ehealth January 2013

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

volume 8 / issue 01 / january 2013 / ` 75 / US $10 / ISSN 0973-8959

Rise of Specialty Clinics in India

Opening New Doors in

Healthcare inside Dr K Ganapathy President, Apollo Telemedicine Networking Foundation p-17

p-52

Manish Menda Director, Mya Health Credit p-61

sp 8 a nn e is c ual su i e al

Dialy sis C entr es

Medical Devices Standard & Regulations

Skin care Clini cs

Tech Trends

Nep hrolo gy C entr es

p-40

eHealth Magazine

ehealth.eletsonline.com

Senior Vice President - Industry Business Solutions

Den tal C are C linic s

Adaire Fox-Martin

volume

issue

contents

ISSN 0973-8959

cover story Specialty Clinic Brings Retailing Of Healthcare By Sharmila Das, Elets News Network (ENN)

Industry Expectation Industry Expectation 2013

rural healthcare

16 17

Rural India Need not Follow Urban India

Dr K Ganapathy, President, Apollo Telemedicine Networking Foundation

it tech trend 2013 is for cloud

Zoom-in NIKSHAY: Online tool for monitoring TB control programme

18 30

Leveraging unified communication in delivering quality healthcare

Gp Capt (Dr) Sanjeev Sood, Hospital and Health Systems Administrator, Air Force Hospital, Chandigarh

january / 2013 ehealth.eletsonline.com

expert speak Technology enhances precision in procedures

Varun Khanna, Regional Director, West & East, Fortis Healthcare Ltd

35 38

Dr Shefali S Dash, Deputy Director General, National Informatics Centre, Government of India & Sunil Kumar, Senior Technical Director, National Informatics Centre, Government of India

zoom out

Dr K Ganapathy, President Apollo Telemedicine Networking Foundation, and a pioneer of telemedicine in India

Strengthening telemedicne network In Rajasthan G N Saxena, Professor, SMS Medical College (Retired)

in focus

Telemedicine 2.0

G Sridharan Mani, Director & CEO, American Megatrends India

â&#x20AC;&#x153;You pay as you consumeâ&#x20AC;?

Ably grounded

Synchronised health service

expert corner

tech trends

Adaire Fox-Martin, Senior Vice President

Dr PM Murali, Managing Director and CEO, Evolva Biotec Ritu Maheshwari (IAS), District Magistrate, Shahjahanpur, Uttar Pradesh, India

ECMO The final frontier Medical Devices Standard & Regulations

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asia’s first monthly magazine on The Enterprise of Healthcare volume

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january 2013

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editorial

Specialty Clinics: Practice does make perfect There have been landmark changes in the processes that clinics use to treat their patients. Obviously much of these changes, or all of it, has been inspired by the development of new technologies in healthcare. Instead of having separate departments, working independently, doctors from every specialty work together to care the patients. The coordination is possible due to the presence of ICT solutions for hospital management. The basic objective behind any new innovation or procedure is to address the needs of the patient first in an efficient and cost-effective manner. It is the desire for better healthcare systems that has led to the rise of specialty clinics. These clinics promise to provide personalised care and treatment to the patients. The modern speciality clinics are typically known for the compassionate hearing that they give to every patient. Lot of efforts are made to diagnose the problems and suggest remedies. This concept has attributed to the popularity of these types of specialty clinics. These clinics allow specialists to function collaboratively and provide more comprehensive treatment to the patients as compared to normal OPD clinics. As specialty clinics perform high volumes of few procedures, it leads to greater standardisation and efficiency. We greet with the delight, the recent announcement by the healthcare major Apollo Hospitals Enterprise that they are going to take the strength of their multi-specialty clinics to 150 by October 2014. This by itself is also a testimony to the fact that health conscious people in the country now prefer to visit Specialty Clinics which have highly skilled specialist doctors, tools and technologies. The January issue of eHealth magazine is the 8th annual issue. The magazine has now been engaged in the coverage of the ICT in healthcare sector for last nine years. To make this issue really special, we have decided to focus on the key area of Speciality Clinics. You will find in the issue, inputs from a range of industry experts. We have taken a comprehensive overview of all the new developments that are happening in the Speciality Clinics space. We are also covering the role that Cloud Computing is playing in the healthcare space. The interviews of industry stakeholders will also give you insights into the seminal developments that are taking place. As the month January marks the beginning of the fresh year, the special edition has taken the initiative of trying to discover the developments that we can expect in the year 2013! I hope you will enjoy reading the special edition of the magazine. Do come back to me with your feedback and suggestions. Happy reading!

Dr. Ravi Gupta ravi.gupta@elets.in

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cover story

Specialty Clinics

Bring Retailing to Healthcare

Specialty clinics are offering solutions to many lifestyle and health related issues we face By Sharmila Das, Elets News Network (ENN)

january / 2013 ehealth.eletsonline.com

cover story

ver since the emergence of lifestyle diseases, it is regular to see people visiting doctors/clinics for reasons like stress, infertility, performing dialysis etc more often than a serious medical issue. Urban corporate executives prefer visiting a Trichilogy, Allergy, Nephrocare than visiting a super specialty hospital offering similar kind of services. “Specialty clinics are definitely emerging as a trend in India because people today want dedicated services on their health issues without wasting much time,” says Dr Bharat Inder Singh, Chief Administrator, Max Healthcare Centre. The rationale behind approaching a specialty clinic is that, “In a specialty clinic you get medical attention from experts under one roof whereas in a hospital you have to keep running from one department to another,” says Dr Puroshottam Lal of Metro Clinics. “It’s also cost-effective,” he adds. For instance, at Metro’s antismoking clinic, which is popular with professionals, pulmonary tests sessions with an expert panel of doctors and carbon monoxide evaluation tests cost around `500. A follow-up would cost `200. “The same tests in any hospital would cost at least `2,500 because the consultation fees can be anywhere between `500-700.”

Popular types Specialty clinics save the pain of traveling to big hospitals and thus it has received good responses from end consumers over the years. However, there are some sort of demarcation exists that differentiates the popular types of specialty clinics in India. Suresh Soni, CEO, Nova Medical Centers Pvt Ltd says, “Eye Care, Dental Clinics, IVF, Cosmetics, Dialysis Centres, Day Surgery, and Primary Care (emerging specialty) are the popular types of specialty clinics in India. And the target groups are people from the lower middle class to the rich (except for cosmetics surgery which would be targeted at the upper middle class onward)”.

Factors responsible for the booming market of specialty clinics in India The sudden rise of specialty clinics in India has been caused by certain sup-

Dhruv Chaturvedi

Managing Director, Fresenius Medical Care India

Specialty clinics save the pain of traveling to crowded and far distanced big hospitals and thus it has received good response from consumers over the years

In one of its reports, WHO said that the End Stage Renal Disease (ESRD) rate in India is 850 in 1 million people and the patient getting treated is just 60. So you can see there are huge demands of people to be treated

porting factors like increasing disposable income, desire for special treatment etc. Fresenius Medical Care, one of the global leaders in dialysis treatment, product and services industry, has recently launched their first dialysis clinic in India by the name of Shrinath NephroCare in the heart of Jalandhar, Punjab. Dhruv Chaturvedi, Managing Director, Fresenius Medical Care India says, “India is very fast growing country when it comes to GDP, knowledge sharing and information flow. But one of the drawbacks that the country has is that India with 6.22 crore diabetic patients is fast becoming the diabetes capital of the world. So diabetes, hyper-tension, lifestyle diseases etc are affecting the renal diseases. In one of its reports, WHO said that the End Stage Renal Disease (ESRD) rate in India is 850 in 1 million people and the patient getting treated is just 60. So you can see there are huge demands of people to be dialysed and the facilities that are available are not sufficient. So there comes the role of a specialty clinic in India like Nephrocare. You can see the medical facilities are all mostly confined to the state capitals and metropolitan cities, so there is a huge gap in the tier I and tier II cities too. One of the reasons, Nephrocare has started its operation in Jalandhar”. Dr Kiran Lohia, MD - Dermatologist and Founder of Cosmedic Skin Solution, a registered brand of Future Skin Pvt Ltd says, “The factors responsible january / 2013 ehealth.eletsonline.com

cover story

Dr Vijay Singh

Chief Administrator Officer, Heart Centers & Diagnostics, Narayana Hrudayalaya

“Increasing health awareness among the population, focus on specialty healthcare in non hospital ambience, diagnostics centric, better accessibility and faster services with less queuing, asset light models with multi specialty offerings have lead this development”

january / 2013 ehealth.eletsonline.com

for the rise of specialty clinics in India include-increase in the income of the middle class, more awareness of taking care of one’s health and of prevalent diseases such as diabetes, heart disease, cancer and more, affordable cost of healthcare in India, health insurance rise, resulting in people having more access to medical care and finally a large young population, who are more aware of the specialty options available to them due to their cognizance of the web, facebook, etcetera”. “Increasing health awareness among the population, focus on specialty healthcare in non hospital ambience, diagnostics centric, better accessibility and faster services with less queuing, asset light models with multi specialty offerings have lead this development,” says Dr Vijay Singh, Chief Administrator Officer, Heart Centers & Diagnostics, Narayana Hrudayalaya. Dr DP Saraswat, CEO, Action Group of Hospitals says, “Healthcare scenario in India is gradually shifting towards specialty clinics. Patients are now looking for centers of excellence,

rather than going to the same doctor or OPD every time. Specialty clinics being centers of excellence assure to deliver high standards of clinical outcomes. Because specialty clinics focus on any one organ, system of the body or any one disease. These clinics are staffed with para-medical and nursing personnel of specialised skills which have been perfected over a period of time, besides adhering to predefined protocols through high-end equipments, better service quality add value so that patient gets more than other set ups”. Dr Manoj Kumar Mehta, Medical Director and Mentor, Aster Eye Care says, “Specialty clinics are coming out of the general hospitals as a universal trend. Across the world, niche specialties are being catered to by specialty clinics. The reasons for this are: 1. Need for specific infrastructure and special support services in the ORs and outpatient offices. 2. Patients/customers do not like to mix up with general patients who have diverse problems. 3. Patients/ customers demand specialty care for

cover story

which they are willing to pay for the services rendered”. Dr N Ramakrishnan, Director, Nithra Institute of Sleep Sciences & President, Indian Sleep Disorders Association)” says, “Healthcare consumers in India pay ‘out of pocket’ unlike in the West where third party payment is predominant. This allows them to exercise their choice of healthcare providers. In an attempt to get the ‘best possible care’ they are increasingly move away from generalists to specialists which seems to be driving the booming market of specialty clinics”.

Dr Manoj Kumar Mehta

Medical Director and Mentor, Aster Eye Care

Role of technology Here, technology is a vital element that makes the functioning of these specialty clinics possible. However, technologies used in various categories of standalone specialty clinics are different and therefore the clinics founders require sound understanding of these technologies. Dr Loha says, “Technologies used in dermatology clinics include cosmetic la-

in size as well as reach in India. The major segments are the Eyecare, ENT, Dental Care, Joints Replacement, Trichology, Dialysis, Diabetes Clinics, Weight Management and Endocrine disorder(s) clinics etc. Apart from these wellness clinics, rehabilitation clinics of various kinds are going to be seen in near future.

Market size Though the market is fragmented, the popularity of specialty clinic has come in a big way lately. Dr Loha says, “Indian healthcare market was USD 22.8 billion in 2005. Share of specialty care in this segment is approximately15-20 percent”. Dr Singh says, “Currently in nascent stages with a small share of the healthcare market with less than 10 percent market size, with few groups focusing on specialty clinic models like Fortis, Vasan, Nova, Kaya, Apollo, Narayana Dental, and few more”. Dr Mehta says, “Specialty clinics are expanding in size as well as reach in India. The major segments are the Eyecare, ENT, Dental Care, Joints Replacement, Trichology, Dialysis, Diabetes Clinics, Weight Management and Endocrine disorder(s) clinics etc. Apart from these wellness clinics, rehabilitation clinics of various kinds are going to be seen in near future. It is difficult to quantify the business as of now because the trend has just begun and industry has captured only a small portion of the potential business”.

“Specialty clinics are expanding

sers such as Q-switched Nd:Yag lasers, Fractional lasers, Diode lasers for hair removal. They also include technologies such as dermabrasion, microdermabrasion, chemical peels etcetera”. Suresh Soni says, “Technologies we use range from advanced techniques like laparoscopy, use of fibre optics and imaging in devices like Embryscope (only offered at Nova IVI), In Vitro Fertilisation (IVF) involves uniting the ovum (egg) with the spermatosoid inside glass – in vitro – in order to achieve a number of embryos to transfer to the mother’s uterus, Cryopreservation and vitrification of eggs and embryos”. Dr Santanu Chattopadhyay, Founder & CEO, NationWide Primary Healthcare Services Pvt Ltd says, “Technology is a value addition in 21st Century. In Nationwide, all the medical records are kept in electronic records format, anytime you call up Nationwide and if you have customer ID number, the doctor can easily see all the medical records and then start treating you. Today if you write a piece of paper nobody‘s knows, why did you do that; but If you feed that on electronic records everybody will come to know about this. So I think technology will be a great aspect”.

Challenges for the specialty clinic founders As every coin has two sides, running of a single specialty clinic has its own

challenges too. Soni says, “Challenges include paucity of professional talent, attrition with staff, very expensive real estate, regulatory framework etc. To overcome these challenges we need good planning, hiring good talented staffs with profit sharing schemes”. Dr Singh says, “Though they are asset light models, operationally require the same attention and initiatives for better outreach, care, having specialists round the clock or for the whole day becomes difficult at times, transit times need to be managed well, hospitality at its best, hospital equivalent care and outcomes expected which have to be met”.

Future of specialty clinics The future of specialty clinic in India is certainly looks good. As more and more players coming into the space, there will be more competition in the coming years. Soni says, “The future is very bright. Single specialty clinics are focused on providing a comprehensive range of services for a particular medical specialty. As they require lesser investment than multi-specialty hospitals, they are easier to put together. They will lead growth in healthcare services segment in India”. At the end it can be said, no one can deny the fact that, standalone specialty clinics are here to stay if the sector continues to show the present developments. january / 2013 ehealth.eletsonline.com

cover story

Specialty Clinic Introduces a New Era Considering Namokar Eye & Gastro Centre a specialty clinic, what are the factors you think are responsible for the booming market? Specialty clinics in India are booming because of increased awareness among the public towards healthcare, as a result of better education, globalisation, usage of Internet etc. Easy availability of specialists and superspecialists in such clinics ensures early diagnosis and early treatment of patients saving time spent in hospitals. Most of these clinics are open till late in the evening. People find it convenient to take a sick family member for treatment without always taking leave from work. Specialty clinics not only save time of patients but provide more patients friendly environment with personalised care and attention away from the intimidating, impersonal atmosphere of hospitals.

