eHealth July 2013

asia’s first monthly magazine on The Enterprise of Healthcare

volume 8 / issue 07 / july 2013 / ` 75 / US $10 / ISSN 0973-8959

Medical Technology Widening Healthcare Eshwar Chandra General Secretary, Andhra Pradesh State Chapter of IRIA

eHealth Magazine

Dr Yatin Mehta Chairman, Institute of Critical Care & Anesthesiology, Medanta, The Medicity

Dr (Prof) Mohan Nair Chairman, Cardiac Sciences, Saket City Hospital (SCH)

Dr Omender Singh Dr Sudarsan De

Dr Arun Bhanot

Chairman Oncology & Senior Consultant, Galaxy Cancer Institute

Chief of Spine Service, Paras Hospitals

MD, FCCM, Head Department of Critical Care Medicine, Max Healthcare

ehealth.eletsonline.com

volume

08

issue

7

contents

ISSN 0973-8959

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08

cover story

Dr Narendra Rungta

Innovating Landscape of Medical Technology

President, Indian Society of Critical Care Medicine

cover story Krishna Kumar, President Healthcare Technology

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Ashokaan VRS, Group CIO, Columbia Asia Hospital

Kaustav Banerjee, Country Manager

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Ambarish Gupta, CEO & Founder

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Dr Vishal Gupta, VP/GM, Cisco Services & Healthcare Business Unit

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Dr Sudarsan De, Chairman Oncology & Senior Consultant, Galaxy Cancer Institute

Arindam Sen, CEO, Advanced Micronic Devices Ltd (AMDL)

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J Sunderrajan, Head-Strategy and Business Development, Siemens Healthcare

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zoom in

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R K Narang, Executive Director – Sales, Allengers Medical Systems Ltd

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Razi Ahmed, Country Manager / CEO – India, Mazik Tech Solutions

special focus Critical Care Evidence Based Emergency Care

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Dr Yatin Mehta, Chairman, Institute of Critical Care & Anesthesiology, Medanta

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Dr Omender Singh, MD, FCCM, Head- Department of Critical Care Medicine,Max

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Dr Rajib Paul, Head Critical Care, Apollo Hospital, Hyderabad Dr Abhay Patwari, Consultant anesthesiologist ,Farwaniya Hospital, Kuwait Dr Narendra Rungta, President of ISCCM

tech trends

42

Imaging the Next Revolution

44

Eshwar Chandra, General Secretary, AP State Chapter of IRIA

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Dr Pradeep Muley, Head & Senior Consultant Interventional Radiologist, Fortis Hospital, Vasant Kunj, New Delhi

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power hospital

expert speak Sid Nair, Vice President and Global General Manager, Dell

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Dr (Prof) Mohan Nair, Chairman, Cardiac Sciences, Saket City Hospital (SCH)

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Dr Devinder Rai, Vice Chairman, Department of ENT, Sir Ganga Ram Hospital

SPECIALTY

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Dr Arun Bhanot, Chief of Spine Service at Paras Hospitals

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

08

issue

7

july 2013

President: Dr M P Narayanan

Partner publications

Editor-in-Chief: Dr Ravi Gupta group editor: Anoop Verma

Editorial Team

WEB DEVELOPMENT & IT INFRASTRUCTURE

Health Sr Assistant Editor: Shahid Akhter Sr Correspondent: Sharmila Das governance Assistant Editor: Rachita Jha Research Assistant: Sunil Kumar Correspondent: Nayana Singh education Senior Correspondent: Pragya Gupta, Mohd. Ujaley Correspondent: Rozelle Laha Sales & Marketing Team National Sales Manager: Sunil Kumar, Mobile: +91-9910998067 Assistant Manager: Vishukumar Hichkad, Mobile: +91-9886404680 (South) Manager - Sales: Douglas Digo Menezes, Mobile: +91-9821580403 (West) Assistant Manager - Sales: Bhupendra Singh, Mobile: +91-9910998066 (North)

Team Lead - Web Development: Ishvinder Singh Executive-IT Infrastructure: Zuber Ahmed Information Management Team Executive – Information Management: Khabirul Islam Finance & Operations Team General Manager – Finance: Ajit Kumar Legal Officer: Ramesh Prasad Verma Sr. Manager – Events: Vicky Kalra Associate Manager – HR: Sushma Juyal Associate Manager – Accounts: Anubhav Rana Executive Officer – Accounts: Subhash Chandra Dimri

