as the ‘holy grail’ of healthcare, the final answer in resolving all problems that ever existed. Unfortunately, most of these solution providers come from the financial or logistic industry and lack the

expert speak

eHEALTH 50th Issue Special

inability to understand clinicians’ needs. Further, with the limitations of technology at that time, the faith placed in this discipline plummet. Effective expectations and change management by experienced healthcare information technology professionals are crucial in accelerating the re-embracement of healthcare informatics in the healthcare enterprise, especially among clinicians. In order for technologies to be implemented and used meaningfully in the healthcare enterprise, they need to become transparent to the intended enduser and associated workflow. Picture a duck swimming; it looks graceful on the surface but a lot of paddling is happening under the water. That’s exactly how effective healthcare information technology is and this concept took healthcare information technology professionals a long time to figure out.

What will change this industry The introduction of new enabling technology and devices will definitely redefine the rules and boundaries that presently exist; these include: New generation tablets: This will change access of patient information by clinicians, nurses and supporting paramedical staff and redefine point-of-care. Cloud computing: This will change the business model adopted by healthcare enterprise as well as how they offer health services to their patients. If you look at the examples above, mobility is the trend. The ability to break the barrier of patient care and treatment, taking place only when the patient and healthcare professionals meet physically, by providing remote monitoring and patient care is the key. Effective telemedicine at low cost are some of the trends of things to come. In addition, we need to focus on lowering healthcare cost by looking at public health and primary care. Prevention is better than cure and spending money on tertiary care is not sustainable and many governments have started to realise that and more importantly, they

Broadband and storage served as catalyst in enabling the adoption of health information technology also understand that effective utilisation of healthcare information technology can help smoothen the bumps due to high cost and lack of qualified manpower, as well as the fact that some things are done better by computers.

Advancements in the past decade Looking back at the past decade and reflecting on the success and failure factors, it is evidential that in the adoption of healthcare information technology, it is not the latest or greatest technology that matters but rather, the technology that brings benefits and value to the clinicians and patients. It is important to always seek in understanding the underlying paint-points and then develop the solution to address the needs by utilising the most affordable technology that will deliver the greatest benefits while having minimal impact on the end-users. Remember, technology serves as an enabler and not as the end goal, let us learn from the experience gained in the past decade while we embrace the exciting journey ahead.

About the Author

January 2011 < www.ehealthonline.org <

Dr Adam CHEE Chief Advocate (Director) binaryHealth Care.com

expert speak

eHEALTH 50th Issue Special

Satellite Technology Bridging the Health Divide With satellite communication technology, telemedicine provides access to quality healthcare, even to the farthest reaches of the nation By Ramachandran Viswanathan

housands of women die every day due to complications during child birth in the villages and small towns of India. The reasons are dependence on local midwives, who cannot tackle any complication during childbirth, and absence of good and accessible healthcare. Similarly a large number of people die every year due to some or the other complication or in the absence of correct diagnosis. In India of the 21st century, providing universal access to good and affordable healthcare is the biggest challenge. The government reiterates this whenever the issue of challenges before the public healthcare system is raised. Though there have been some improvements; child survival, maternal mortality and communicable diseases still constitute 38 percent of deaths, while non-communicable diseases account for 42 percent of all deaths. More startling is the data that one-third of global cases of filaria are in India, half of the worldâ&#x20AC;&#x2122;s leprosy cases are found in India and every year more than 300 million episodes of acute diarrhea occur every year in India in children below five years of age.

Gaps to fill Public healthcare is the responsibility of state governments and has three facets: primary healthcare at the village level, district level health centers and medical colleges, and at the city level public and private hospitals.

Telemedicine has been recognised as an area that can solve many of the countryâ&#x20AC;&#x2122;s health problems, by the Government of India In rural or semi-urban areas the situation is worse in the absence of buildings, refusal of doctors to live and work in areas far removed from cities and the unavailability of trained staff and medicines. For the last three decades efforts are on to ensure that every primary health centre at least has a building. Unfortunately, even today many primary healthcare centers donâ&#x20AC;&#x2122;t even have buildings. If there is a structure, there is no

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medical staff to man them, or there is lack of availability of life-saving drugs.