Dr Pradeep Jain, Founder & MD, Namokar Eye & Gastro Centre, speaks about the nuances of specialty clinics in India

What are the technologies that are used in such specialty clinics in India? A few examples please? Specialty clinics are day care facilities using diagnostic and therapeutic modalities not requiring patient admission where the patient can be treated and immediately sent home. For example, in eye care clinics, lasers for retinal diseases and glaucoma, Lasik surgery, investigations like field charting, fundus angiography; optical coherence tomography, ultrasonography etc. are performed. In gastroenterology clinics, patients are examined and investigation endoscopic procedures are performed. How these technologies come handy in the functioning of the specialty clinics such as Nephrology, Trichilogy, Day-Care, Eye-care etc. How Namokar Eye & Gastro Centre is using technology? In Namokar Eye & Gastro Clinic, besides comprehensive eye care facilities cosmetic treatments like Botox and filler injections are also available. Cataract surgery and Eyelid plastic surgery procedures are performed using the latest techniques. What are the challenges that the founders of specialty clinics are facing? What are your suggestions in overcoming those challenges? The owners of such specialty clinics are the doctors themselves. Doctors are less equipped with marketing and administrative skills. Therefore the most important challenge faced by the ownerâ&#x20AC;&#x2122;s is towards publicising their facilities and procuring more patients, improving their visibility to increase work. All new technological advancement comes at a high price. Constant up-gradation of facilities and equipment adds to stress for the owners. Group practice by different specialists using the same premises and equipment is one way of sharing expenses and reducing stress.

january / 2013 ehealth.eletsonline.com

Exclusive

Tele-ECG Runs “Live” with Mobmon Mobmon records, stores and manages ECG and pulse-ox records in form of EMR using an Android application

Gajanan Nagarsekar, MD, Kallows Engineering

Kevin Kreger, Co-founder & Technical Director, Kallows Engineering

Looking at the news on Mobile Health (mHealth) technology disseminated over the Internet and other news media, one would imagine that the best devices in the mHealth sector will not be arriving until next year or by 2014. However, an Indian start-up founded by an American and an Indian has leapt ahead of the competition with the release of their first mHealth product. Kallows Engineering India Pvt Ltd based out of Goa is already manufacturing and selling advanced and innovative multiparameter patient monitors, such as their revolutionary Android Smartphone (or Tablet) based ECG and Pulse Oximeter. Their flagship product has US and Indian patents pending and is known as mobmon 3.0 (an acronym for mobile monitoring). This compact and inexpensive product fits in your hand and records, stores and manages ECG and pulse-ox records in form of Electronic Medical Records (EMR) using an Android smartphone or tablet based application (app). All of the hardware and software for the product is designed and manufactured by Kallows in India. Doctors who have clinically tested the device and the ones who reviewed the demonstration were amazed to see that

Fig 1: Mobmon 3.0

the ‘Tele-ECG’ offered by Kallows has a real-time mode wherein a remote physician can view the patient’s vitals and waveforms on his mobile while the patient is connected (not as a mere picture or PDF file sent to the remote doctor via email.) In addition, the records are stored and can be browsed online and shared anytime between doctor’s mobiles. Speaking to the Managing Director of Kallows, Gajanan Nagarsekar, he explains how the mobmon device (Fig 1) functions: “Using mobmon is a very easy threestep procedure. First, you connect your patient to ECG cables and/or Pulse oximeter as you would normally. Second, you plug the mobmon USB cable into your Android smartphone or tablet and the mobmon app starts automatically. Third you use the screen on the mobile device to view patient’s ECG and SpO2 readings and waveforms. Then you can run the LiveTransfer feature to send the entire EMR to a remote doctor or hospital for instant viewing wherein the waveforms are viewed ‘live’ from the patient while connected.” As per Kevin Kreger, Co-founder and Technical Director at Kallows, “Tele-ECG and EMR offered by Kallows is the fastest, most reliable and hassle free product

used as compared to any other Tele-ECG monitoring in the market. Moreover, we are expanding the product portfolio by 2013 to at least three more innovative mHealth products.” Kevin adds, “The EMR also contains patient info and vital signs along with the ECG and SpO2 waveforms all bundled into a standard DICOM file which can be imported by any standard hospital information system that can read a DICOM file.” These kinds of features and standardization make mobmon devices affordable along with reducing operating cost of ease of use in operation with minimal training. “It is as easy as using your mobmon smartphone app,” mentions a smiling Gajanan. In addition, Kallows programming experts can provide customisation of the app to add patient information required by any ambulance company or hospital having special EMR requirements. Having researched and developed the product for nearly 4 years and being a pioneering company in the mHealth sector Kallows Engineering India Pvt Ltd based in Goa, India is definitely creating waves with its hi-tech products. Company website: www.kallows.com january / 2013 ehealth.eletsonline.com

Industry Expectation

Industry Expectation 2013 As we look forward to a fresh year ahead, we spoke to different industry experts to get their views on how the Indian healthcare sector is transforming in the coming year. We have also tried to find out how these changes will lead to greater strength to common man. Our analysis reveals industry experts are full of hope and they see a bright year ahead for Indian healthcare. Excerpts: Suresh Babu, Director & CTO, PROSIT says, “In the year 2013, we wish to see more mHealth solutions, cloud based solutions, data analytics, remote patient monitoring, telemedicine, personal health records, health information exchange etc. Dr Annie Stanley Thakore, Hospital Administrator, CARE Hospitals says, “India will have a new cyber security policy in the Year 2013. Designed to protect critical communication and infrastructure from cyber threats, approval of the policy will see formation of a national cyber alert system and sectoral computer emergency response teams (CERTs)”. Siva Vageesan, CEO, AmbalSoft InfoTech Private Ltd says, “In year 2013, we believe that role of ICT in healthcare will increase tremendously and the use of integrated EMR systems will also increase to a great extent”. Dr Arun Kumar Datta, Vice President Operations (Medical), Rockland Hospital says, ”I would like to see a real-time, IT-based interaction between the service providers and the sponsoring or paying agencies, which at present is tilted majorly in favour of the latter”. M V Saneesh, Senior Manager, Sys-

january / 2013 ehealth.eletsonline.com

tems, Shalby Hospital, Ahmedabad, says, “Just as the India Nursing Council mandated ICT to nursing curriculum, the Medical Council shall imbibe ICT into medical education as well. Government hoisting a cloud solution for all clinics and hospitals to use an H-ICT frame work would be interesting. Early usage of Aadhaar across applications shall be encouraged”. Shrinivas Birla, CEO, Birlamedisoft Pvt Ltd, says, “I strongly feel that the Government should pass a resolution making HIS compulsory for all hospitals. This is a growing need of current times”. Suchet Singh, CEO, Srishti Software Applications Pvt Ltd, says, “With endless positives and benefits of Medical IT, the present, seems to be the right time to devise a National Health Information Technology policy, which would result in standardised adoption and use of the Healthcare Information Technology across the country”. Dr Akash S Rajpal, MD & CEO, EKOHEALTH Management Consultants PVT LTD, says, “We are looking forward to a regulation that shall make basic use of IT mandatory for all health centres and enable data sharing for portability. Also,

training centres should be created for training data entry operators. We are also looking forward to the Government for making IT an important part of course curriculum for doctors and nurses”. Vasukumar Nair, Director – Marketing & Sales, 21st Century Informatics, says, “There are many technology trends in the market. Whether it is Cloud, Analytics, Big data, the technology is here to stay, but I do not believe that the mid market healthcare organisations have yet taken full advantage of it. I am sure, they can capitalise these emerging technologies and attain competitive advantage”. R Viswanathan, Business Unit HeadHealthcare, PCS Technology, says, “The major expectation will be standardisation of hospital processes which is a long way to go. Accreditation of medical services to improve the standard is necessary. This will ensure all the hospitals, labs, service providers the minimum quality of service. Every hospital has its own process within a city/town, which is a critical factor in making the solution unstable. TPA should have common templates /practice/standards across India to ensure the transparency and effective utilisation of software”.

rural healthcare

Rural India Need not Follow Urban India

Dr K Ganapathy, President, Apollo Telemedicine Networking Foundation, and a pioneer of telemedicine in India, shares his views on the ways in which technology has proved a boon for rural healthcare. In conversation with Nikita Apraj, ENN

What kind of potential do new advances in communication technologies have for rural India? In the years to come the definition of ‘rural’ will itself undergo a change. Technology will be the game changer helping to gradually reduce the urban rural divide. Cable TV, mobile phones,

a chip-embedded Aadhaar smart card and m-Money is slowly but surely making inroads into towns and even villages. e-Governance is slowly leading to m-Governance. Internet-enabled Village Resource Centres and Village Knowledge Centres are today still in the proof of concept stages. Bharath Broadband has publicly announced that by December 2014 at least 100,000 villages will have fibre optic cable. `20,000 crores have been set apart from the Universal Service Fund for this. Rural India need not follow urban India. It need not piggyback. It will actually leap frog. I am looking forward to spending my retired life in the pristine villages of India with 2020 technology at my fingertips. There will be a reverse migration from the very expensive overcrowded metros once creature comforts are available in rural India. Why is the potential of telemedicine underutilised? We can’t go far with conventional brickand-mortar hospitals. 80 percent of India’s population has no direct, physical access to specialist healthcare. Estimates suggest that the telemedicine market is at least for 800 million Indians. Even if half of these 800 million need to consult a specialist once a year, that still amounts to 400 million specialist consultations per year. Even if 10 percent of these are enabled through telemedicine we are talking about 40 million consultations per year from rural India alone. The market potential for telemedicine is obviously enormous. The potential of telemedicine in India is still under-realised because of lack of awareness among the masses and lack of a business model that caters to all the

stakeholders. Telemedicine will never reach the critical mass for take-off until doctors are excited about it and unless people clamour for it as a cost-effective method. We need public-private-partnerships to drive telemedicine in India. Please provide us with an overview of the challenges in telemedicine. What are the solutions to these challenges? There are several challenges. The problem is to say the least enormous. Providing “better healthcare” to 700 million Indians living in rural India requires radical exponential transformations not routine incremental changes. Technology-based 21st century solutions are required. WiFI and WIMax is not the answer. WiiiFM (What is in it For Me) is the only answer. Any solution must be costeffective, need-based, using appropriate technology. The solutions need to be self-sustaining which pre-supposes revenue generation. Worldwide it has been shown that political will at the grassroot level is the key factor. The individual MLA and MP must feel that providing better healthcare in his constituency will alone get him reelected! Health insurance to all is vital. Tele-consultations must be reimbursed. All interns should have a compulsory virtual village posting so that they understand the realities of life. Knowledge empowerment using cable TV etc will go a long way to create awareness on health issues. Ultimately there needs to be a mass revolution from the bottom of the pyramid demanding healthcare as a birth right. Thrusting ‘better’ healthcare from the top will not be enough. Finally one size does not fit all. Multiple everchanging solutions will be required. january / 2013 ehealth.eletsonline.com

IT Tech Trends

2013 is for cloud Despite the many challenges that persist in the Indian healthcare IT sector, the mood of market players is upbeat for the year 2013. Cloud Computing is going to be the major focus. Hospital Information Systems(HIS), Picture Archiving and Communication Systems (PACS) and web-based technologies are picking up in a big way By Monalisa Das, ENN

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IT Tech Trends

technology, supported by ICT, has the potential of increasing access, significantly reducing the burden of disease and the load on healthcare delivery services through early diagnosis, better clinical outcomes, less invasive procedures and shorter recovery times.” The persistant question remains ”how”?

Challenges of 2012

he verdict is out. The year gone by carried a mix bag of achievemnts and unique challenges for the Indian healthcare IT sector. Nevertheless, the challenges are not going to deter players from achieving their targets this year. As the new year unfolds, it’s time for the market players to assess their growth trajectories, lessons learnt, and move on. ICT is definitely going to play a huge role in the Indian healthcare sector, with Cloud Copmuting and web-enabled HIS expected to grab the limelight. According to a study by Zinnov Management Consulting, titled ‘Cloud Computing: An Enabler of IT in Indian Healthcare Sector’, ”The total addressable opportunity

for Cloud solutions in the Indian healthcare industry is estimated to touch USD 600 million by 2020. With this, Cloud can potentially address close to 40 percent of the total annual healthcare IT spending in India.” Going by the findings of this study done in 2010, ”The healthcare spending is expected to reach USD 164 billion by 2019-20, from USD 54 billion in 2010. Also, the estimated annual IT spending within existing hospitals in India is expected to go up to USD 1.5 billion by 2020, as against USD 191 million in 2010.” As per a report titled ”Medical Technology Industry in India: Riding the Growth Curve”, released by Deolitte, ”An effective and innovative use of medical

Dr Sanjay Bedi, President, Indian Association for Medical Informatics points at the factors that posed as major challenges in realising this dream. ”IT literacy among healthcare professionals, especially among key decision makers, continues to be lower than expected. We need to gear up on this aspect,” says Dr Bedi. Agrees Dr Annie Stanley Thakore, Hospital Administrator, CARE Hospitals, Surat: ”The healthcare sector’s fragmented constituencies and complex transactions present a major barrier, making the application of ICT enabled Information Management Systems extremely difficult to the end user which can only be overcome by adequate and proper training,” Another area of concern is the lack of IT infrastructure at grassroots level. ”Take for instance data cards. They work well in metro cities, but the moment you take them to tier-II and tier-III cities, their speed drastically comes down,” says Dr Bedi. Moreover, since most hospitals and medical colleges are in the process of automation, they need to maintain paper work as back-up. This escalates the cost and effort of maintainig medical records. Slow decision-making; low penetration of IT; mismatch between the expectations of people, medical organisations and institutes and their paying capacity; lack of standardisation or regulation; and low IT budget are other salient features of the Indian healthcare sector that continue to act as roadblocks in the implementation of ICT.

Vision 2013 Despite these challenges, market players are hopeful of better growth and development in 2013. ”The picture isn’t that grim though. The role of medical informatics is increasing in both record keeping january / 2013 ehealth.eletsonline.com

IT Tech Trends

and data mining. In fact, the year 2012 witnessed an increasing role of data mining. Haryana is a case in point, where all medical records in Government hospitals and medical colleges have gone online. Other states are also adopting the system now,” informs Dr Bedi. As the health insurance sector grows, it is going to further push for the need for electronic records by hospitals. ”Most healthcare organisations are now aspiring to have an overarching IT vision which is aligned with clinical care require-

ments, business strategies and longer term goals as well, beyond achieving operational efficiencies,” says Dr Mahipal Sachdev, Chairman & Managing Director, Centre for Sight Eye Hospitals. The answer lies in innovation. According to the Deolitte report, ”Medical technology innovation can be the tool to make modern healthcare accessible, available and affordable to all. Innovation need not only be restricted to products, but also to business models. For innovation to make an impact, collaboration between the

stakeholders in the medical technology ecosystem is a key success factor. The industry must move from ‘company-centric’ innovation, towards ‘co-creation’. All stakeholders – Government, industry, academia, healthcare and insurance providers - need to co-ordinate, strategise and move in step for their actions to resonate and bring about lasting change.” We spoke to key players in the market – including representatives of hospitals and health IT companies to share their outlook for tis year. Excerpts:

Real-time interaction of service providers & paying agencies needed What changes have you noticed in healthcare in areas such Health IT, Medical Equipment, Regulations, etc? HISs are becoming more sophisticated by the day and are adapting to the needs of hospitals as more and more hospitals install HIS. The limiting factor still remains the price, especially for smaller hospitals. With vendors offering an intake in it, there is an extra cost levied for customisation. Bi-directional interfacing of medical equipment with the HIS is becoming a very critical development in view of its inherent reduction of man-made errors and should be taken as the focus of the IT and other sectors.

Dr Arun Kumar Datta, Vice President Operations (Medical), Rockland Hospital

What were some of the key challenges that you faced in IT implementation in 2012? The key challenges that we faced in the procurement of a new Hospital Information System (HIS) was the selection of a reliable vendor. We needed a vendor who could assure capability of providing after-sales services, preferably locally. This was a major challenge.

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What are the prospects of growth for the ICT implementation in Indian healthcare in 2013? There is a huge opportunity for ICT implementation in healthcare, both in the government and private hospitals. There shall be special emphasis on centralised purchase and inventory management systems. Are there some specific segments of the healthcare sector that are likely to witness a larger demand for IT adoption? The need for real-time interactions between service providers and agencies

like insurance, Third Party Administrators (TPAs), Central Government Health Scheme (CGHS), Ex-Servicemen Contributory Health Scheme (ECHS), etc, is going to increase. This is one area where there shall be a major demand for IT adoption, especially in the areas of approvals and submission of bills. Talking about hospital management, how do you foresee the role of ICT growing in 2013? The administrator cadre of hospitals have realised the benefits that ICT can provide in facilitating and supporting the management function. As a result, more facilities will adopt such systems to work more efficiently. What are the top technologies in healthcare that will play a crucial role in the year 2013 and beyond? The installation of Picture Archiving and Communication Systems (PACs) and Electronic Medical Records (EMRs) with web-based systems will play a crucial role henceforth. The use of Computer on Wheels (COWs) / WiFi at the point of care will also facilitate services, especially in high-tech equipment dense areas such as ICUs, provided there is no interference with monitoring equipments.

IT Tech Trends

Looking ahead at consolidation What were some of the key challenges that your hospital faced in IT implementation in the year 2012? Our institute, into the third year of operations, completed with the implementation of a dependable IT infrastructure. Standardisation across equipments, environment and functions was a major challenge. Few quick-fixes to enable quicker delivery of services and capex intensive dependable solutions led to delayed decisions. Are there some specific segments of the healthcare sector that are likely to witness a larger demand for IT adoption? It would be interesting to see consolidation of few players and emergence of world-class solution providers among them. A platform matching to ‘Core Banking’ in healthcare will really make implementation and preservation budget rational with further contribution and enhanced accessibility. Tremendous growth is foreseen for the healthcare ICT sector. Established international vendors are making conscious efforts to make inroads into the segment through direct or acquisition route. What are the prospects of growth for ICT implementation in Indian healthcare in 2013? To manage volume, effective ICT implementation is inexorable. ICT is already a mission critical service to any major healthcare provider’s operations. Increased life expectancy along with patient expectations shall only leverage the growth prospects of healthcare IT in the coming days

M V Saneesh, Senior Manager – Systems, Shalby Hospital, Ahmedabad Talking about hospital management, how do you foresee the role of ICT growing in 2013? Efficiency of hospital management impressively crux on steadfast and ascendable ICT solutions applied. The new breeds of professional healthcare managers are well trained on ICT tools, unimaginative of doing away with those tools.. What changes you have noticed in healthcare in areas like Health IT, Medical Equipment, regulations etc? Provider participation in payee system (RSBY, CGHS reimbursement) is a significant step. This underlines the meaningful usage of resource and makes direct attention of hospital management

and patients. A couple of state governments deciding on a uniform HIS across district hospitals will reap greater benefits. Virtualisation, cloud computing, mobile devices, BYOD, etc penetrated in decent numbers. Medical equipments become more ‘ready-to-connect’ and quick remote support became a norm. What are the top technologies in healthcare that will play crucial role in the year 2013 and beyond? Cloud Computing, Software as a Service, Mobility Computing, Information from Unstructured sources and Clinical Data Analytics shall be the most prominent technologies that shall take the Indian healthcare to new paradigms this year. january / 2013 ehealth.eletsonline.com

IT Tech Trends

Time for innovation

Dr Mahipal Sachdev, Chairman & Managing Director- Centre for Sight Eye Hospitals What were the top tech trends in healthcare in the year 2012? Ophthalmology has seen a rapid growth in technology with respect to precision and efficiency which will continue in the year 2013. As of now, the latest technology is expensive and hence difficult to adopt on a mass scale. At present, the technology such as Femtocataract and Femto LASIK is available in India, though for the niche segment only. The future should see this technology become affordable & a boon for the masses.