OUR UPCOMING EVENTS 9th

Subscription & Circulation Team Sr Executive - Subscription: Gunjan Singh, Mobile: +91-8860635832 Design Team Shipra Rathoria: Assistant Art Director Team Lead - Graphic Design: Bishwajeet Kumar Singh Sr Graphic Designer: Om Prakash Thakur Sr Web Designer: Shyam Kishore Editorial & Marketing Correspondence eHEALTH - Elets Technomedia Pvt Ltd Stellar IT Park, Office No: 7A/7B, 5th Floor, Annexe Tower, C-25 , Sector 62, Noida, Uttar Pradesh 201309, email: info@ehealthonline.org Phone: +91-120-4812600 Fax: +91-120-4812660

india’s premier ict event 23-24 July 2013 Hyderabad International, Convention Center, Hyderabad

Knowledge Exchange

KOVALAM 30 Aug-1 Sept 2013, The Leela, Kovalam, Kerala

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The magazine is not responsible or accountable for any loss incurred, directly or indirectly as a result of the information provided. ehealth is published by Elets Technomedia Pvt. Ltd in technical collaboration with Centre for Science, Development and Media Studies (CSDMS) Owner, Publisher, Printer - Ravi Gupta, Printed at R P Printers G-68, Sector 6, Noida, UP, INDIA & published from 710 Vasto Mahagun Manor, F-30, Sector 50, Noida, UP, Editor: Dr. Ravi Gupta © All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic and mechanical, including photocopy, or any information storage or retrieval system, without publisher’s permission.

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editorial

Transforming Healthcare with Medical Technology An innovative landscape for medical technology has been the need of the hour for long. As per the CII research report, the current size of Indian medical technology market stands at ` 25, 000 crore, 75 percent of which consist only import products. Over the years, there has been a lot of emphasis coming on the country’s regulatory policy that in a way impending the environment to manufacture medical devices in the country, which has created ripple effect. We all know that primary and secondary care hospitals are not been able to take advantage of latest medical devices like 3 Tesla MRI etc and it is due to the heavy investment that a primary or secondary hospital needs to embark on buying these devices.

The medical technology has traditionally developed its design and technology with new advancements as pure iterations to their previous equipments as incremental innovations as enhancements in the power, efficiency or performance. However, in recent times as the industry moves from a clinician-centric approach to a patient-centric approach, the new trends in medical device designs reflect the new ideology of this industry to re-invent healthcare as an experience from the patients’ viewpoint and the doctor as just a facilitator.

In its Medical Technology Report 2012, Ernst & Young state that the move to an outcomes-focused ecosystem will involve a changing customer base. While the primary customer for many medical technologies has historically been the physician, medical technology firms will now need to focus on understanding and serving a more diverse set of customers. The patient-empowerment is being provided from technology platforms such as smartphone apps, social media platforms, sensor-embedded smart devices and more.

The July issue of eHEALTH covers the above aspects of medical technology along with a few innovative medical devices that have benefited the healthcare eco-system. In addition, the coverage on Critical Care is an attempt to understand the various developments that have happened in this segment. Like earlier issues, the July issue of eHEALTH has interviews of eminent radiologists too.

I’m glad to invite you at the upcoming 9th edition of eINDIA Health Summit scheduled to be held on 23-24 July 2013 Hyderabad International Convention Centre. As you might know, the last year’s eINDIA had been a great success, many key stakeholders from the areas of Governance, Healthcare and Education, were there to discuss and deliberate upon the ways by which new technologies can be used for public benefit. This year also we are going to have a vibrant healthcare track at the eINDIA 2013. We hope that you will be there at the eINDIA 2013 to contribute to the discussions that take place.

Dr. Ravi Gupta ravi.gupta@elets.in

july / 2013 ehealth.eletsonline.com

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Cover Story

Medical Technology

Innovating Landscape of Medical Technology Medical technology has been instrumental in extending healthcare by way of improving care, alleviating pain, injury, etc. Thus an incessant innovative medical technology landscape is more than required g

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By Sharmila Das, ENN

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T

he medical technology sector has been witnessing significant growth over the years. Some experts say, it is going to be the next Pharma boom for the country.