Communication technology goes the distance This is where technology can provide an answer. And to some extent a small beginning has been made by institutes like the Sanjay Gandhi PGI in Lucknow or by individuals like Dr Devi Shetty at Narayana

expert speak

eHEALTH 50th Issue Special

At present the Indian space agency, ISRO, is using satellite technology to set up a telemedicine network with 200 nodes spread across the country Hrudayalaya who use telemedicine and tele-mentoring to treat patients in hospitals in different parts of India and even with hospitals in Pakistan. The Indian government has recognised tele-medicine as an area that could provide a solution. The effort over the years to get doctors to work in rural areas has not succeeded. Now it hopes to raise a team of paramedics in rural and semi-urban areas, but that has faced opposition from trained doctors and it has not solved the problem of ensuring universal access to healthcare. Satellite technology is being used in Nigeria to control the spread of malaria. According to a European Commission report, the Nigeria Malaria Control Programme uses space technology to evaluate and monitor malaria outbreaks. The Nigerian satellite capacity is used to monitor climate and earth conditions, which influence the spread of the disease across Nigeria throughout the year. This satellite information is completed by surveys of infected areas. Linking data on climate, temperature and disease pattern can help provide both real-time and projected understanding of the disease features. Earlier this year Nepal announced a US $400,000 project to use tele-medicine to reach out to people in remote areas with no road connectivity. At present the Indian space agency, ISRO, is using satellite technology to set up a telemedicine network with 200 nodes spread across the country.

National projects The central health ministry has launched two projects: OncoNET India and Integrated Disease Surveillance Project. Under the OncoNET project 25 regional cancer centres will be connected with

four peripheral medical colleges/hospitals each and create a network of about 100 telemedicine nodes. All district hospitals under the Integrated Disease Surveillance Project will be networked with regional medical colleges to deliver continuous professional education and advice. A national task force is also at work to frame guidelines to aid the growth of telemedicine. Tele-mentoring is an area that should be seen as an area of investment for widening the reach of healthcare. Using satellite technology a remotely located surgeon can seek the help of a centrally located and more experienced surgeon to say, perform a complicated procedure. The central health ministry plans to focus attention on 235 districts that account for a major proportion of infant and maternal deaths. This is an area where telemedicine and tele-mentoring could come in as a helpful tool.

State-level thrust Public healthcare, however, is a state subject. It is the state governments that are ultimately responsible for setting up the infrastructure and ensuring universal access. The central government can only offer broad policy guidelines and carry out centrally targeted schemes. States need to be educated and brought on board on using satellite technology as an effective tool. In Jammu and Kashmir, as part of the larger telemedicine initiative at Delhiâ&#x20AC;&#x2122;s All India Institute of Medical Sciences (AIIMS) run by ISRO, 12 centers are being connected. Emergency on-call consultation regular telemedicine consultation and medical lectures are planned to be conducted. States that figure low on the human development index are the ones that have

higher percentages of people below the poverty line.

The road ahead Given the low public investment in healthcare across the country the use of cheaper but effective technology could provide answers to such states. Most city-bred and city-located doctors are reluctant to work in rural areas. Their argument is lack of infrastructure facilities and availability of modern educational structure for their children. Setting up hubs and deputing doctors from state hospitals to interact with specialists sitting far away through satellite technology needs to be addressed seriously by governments. A few corporate hospitals in the country have used telementoring through self-funding. There is need for the central government to rope in states particularly, those with larger number of poor people lacking access to healthcare and plan a national mission on healthcare through satellite technology. Northern states like Uttar Pradesh and Bihar apart from areas in remote hills should be the first to be integrated with modern health facilities though this technology. Subsidies or financial assistance to develop cheaper application of satellite technology for ensuring benefits of good healthcare to reach out to larger number of people should be considered by the government. After all, a countryâ&#x20AC;&#x2122;s economic growth also depends on the state of health of its people and India which, in the coming years will have one of the largest working populations in the world needs to make a big investment in this area for a glorious future.

About the Author

January 2011 < www.ehealthonline.org <

Ramachandran Viswanathan President and CEO Devas Multimedia