What changes have you noticed in healthcare in areas like Health IT, medical equipment, regulations etc? IT in healthcare has seen a level change. While IT started as an electronic record keeper long time ago, it has grown to be recognised as an overall decision support mechanism and a value builder. Every healthcare organisation is now trying to have an overarching IT vision which is aligned with clinical care requirements, business strategies and longer term goals as well, beyond achieving operational efficiencies. The experimentation phase is over and the latest technologies and platforms are being used to build innovative solutions. While HIMS remains to be of pivotal importance to any healthcare delivery organisation, technologies like digital social media assists in maintaining a constant connect for disease awareness and prevention and knowledge sharing among clinical fraternity. We were able to achieve a real time multi-location multibusiness integration of our group by creating private cloud by leveraging upon the latest available technologies. We believe this could happen only as a result compelling transformative vision, strong governance and inclusive engagement of stake holders. Medical equipment: Ophthalmology is now witnessing the Blade-free revolution. Femtosecond laser had made the LASIK procedure blade-free ensuring greater safety & predictability. This technology has now been adapted to cataract surgery. With the Femtosecond laser, the crucial steps of cataract surgery are now automated, attaining levels of safety & predictability not attainable in traditional surgery. Regulations: There havenâ&#x20AC;&#x2122;t been any major changes or developments in the medical regulations recently.

Focus on hospital information systems What were some of the key challenges that the Health IT sector faced in 2012? One of the biggest challenges for the health IT sector was the mismatch between the expectations of people, medical organisations and medical institutes and their paying capacity. They were looking for software but did not want to pay appropriately for the value of the product. This was a common tendency that we experienced throughout all our business transactions last year. What changes you have noticed in the health IT market in the year 2012 and what are the prospects of growth in 2013? The year 2012 proved that despite all the challenges, the health IT market is definite-

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expected to increase by 10 percent. Hospital Information System (HIS) shall be in demand in a big way. The market trend is expected to move towards cloud computing whereby most hospitals will aspire to adopt web-enabled hospital management systems and lab information systems (LIS).

Shrinivas Birla, CEO, Birlamedisoft Pvt Ltd ly picking up and software awareness is increasing as well. In this year the market is

What are some key areas in Indian healthcare where your company is likely to play a big role in 2013? We currently occupy 10 percent of the health IT market. Our target is to attain 15 percent of market share by the end of 2013, and gradually grab 50-60 percent of the market in another five years. Talking about the top technologies in healthcare that will play crucial role this year, I think Microsoft .Net technology is going to be the game changer.

IT Tech Trends

Cloud to play a major role What were some of the key challenges that the Health IT sector faced in 2012? Despite the strong growth of the Indian healthcare technology market over the past few years, the industry is plagued by low penetration. The challenge here lies in expanding the market. True, that the healthcare industry in India has shown a rapid growth, but majority of the demand has been coming from tierI cities, whereas tier-II and tier-III cities remain neglected, owing mainly due to lack of affordability, accessibility, awareness and availability. What changes you have noticed in healthcare in the year 2012 in areas like Health IT, Medical Equipment, Regulations, etc.? The use of ICT has been very instrumental to the concept of â&#x20AC;&#x2DC;integrated careâ&#x20AC;&#x2122; and has the potential to enforce a remarkable transformation in the delivery of health-

lowering down defect-rate and at the same time raising levels in storage and transmission of data. Please tell us about some new and innovative solutions that you are planning to introduce in 2013? In an age where the world is embracing mobility like never before, Srishti has been able to deliver a product called PARAS, which has carved a niche for itself in the market that is easily installed in tablets, smartphones or handheld devices.

Suchet Singh, CEO, Srishti Software Applications Pvt Ltd care, making it safer, easier, effective and efficient. If implemented in the right way, these IT systems possess mechanisms to reduce administrative and clerical work, thereby sparing more time for patient care,

What are the top technologies in healthcare that will play crucial role in the year 2013 and beyond? In the coming days, we will see a remarkable advancement in the way images are stored in Picture Archiving and Communication System (PACS). Holographic storage and retrieval technologies will define the future of PACS.

The future lies in tele-consultations

Dr Akash S Rajpal, MD & CEO, EKOHEALTH Management Consultants PVT LTD What changes you have noticed in healthcare in areas like Health IT, Medical Equipment, regulations, etc in 2012? Healthcare Management System (HMS) penetration is increasing but very slowly.

There is no standardisation or regulation on the same. This leads to great underutilisation of many important features of HMS which can be useful for patients & hospital administration. Use of IT in telemedicine is attracting great interest from private players, and a lot of online consultation space has opened up with private equity investments. However, on the other hand, no cost-effective solution for SME hospitals & clinics has come up yet, hence leaving a large chunk of healthcare delivery out of ambit. Are there some specific segments of the healthcare sector that are likely to witness a larger demand for IT adoption? Tele-consultations are going to pick up in a big way. As our urban lifestyles become more hectic, more and more people shall opt for medical consultations

on phone, hence saving time and energy in physically visiting a doctor. Growing demand from tele-consultations will press for the need for accuracy, and IT adoption has a big role to play in this direction. Also, home care monitoring is expected to become popular and again IT will have a significant contribution in the success of the concept. What are the top technologies in healthcare that will play crucial role in the year 2013 and beyond? Cloud based hosting of services is going to be the highlight of 2013. Also, pay for service model, medical equipment in imaging & remote diagnostics, telemedicine, tele-consultations, tele-radiology & home care monitoring are the technologies that shall make a mark on the health IT market in India in 2013. january / 2013 ehealth.eletsonline.com

IT Tech Trends

Embracing healthcare software applications

about interoperability and standardisation. Advanced healthcare applications definitely require reliable and secured interoperable standards. Another factor is that standardisation of a healthcare process needs to be in place, which can also promote better regulation. What are the prospects of growth for the health IT market in 2013? Whether it is green fields or expansion of hospitals, or chain of general clinics, speciality clinics – all components of the Indian healthcare, irrespective of their size, are rapidly embracing healthcare software applications and we are seeing a healthy demand for our solutions. Definitely, there are some new healthcare projects coming up and also many in the expansion mode. There will be a need of healthcare IT applications for these new ventures.

Vasukumar Nair, Director – Marketing & Sales, 21st Century Informatics What were some of the key challenges that the Health IT sector faced in 2012? 21st Century Informatics has achieved a few good orders in 2012. For these customers, we are providing solutions ranging from end-to-end hospital information systems to a multi-centred chain of enterprise level solutions. We have leveraged our domain expertise acquired through the last 18 years and continue to provide a scalable, affordable and reliable Hospital Information System. However, the key challenges continue to be slow decision-making and low-budget allocation from the providers’ side. I think there is still lack of awareness on advantages of IT automation and they don’t consider IT as an enabler to improve

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organisational performance. Finally this will reflect in low IT budgets allocated and sometimes lack of support during the time implementation and that has to be certainly changed. What changes you have noticed in healthcare in the year 2012 in areas like Health IT, Medical Equipment, Regulations etc? One of the few areas that we call ‘happening’ in India is healthcare. We found a lot of stakeholders such as service providers, regulatory bodies, software providers becoming very active and we believe they are the driving forces for that positive happening. In 2012 we participated in a few healthcare events and we found that the industry is talking

Please tell us about some new and innovative solutions/technologies that you are planning to introduce in 2013? We are constantly innovating to provide new features and functionality to our users. We are working on a new technology platform that enables rapid expansion of functionality during IT products implementation. It is supported by advancement in cloud computing technology and emergence of the SaaS model. We are hoping that by mid of 2013, we would be able to launch this for our customers. What are the top technologies in healthcare that will play crucial role in the year 2013 and beyond? There are many technology trends in the market. Whether it is Cloud, Analytics, Big data, the technology is here to stay, but I do not believe that the mid market healthcare organisations have yet taken full advantage of it. I am sure; they can capitalise these emerging technologies and attain competitive advantage.

IT Tech Trends

Intagration is inevitable was the increasing presence of professional administrators, finance heads and CIOs in hospitals.

R Viswanathan, Business Unit Head-Healthcare, PCS Technology What were some of the key challenges that the health IT sector faced in 2012? One of the biggest challenges for the health IT sector is that except few corporate hospitals, the healthcare industry does not plan budget for IT. The IT budget of any new hospital should ideally be around 4-6 percent of overall hospital budget, but in reality it is less than 2 percent. Another challenge is the dearth of qualified staff in ICT, which results in poor implementation of best practices. Moreover, since the benefit of IT is not tangible till some point of time, the overall confidence to invest in IT is low as against investing in equipments. A majority of hospitals that are considering Hospital Information System (HIS) applications, limit their scope to admission, billing and revenue cycle management. Hence, the purpose of IT automation gets defeated with local vendors aiming to gain short-term benefits. Creation of EMR/PHR is still a long way to go in India since very few clinicians/nurses have started using hospital software for noting their patientsâ&#x20AC;&#x2122; clinical records. What changes you have noticed in healthcare in the year 2012 in areas like Health IT, Medical Equipment, and Regulations etc? One remarkable change was more government initiatives on various healthcare schemes and allocation of additional budget for ICT. Also, hospitals showed more willingness to adopt IT automations compared to previous years. They started looking for turnkey solution or single vendor for all their IT requirements. In terms of regulations, the number of hospitals applying for accreditation was on the higher side in 2012 as compared to the previous three years. The overall growth of insurance and corporate tie-ups forced many hospitals to look for proper IT software. Another positive trend

What are the prospects of growth for the health IT market in 2013? The Venture Capital Funding will get a major boost in 2013. Mergers and acquisitions by major corporate hospitals will drive the IT automation in India. Health information management companies will continue to receive major funds. With growing patient awareness, the diagnostics market will experience major growth and tier-II and tier-III cities will adapt to IT in a big way. Practice Management will have high potential in the coming year with more and more clinicians moving towards creating EMR. There will be major growth in daycare centres. A lot of corporate chains are on the verge of opening their branches in 2013-2014 and chronic segments such as cardiology, endocrinogy, etc, will look for tie-ups to start chain of specialty hospitals across the country. What are some key areas in Indian healthcare where your company is likely to play a big role in 2013? We will continue to focus on turnkey solution by providing IT consultancy, HIS, lab information system (LIS) and will also help in the maintenance of the entire IT by providing skilled resources. We have a successful delivery model for multi-location labs and hospitals, and hence will be focusing on them. We shall also be focusing on our middle enterprise which will cater to the mid-sized hospitals looking for core hospital process. Please tell us about some new and innovative solutions/ technologies that you are planning to introduce in 2013? We are working on additional modules that can be provided with HIS for big corporate hospitals and for international markets. These include Vehicle Parking System, Medical Gas Pipeline System, Pneumatic Tube System Management, Online Leave Management System for hospital staff. Moreover, we are working with an US based organisation for developing specific clinical modules especially for Oncology, NICU, etc. On technology front, we will be moving towards Rapid Implementation Methodology tool, which will help hospitals in quicker implementation. What are the top technologies in healthcare that will play crucial role in the year 2013 and beyond? In 2013, the focus will continue to be on using the existing HIS and retaining the core IT resource. However, cloud computing will gain momentum. The usage of mobiles and tablets will gain momentum, especially among doctors. Smart cards shall be playing larger roles in top hospitals. Above all, integration of HIS, LIS, radiology information system (RIS) and PACS is inevitable in the coming days.

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IT Tech Trends

Standardisation makes a strong case What changes have you noticed in healthcare segment? We are beginning to see almost all equipment today exposing standard IT interfaces and customers see value in interfacing these equipments as it offers seamless information exchange across their workflows. Authorities and regulatory bodies must begin to accept printouts of reports directly from the software as opposed to handwritten registers. This will enable champions of IT projects spearhead the effort in an effective manner. What are the prospects of growth for ICT implementation in Indian healthcare in 2013? Standards in medical insurance will drive standardisation of tariffs as well as electronic document exchange, making a strong case for ICT in healthcare. The industry will also witness an exponential

healthcare sector has led to the emergence of the concept of wellness. The new consumer not only wants to stay healthy but also wants to ensure he/she is free from any illness. This awareness will result in an increase in proactive diagnostic testing which will drive an increase in consumer facing online portals, home care devices and smartphone apps.

Aditya Mani, Director-Technology, Acuity Information Systems Pvt Ltd surge in use of devices like tablets and smartphones in the year 2013. Are there some specific segments that are likely to witness a larger demand for IT adoption? Increase in consumer awareness in the

What were the key challenges that hospitals faced in IT implementation in 2012? We continue to see low ICT adoption in clinical and non-clinical settings due to improper system design and not because doctors are not IT savvy. However, all these are changing now with the advent of 3G enabled devices like the iPad and Android tablets. We have come across many scenarios where tablets would enable a doctor to work better with the IT system.

2013 will see many positive changes

Sadanand Reddy, MD, Goldstar Healthcare Pvt Ltd What changes you have noticed in healthcare in areas like Health IT, Medical Equipment, regulations etc? To get Central Government Health Scheme (CGHS) and public sector employee affiliation for hospitals, NABH accreditation has become mandatory. As per NABH guidelines, software has also become major part of hospitals

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requirement. Because of this, hospitals are looking for Health Information Management Services (HIMS) to fulfill NABH requirement without understanding the benefits of the same and not looking for complete HIMS product. As medical equipment also coming with latest software like Dicom, HL7 compatibility most of the equipments become easy for interfacing with HIMS which in turn helps in time saving and reduction of human errors as well. What are the top technologies in healthcare that will play crucial role in the year 2013 and beyond? Newer technology like web based, Bar Code/RFID technology has become future technology and interfacing most of the medical equipments and tablets etc. will play greater role in this healthcare industry. EMR and HIMS will play good role in future to come. Mobile applications for doctors help in explaining the patients about their problems illustri-

ously and make the patient satisfied with their treatment plan. Are there some key policy changes or regulations that you are looking for in 2013? An autonomous body Quality Council of India under Government of India, has brought NABH accreditation processes for all hospitals after getting JCI accreditation in few hospitals in the country. Keeping in mind, the international guidelines or standards which are basic requirements of our countryâ&#x20AC;&#x2122;s healthcare sector some standards are made by governing body like NABH and enforcing the same is the key to ensure some benefits to the Government as well as service providers in terms of taxation and having personal Medical Information records. Patient satisfaction by ensuring the patient care with appropriate treatment and having some protocols likes NABH standards can help better adoption of IT in this field.

IT Tech Trends

When PHR is inevitable Overview Personal health records have the potential to enhance healthcare and reduce costs through better analysis and accurate diagnoses. PHR on cloud computing & mobile offer cost-effective information services that can help realize the benefits of PHR. Though in a very nascent stage in India, there is a promising scope for Personal health records in Indian Healthcare Industry. There are various firms who have already set their footprints in this segment and have a substantial subscriber base.

Present challenges Most of our health management systems in India have been developed keeping the core interests of healthcare service providers, thereby keeping away the consumer or payerâ&#x20AC;&#x2122;s interest on the periphery. This has often lead to issues of interoperability of electronic/health records between healthcare payers & providers. PHR if well adopted can be a powerful instrument & in fact result in altering relationships with in healthcare industry. A consumer with his access to PHR can have better access to quality healthcare & can control their own healthcare needs. The increase in online second opinions & doctor consultations is a direct reminder to the decision makers in healthcare on how the PHR can impact the market. In India many players have emerged in this segment like Prime India healthcare, mediangels, mdhill, dialadoc etc. The PHR industry or Mobile health technologies are often backed & promoted by payers & Insurance providers, whilst it also faces the disruptive

V Vinod Sharma, Managing Director- Prime India Healthcare Solutions Pvt Ltd challenges from within the industry i.e. doctors & hospitals as they believe the growth of this sector may lead to reduction in their revenue streams in the longer run. A few providers also relate this to . privacy or security issues. Why PHR is inevitable, an emerging solution? The rising number of lifestyle and chronic diseases, the cost of healthcare & the growth of health awareness along with growing broadband access have pushed the consumer to shift to self

care methods like subscribing to health related web content providers, online second opinions & search for doctors & hospitals reviews. This potentially alters the decision making of the consumer seeking healthcare services. This is where the PHR plays a major role as it facilitates and empowers the consumer to store, manage & share their health data & to access the services from various providers. As time goes we will see that how PHR will reach its full potential and becomes a way of life.

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IT Tech Trends

EHR to pave the way through what is often broadly referred to as e-Health. All the four segments namely â&#x20AC;&#x201C; payers, providers, practitioners and patients â&#x20AC;&#x201C; shall be benefitting from ICT adoption. The major impact of ICTs on payers will be the ability to manage the system in order to better account for expenditures, to manage the flow of funds and contain costs. Electronic scheduling and patient management systems could improve scheduling of tests and procedures, and thereby reduce the length of hospital stays and reduce the need for multiple visits. Linking insurers, healthcare providers, financial institutions and consumers into claiming and payments systems also has the potential to reduce significantly administrative costs and improve quality of service, hence benefiting service providers. From the perspective of medical practitioners, knowledge enrichment or education, practice administration, and clinical tools are among the most important ICT applications.