Presently the size of medical technology market pegged at ` 25, 000 crore, 75 percent of which consist only import products.

The growth drivers Medical technology or the popular short form med-tech has come of age.

Matching with India’s huge unmet demand for quality healthcare, the industry has developed a range of both high-end and cost-effective solutions. Yet, there is a lot of scope to have an effective and innovative use of medical technology, supported by ICT, which 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.

A transforming medical technology landscape, improving healthcare delivery and financing mechanisms, and changing patient profile are driving growth in the medical technology industry. However, the industry has been stifled by some key impediments to growth.

The foremost among these is the lack of - affordability, accessibility, awareness and availability. A key question, therefore, is how to increase penetration of medical technology to improve health outcomes in India?

The answer lies in innovation.

Medical technology innovation can be the tool to make modern care accessible, available and affordable to all by lowering the cost of the product or delivery. CII report says, 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 insur-

NUTS & BOLTS Medical technology (Medtech) companies are accelerating their investments in emerging markets, and India is a prime target because of its large population, growing middle class, and improving healthcare infrastructure. India ranks in the top three emerging nations for direct investment by large, multinational Medtech companies Source: India Medical Technology Report 2012 by Pwc

ance providers - need to co-ordinate/ strategise and move in step for their actions to resonate and bring about lasting change.

Rajmohan Nair, Head - Marketing and Partner Sales 21st Century says, “Technology innovations in healthcare can reduce the over head and operational costs. For example, just to connect between patients, doctors and healthcare institutions in a mass, a mobile health has shown a tremendous transformation in rural healthcare.

The key challenge is now to be able to combine progress in patient care with progress in overall productivity of the healthcare programmes. Incremental of changing technology in stages would ideal for healthcare, since healthcare is not global. It is local, sensitive, complex, multidimensional and individual patient centric. Our solutions are focussing these elements and we are working towards bring in technologies that will collaborates all stake-holders of the ecosystem”.

To understand the innovative landscape of medical technology, we discussed the following innovative solutions from some med-tech entrepreneurs.

july / 2013 ehealth.eletsonline.com

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Cover Story

Medical Technology

Philips Strives to Make

Healthcare Affordable With new range of products being launched at the Philips Innovation Centre in Bangalore, Krishna Kumar, President Healthcare Technology, talks about how Philips has made healthcare technology affordable and simplistic to Sruti Ghoshal, ENN In 2012 you announced the commencement of operations at the first Greenfield manufacturing facility in the imaging system in the country.

What was the reason behind setting it up and how has it benefited the healthcare market in India?

Any emerging market in India has huge population and huge disease states on the one hand and addressing the three classic A’s that is awareness, access and affordability. Philips has been one of the longest serving MNC in the country and we have had our presence over 80 years. So when we draw a long term strategic plan for the country it becomes important for us to address the key issues and it can be only fulfilled if we build an end to end eco-system in the country.

The access challenge is huge, both physical and geographical access and financial access to technology as well and affordability also remains a huge challenge. Today cardiac disease is one of the top killers in the country and we have 60 million people with heart disease and only two million angiography being performed in the country, which is one of the lowest in the world. The fundamental reason is not a dearth of cardiologist but the dearth of number of cardiac centres in the country and underneath this challenge lays in the unaffordability

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Krishna kumar

“When we first launched the three test layer MRI scanner, which was the first in the world, AIIMS was one of the first adopters.” of technology. Out of our Greenfield facility in Pune, we have built an entire ecosystem of products ranging from world’s most affordable cath labs to a wide range of cathlabs. And today because of this investment today we have been able to bring the most affordable cath lab which now starts from `70 lakhs.

How has Philips Healthcare Technologies penetrated the tier I and tier II cities in India?

We are probably one of the best penetrated MNC in the country, certainly in the lighting space. In healthcare, the rural market predominantly gets addressed through the National Rural Health Mission, so our products go

Cover Story

Medical Technology

through NRHM. In urban space we are serving nearly 700 cities in the country

What are the new innovations that you are bringing in sectors like women and child care, cardiology and oncology?

In the last two years we launched 33 new products, which have never happened in the history of medical healthcare previously. If we take radiology, we are first one to launch digital broadband MRI scanner, similarly we have

Factsheet

India spent 4.8 percent of its Gross Domestic Product (GDP) on health care in 2003, somewhat less than China’s 5.6 percent.