Dr Annie Stanley Thakore, Hospital Administrator, CARE Hospitals What were the key challenges that your hospital faced in IT implementation in the year 2012? The health system is some way behind other industries in the adoption and application of Information and communication technologies (ICTs). In general, the situation seems to be one of relatively slow progress through the evolving computing paradigms of functional computing, enterprise computing and network computing. The healthcare sectorâ&#x20AC;&#x2122;s fragmented constituencies and complex transactions present a major barrier, making the application of ICT enabled information management systems extremely difficult to the end user which can only be overcome by adequate and proper training. What are the prospects of growth for ICT implementation in Indian healthcare in 2013? ICT has the potential to enable practitioners and consumers to gain rapid access to essential and up-to-date information about individual patients, their conditions and management choices, thereby supporting decision-making for both practitioners and patients. Are there some specific segments of the healthcare sector that are likely to witness a larger demand for ICT adoption? There is an enormous range of opportunities for significant cost reductions, service enhancements and behavioral change

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Talking about hospital management, how do you foresee the role of ICT growing in 2013? Technology will increasingly be deployed right next to clinical care and the patient in a number of ways. Using biometrics, Radio Frequency Identification (RFID) and barcode to establish patient identity before treatment administration. Bedsides, clinical information displays to keep patients engaged in their own care. Computer navigation via integration of a multitude of medical imaging data sets through real-time display of anatomy during surgery. This will be taken further via telemedicine, head up displays and haptics feedback technologies. Knowledge bases will increasingly be deployed to bring about best evidence-based healthcare. Evidence-based driven guidelines will bring about rule-based diagnosis and treatment. What are the top technologies in healthcare that will play crucial role in the year 2013 and beyond? IT will re-define healthcare. Most of us are moving towards an electronic health record (EHR) system that unifies patient records. But the new-era EHR will provide the clinician with systems that could dispense the course of action through analysis of the past history and assessment of the present health issue. Doctors should be able to focus on making real decisions that require human judgment aided by IT. Standards such as the ICD-10 and Snomed will be used pervasively, and clinicians will become familiar with codifying diagnoses and procedures since the language of healthcare will be universal. This provides for great opportunities for the globalisation of healthcare where records could also be retrieved from a foreign country where the patient seeks treatment. Common standards and terminology will make this possible.

SRINAGAR

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NIKSHAY

Online tool for monitoring TB control programme NIKSHAY has been launched by the Government of India with the intention of creating a tuberculosis free nation By Dr Shefali S Dash, Deputy Director General, National Informatics Centre, Government of India Sunil Kumar, Senior Technical Director, National Informatics Centre, Government of India

o keep a track of the TB patients across the country, the Government of India has introduced a system called NIKSHAY. The word is combination of two Hindi words NI and KSHAY meaning eradication of tuberculosis. NIKSHAY (www.nikshay.gov.in) is a web enabled application, which facilitates monitoring of universal access to TB patients data by all concerned. The system has been developed jointly by the Central TB Division of the Ministry of Health and Family Welfare and National Informatics Centre (NIC) and it was launched by the Government of India in June 2012 with issue of required administrative directions from Central TB Division for use of NIKSHAY. A gazette notification was published by the Government of India mandating all private health establishments to inform the details of TB patients treated by them to NIKSHAY repository. NIKSHAY has two broad objectives. One is to create database of all TB patients including Multi-Drug Resistant cases across the country and to use this database for monitoring and research purposes at all levels so that TB can be eradicated from India in an effective manner. Overview of NIKSHAY The innovative IT application of NIKSHAY makes it possible for the grassroot level

january / 2013 ehealth.eletsonline.com

healthcare providers to track every TB patient. The most significant feature of NIKSHAY is that it promotes using IT by Tuberculosis Unit (TU) level. In this way, NIKSHAY also contributes to reduction of the digital divide. Video based training module has been developed in Hindi and English with message from Deputy Director General, CTD, emphasising the importance of NIKSHAY in eradication of TB from India. NIKSHAY has been implemented at national, state, district and Tuberculosis Unit (TU) levels. Data entry in terms of registering the TB patient, pre-treatment and follow-up tests, treatment, HIV and contact tracing details is done at TU level. More than 3.5 lakh TB patients have been registered since its launch in June 2012. Such TB patient database is being used at district, state and national level for monitoring purposes. Since TB has been notified by the Ministry of Health & Family Welfare, Government of India, therefore it is mandatory for the private health establishments or Government health establishment not covered under Revised National TB Control Programme (RNTCP) to inform about TB patients. NIKSHAY registers all such health establishments and entry of TB patients. Ministry of Health & Family Welfare funds the hiring of contractual man-

power at various levels for effective implementation of RNTCP scheme and programmatic management of drug resistant TB (PMDT). NIKSHAY facilitates the maintenance of details of all such contractual manpower helping the Central TB Division (CTD) to monitor the resource utilisation in an effective manner. NIKSHAY utilises SMS technology in an effective manner. Through SMS, it communicates with TB patients and grassroots level healthcare services providers as well as health and family welfare policy makers, health managers and health administrators at different tiers of the healthcare delivery system. Whenever a new patient is registered on NIKSHAY, an SMS is sent to the patient with registration ID and details of DOTS Operator along with advisory note to take the regular medicine. Daily SMS is sent to all monitoring authorities in CTD, to State TB Officers (STO), District TB Officers (DTO) giving the number of patients, Designated Microscopic Centre (DMC)/Peripheral Health Interface (PHI) registered, profiles of STOs, DTOs and TUs updated, entry of contractual manpower, Health Establishments registered and patients have been notified. The emergence of resistance to drugs being used to treat tuberculosis (TB), and particularly multidrug-resistant TB (MDR-

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TB), has become a significant public health problem in a number of countries and an obstacle to effective TB control. NIKSHAY has also felt the importance of MDR-TB patients and a module has been developed for keeping the records of patients at Intermediate Reference Laboratory (IRL), who are referred for Culture and DST test. These patients could be from RNTCP or come as follow-up patients from DRTB Centres or directly sent for pre-treatment test.

NIKSHAY is a role based web application with four distinct roles allocated to different levels as per details the following.

Role

Modules

Tuberculosis Unit Level

TB Patient Registration, Contact Tracing, HIV Treatment, Treatment Outcome, Follow Up, TB Notification Patient Details Entry, Search TB Patient by Patient ID or Navigation, Master Management of DMC/PHI, User Management, Reports related to DMC PHI Directory, PHI wise Patient Details and TBU Official Details, Training Video.

District Level

TB Notification Health Establishment Registration and Patient Details Entry, Contractual Staff Entry at district level, Search TB Patient by Patient ID or Navigation, Master Management of TUs and DMCs /PHIs under the district, User Management of TUs under the district, Reports related to DMC PHI Directory, DMC PHI Status, Staff Details, Patient Registration Status and DTO/TBU Officials Directory.

State Level

Search TB Patient by Patient ID or Navigation, Contractual Staff Entry at State Level, User Management of TUs and districts under the state, Master Management of TUs under all districts of the state, Reports related to DMC/PHI Directory, DMC PHI Status, Staff Details, Patient Registration Status and STO/DTO/TBU Officials Directory

Central TB Division

User Management for State/District and TUs, Master Management of CDST Labs/DRTB Centres/State Drug Stores /Coverage Area Details of CDST Labs/DRTB Centres , Data Management of Patients and DMC/PHI at National Level, Contractual Staff Entry at CTD level, Search TB Patient by Patient ID or Navigation, Reports related to DMC PHI Directory, DMC PHI Status, Staff Details, Patient Registration Status, STO/DTO/TBU Officials Directory/CSDT Labs/ DRTB Centres/SDS Details, Dash Board Reports related to National/State and District wise Patient Registration Status, Health Facility Notified Patient Status, Health Facility Registration Status, TBU Wise Patient Details.

Present status NIKSHAY was launched on 4th June, 2012 at http://www. nikshay.gov.in. As of now more than 3.6 lakh TB patients have been registered. Details of 34,261 DMCs/ PHIs, 2268 TBU, 629 DTO and 53 STO are available. CTD has been facilitated with reports having details of all the patients at national level and concerned patients at state, district and TU level through query and reports system. Dashboard has been provided so that any TB patient of the country can be contacted from CTD. Information about TB patients, which was earlier in Treatment Cards at Tuberculosis unit level, has been digitised for faster access and monitoring.

Impact During the last five month of its operations, substantial improvement has been observed in RNTCP operations. Programme implementing authorities at all levels are now enabled to retrieve details of any TB patient and if necessary, contact them for monitoring their DOTS administration schedule. The TB patients are now being given

advisories through SMS. This facility has helped in awareness generation as well as encouraging patients to comply with their DOTS Programme. Another benefit of NIKSHAY is correlation between TB & HIV, leading to outcome analysis of treatment, which may give new directions to TB treatment in the coming years.

Expectations Through NIKSHAY, CTD in association with NIC, wish to

develop an integrated application for all types of TB patients across the country. Use of mobile technology for fast data availability and effective monitoring is expected from

NIKSHAY. Innovative ideas through the use of other technological options are also being explored so that TB can be monitored effectively for its eradication from India.

About Authors Dr Shefali S Dash Deputy Director General, National Informatics Centre, Government of India

Sunil Kumar Senior Technical Director, National Informatics Centre, Government of India

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Leveraging unified communication in delivering quality healthcare A modern healthcare organisation (HCO) uses several modes of communication to reach out to its employees and to seamlessly integrate information to deliver safe and quality patient care while aiming to achieve better organisational efficiency and effectiveness By Gp Capt (Dr) Sanjeev Sood, Hospital and Health Systems Administrator, Air Force Hospital, Chandigarh

mooth and uninterrupted flow of horizontal and vertical communication is the backbone of any HCO and Unified Communication (UC) has an immense potential to facilitate this process. UC helps in easier communication amongst care providers, between management and employees, R & D Labs, doctors and patients etc.

Limitations of existing systems Today all healthcare professionals are mobile and everyone has at least one communications device and use more than two communication channels; reaching the right person in a time of critical need can be a complex process. These communication channels are broadly classified as:One around a voice network (telephone - fax â&#x20AC;&#x201C; voicemail- mobile telephony- video conferencing), and Another around a data network (data,Internet , email). This ends up with multiple communication modalities operating in separate silos that are time-consuming and awkward, have different interfaces and technologies, and lack effective integration of the multiple devices and their applications, making the whole process cumbersome and inefficient.

UC defined UC may be defined as converged communications that integrate real time services such as Instant Messaging,Internet Protocol telephony, video conferencing with non real time communication services such as unified messaging, integrated voice mail, email, SMS and fax

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to enhance productivity and business continuity. UC is all about intelligent connections made among the many systems that may already be in place in any HCO. It enables hospitals to transform information sharing by automating and streamlining the way HCPs, their devices, and systems interact. The goal is to optimise workflows in new ways that improve staff efficiency as well as patient care and safety.

Why healthcare needs UC? Healthcare isnâ&#x20AC;&#x2122;t like other industries when it comes to communication. Given the serious nature of their role, hospitals need to approach communications differently from other industries. A different

type of communications infrastructure is required due to following reasons:First and foremost, communications are mission-critical in a hospital and can make a difference between life and death. healthcare professionals are highly mobile workforce and always on the go. They spend the majority of their time delivering care and not bound to a desk phone or computer. In a dynamic and complex directory, patient information is transitory, and doctors may or may not be employed by one hospital, so creating an accurate directory that is continuously updated is a challenge. In healthcare, there is certainly large emphasis on paging/messaging to a variety

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of endpoints. This is actually becoming more complex with an ever-widening variety of communication endpoints, particularly smartphones. More data, nurse call, patient monitoring, etc emerges from medical equipment and systems than most organisations. There is a significant potential to redefine workflows by delivering this data directly to mobile staff on the devices they carry. Frequent group communications in healthcare are also prevalent eg, crash teams and those involved in various codes need to be notified quickly. Notifications may have to go to roles rather than a named individual. Traceability of sequence of events that happened during a time- critical situation is of utmost importance, so a full audit trail is required.

Benefits of UC deployed To overcome above barriers, UC integrates communications tools and seamless transitions between modes and wide range of devices ensuring anywhere access.UC improves productivity and efficiency in following ways:Coordinated intelligent handling of all communication regardless of physical location. Messaging the person, not the device or the location. A single mailbox available anywhere in any device. Knowledge about an individual’s presence and availability. Rich, powerful tool to effectively collaborate and allow info sharing. Access to a common directory resource. Automate contact center communications to provide a foundation for efficiency and improved information sharing.

Technology behind UC UC is an architecture that offers servers like chat, messaging,text,audio and video communication and collaboration with several nodes and servers connecting enterprises and clients across multiple locations in real time. Intelligent middleware connects critical information from HCO’s alert systems, such as nurse call, fire, security, patient monitoring, and building management,

to mobile staff on their wireless communication devices. These mobile event notification middleware systems should be ‘vendor neutral,’ allowing one to connect a myriad of systems that create an enterprise-wide hub for the management, prioritisation, and response to key events. This includes the ability to send messages to the right people based on rules set up in the hospital, including escalated communications whenever necessary. It also means that the staff can be managed easily and devices allocated appropriately.

instructions and receive their responses regarding availability is also key, so others can be contacted if they cannot arrive in time. With the advanced communications the HCOs can redefine workflows in a way that saves lives and enhances efficiency. Thus, overall UC enables HCOs to respond quickly to unexpected situations, speed response times to patient requests and a myriad of other alarm and updatedriven situations. It ensures to reach out to the right people at the right time on their preferred devices for all communications.

UC in action- a case study

Some vendors and early adopters of UC

Every hour hospitals have to carry out time-critical communication processes. From code blues, to code STEMIs, to code pinks and beyond, hospitals are in the business of providing care with speed and safety as top priority. But many hospitals struggle to reach all the right people quickly and efficiently when codes are called. Agents often use inefficient phone trees and outdated contact information. Or, they’re unsure of which device to use to contact each person or the escalation may not be streamlined. For example, many leading HCOs have advised a 90-minute door-to-balloon time for treating heart attack patients. A seamless approach to communication is essential for this. The key is unified communications, which allows HCO to quickly assemble the right team by contacting the appropriate people instantly and simultaneously on the right devices. The ability to send them

Office Communications Server 2007 helps to improve users’ productivity by enabling streamlined communications from within the applications they use most. Using Communicator 2007 as the principal client application, the solution provides a rich, integrated communications experience for enterprise users. Whether making a phone call right from Office Outlook or identifying the availability of a business document’s author, users can find who they need and communicate using the right method. It is possible to answer an email with a phone call with the sender or with a conference call with all the involved parties. Companies like CISCO, Tata Teleservices Ltd, Amsoft, Avaya,Omega Healthcare deliver integrated, seamless and smarter communication solutions that enable HCOs achieve better health outcomes and business growth. january / 2013 ehealth.eletsonline.com

expert speak

Technology enhances precision in procedures Varun Khanna, Regional Director, West & East, Fortis Healthcare Ltd, speaks to Nikita Apraj, ENN, about the technology implementation in Fortis Hiranandani Hospital, Vashi, Navi Mumbai The HIS supports doctors in scheduling their appointments, in bed management, in the billing of procedures and investigations, issuance of medicine, online report entry and validation of results. The system also supports online indenting at multiple nursing stations or front desks which flow to pharmacy/ surgical stores, investigations and procedures departments. On interface with patients, the system generates automatic SMSâ&#x20AC;&#x2122;s for doctor appointments and admissions and patient transfers, among others. Besides core hospital functionality, the system also provides for automated reports on revenue, patient counts and inventory. These reports are further taken to Prodigious for financial accounting and book-keeping.

How is technology important for a hospital in providing better-quality services? Technology in hospitals covers two aspects: medical or diagnostic and informational and both have a significant impact in delivering superior care to patients. Modern medical technologies help clinicians in accurate assessment of a patientâ&#x20AC;&#x2122;s condition and enhance precision during procedures. On the IT front, a Hospital Information System (HIS) integrates multiple disciplines and functions and enables the improvement in operational efficiency. A robust HIS ensures a reliable and seamless flow of information across clinical, administrative, billing, accounting and finance modules. Having an automated platform ensures the speedy processing of data and results in efficiencies in registration, admission, movement and discharge of patients. What IT solutions you have implemented in Fortis Hiranandani hospital at Vashi for better management? At present we are using Medtrack at our Vashi facility in Mumbai. This has multiple modules covering the entire process from the time a patient walks into the hospital till the time of discharge.

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Fortis Hiranandani is one of the few hospitals in Mumbai that provides treatments for cancer and in neurology. Which state-of-the-art technologies and equipments do you use in these departments? Yes. Fortis Hiranandani is amongst the pioneer hospitals in Navi Mumbai and deploys the latest technology for excellent clinical outcomes. For cancer patients, our qualified team of Oncosurgeons, Medical oncologists, Haemato-oncologists are provided round the clock availability of diagnostic technologies and facilities such as CT, MRI, Pathology lab, Blood Storage & Pharmacy. With modern technology, the centre conducts minimally invasive Cancer surgeries and runs a Day Care Chemotherapy centre for cancer patients. In Neurology, our team of qualified and experienced Neurologists, Neurosurgeons & Interventional Neuro/radiologists use technology such as CT, MRI, Video EEG, EMG, ENG, NCV, VEP and BERA. We also have a dedicated Stroke Unit & Stroke Protocol. What would you recommend the state government for a better healthcare policy in Maharashtra? With private sector hospitals coming up, the healthcare standards have risen significantly. Mumbai needs to be geographically balanced in terms of tertiary healthcare availability by having more beds along the western and central lines. The Government should consider plans to increase private sector healthcare participation by creating a conducive environment.

expert speak

Strengthening telemedicne network In Rajasthan G N Saxena, Professor, SMS Medical College (Retired) Telemedicine as a technology has been introduced in Rajasthan for quite some time. How has it benefitted the people of the state? We brought in telemedicine in the state of Rajasthan six years ago. It started in the form of a pilot project in one district which was linked to Jaipur. Within a few months, other districts within the state were connected to district hospitals. Thereafter, district hospitals were connected to medical colleges, and all medical colleges were connected to each other. Telemedicine was established in Rajasthan with the help of ISRO, which provided us with satellite connectivity and the required bandwidth and the state government provided the required infrastructure for the project. Education is a key component of telemedicine, which acted as a platform for knowledge exchange. Topics were assigned to various districts for discussions and demands for discussions on specific topics were also placed from the districts. These discussions brought in a lot of solutions during times of crisis and epidemics, when the state was affected by bird flu and swine flu. How was the computerisation of hospitals completed and to what extent did it benefit the people? The operations at hospitals started becoming computerised almost five years ago. Huge number of patients pay visit to the government hospitals on a regular

basis. So initially the administrative workings of hospitals such as registration of patients, data collection, and investigative facility â&#x20AC;&#x201C; all began to be computerised. As people grew more familiar with computerised processes, we started increasing the amount of work being done by computers. We started digitally storing patientsâ&#x20AC;&#x2122; demography, history, etc. Maximum benefit of this new method was felt by the patients as they could now see their reports online. They could access the information from anywhere and did not have to travel for long distances for the same. A lot of technology is being constantly incorporated in the medical world. So how do you ensure that the syllabus at medical colleges is getting updated accordingly? The curriculum taught to medical students are constantly being updated. Moreover, the website contains a lot of information -both for the graduate course as well as for the post graduate course. Most of the students are computer-savvy and therefore, can catch up with the developments quite rapidly. We are also establishing e-libraries in all the six medical colleges throughout the state. So now, a lecture which is being delivered at Jaipur can be accessed from Kota, Bikaner, Jodhpur or any other part of the state. We are planning it in such a way that it can be used both in the form of direct communication and also in the form of a

store and forward form of communication. Even though a lot of progress is being witnessed in the field of medicine, malpractices such as female infanticide still persist in the state. Please highlight the initiatives that have been adopted to address the alarming issue? Education is the only medium which we can change mindset of people. Developments in the fields of telemedicine, computerisation, along with several other progresses are acting as stepping stones towards transformation of the society. The state government, through the electronic media, has made sincere efforts to reach out to even the most distant villages and educate the folks about such social evils. Can you share your experience regarding any particular project which distinctly stands out in your mind which has brought remarkable benefits to people? The online reporting of investigations has been a great success. No other state government has been able to put up investigative reports online. Also, the biometric identification of donors have drastically reduced the number of professional blood donors. In our country, people still believe that donating blood will make them weak. The biometric way of identifying donors has been a major success. january / 2013 ehealth.eletsonline.com

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Doubly accurate New high definition CT Scanner improves Cardiac Imaging and reduces radiation exposure to patients by up to 50 percent; a fresh development in diagnosing heart disease

Dual Energy CT Scanner with Cardiac Spectral Imaging capabilities ‘Discovery CT750-HD FREEdom Edition’by GE Healthcare is a fresh development in the heart scanning technology. Brought to our nation by Mahajan Imaging, the scanner is designed to provide a new level of cardiac CT performance and to help physicians’ better serve patients. Based on exclusive (Fast Registered Energies & ECG) FREEdom technologies, this innovative system provides a three-pronged solution to the challenges in traditional cardiac CT. First-motion FREEdom, with intelligent motion correction via SnapShot Freeze; Second- Calcium FREEdom, with enhanced coronary visualisation using Gemstone Spectral Imaging (GSI) Cardiac; and third- horizon free opportunities, going beyond today’s clinical information with plaque material composition assessment and accurate perfusion calculations. Low radiation CT scanning is the new technological advancement in Discovery CT750 HD which allows physicians to immediately lower radiation by up to 50 percent for examinations in patients of all ages. Lowering patient radiation is

january / 2013 ehealth.eletsonline.com

important to all patients, especially infants and children, women, and patients getting follow up scans. “The installation of this machine is a statement to the world that there are no compromises in India when it comes to healthcare. There are only few of these machines in the world today and getting one of the first machines in India is testament to the economic growth of the country and the strides made in the healthcare sector”, said, Dr Harsh Mahajan, Founder and Chief Radiologist, Mahajan Imaging; President of the Indian Radiological and Imaging Association and Honorary Radiologist to the President of India. Coronary Heart Disease (CHD) is estimated to become the most common cause of death in India and globally by 2020. CHD occurs when the arteries (blood vessels) of the heart that normally provide blood and oxygen to the heart are narrowed or even completely blocked. The narrowing is caused by deposition of fatty plaques and calcium in the vessels. It is blockage of these vessels and breaking of fatty deposits that leads to heart attacks.

With the advent of 16, 64, 128 and 256 slice CT scanners, diagnosis of coronary heart disease reached an all time high, since these machines enabled visualisation of the heart and its vessels in great detail non-invasively allowing to find out what the condition of the vessels was, but, this was not without its problems. “Many times with 16, 64, 128 and 256 slice CT scanners we would not be able to see the condition of the vessels because calcium deposits in them would obscure our view. Also, even if we were able to see the blockage, it was difficult to tell what kind of deposit the patient has. The Dual Energy Spectral CT scanner actually shifts the CT paradigm beyond slices and enables us to see the deposits with dramatic clarity using much less radiation exposure”, explained Dr Mahajan. “Most of the times if a patient has a heart attack, it is very difficult to tell whether or not a stent or a bypass surgery will help him or not, since we do not have a quick test to detect the viability of the heart muscles”, said, Dr JPS Sawhney, Chairman, Department of Cardiology, Sir Ganga Ram Hospital, New Delhi.

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In focus

Telemedicine 2.0

ndian rural healthcare has a significant growth potential, as market still remains untapped. Recently, National Rural Health Mission (NHRM) has been allocated close to `20,822 crore (USD 4.14 billion) in 2012-13 for rural healthcare initiatives. According to McKinsey, the Indian rural healthcare is expected to expand at a pace of 44 percent by 2015, totaling its worth to USD 8.8 billion.

Indian healthcare – the way forward The growth potential for Indian healthcare is immense. The market opportunities are significant. Being the home for 17.5 percent of world population with world-class doctors and state-of-theart medical facilities, India can provide the best in class healthcare across the globe. However, the challenges are many. The big question is “is india ready to lead the healthcare across the globe?” Prof K Ganapathy, President, Apollo Telemedicine Networking Foundation, Past President of the Telemedicine Society of India and Adjunct Professor at the Indian Institute of Technology, Chennai says, “We can’t go far with conventional

january / 2013 ehealth.eletsonline.com

brick-and-mortal hospitals and Telemedicine is the way forward”.

Telemedicine: Market size Prof Ganapathy points out that 80 percent of India’s population have no direct, physical access to specialist healthcare and gives some back-of-the-envelope calculations: “Estimates suggest that the telemedicine market is at least for 800 million Indians. Even if half of these 800 million need to consult a specialist once a year, [that still amounts to USD 400 million specialist consultations per year. Even if 10 percent of these are enabled through telemedicine we are talking about 40 million consultations per year from rural India alone. The market potential for telemedicine is obviously enormous”. According to BCC research, the global telemedicine market in 2010 is USD 9.8 billion and it is expected to be USD 23.0 billion by 2015.

Current state of telemedicine and its challenges The major challenges of the current telemedicine setup is that it requires

Sridharan Mani, Director & CEO, American Megatrends India discusses the challenges related to rural healthcare, medical tourism, home healthcare & out patient monitoring, and the way the challenges can be met with advancements in telemedicine technology. dedicated infrastructure, high capital requirements and computer savvy talent pool to access sophisticated systems. The system is not user friendly and not scalable to meet the ongoing demands. The current infrastructure only provides video conferencing facilities to link patients with specialists. Also, all specialists cannot be made available at the same time as the case requirements may differ. Telemedicine in the current form is not providing better time management for specialists. In some cases, the specialists are required to wait on call for all day long to handle a few patient cases. Also, the current telemedicine system makes the specialist/ physician to be in conferencing location for the day to handle patient calls and it makes them immobile. With the shortage of specialists and

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physicians, an intelligent telemedicine system is needed to efficiently identify the patients that require immediate care to be linked with right specialist/physician.

can have live video/audio communication with the patient/paramedic/nurse instantaneously by directly connecting to peers mobile device.

TeleMed 2.0: Technology overview

AMI M2M Cloud Gateway

TeleMed 2.0 architecture is based on M2M Communication Gateway integrated with Publish Subscribe model framework. The illustration of M2M Communication Gateway based on American Megatrends (AMI) M2M Cloud Framework.

TeleMed app for collecting patient information In today’s world, a portable phone that is based on Android with camera, voice, Bluetooth with built-in 3G support costs less than USD150 and a great replacement for traditional desktop infrastructure used in telemedicine. These android-based devices can be instantly integrated with sensors for SPO2, blood pressure, temperature, ECG and blood sugar for collecting the real-time vitals. The TeleMed application running on these devices can do real-time monitoring based on schedule. Also, they can record and upload the patient information and real-time vitals collected through sensors to hospital information system from remote locations. The application in the devices will have SOS alert mechanism to alert the remote physician/specialist on call, whenever a vital sign cross the threshold that is life threatening or indicating a serious disorder.

TeleMed app for healthcare professionals The specialists and physicians can now benefit from these advancements and they can access all the patient records with real-time vitals on their iPhones/iPads12 from anywhere across the globe with TeleMed application that is integrated with HIS. The real-time notifications received from patients with realtime vitals collected through sensors indicate the seriousness of the issue and the specialist/physicians can take the appropriate call to save lives. They

AMI M2M Cloud Gateway provides the middle-ware interfacing layer support. It runs the notification and business routing engine based on publish-subscribe model. All patient and healthcare professional smartphone devices will get themselves registered with TeleMed application integration gateway. AMI M2M Cloud Gateway constantly monitors the key vitals received from the patients and if any abnormality is found, it immediately invokes the alert engine to alert the right healthcare professional based on the information and routing path. The alert engine sends notification to the healthcare professional along with the real-time vitals received from the patient’s device. This enables the healthcare professional to have a peer-to-peer video conferencing call with a mobile from anywhere in the globe.

TeleMed 2.0: Creating a new vision in healthcare •

•

Provides a healthcare connectivity infrastructure that allows hospitals to extend the proven care benefits and efficiencies of remote health monitoring services to a broader patient population. Healthcare professionals can be located anywhere around the world and still can provide the best care to their patients by overcoming distance barriers. TeleMed 2.0 will specially be helpful in monitoring post-surgical patient conditions. AMI’s (compact & removable) TeleMed device will be tied to the patient’s arm. This device sends health progress reports for every one minute, based on the health condition of the patient. The monitored data gets pooled in HIS and that is accessible only by the authorised surgeon(s). Prevention is better than cure. Intelligently and accurately programmed

•

• •

•

TeleMed device sends health trauma alarm to the hospital, before the patient’s health condition gets to emergency stage. This alarm will particularly be useful in rushing the patient to Intensive Care Unit, before the condition gets out of control and also helps in preventing time-based emergency cases. The cost of setting up the infrastructure for Telemedicine is drastically reduced as the adoption of smartphones is increasing in the market. Improve patient safety, caregiver productivity and operational efficiency with real-time reliable information at the point of care Link to every hospital and doctors clinics in the province. Allows providers to deliver quality care in every location no matter how remote Link nurses to up-to-the minute information about patients, monitors, pumps, medical records and medication schedules, regardless of where they are working. Serve more patients and doctors with significantly lower operating cost.

Summary In summary, TeleMed 2.0 provides the state-of-the-art platform for hospitals and healthcare professionals to provide the best quality healthcare for those who need remote monitoring and healthcare support. This enables the healthcare professionals to be located anywhere and yet provide the best medical attention care to their patients. The relationship between the healthcare professionals and patients are strengthened and medical tourists can feel at peace that they are in good hands and their health is safe. The elderly can live in peace that their vitals are constantly being monitored and abnormality will be notified to their healthcare to take the required medical attention. With TeleMed 2.0 implementation, the patient care can be improved significantly and healthcare professionals can reach out to many patients remotely that need quality medical attention. january / 2013 ehealth.eletsonline.com

expert speak

What does SAP aim to bring into the healthcare industry? Globally healthcare has been a significant sector and it’s a history of SAP that says it all. SAP has over 2,300 customers in more than 60 countries and it operates in 24 industries and has particular footprints in each sector. Healthcare is one of the oldest, with 800 customers globally with a combination of private and public collaborations and some other providers. In the private segment, we have emphasis on managing, analysing costs, platform; primarily- cost of labor to allocate right skills to right patient that comes under human capital resources. In India, aging population is creating pressure on healthcare professionals, managing turnover and we have built solutions to manage all that. We have also developed integrated solutions for patient administration, HR, payroll, billing, admin billing, and many other processes. Billing is different in every country and there we have been careful to develop to understand all mechanisms. SAP’s one of the first innovations that has been brought to the market is the real time and in memory computing which allows that variety of data and volume of data in a time frame that is now acceptable to actually deliver a result or an outcome.

“You pay as you consume” Adaire Fox-Martin, Senior Vice President - Industry Business Solutions, SAP APJ believes, “In the wider IT world, there are some significant changes, in not just the consumption of IT but how people are making use of information that’s been collected over a period of time”. In conversation with Shally Makin

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Share with us the portfolio of software solutions offered by SAP for the healthcare industry. The portfolio of solutions we have in our suite is the whole back office solutions, in memory real time solution for consuming technology for valuing the computing database, hospital word level of communication etc. In India, particularly in public systems, there have been funding issues as the 2/3rd of clinics in India are funded and others need investment. With the IT perspective, the challenges which we would expect is affordability and the ability to deliberate and here comes the game changer from SAP that brings a solution which has an ability to offer an end to end facilities in a private cloud environment. It needs an enormous capital expenditure to deliver result on the other hand use this solution to cater facilities to patients. It’s the matrix which depends on the

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expert speak

various solutions.. The affordability issue has gone away as the operational costs have equated to this solution. The backbone is based in 800 healthcare clusters coupled with preventive healthcare and unique analysis allows us to do preventive healthcare which allows creating volume of data. It’s about encapsulating data and answer to what mobility means to India and it’s about creating these two solutions at a common platform for both public and private sector. Valuing the power of healthcare, how do you think SAP can empower the healthcare providers with their solutions in the industry? In terms of patient, be it in the public sector or private sector, these applications gives you greater control and visibility over the healthcare destiny. This can change the vision holistically. Ten years later from now healthcare will see a vibrant phenomenon which will reduce overall virtual cycle and reduce huge investment in the healthcare infrastructure. An application on a mobile phone creates a sense of ownership while you use it and similarly the pieces of information in terms of your heath will change the mindset if offered a solution like this. In the private sector perspective, it’s the competition where every CRM creates a whole history of the healthcare environment and analyse the holistic status of the consumer of healthcare. In the areas of genomics, DNA analysis, predictive diseases like Diabetes, some of the customers have taken this up and are working with it. We are working on a project to deliver in genomic analysis of cancer patients and through this we can customise the medicine for patients through laser therapy. The analysis of the volume of data that has to be accessed is undertaken with this solution which has reduced the time frame of the result from 30 days to the same time patient gets themselves tested. The personalised prescription is one of the interesting projects SAP is working on. It is capturing how you could deliver results to patients as in India, the different levels of community and panchayats deliver healthcare and like mobiles we would like to penetrate and serve these areas. The success of the programmes