Translated into per capita total expenditures at an average exchange rate, however, the Chinese spent an average of USD 61 million compared with India’s USD 27 million.

“Today cardiac disease is one of the top killers in the country and we have 60 million people with heart disease and only TWO million angiography being performed in the country, which is one of the lowest in the world. The fundamental reason is not a dearth of cardiologist but the dearth of number of cardiac centres in the country and underneath this challenge lays in the unaffordability of technology” also launched a new CT scanner like ingenuity which is today the lowest radiation dose scanner in the world. If you take USG then we are the first company to launch a technology called Xmatrix.

We entirely developed a whole new platform called Clear Vue. With this most of the information that used to be with the server has been moved to the probe or the transducer. This is the first time in the world that such technology has happened. With this technology the maternal mortality which is a concern in rural India can be solved where a social worker can actually use the probe. If you talk about critical care we have introduced a whole new range of products. We have launched a few high end ventilators. We have launched the world’s first e-ICU where the patient can be monitored from any where.

Have you extended these technologies to the government

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as well? How has been the response?

Government is the second largest category of hospitals that we serve. Adoption of technology in the private hospital is usually swifter than the government hospitals, but in the leading government hospitals government does take a lead.

When we first launched the three test layer MRI scanner, which was the first in the world, AIIMS was one of the first adopters. In the leading government hospitals they are very progressive in terms of adopting technology, but when you go down to the PHC there is a lot of modernisation that is required.

What are the innovations that you are planning to introduce in the healthcare informatics space?

We look at healthcare in four layers.

In the foundation level we have HIS, most of its use is for non-clinical ap-

plications and above that is Electronic Medical Records(EMR) and EHR. This is characterised by clinical informatics and telemedicine. So our expertise lies in these layers. For cardiology we have a solution called Exelera that stores all the video as well as the image information of the patient. For critical care we have solution called ICCA. We also introduced new range in telemedicine in the field of radiology and critical care.

What is the percentage of market share in medical technologies?

According to the 2012, four out of the five verticals that we play in, we are the market leaders. In radiology we have a 39 percent share, in cardiology we have a 53 percent share, in respiratory we have 53 percent and oncology 26 percent. The source of all these data is COCIR.

Introducing Introducing Introducingthe the thenew new new DIRECTVIEW DIRECTVIEW DIRECTVIEWVita Vita VitaCR CR CRSystem System System Available Available Available Available with with with with Carestream Carestream Carestream Carestream Image Image Image Image Suite Suite Suite Suite mini-PACs mini-PACs mini-PACs mini-PACs solution solution solution solution Improved Improved productivity productivity productivity productivity - First - First -- First First image image image image inin 50 in in 50 seconds 50 50 seconds seconds seconds and and and and fast fast fast fast processing processing processing processing � �Improved ��Improved time time time time (40+plates (40+plates (40+plates (40+plates per per per per hour) hour) hour) hour)

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COMPACT, COMPACT, COMPACT, HIGH HIGH HIGHQUALITY, QUALITY, QUALITY, ROBUST ROBUST ROBUST&& & AFFORDABLE AFFORDABLE AFFORDABLE CR CR CRSYSTEM SYSTEM SYSTEM

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Medical Technology

Offering Cost-effective Technology

“When we talk about affordability, we must also focus on technology that can make healthcare cost-effective,” says Kaustav Banerjee, Country Manager, St Jude Medical in an interview with Mohd Ujaley, ENN You have facilities and operation in 10 countries and your products are being sold to many countries. How has been your experience in India so far?

India is a very exciting market for various reasons. Indian market is uninterrupted in medical technologies. There are several challenges in terms of patient access. When I talk about access it means therapeutic access. First access relating to awareness, second geographical access because most of the development happens around metro cities and the third challenge is affordability. We, as an organisation are extremely successful in India over the period because we have always been introducing innovative technologies which reduce the cost of entire medical system. So, if you look at St Jude’s medical products they are available in India through many institutes since 1994. St Jude’s valves are always termed as the ‘gold stranded’ valves.

“The study that we did with our

Fractional Flow Reserve (FFR)

technology in India demonstrated that each patient would have saved

` 67,000

rupees in treatment.

That’s a phenomenal saving and this is one of the technologies that we have introduced”

How has been your experience with tier II cities?