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needs to be replicated rather than just appreciating and working on the same area. Such programmes need to be expanded rather than just making into the news. In our association with Hope Foundation we have started a pilot project that manages a child’s vaccination programme. With the latest mobile technology, we can immediately access the parent and follow up on the SMS, local center, with schools. So far, it has been a success and we see an encouragement from the Indian Government for better usage of this technology. How do you maintains its market presence? If we take market of the healthcare sector and the healthcare we build, we see ourselves as the biggest competitor. Comparing the cost and building a single scenario, we definitely would be processing a point solution in your word processes, and five years down the lane, the empirical data we create is value addition in much larger opportunity. When it comes to operational costs in order to do that operation mechanism it should demonstrate capacity aptitude. We have developed a variety for different localised one package mechanism for the Indian market consumption so that affordability and non adoptability is not an issue while penetrating into the rural areas. With a holistic approach, the outcome will be a much larger than we expected five years back. SAP is currently working with Ranbaxy Laboratories Limited, Johnson & Johnson, GSK Glaxosmithkline, Cardinal Health, Mayo Clinic, Medline and Mckesson etc. The consumption method is different,

“We have emphasis on managing, analysing costs, primarily the cost of labour to allocate right skills to right patient”

some develop a subscription model for use of software initiation capital extending and some purchase it and use the software and implement it in the entire centre. Another method is through an integrated platform put multiple mechanisms according to the different consumption model on service deliver via cloud. We have mobile consumption models which differentiate SAP from others and sustain itself in this kind of predictive market. What were the challenges when you started with defining the need of the solutions and today to its implementation? We are a very customer’s outcome focused organisation and we are very cognizant that there are 10,000 customers in every country/sector/ language/ currency / size of business. We have addressed various different challenges, reducing the on-premises-time for outcome thus reducing costs. Data security is very important where a lot of countries are looking into. Government is reviewing policy and trying the legislation to intervene. It will change over time in terms of people’s perceptions, when we talk about cloud environment one of the things that SAP identified 120 processes and we believed that it is practical to do over the cloud rather than by IT. These are not critical or business processes that had to be done in a multitalented cloud environment. So we have a scenario which start from premises and orchestral level that allows connecting with the cloud platform. The data centers we have the best security experts and we have the highest standards that the data is secured as per the Government laws. In defence areas, reducing the operational time with lower latency was a huge challenge. We try to reduce resonance of these challenges into the other sectors. We are careful that these challenges do not cascade over other sectors as during the 40 year journey we have learnt a lot. We do think that such solutions are of significant future and a journey to go on for futuristic outcomes. There are a variety of models working in this country and in long time view that it is quite integrated and there are various opportunities to look for.

expert speak

Ably grounded Dr PM Murali, Managing Director and CEO, Evolva Biotech & PresidentAssociation of Biotechnology Led Enterprises (ABLE) speaks about his organisation’s vision for Indian healthcare What role ABLE has been playing in Indian healthcare sector? What is the mission and vision of the organisation? ABLE has been playing a very proactive role in this space. New and improved drugs need to come out to take care of patient’s needs. However these drugs come out only after considerable spend on innovation to bring out into the market at affordable price points. ABLE has thus been playing a very responsible advocacy balancing between the needs of industry having to spend to innovate and policies that are formed by the Government to make drugs affordable. ABLE will be spearheading the next generation reforms that are needed to quickly bring new products into the market including making India a manufacturing hub for global supplies of biologics and other fermentation based pharmaceuticals. In your opinion, what is the position of Biotechnology sector in India? What are the challenging areas the sector has and what are the corrective measures the sector can adopt? Biotech is still a very small industry in India. However there is immense potential for this Industry to grow to about USD 100 billion within the next decade. The core engine of this sector is innovation which drives its growth. The developed world has a well-oiled system to cater to innovation through the use of cutting edge technology. In India we are still at a very nascent stage. The ecosystem for Biotechnology encompasses talent, infrastructure, regulatory and funding which are the key drivers. This environment is still evolving and unfortunately

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at a slow pace. ABLE’s role has been to sensitise the stake holders to move with speed and purpose to get into the train before it leaves the station. What are the new developments happening in the Biotechnology sector? Technology is a great enabler for creation of innovative products which we humans need. However the need to use it responsibly and also where it is most needed is very important. While not all fears by Biotech advocacy groups are real, a few of them needs attention and evaluation. But this does not mean that it has to be an all or none phenomenon. Safety, regulation, evaluation should all be part of the system when modern technologies are put to use. I feel politicians and practioners need to keep the future needs of the country in mind with respect to food and energy security and cautiously grow this branch of science to address these needs. The present all or none phenomenon and knee jerking bow to popular sentiments are the most dangerous ways of going about building a bio-economy. What new innovations are coming up here in this space? Biosynthetic technology is the next wave that is going to sweep the world. It will encompass offering solutions to Pharma, Energy, Food and so many other sectors that will benefit from this application. What contribution Biotechnology sector has been making to Indian healthcare sector? Despite all the negative press coverage and figures which portray BT cotton in poor light, some of us personally feel the farm-

ers have benefited. Less use of pesticides is the biggest contribution to health. What are the top Biotechnology companies doing well in India? What challenges they have been facing? Most biotechnology companies struggle due to the lack of enabling regulation. ABLE is certainly focusing on this. If the climate is good, then you are going to see plenty of companies in this sector. Small and large companies are working in a number of areas, for example, Evolva Biotech in Biosynthetic Technology space. The larger companies like Biocon, Dr Reddy’s Laboratories Ltd in Biosimilars and a number of other areas. Strand, Genotypic etc in informatics and in providing customised solution. You have a number of stem cell and regenerative companies which are now trying to unleash the potential of this segment. We have Metahelix and other multinational companies in the agricultural space. In this context, is ABLE lending a helping hand to them? ABLE has 11 committees across different verticals. These committees deliberate the issues of the sector they are focusing on and hammer out solutions which are then passed on to the stakeholders. We have committees focused on IP, regenerative medicine, similar biologics, education, HR and so on.

preventing arthirits

An easy guide to Arthritis

Prevention and Cure

Rheumatologist is a joint arthritis specialist; he treats joint arthritis pains like a cardiologist treats heart diseases Dr OP Garg, Senior Consultant Rheumatologist & HOD, Advanced Interventional Rheumatology at BLK Hospital, New Delhi

spent on unproven therapies will never come back. Damage done to the joints during the trial of unscientific therapies will never be reveresed. It is time for consumer awareness, so be wise, be aware of the new medication techniques to keep your joints pain free throughout of your life.

Dealing with Arthritis

Arthritis simply means joint pains, stiffness or swelling due to inflammation. Fever is a symptom of hundreds of the diseases, and arthritis is a symptom caused by more

very relative and friend is a medical advisor in India and often you have to hear them out. Sometimes out of respect, but should you follow every bit of the advice that you getâ&#x20AC;Ś. Ten years back, deformity and destruction were foredrawn conclusion for the joints affected by arthritis, prevalent therapies in all the disciplines of medicines were just pain relieving. New medicines of Rheumatology has changed the scenario completely, joints do not get deformed anymore due to arthritis. So decide what outcome you want for your joints. About side effects, there are much more serious side effects of the uncontrolled arthritis than the medicines. Time and money

than 100 diseases. Only further clinical details will reveal the actual disease. The specialty dealing with arthritis and Rheumatism is called Rheumatology. Patients having persistent arthritis and who are unfortunate not to have been seen and treated by trained and experienced Rheumatologists, may get their joints completely destroyed requiring joint replacements by Orthopaedic surgeons at `3 lakh per joint. Rheumatology is a recent sub-specialty in internal medicine devoted to medical management of all forms of Arthritis. Connective tissue diseases like SLE, Soft tissue rheumatism, Gout, Osteoporosis and other Musculoskeletal diseases. Cli-

Rheumatic diseases are of more than 100 types and fall into four main groups: Autoimmune inflammatory arthritis: This condition results, when bodyâ&#x20AC;&#x2122;s immune system attacks own healthy joint tissues, leading to inflammation and damage to the joints tissues. Rheumatoid arthritis is most common and is of the most damaging kind. It effects more than one crore people in India. Other types include Gout, Spondyloarthritis such as Ankylosing spondyloarthritis, Reactive arthritis and Arthritis associated with Colitis and Psoriasis. Other rarer disorders that can affect multiple parts of the body called connective tissue diseases such as Systematic Lupus Erythematosis (SLE), Scleroderma, Polymyositis and various vasculitides. In this group, Ankylosing spondylitis affecting young men involves low back pain causing severe back stiffness before spreading to other joints. Degenerative diseases called wear and tear diseases are most common and include Osteoarthritis of knees, hips and vertebral column (i.e., cervical and lumbar spondylosis). Soft tissue rheumatism where rheumatic pain arises from damage to areas around joints, such as ligaments and tendons. Minor injury or over use can result in localised pain which often lasts only for a short period, Tennis elbow for example. Infection: when bacteria directly cause septic arthritis, it can rapidly destroy the joints and hence is an emergency.

january / 2013 ehealth.eletsonline.com

preventing arthirits

The treatment strategies

It depends upon the cause. A patient with arthritis, if reports early, can lead a normal life with modern anti-rheumatic therapy. Even in late stages much can be done. If symptoms of arthritis have not subsided within 04 weeks, indication is that joints are in trouble and require professional help as body has already failed to ward off the evil of arthritis by itself.

nicians who specialise in Rheumatology are called Rheumatologists. After five and half years of medical schooling and three years of training in internal medicine, Rheumatologists devote an additional two to three years in specialised rheumatology training to treat more than 100 types of arthritis. Arthritis patients will experience pain and swelling of one or more joints, feel stiffness in the joints – more in the morning. In some type of arthritis you may have long fever associated with skin rashes or ulcers, in others you may have stiffness and pain in the lower back, in others your fingers may turn blue in winter climate. Your joints may start making noises like grating sensation. Inflammatory arthritis can affect any age group, but usually affects females in reproductive years. It can affect children too, when it is called JIA (Juvenile Inflammatory Arthritis). Osteoarthritis (wear and tear arthritis) usually affects old people but can occur earlier in people with history of joint injuries & in those with hypermobile joints and obesity. Rheumatoid arthritis and other Autoimmune arthritis like SLE, Scleroderma are more common in women. However, Ankylosing spondylitis presenting with severe early morning stiffness and Gout is found more common in male population. Exercise plays a supportive role. It may help to reduce pain and joint stiffness. Exercise also helps in increasing the flexibility, range of movement and strengthening the muscles around the joint. However, patients with deformities of the joints should consult a Rheumatologist to know about the type of exercise they need to undergo. Osteoarthritis and Rheumatoid Arthritis are the two most common conditions we come across. A correct diagnosis is very important for almost all arthritis types otherwise im-

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mune system will go on attacking joint & body tissues, and though the pain may be controlled, the joints will continue to erode without appropriate treatment. The message is, don’t be afraid to see a Rheumatologist about your aches and pains, and don’t be afraid to protest if you’re told just to take a pain killer to relieve your pain without knowing the type of arthritis. Pain killers do not cure any of the arthritis types. Timely diagnosis and early treatment will stop the further damage to the joints as well as will prolong your life.

Difference between Arthritis and Rheumatism People are often confused about the meaning of the two words – Arthritis & Rheumatism (Gathiya & Bai). Arthritis means disease of the joints and generally results into inflammatory swelling of the joints. The term Rheumatism (Bai) is used by common people to refer to all types of diffuse or migrating body aches and pains, which may include early arthritis. We now think of four different types of treatment strategies to save your joints: Prevention is better than cure: Steps can be taken to prevent development of arthritis. Get your joints be screened by a Rheumatologist for any risk factor to ward off the development of arthritis. Cure: In some cases, Arthritis can be cured depending upon the cause, if treated early. Effective treatment and control of established disease: Nowadays, modern anti-rheumatic therapy rendered by Rheumatologist can save the joints from damaging effect of arthritis. Earlier treatment is better. These include disease modifying antirheumatic drugs (DMARDs), Anticytokines and anti B cell therapies. Rheumatology treatment is getting bet-

ter day by day. New anti Rheumatic drugs and procedures are safer and more effective than before. The best of old therapies is being combined with modern therapy; we call it “fusion therapy” to improve the quality of life.

Role of diet in arthritis Painful arthritis occurring in men due to over consumption of alcohol, nonvegetarian food and tea or coffee can increase se blood uric acid and precipitate gout. An overweight person is more prone to develop osteoarthritis, when calorie intake needs to be controlled. Consuming fresh fruits in balanced diet and keeping normal weight will help in prevention and treatment of arthritis.

Is arthritis curable? It depends upon the cause and the stage of the disease. Some types of arthritis may not be totally curable but are certainly controllable. After all diabetes, hypertension and other chronic diseases are also incurable, yet people take treatment for these diseases with a view to control them and save their organs. So, why neglect arthritis? At an early stage, most types of arthritis are easily controllable perhaps even curable. Prolonged treatment is required, but even this helps a lot in preventing the patient from becoming crippled. However, Arthritis does not run in families the way diabetes does. Yet a few families show traits to develop arthritis, based on their genetic makeup.

About Author Dr OP Garg Senior Consultant Rheumatologist & HOD, Advanced Interventional Rheumatology at BLK Hospital, New Delhi

expert speak

Synchronised

health service

Ritu Maheshwari (IAS), District Magistrate, Shahjahanpur, Uttar Pradesh, India, speaks about the healthcare initiatives her department has undertaken

ealth is a very crucial parameter of human development. If we look at the various indicators like IMR, MMR, full immunisation and deliveries or the registration of births, we find that we are way behind the Millenniums Development Goal. Another issue as far as healthcare deliveries in India is concerned is that, healthcare is being developed in a rather supply based approach, and this leaves very small amount of room for feedback mechanism. The project we have conceived is called Aarogyam and we designed the project keeping in mind the healthcare needs of the country. Aarogyam is basically an individual digital health mapping system; it is a two way demand based ecosystem based on the feedback and the needs of the common man. The project seeks to empower citizen, by taking into account their healthcare needs and providing them with the necessary information. Basically we conduct health mapping survey for different districts. We involve various departments and the survey we conduct are on different parameters like the name of the stakeholder, the age, date of child delivery, phone number, the region where the person is located. All the data is uploaded on the central server. The central server is connected to an automatic Interactive Voice Response (IVR). Now coming to what the project actually offers; it is basically Health Mapping and Pregnancy Tracking System, which tracks the health status of a lady from the time she become pregnant till the baby is delivered and further on till the baby gets fully immunised. It is the first outbound IVR system which disseminates personalise information to every family with respect to both mother and children for all kind of vaccines wheather BCG, DPT or JSY, telling the stakeholder that when the deliv-

ery is due etc. We inform the entire stakeholder free of cost and we send specific information before due dates. Secondly it also has a dial in number where anyone can dial it and specifically retrieve the information as to when is a particular health service is due for him, how to get it done etc. Thirdly it also has an inbuilt complaint mechanism. The complains are recorded and automatically forwarded to those people who have to address these complains. The most important part is the regular pendency calls that we send to all the families, to the pradhan and to the ANMs. So basically it is very a powerful medium. We started the project basically in two districts of UP and now it is running in many other districts of UP. So once the phone numbers of different beneficiaries are collected, we have a database and many Government schemes whether health or it be sanitation or it be voter id registration they can be linked through this data base and the ultimate purpose of disseminating information is served too. With the help of this system, different Government bodies too can check information related to different schemes before due dates of different beneficiaries. It also has web based monitoring portal where we can login and administration can login and see what is the status in a particular village and in other medical office area. Can check what the target was, what has been achieved what has been left out etc. Generally when health service provider goes to the field they are not really aware of what their duties are and what they have to do. The basic problem was that all information was based on the statistics but now they have data of a ground level survey consisting what the need is. january / 2013 ehealth.eletsonline.com

expert corner

ECMO

The final frontier

An innovative technology that helps treat lung and heart failure

By Dr Indira Jaykaumar, Senior Consultant ER & PICU, Apollo Childrenâ&#x20AC;&#x2122;s Hospital, Chennai

january / 2013 ehealth.eletsonline.com

expert corner

n 11-year-old girl who suffered from life-threatening pneumonia progressing to Acute Respiratory Distress Syndrome (ARDS) becomes the first pediatric patient in South India to have successfully recovered by the use of artificial heart-lung by-pass machine known as Extracorporeal Membrane Oxygenation (ECMO) at Apollo Children’s Hospital, Chennai.