We have sales offices in five cities. We have access all over the country both in

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Kaustav Banerjee

tier-I and tier-II cities through a set of service providers and our own people who are residents of many of the smaller cities. Tier-II cities are growing very fast. The main disadvantage of the tier-II cities was that the patient had to travel long distances to get treated and finding a place to stay in a metro That has been addressed, as we can see super-speciality hospitals coming up in tier-II cities. Also, we have created infrastructure for our physicians and customer care. We are also investing on training and education of physicians in tier-II cities. The response has been very encouraging.

For a developing country like India, an affordable healthcare on a universal basis is paramount. How organisation such as yours can provide technologies to improve patient outcomes while also reducing the cost of healthcare?

When we talk about affordability, we must also focus on how to make healthcare cost effective for the patients. The study that we did with our Fractional Flow Reserve (FFR) technology in Indian demonstrated that each patient would have saved Rs 67,000 rupees in treatment. That’s phenomenal saving and this is one of the technologies that we have introduced. Secondly, in technology enabling cost-effectiveness, you have to look at the overall cost of the therapy which includes initial cost of treatment, the continuing medication, chances of rehospitalisation and if you aggregate all of that you will get to see some of the technologies that we have introduced, have significantly reduced the cost. Our Quadripular Technology which has four electrodes versus the conventional one or two has significantly reduced common complications. The longevity of the device is also important because of the tenure of the treatment. Our pacemakers have highest longevity in the marketplace.

“We have programmes related to awareness and developing

the skills of cardiologists and cardiac surgeons to do different kind of therapies

that are available worldwide. On the other side we are also making investments on identification of the disease and their diagnosis”

market, alone contributing to 47 percent in net sale. How much is the contribution of India?

India’s contribution is continuously growing in this market. We are growing faster here. India’s challenges are different. India is more about addressing the barriers to access like affordability, geographical locations etc. We are working very closely and making investments on awareness. We have programmes related to awareness and developing the skills of cardiologists and cardiac surgeons to do different kind of therapies that are available worldwide. On the other side we are also making investments on identification of the disease and their diagnosis.

Are you also focusing on medical students who are going to lead the healthcare system in the country?

Yes, we have programmes for MBBS students. These are structured programmes wherein we give them experience of different kind of device therapies by bringing in experts from that particular field. We do this programme three to four times in a year across the country so that the medical students from the entire country can benefit.

In Health IT both operating profit and net sale have slightly gone down in last couple of years, why it is so?

There are two sides of it. From overall business standpoint, there is dependence on US and European markets.

There have been challenges in these markets. The international division contributes more than 50 percent. If there are challenges in those markets, it will reflect. If you look at the general growth rate of those markets, it’s been on the lower side. However, if you look at Asia, then there has been growth.

We understand for Jude Medical, USA is the biggest

What are the major challenges you see in India?

The major challenge is health infrastructure which I believe is improving but yet to catch up with the global standard. Total number of beds, number of nurses and doctors are those factors which will significantly improve the health infrastructure. Unless these factors are increased, the bottleneck will continue to be there.

The good part is that government has made lot of conscious efforts to invest on medical colleges, initiatives being taken to build AIIMS like institutes which will help tremendously. All the large hospitals in India are building new hospitals or acquiring one and increasing the capacity.

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Cover Story

Medical Technology

‘In emergency care every second is precious’ Ambarish Gupta, CEO & Founder, Knowlarity Communication speaks about his newly launched Code Blue Medical Emergency Response System that provides emergency medical care to patients Kindly tell us about your newly introduced medical emergency response system?

Fortis in Gurgaon uses our Code Blue Medical Emergency Response System to provide emergency medical care to its patients. Code Blue is a medical terminology used for patients who need emergency resuscitation following a heart attack. Usually there is a small time window for emergency treatment beyond which the patient

cannot be revived. Our emergency response system ensures that the patient receives prompt medical treatment after an emergency.

How does it work? How much investment it requires to be installed in the hospital infrastructure?

The software is simple but effective during an emergency as it sends out an SOS message to as many as ten

people at the press of a button. Any hospital administrator or nursing staff can be authorised to send out the message in the event of an emergency. This emergency response system is robust and affordable. There is no need for any upfront investment on telephony servers or networking equipment as it runs in a hosted environment. Integration into existing systems is hassle free and takes a few minutes at the most.

How does it work?