ECMO is an advanced technology, which ensures that oxygen goes in and carbon dioxide is taken out of the body for patients who have heart or lung failure or both. It delivers oxygen and support to the heart by a modified heart -lung machine in the ICU

The child was transferred to Apollo Children’s Hospital, due to progressive pneumonia and acute respiratory distress syndrome. Her condition quickly worsened as there was a rapid loss in the functioning of her lung leading to drastic drop of oxygen levels and her liver showed signs of decreased function. Hence, as a final option, the child was put on ECMO. Though ECMO has been used in adult cases in the past, for the first time in South India, the technology has saved a pediatric patient, who was suffering from a life threatening pneumonia to give her a chance to survive and quicker recovery. The child was taken off the ECMO machine after six days of treatment and was discharged in a fully fit condition a few days ago. Apollo Children’s Hospital gave her a gift of life on her 12th birth day (the day she was discharged). ECMO is an advanced technology, which ensures that oxygen goes in and

carbon dioxide is taken out of the body for patients who have heart or lung failure or both. It delivers oxygen and support to the heart by a modified heart - lung machine in the ICU. ECMO is a temporary life support system that allows time for evaluation, diagnosis and treatment of the condition that caused heart or lung failure. It performs the work of the lungs and heart and prevents organs and the patient from dying during healing and ECMO supports the patient for days to weeks. The ECMO technology has a proven track record in a variety of conditions especially with respect to children and it requires a dedicated team of medical and paramedical experts with round-the-clock bedside care. Technically speaking, cardiothoracic surgeons insert a cannula into a major vessel of the body. Blood from the patient drains through a catheter placed in a large vein (usually the neck or groin) into a pump. The pump acts as an artificial heart and pushes the blood through the rest of the ECMO system.Blood is pumped into the oxygenator (which acts as an artificial lung), where it will be cleansed of carbon dioxide and will pick up oxygen. Once the blood leaves the oxygenator; it is warmed and is returned to the patient through a catheter. This oxygenated blood will look bright red in color. Blood is drained out and pumped back to the patient and this cycle goes on and on. Even though the patient is being supported by ECMO, he/she will remain on the ventilator (breathing machine) but with very low settings. This will allow for removal of secretions from the lungs and will give breaths to help keep the lungs inflated. There are two types of ECMO therapy: venoarterial (VA) and venovenous (VV) ECMO. The terms VA and VV refer to the blood vessels used during the procedure. VV (venovenous) indicates that the mode of entry into the body is a vein. This is usually the preferred method when the patient has suffered the loss of lung function exclusively. In contrast, VA (venoarterial), means that dual access by a vein and the carotid artery is necessary, and usually applies to patients with both lung and heart impairment.

As with any form of treatment, there are risks associated with this procedure: The blood must be kept from clotting while it goes through the machine, so a drug called heparin (a blood thinner) is given to prevent clotting. Sometimes this can lead to bleeding. The amount of heparin needed is monitored closely and steps taken to minimise any bleeding that occurs. Whenever a catheter is inserted into a blood vessel, there is an increased risk of infection. Although every safety measure is taken, the ECMO circuit can malfunction, fail or small blood clots or air bubbles can get into the blood stream from the circuit. But patients are very closely monitored for all these complications by experienced personnel the perfusionists and critical care specialists. The patient remains placed on the ECMO machine until his/ her heart and/or lungs resume normal functioning and that will depend on the original diagnosis. The average number of days on ECMO is 5-7, but can be as many as 14 or more days. Each patient is different and the length of the course of ECMO may be affected by these individual differences like the type of lung or heart disease, the amount of damage to the lungs before ECMO , the underlying problem, etc. Coming off ECMO is done when the heart and/or lungs are better. A ‘trial off’ will let us know if the lungs are able to work and put oxygen in the blood. The speed of the blood flow through the ECMO pump is decreased, and help from the breathing machine is increased. The ECMO tubing is clamped for short periods of time. The breathing machine then gives more help with breathing. The blood still flows through the ECMO. If the patient does not do well during the ‘trial off’, ECMO is continued. A repeat ‘trial off’ is done later. When the heart and lungs have improved enough, ECMO is stopped.The tubes are taken out of the blood vessels. The place where the tubes were placed is closed with stitches, and a dressing is placed on the site. There may be a small scar, which will fade with time. The way forward when all conventional therapies to improve lungs or heart function fail. january / 2013 ehealth.eletsonline.com

in person

Keeping disease at bay ‘Prevention is better than cure’- inspired by the saying Kanchan Amol Naikwadi, Director of Indus Health Plus, thought of coming up with a company that offers preventive healthcare packages. In conversation with Sharmila Das, ENN

What is the idea behind the launch of Indus Health Plus? What was the Eureka moment for you? It is a cause. My father was ill. I was pregnant at that time and was kept away from my father as he had to go for chemotherapy sessions. We couldn’t realise what he was suffering from until he was diagnosed with pancreatic cancer. It was very shocking and unexpected to all of us. It triggered me for this cause. Also healthcare facilities were costlier and we wanted to make it affordable and accessible. People have knowledge about diseases but they need education on it and we try to educate people. Kindly tell us about your education and career? I am a graduate in Commerce. But I learned the basics and fine nuances of business from my uncle. We started

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Indus Health Plus in a room in Model Colony, Pune. We wanted to make preventive healthcare affordable, accessible and it was very challenging. We didn’t have anybody as a mentor or anyone whom we could look up to mainly because there wasn’t any preventive healthcare company before. We were the ioneers and we had to learn it ourselves. What comes under Indus’s Preventive Health Package? Indus, at present offers four preventive health check-up packages ranging from basic fitness tests to a comprehensive full-body check-up. The packages are – essential care health check-up package, early care health check-up package, exclusive health check-up package and exclusive and comprehensive health Check-up Package.

How difficult or easy is to get success in Preventive Healthcare? How India as a country is doing in Preventive Healthcare? Achieving success in any field requires a sustained effort coupled with an untiring zeal to reach one’s goal. It is no different when it comes to preventive healthcare. We met with our share of challenges, but our faith in the cause of preventive healthcare helped us reach the shore. India is awakening to the need for a greater health consciousness. Even a decade ago, people were not so conscious about certain things as they are today. With greater consciousness and care for one’s health comes the need for prevention of diseases instead cure, which is what preventive healthcare is all about – a timely knowledge about one’s health status. What are the challenges you have faced in this domain? It was not very easy in the beginning however my cause kept me going. Our product is very different. You know it is essential but you wouldn’t buy it unless you see someone close to you getting benefited from it or somebody like an agent pitching for it. Initially we thought we were a marketing company but now we have surpassed that identity and we are known to sell preventive health check-up packages. It isn’t easy for a woman to do business and especially for an Indian woman. It wouldn’t have been possible without the support of my family. Who were your mentors? The transformation from a homemaker to a successful businesswoman wouldn’t have been possible without my uncle, Sadanand Bapat. He is an eminent entrepreneur who has been an inspiration in my life and played an influential role, in moulding my personality. He is my friend, philosopher and guide. Following his footsteps, I have learned the art of business and have built my professional career. As a result I could venture into this industry and come such a long way.

Power

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tech trends

Medical Devices

Standard &

Regulations India holds the position of largest medical device market in Asia and the market has been growing consistently well despite the troublesome regulatory environment. A closer look!

By Sharmila Das, ENN

ndian medical device market has been growing at an impressive rate and experts feel it will continue to grow at 15 percent in the coming years. The medical device fraternity comprise of manufacturers, distributors, buyers like different hospital chains, stand alone pathology labs, diagnostics centers and the like. Arindam Sen, CEO, Ad-

january / 2013 ehealth.eletsonline.com

vanced Micronic Devices Ltd, subsidiary of Opto Circuits (I) Ltd says, “The medical device market in BRIC (Brazil, Russia, India and China) countries account for nearly USD 10 billion and is growing at an annual rate of 8 percent”.

Wholesome picture Sen gives the ground reality of the differ-

ent compliances of medical device regulations in India by saying, “The medical device segment is primarily dominated by the diagnostics segment. In India, a medical device manufacturer can legally sell medical devices in the domestic market, post meeting compliance parameters as per the Indian medical device regulations”.

tech trends

Rajiv Nath

Forum Coordinator, Association of Indian Medical Device Industry (AIMED)

“India is growing as a key market for medical devices and diagnostics. It is currently the fourth largest market in Asia and is worth about ` 20,000 crore. The industry had seen tremendous growth over the last decade of 15-20 percent but is currently projected to grow at a slower rate of 10-15 percent though the market is growing more rapidly at 15-20 percent which indicates a declining share of domestic industry”

He adds further, “Prior to 2005, there were no regulations for medical devices in India. Today, there are registration procedures for certain classes of medical devices regulated under the provisions of the Drugs and Cosmetics Rules. Comprehensive legislation governing medical devices is pending. Currently India has no specific regulations for medical devices. They are freely imported into India, except for implantable devices, critical diagnostic kits and sterile devices, which are required to be registered”. Rakshith Shetty, CEO & Managing Director, Fanem Medical Devices India Pvt Ltd says, “Today the regulation is more to do with radiation, Indian FDA for drugs,BIS and electrical safety It is true that we have more than one body to regulate Medical Devices. But I am afraid none other than BARC has really put an effort to get the manufacturers/traders to be more responsible in manufacturing,import X-ray and other radiation equipments. The other bodies are not in a regulation mode but have been more harassment to both the local manufacturers and the importers of medical devices. It is also true that most countries around the world, where regulations have had a strong hand in protecting the market, have been benefitted. BARC is very clear with the regulation and this helps the complete industry to make better products and also trade with products

which are reliable. I hope to see this kind of regulation from BIS”. Suresh Shammugan, Manger-Finance, Vin Biotech shares, “We need more ethical and financial institutions as you know, we don’t have any. India doesn’t have any big manufacturing sector in medical equipments, small units are there. China and other countries have very hitech technology but in India, we don’t have. However, can be developed in constitution with Government bodies and private companies”. For medical device manufacturers to legally sell medical devices within India, they need to be in compliance with Indian medical device regulations. Currently, manufacturers of medical devices which require registration can leverage their approvals in the US, Canada, Europe, Australia or Japan to register their medical devices in India. During the medical device registration process, the primary entity to work with is the Medical Devices Division of the CDSCO. The hierarchy of medical device regulatory entities in India is as follows: a) Ministry of Health and Family Welfare-Drug Controller General of India - DCG (I), b) Central Drugs Standard Control Organisation (CDSCO - Medical Devices Division). However, with the nonavailability of medical device regulations in India the manufacturers are in catch 22 situation. They neither can overlook the demand that the industry throws at them nor do they completely make use of the situ-

ation. Hence they suffer. Sen says, “It is challenging for the Indian manufacturers to grow in this framework. With an absence of a regulation or standard certification process for manufacture of medical equipment in India, companies do not receive international certifications such as US FDA and or CE mark. Hence face the challenge of low credibility thereby making it difficult to compete with international players within the country as well as expanding to other countries”. Nonavailability of standard medical device regulations in India has been a drawback. It’s been posing a slow growth in demand for the domestic players, hence predominant awareness and acceptance for its international peers. The regulatory environment for medical technology in India is ambiguous, complex and lacks transparency. Absence of specific regulation for the industry has resulted in lack of clarity and transparency about the regulations. There are problems pertaining to multiple levels of Government authority involved in enforcing the guidelines, as well as inconsistent interpretation and application of the regulatory guidelines by customs officials at the ports, state drug controllers, and officials within CDSCO. This results in a prolonged and cumbersome regulatory pathway, especially for new products. Lack of regulation of the industry has also resulted in products of sub-standard january / 2013 ehealth.eletsonline.com

tech trends

Arindam Sen

CEO, Advanced Micronic Devices Ltd, subsidiary of Opto Circuits (I) Ltd

“It is challenging for the Indian manufacturers to grow in this framework. With an absence of a regulation or standard certification process for manufacture of medical equipment in India, companies do not receive international certifications such as US FDA and or CE mark. Hence face the challenge of low credibility thereby making it difficult to compete with international players within the country as well as expanding to other countries”

quality being brought into the market, creating wider gaps of quality and cost within the same category of products; which also creates significant risk for the consumer.

ate a supportive enabling environment. This would require the establishment of a new regulatory regime for medical devices and diagnostics products with focus on Safety, Quality and Efficacy. Currently, the Indian healthcare scenario is characterised by lack of standardisation and ambiguity on regulatory standards. A lot has been achieved in terms of optimal regulation for Pharmaceutical Industry and the same needs to be replicated for Medical Devices and healthcare delivery sector. Proper regulation can help the industry positively by harmonising it with rest of the world, though with local needs in consideration. It’s imperative to have a separate regulatory body equipped to understand and evaluate medical devices”. Shetty says, “The regulatory bodies have to issue a protocol to all the medical devices manufacturing companies to achieve the required certifications in the coming two years. Also make a support system to help bigger companies to get certified as they will have a high market share and they would want to inform the market about the superiority of their products. This will make the complete market prepared to face the future. My recommendation would be to have a registration of each type of equipment because; this will ensure that when the new equipments are introduced in the market, the product has all the recom-

Expert recommendations Rajiv Nath, Forum Coordinator, Association of Indian Medical Device Industry (AIMED) says, “India is growing as a key market for medical devices and diagnostics. It is currently the fourth largest market in Asia and is worth about `20,000 crore. The industry had seen tremendous growth over the last decade of 15-20 percent but is currently projected to grow at a slower rate of 10- 15 percent though the market is growing more rapidly at 15-20 percent which indicates a declining share of domestic industry. Hence now is the time for a policy review so that domestic industry growth exceeds 20-25 percent by increasing its share in the domestic and international market”. Sen says, “As India’s burden of disease transitions from communicable to non communicable diseases (NCD) driven by socio-economic advancements, medical devices will play a critical role in helping the Government to diagnose and treat NCDs. For the industry to maximise its reach, scale and potential to address India’s healthcare needs, the Government needs to cre-

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mended safety standards. The MCI and DCI should recognise the products based on some certifications that the educational institutes can buy. This will reduce the impact on the young doctors who are so used to looking at non-functional equipments in their educational institutions, that they end up with low skills of managing equipments. When trained under bad products, the impact is very long term. Many institutions have looked at only fulfilling the requirements and not actually looked at what they are buying.

Guidelines for import India has not been able to develop itself as a strong manufacturing base for medical technology. The industry remains dependent on imports for meeting its domestic requirements. There are two key factors contributing towards this trend. One is that the Government has not been proactive in encouraging the development of a domestic manufacturing industry. There are no specific incentives in place to attract local or foreign companies to set up a production base in India. Secondly the current duty structure for medical devices and equipments favours imports, reducing the competitiveness and growth potential of the local medical technology industry. For now, it’s all important to look at these aspects and solve the bothering situations.

NEWS

Medical devices sector to be under D&C act soon

The Planning Commission has recommended for amendment in the Drugs and Cosmetics (D&C) Act to include medical devices incorporating provisions for their

risk-based classification, clinical trials, conformity assessments and penalties. The recommendation has been included in the draft plan document for the current 12th Five Year Plan. The regulation of medical devices is a vast and rapidly evolving field that is often complicated by legal technicalities. Optimum safety and performance require among all involved in the life span of a medical device: the government, the manufacturer, the importer/vendor, the user and the public each has a specific role to play in this risk management.

Apollo plans to set up 10 new hospitals by 2015

Healthcare major Apollo Hospitals is said to be investing Rs 400 crore to set up 10 specialty heart and cancer hospitals in India by 2015. Out of the

Healthcare industry may reach USD155 bn by 2017 The healthcare industry in India is expected to reach USD155 billion in terms of revenues by 2017, says a study by LSI Financial Services. At present the industry is pegged at USD 65 billion, of which 30 deals valued at USD 754.33 million were signed last year, the report by the Kolkata-based financial services company said. LSI Financial Services Managing Director, Rajya Vardhan Kajaria said, “There is a huge demand-supply gap in the healthcare delivery business in India”.

total, five will be focused on treatment of heart diseases and the other five on cancer treatment. These will be in addition to the group’s plans of adding 2,000 beds at an estimated cost of Rs 1,200 crore. “All these 10 hospitals will have between 50-75 beds each. For these hospitals, we are looking at locations like Chennai, Ahmadabad, Kolkata, Delhi, Varanasi,” Apollo Hospitals Group Chairman Prathap Reddy said. At present, the group is one of the largest healthcare chains in Asia with over 8,500 beds across 50 hospitals.

New BI solution for writing updated prescription

System integration provider, Team Computers, is soon going to launch advanced mobile-based Business Intelligence (BI) Solutions that will keep medical specialists updated with new drugs and write accurate prescriptions. The company is now engaged in real-time and social collaboration tools on mobile phones. It pairs medical diagnostics with mobile phones for real time decision support, chronic disease management and patient engagement.“Doctors can prescribe the latest medicine as they have the information on new drugs through eDetailing on iPads or mobiles. It is easier for doctors to make quick decisions and write an accurate prescription,” Team Computers MD Ranjan Chopra said.

DGCI moots alert system to curb spurious drugs The Drug Controller General of India (DCGI) has made it mandatory for all pharmacy companies and laboratories to report cases of substandard drugs. All details of such substandard/spurious/adulterated/misbranded drugs will be uploaded on the website of the Central Drugs and Standards Control Organisation (CDSCO) every month. This is the first concerted attempt to develop a pan-India drug alert system for consumers, which some states like Gujarat have already started. The Gujarat drug controller regularly sends out SMS alerts on substandard drugs. CDSCO’s drug testing laboratories have also been instructed to send regular updates to the headquarters on drugs that fail the test. january / 2013 ehealth.eletsonline.com

NEWS

Govt plans a law to check pharma-doctor nexus In order to break down pharma-doctor nexus, the National Development Council (NDC) is planning to bring a legislation requiring mandatory disclosure from drug companies. The legislation will require the pharma companies to mandatorily disclose payments made to doctors for research, consulting, lectures, travel and entertainment. The legislation also plans to

disqualify doctors who are involved in ghost writing to promote pharma products. The government will also make compulsory the use of generic names or the International Non-proprietary Name (INN) instead of brand names, at all stages of government procurement, distribution, prescription and use.