Ambarish Gupta

Knowlarity’s Code Blue Emergency Response System sends out SOS messages to the medical team attending the patient immediately following a medical emergency resulting in timely medical care. In emergency care every second is precious. Knowlarity’s Code Blue Emergency Response System saves many lives by ensuring prompt medical care in the event of an emergency.

What are the benefits it has offered to the users?

The biggest advantage is quicker response times during an emergency.

There is no confusion as the emergency medical response system takes over after it has been activated by the hospital administrator or nursing staff. The attending doctors are intimated with patient specific information – name, type of illness, bed number, location etc – which is necessary for providing emergency medical help.

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Cover Story

Medical Technology

Viable Med-tech Solution Arindam Sen, CEO, Advanced Micronic Devices Ltd (AMDL), Subsidiary of Opto Circuits (India) Ltd, speaks about the company’s offerings for Indian medical technology industry What is the USP of opto circuits? What kind of medical devices you provide to India’s healthcare?

Opto Circuits primarily caters to the monitoring segment and all the recent acquisitions, including Mediaid and Criticare, have also been focused on the same. We own IP in pulse oximetry, enabling manufacturing and sale of SPO2 sensors - consumables that go with the monitors. We supply monitoring equipment to ICUs and NICUs. Cardiac Science, one of the largest subsidiaries of Opto Circuits, owns public

access defibrillation technology. It sells “Powerheart” branded Automated External Defibrillators (AEDs). The Opto group, in general, caters to a broad spectrum in healthcare affordability.

Some group brands sell high-tech premium equipment and some others focus on cost-conscious markets.

Who are the hospitals who have taken your products or solution?

We have sold to quite a number of premier institutes like PGI Chandigarh, AIIMS hospitals etc which are our regular customers and to whom we supply

some quantity every year. We are also dealing with Apollo and Fortis in the South and the North. We have done significant amount of business with hospitals like Chacha Nehru Hospital in Delhi, government hospitals etc. and we have deals with a lot of defence hospitals. We have done supplies to a lot of defence establishments. As recently, last year we have supplied 200+ AEDs to Northern Command. We provide to different government establishments and also big corporate hospitals. We are increasing our presence in India; India was not a very focal point for Opto for long time, but we are now focusing on Indian markets.

Since when you have started focusing more on India markets?

Opto Circuits acquired Advanced Micronic Devices Ltd (AMDL) around 12 years ago. It used to be a company dedicated to third party medical equipment distribution. It is a BSE listed company.

Primary purpose of this acquisition was to get distribution foot print in India.

Tell us some specialities of Opto Circuts?

ARINDAM SEN

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Within monitoring itself, we sell affordable technology from Mediaid and high end measurement and monitoring products from Criticare, some of which are also used in operating rooms. We also offer affordable solutions for ECG diagnosis under the Mediaid brand, starting from very basic single channel and way up to 12 channel ECGs. These products are used by physician offices as well as in tertiary care hospitals and diagnostic center chains.

ICT is Driving the Med-tech Industry

‘Though investment for hardware takes a major share in the total investment for ICT, the software segment is growing at an annual growth rate of 15 percent’ says Rajmohan Nair, Head - Marketing and Partner Sales, 21st Century Informatics

What ate the unique medical technology product/solution you provide to hospitals?

We have been successfully transforming 21CI Apex Enterprise HIS into a new healthcare technology platform.

This is true, if you go through market acceptance of our product that we received a good response from the market. The product is designed so as to help our customers to standardise their treatment processes, resulting in increased safety and quality for patients and increased productivity for the hospitals. With this we could bring-in uniqueness by providing innovative solutions that can integrate and coordinate a diverse set of factors including medical technologies, critical processes, inventories, revenue cycle management and MIS analytics. The solutions address the key challenges of ‘change management’ that constantly affecting the modern healthcare organisation.

Can you tell us about any of your innovation in medical technology field?

We found that CXOs of healthcare organisations are facing the twin challenges of delivering a high quality healthcare in one hand and maintaining significant operational process efficiencies and cost optimisation in other end. We are constantly innovating to provide new features and functionality in such a way that both these objectives are met. We are work-

Which are the hospitals have taken your solutions?

This quarter of 2013, we have received a good response from Indian healthcare market. Our Flagship product Apex Enterprise HIS product has been selected by reputed brands from the Industry such as Hiranandani Group of Hospitals, Mumbai, QRG Healthcare group, NCR Region and HLL Life Care, India Rajmohan nayar

India’s emerging economic trends, increase in medical entrepreneurs and demand for quality healthcare is fuelling growth in private and public sector investments in healthcare in urban India ing on a new technology platform that enables rapid expansion of functionality during IT products that serves these challenges faced by CXOs. Our innovation team is currently working on launching our new platform ‘Componium’, which is aimed at empowering the entire value chain of Business Software Application IT lifecycle. With this platform, different stakeholders will be able to contribute to enrich the habitat and build newer functionalities for a specific or generic need of businesses.

What is the size of medical technology product and solution in India? In what percentage the segment is growing?

ICT also plays an important role in this growth. India’s emerging economic trends, urbanisation, growing middleclass, increase in medical entrepreneurs and demand for quality healthcare is fuelling growth in private sector and public sector investments in healthcare in urban India. ICT opportunities in tier two and tier three cities is growing fast. Mid-market opportunities & green field projects are having reasonably allocating good investments in ICT. The report about healthcare industry says that it is growing 20 percent per annum. Though investment for hardware takes a major share in the total investment for ICT, the software segment is growing at an annual growth rate of 15 percent. In a few years, healthcare technology segment, both product and services will grow faster due to technology triggered introductions of big data, BOYD, cloud services and other innovations in mobile solutions.

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Cover Story

Medical Technology

Med-tech For Speedy Recovery “Medical technology has improved the quality of life, as it enables diagnosis at an earlier stage, which further helps in timely planning of treatment” feels J Sunderrajan, Head-Strategy and Business Development, Siemens Healthcare How crucial is the role of medical technology in today’s healthcare?

The role of medical technology is very crucial today. Technology in healthcare diagnostics has evolved over the years.

The three core aspects of quality, speed and accessibility have helped improve the healthcare scenario tremendously in India. More over, technology and features from high-end systems trickle down to entry level equipment, which significantly impacts the quality and diagnostic confidence at the base level of healthcare. Also it is well known fact that any disease detected at an early stage is both easier to cure and much less expensive. The focal areas of medical technology are early detection, high quality and consistency leading to diagnostic confidence and all this at an affordable cost.

Do you agree that the rise of dependency on medical technology in several aspects of healthcare has raised the cost of healthcare? If yes, how to rectify the situation?

In fact it’s the other way round. Medical technology has improved the quality of life, as it enables diagnosis at an earlier stage, which further helps in timely planning of treatment. Because the diagnosis is made at an early stage, it also makes treatment affordable. More-

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We want to improve access to high-end technology by further extending our portfolio of systems in the middle price segment, developing next-generation IT solutions that increase efficiency, and expanding our regional presence in fast-growing emerging markets like India.

What is the unique medical technology product/solution you have devised?

j sUNDERRAJAN

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special focus

CRITICAL CRITICALCARE CARE

Critical Care Evidence Based Emergency Care Critical Care in India is a booming specialty, especially in tertiary care hospital.

With new technologies being introduced, the field is promising new dimensions and opportunities to help the patients

By Ekta Srivastava, ENN

R

am Ashish, 22 years, male, suffering from Hypoxic Ischemic Encephalopathy (HIE), a condition that occurs when the entire brain is deprived of an adequate oxygen supply but the deprivation isn’t total. ‘’He was unresponsive, BP was not recordable, there was no pulse and Cardiac monitor showed Ventricular Tachycardia (irregular heart activity in which heart cannot pump the blood). Immediately we incubated him, gave ventilator support, DC shocks were started. Then his Cardiac rhythm reverted to normal and all other drug supports started’, says Doctor, Emergency, who saw him first.

While fixing the fault he climbed to the pole and accidently touched a high-tensioned wire. His co-workers

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immediately rushed him to the private hospital in Gurgaon.

After his heart rhythm comes into normal condition he was shifted to Coronary Care Unit (CCU).Gradually all the drugs support and ventilator support under the supervision of cardio team, critical care team and neuron team was wined off and he was shifted to High Dependency Unit (HDU), which is a step down to ICU with a plan of discharge. This is the miracle of the Critical Care and its experts, which can bring the hopes back to people who are about to lose their loved ones.

Critical Care offers intensive care towards patients who are very sick.