Abbott launches Bioresorbable Vascular Scaffold

Indian Drug Vetting System gets WHO clearance

Abbott has launched the world’s first drug eluting Bioresorbable Vascular Scaffold (BVS) in India, a unique device for the treatment of Coronary Artery Disease (CAD).It works by restoring blood flow to the heart similar to a metallic stent, but then dissolves into the body over time, leaving behind a treated vessel that may resume more natural function and movement because it is free of a permanent metallic stent. Abbott’s BVS is made of polylactide, a naturally dissolvable material. The potential long-term benefits of a scaffold that dissolves are significant. The vessel may expand and contract as needed to increase the flow of blood to the heart in response to normal.

In what would ensure a smooth passage for the R14, 000-crore vaccine exports from India, the World Health Organisation (WHO) has cleared the Indian drug regulatory system to approve vaccines. This assumes importance as the Drug Controller General of India’s (DCGI) office had failed a similar test in 2009. Had the Indian drug vetting system flunked the test again, it would have jeopardised the fate of exports of Indian vaccines to 159 countries, which take a cue from WHO. A 16-member team, headed by WHO approved the vaccine clearance procedure adopted by the National Regulatory Authority (NRA) or DCGI’s office.

Stem cells give new life to leukemia patient Narayana Hrudayalaya– Mazumdar Shaw Cancer Centre in Bangalore has successfully treated a six month old girl with Infantile Leukemia through ‘Unrelated stem cell transplantation’, for the first time in Karnataka. Stem cell transplantation was the only possibility in this case as this particular leukemia carries an extremely poor prognosis at this age group with the survival rate as low as 10 percent. The baby being the only child, finding a stem cell donor was difficult. A matched unrelated donor was found in USA after a period of 2-3 months from the Registry of National Marrow Donor Programme.

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Policy against antimicrobial resistance needed The Chennai Declaration wants India to take urgent initiatives to formulate an effective national policy to control the rising trend of antimicrobial resistance and to ban on over-the-counter sale of antibiotics. The paper suggests that the National Accreditation Board for Hospitals & Healthcare Providers (NABH) insist on strict implementation of hospital antibiotic and infection control policy, during hospital accreditation and re-accreditation processes. The declaration has also underlined the need to change the medical education curriculum to include training on antibiotic usage and infection control. It

has proposed regulatory authorities and accreditation agencies for Hospitals and ISO to insist on a functioning ICT during the licensing and accreditation processes.

NEWS

Max Healthcare draws energy management plan Max Healthcare has selected Energy Advantage India to assess the former’s hospitals’ energy use. Energy Advantage will conduct a benchmark assessment across three of Max Healthcare’s largest tertiary care hospitals in NCR Delhi. Max Healthcare’s group of hospitals already have five LEED Gold rated hospital buildings and it is now seeking to manage the high energy intensity of its operations and become a leader in energy management in the hospital sector in India. Energy Advantage will conduct an assessment of Max Healthcare’s current environment and to identify energy efficient areas where sustainable improvements and savings can be achieved.

GE Healthcare trains rural doctors in Northwest The American Society of Echocardiography (ASE) and GE Healthcare (GE) are in rural northwest India to utilise advances in cardiovascular ultrasound technology to enhance medical education for healthcare providers caring for the underserved populations in India. The educational event is in collaboration with Medanta – The Medicity. Twenty Indian physicians are receiving training on-site, while half of the physicians are also benefitting from additional training by ASE sonographers providing real-time instruction remotely from the US. The healthcare providers have included two new corporate sponsors to expand the reach from the rural setting with long-distance, web-based technology to the remote sonographers.

World allergy conference concludes in Hyderabad The WAO International Scientific Conference (WISC 2012), organised by the World Allergy Organisation (WAO) concluded on December 9 at Hyderabad with a Patient Forum held at Apollo Hospital that stressed the need for high-quality allergen extracts and allergen-specific tests for Indian foods, and celiac reagents/tests. The conference was held under the aegis of the Ministry of Health and Family Welfare. Spanned four days, the conference offered an enlightening range of educational sessions for physicians and allied health care professionals. Global medical experts who participated in the WISC shared their ideas and new information on the emerging science of allergy and treatment for serious diseases such as asthma, allergic rhinitis and allergic skin diseases.

Fortis Malar performs India’s first LVAD implant Fortis Malar Hospital, Chennai has successfully performed India’s first HeartMate II Left Ventricular Assist Device (LVAD) implant on a 58-year-old male patient suffering from chronic heart failure. The successful surgery was performed by Dr K R Balakrishnan, Director, Cardiac Sciences, with a team of senior doctors. The patient, diagnosed with coronary artery disease, had suffered a heart attack seven years ago. Over the years, the coronary artery disease continued to weaken his heart despite medication, leading to heart blocks and left ventricular dysfunction. HeartMate II does not involve heart replacement, instead it attaches to the heart and is designed to take over the pumping function of the patient’s left ventricle.

Siemens launches new breast analysis software Siemens Healthcare has introduced Syngo Ultrasound Breast Analysis, a software application for offline review of images, volumes and clips. The software offers comprehensive image processing and reporting tools designed to improve breast ultrasound quality and workflow. It can be installed on existing computers and allows physicians to analyze and process 2D and 3D ultrasound images inside or outside the reading room. The software offers image analysis and reporting with comprehensive tools for data review in one place and produces streamlined reports that support the American College of Radiology (ACR) BI-RADS® US Lexicon Classification Form.

january / 2013 ehealth.eletsonline.com

NEWS

FFF Technology for cancer cure comes to India Cancer care specialist HealthCare Global Enterprises Ltd has become the first in India to introduce Flattening Free Filter (FFF) Mode technology. The technology is introduced for the patients diagnosed with prostate cancer at HCG

Cancer Center in the city. Dr.Vivek Bansal, Director, Radiation Oncology, HCG Cancer Center Ahmadabad, said, “With FFF dose rates of 2400 (as compared to 600 or below in filtered beam) the beam on time gets reduced by one third to one fourth. This probably is the biggest add-on as of today adding to patients comfort and minimizes the effect of movement during treatment or during respiration also. The treatment time in delivering doses will come down from minutes to seconds.

Mumbai’s Hiranan- Relisys to ramp up its medical devices business dani hospital in Care Hospitals is planning to ramp up their Guinness Book medical devices business, Relisys Medical Fortis foundation in association with Fortis Hiranandani Hospital, Vashi rewrote the Guinness World Records book for conducting largest number of cervical cancer screening in 8 hour with record breaking number of 751; surpassing the 2011 record of 350 participants held by USA’s Kaiser Permanente. With 20 OPD rooms, 50 gynaecologist and Oncologist with assistance of over 50 paramedic staff, Fortis ran 8 hour marathon screening program. Just seven months ago Fortis bagged up Guinness World Records for “Maximum number of people hand sanitising at a single venue simultaneously. In November Fortis launched India’s Largest Cervical Cancer Awareness Campaign – Teal to Heal Together. Teal is the color of cervical cancer ribbon.

Devices. The business specialises in manufacturing cardiac stents and catheters and is among the few Indian companies which manufacture these key medical devices entirely in India, starting from the raw materials. Dr. N. Krishna Reddy, lead promoter of Care Hospitals is said to be raising around Rs 40 crore for the next phase of commercialisation of the technology. The promoters have so far infused Rs 40 crore through the equity route and have invested another Rs 30 crore through debt. Relisys’ products are already being used at many hospitals in India including at Fortis, Max, Jayadeva, Care Hospitals besides being exported to few countries including to Turkey.

Plan panel recommends e-Gov for Pharma sector The Planning Commission has recommended introduction of e-Governance systems in pharmaceutical sector to inter-connect all licensing and registration offices and laboratories.The panel has made this recommendation in the draft plan document for the 12th Five Year Plan period. It also recommended a GPS based sample collection systems and online applications for licensing.The panel has also recommended for legislation for making mandatory code to identify and penalise unethical promotion on the part of pharmaceutical companies as part of the marketing of drugs.The draft plan document will go for approval by the National Development Council (NDC) which will meet here on December 27.

Assam plans to expand Teleradiology Services Soon after the success of teleradiology services which was introduced last month in Assam, the state government has now planned to expand this service on a bigger scale by linking all the civil hospitals of the state with its hub in Guwahati. Director of Health Services, Dhrubjyoti Hojai said, “There is a dearth of radiologists in the state. As a result, the reports of CT scan and x-ray machines in district civil hospitals will be sent to the doctors stationed at Guwahati after the teleradiology method is linked up. There will be doctors to monitor the reports and the results will be given immediately online.” The decision has been taken to counter the dearth of radiologists in the state, he added.

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telemedicine

Evolving software for transformation The current set of healthcare products is designed to improve the healthcare process by providing customised interventions, reducing the cost incurred, and ensuring an integrated and shared patient-centred care By Rajmohan Nair, Head - Marketing and Partner Sales, 21st Century Informatics

here is a tremendous leap in the market primarily due to the implementation of various healthcarecentric laws and acts by institutions and regulatory bodies, advances in technology, and increased awareness among patients and their demand for quality care at low cost. Healthcare providers, hence, have a wide variety of packages to choose from for facilitating healthcare reforms, competing in the market, providing high quality service with low cost of operations, planning for expansion and maintaining efficient control of operations. During the last two decades, a variety of software products have been developed and implemented for healthcare providers. Initially, when electronic records were introduced into the market, their functionality and application value were restricted to the same location (i.e., hospital) they were operational in. Over the years, this restriction has diminished, and the application has evolved into a unified patient-centred EHR system facilitating a seamless inter- and intra-hospital data transfer. Although the plethora of healthcare ICT products available in the market provides the basis for a collaborative shared patient care, the effectiveness of these products depends on the accuracy with which they fulfil the dynamically evolving needs of the healthcare industry. These approaches generally

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encompass all the key processes such as diagnostic and therapeutic procedures, revenue cycle management, administrative function improvisation, policy management and business and clinical analytics.

The challenge One of the main challenges that affect the need to fulfil the ever-changing requirement scenario is that users are often not satisfied with the products offered and their applications. Survey reports indicate that the dissatisfaction is primarily due to the products’ limited user interface and customisation to overcome changing needs. The healthcare ICT industry is becoming aware that the traditional business software approach towards building healthcare software products, which involves a rapid expansion of functionality during implementation and post-implementation stages, is not suitable for the healthcare segment. It has been observed and approved by industry leaders that, especially in the healthcare applications scenario, the key feature of any product is its ‘change’ capability. When organisations are faced with the ‘constant change’ phenomenon due to changes in the business ecosystem, such as organisational, political, economical, statutory, technological and legal, the need for a constantly improvised change request

in application software is equally demanding. If these modification requests are addressed by the principal software provider, the biggest disadvantages are huge cost and time, both of which go against the primary requirements of an ideal healthcare product - quick goto-market and low cost. The users of healthcare software packages are demanding a new evolutionary approach in the handling of the product life cycle of healthcare systems. An aging product will not fit the current requirements of the healthcare segment. An evolvable application is hence a prerequisite to satisfy the changing needs of the healthcare industry.

The way forward and call to action Moving away from a traditional models of software applications, healthcare providers and other stakeholders in the industry must look forward to adopting highly evolvable healthcare applications software that will have the inherent DNA to adapt to ‘constant change’. This approach will make the product suitable for a multi-organisational management, facilitate collaborative workspace, provide flexibility to the users of the system to adapt the system to changing business needs without large customisation costs and empower the users through its learning tools.

expert speak

Patient financing A new chapter in Indian healthcare Manish Menda, Director, Mya Health Credit, speaks to Sharmila Das about how Mya Health Credit brought the concept of patient financing to India

What was the inspiration behind the launch of Mya Health Credit? After working in healthcare consulting in the US and completing my MBA from the SaĂŻd Business School, University of Oxford, I started studying the healthcare markets in various countries including India out of self-interest. From evaluating the market, I realised there was an immense gap in the number of well reputed providers coming into the market but the middle class patient was not able to easily access these providers. While the model has evolved drastically over the time it was from this realisation that the concept of patient financing in India was born. How does Mya Health Credit help a patient to access healthcare? Who are the other players in the patient financing space? Mya Health Credit is the first patient financing company in India facilitating low interest loans for planned medical procedures. Mya Health Credit provides choice to the patient undergoing planned medical procedures. They can get their medical treatment done at an affordable cost without delaying them due to financial constraints. With the growth of specialised healthcare in India and healthcare services becoming increasingly expensive, the challenge for most Indians lies in accessing healthcare in India at affordable prices. Mya Health Credit fills this gap by

making medical treatments accessible to people through accessible loans. A patient can get pre-screened on the website for eligibility. They would see the list of providers, specialties and apply for a specific loan amount. The system would then show them the financial institution with the range of possible interest rates. They would select Tata Capital and proceed with their detailed application form. The important thing is that a patient should visit the healthcare provider and get an estimate before they actually submit their application. Healthcare financing as a specific product is new in India, though it is comparatively more common in the US and the UK, and normally these loans are given at a concessional rate as compared with normal lending.

to be the patient and there are no extra charges for patients coming through Mya Health Credit. A separate applicant and co-applicant can apply for a loan on behalf of the patient. The important thing to note is that the customer is subject to approval of the loan and patients cannot apply for emergency procedures through Mya.

How similar or different is your business model than a health insurance company? Mya Health Credit facilitates personal loans for planned medical procedures at a low interest rate. The key difference is that a patient would approach Mya at the time of need as there is no plan to buy in advance. Through Mya Health Credit patients can apply for a loan when they would like to do their planned medical procedures. Insurance does not cover pre-existing conditions and various procedures such as Fertility, Dental or Cosmetic Surgery are not covered by insurance. In case of patient finance since itâ&#x20AC;&#x2122;s a loan there is no specific restriction other than the personâ&#x20AC;&#x2122;s eligibility to repay and the medical procedure is within the approved list. The other important aspects are that the person applying for the loan does not need

Who is your target group? Target group are middle class people who want to undergo planned medical procedures but have been delaying due to lack of funds. These patients benefit because they are able to complete the planned medical procedures now instead of waiting for an extended period of time.

How have been the responses so far? We have been working closely with Tata Capital to get the system up and running and to ensure we have procedures in place. We have just launched in the market and our focus right now is to educate the patients to let them know that this facility is available. We are receiving a number of enquiries and currently working processing cases also.

What change or trend you have seen in this patient financing space? I see the Indian healthcare sector evolving to a state where patients will have multiple options in how to access healthcare from a variety of different insurance schemes, Government schemes or patient financing programmes. Insurance plans are already starting to evolve and the Government is working in various healthcare programmes all over India. The key will be consumer choice in the future. january / 2013 ehealth.eletsonline.com

event report

CII- 9th India Health Summit

t 9th India Health Summit organised by Confederation of Indian Industry (CII), eminent personalities from the Government sector participated at a single platform to find way and address the challenges faced by the healthcare sector. “Though India has earned international accolades for its collective efforts at containing Polio, significant reduction in IMR and MMR, the delivery and outcomes of healthcare facilities need to be improved further”, said Shri Ghulam Nabi Azad, Minister of Health & Family Welfare at the summit. He also released the report, prepared by McKinsey for CII, titled, “India Healthcare: Inspiring possibilities, challenging journey”, which provides various stakeholders with an integrated view of the healthcare sector in India by 2022. Addressing the 9th edition of the India Health Summit, Dr Montek Singh Ahluwalia, Deputy Chairman, Planning Commission, asserted that there exists consensus on the fact that India is lagging behind in the provision of healthcare facilities in terms of both the outcomes and money spent by the Government. To solve this anomaly, the 12th Five Year Plan document has accorded increased significance to healthcare by raising the share of total public expenditure on health, he added. “We are determined to put health on national and social agenda by increasing the public-spend on healthcare in the country in the years to come”, he said. Shri P.K Pradhan, Secretary, Ministry of Health & Family Wel-

Forging partnerships between the public and private sector is the way forward for the healthcare sector in India

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fare, highlighted that there is an urgent need for strengthening the public healthcare system in such a way that there is a seamless transition between primary and secondary healthcare facilities in the country. In his special address, Dr Naresh Trehan, Chairman, CII National Committee on Healthcare, remarked that the quality of medical education needs to be improved in India with special focus on the up hauling of both the quality and quantum of doctors in the country. The skills of the ASHA (Accredited Social Health Activist) workers need to be enhanced, in order to improve the delivery of service in the rural sector. The creation of the HSSC is a step in this direction, he further added. Shivinder Mohan Singh, Executive Vice-Chairman, Fortis Healthcare Limited, in his address remarked that to ensure availability of affordable healthcare services in the country, forging public-private partnerships is the only way forward. Additionally, there is also an urgent need for improving the transparency and accountability on the cost of delivery of healthcare services, he added. Dr Prathap C Reddy, Chairman, Apollo Hospitals Group, added that time has come for the healthcare sector to be accorded infrastructure status in order to improve the sector’s outcomes and platform of delivery access across different sections of the society. Addressing one of the earlier plenary sessions held during the day on the topic, “Healthcare Blueprint for India”, Shri Keshav Desiraju, Special Secretary, Ministry of Health & Family Welfare, remarked that the affordability of the healthcare services could be improved further by ensuring adequate insurance cover for the population. There exist a scope of improvement in strengthening regulatory facilities in the field of healthcare in the country, he added.

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