Life threatening illness which requires intensive monitoring that cannot be provided in general wards and

yet to be monitored continuously are put under ICU. There are specific types of CCUs that cater to a particular category of patients, for e.g., CCUs that admit patients suffering from a heart attack, cardio-thoracic or neurosurgical, ICU that admit cardiac or neurosurgical patients, burns ICU that admit patients with burns, neo-natal ICU that admits newborns, PICU or pediatric ICU that admits children with critical illness etc. This is a generic term applied to a specialised area/unit of a hospital (usually a tertiary care hospital) equipped and staffed to provide life- sustaining therapy to critically ill patients with reversible pathology. So, Critical Care is basically Intensive Care which is done by a team of doctors and other supporting staffs.

Technologies Equipments like monitors, intravenous (IV) tubes, feeding tubes, catheters, breathing machines, and other equipment are common in critical care units.

While speaking about the Indian scenario Dr Abhay Patwari, Farwaniya Hospital, says that,’’ most of the equip-

ment is imported. Some small companies are coming up with manufacturing equipment. Most used machines like ventilation machines, dialysis machines, echo machines are to be imported from outside India. It will be really helpful if some companies come forward along with collaboration with

Excessive use of anti-biotics in Critical Care “If you want to use Penicillin, use it in right dose” Sir Alexander Fleming

A

nti-biotic, one millionth of a milli-meter in size, these invisible malevolent bacteria has challenged the whole medical and scientific fraternity against their development and progress about these miracle drugs. Experts believe that a hidden epidemic is upon us. According to them the reason they depict is doctors prescribing longer courses of antibiotics and the antibiotics becoming more expensive, which shows that anti-biotic resistance

(ABR) is rising.

For a long time there has been a talk of unjustified and excessive use of antibiotics in the critical care, when Dr Abhay Patwari, Farwaniya Hospital said,’’ Antibiotic resistance in the ICU is a huge problem and unwise use over the next few years will leave us vulnerable to infection by resistant organisms. A prudent antibiotic policy must be developed and therapy should be tailored to the narrowest spectrum possible. Lot of emphasis and training must go to pre-

some big hospitals. We are ready to accept them if the quality is good.’’

However, when there are almost every International standard facilities are being given in tertiary care hospitals most of the community based and secondary hospitals are lacking from the forefront. vent infection rather than treat it. The assistance of a clinical microbiologist is a must to guide antibiotic therapy.

Now , here are not just today’s experts who are giving caution about the excessive and unjustified use of antibiotic but the smart guy of evolution Alexander Fleming also cautioned on the day he received the Nobel Prize for discovering penicillin in 1945 that antibiotics would lead to a bacterial backlash.

From where drugs become bugs Unfortunately, antibiotics in India are Over the Counter drugs (OTC) drugs and most of the higher antibiotics are available without the prescription.

That is the reason the use are more in clinics and smaller hospitals and by the patients who get the names of the antibiotics from the Google and then shall procure it from the chemist shop.

In most of the hospitals Critical Care heads believes that most of the time when patients come to the tertiary care centre they were already loaded with higher antibiotics. As Dr Omender Singh, Max Healthcare said,’’ Most of the time when patients arrive in the hospital they already have all the antibiotics because they are easily accessible, you go to any chemist they will give you that and then we can’t try the same antibiotics because the bugs get resistance.

That is when they landed up with the resistance bugs in the hospitals then we have to use higher antibiotics.

On similar situation further adds Dr Yatin Mehta, Medanta, The Medicity, “Now these higher antibiotics , they can cause up to ` 10,000 for one

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special focus

CRITICAL CARE

Alarming Sanpshots 50 per cent antibiotics are overused and

misused by physicians and patients globally

70 per cent ICU patients surveyed in India carry

bacteria immune to multiple antibiotics

30 per cent infants die in India each year from

germs that do not respond to antibiotics

95 per cent rise in pneumonia, blood and wound

infections in last 10 years in India; can’t be cured by last –resort drugs day therapy, and say if you are giving it for 10 days then the bill cost will be like `100,000 plus your antibiotics organism are also growing up’’.

The million dollar question here is from where are they getting to becomes anti-biotic resistance ( ABR) and so said Dr Mehta, Chairman Critical Care ‘ Every homeopathic doctor is prescribing the antibiotics, chemist are giving that .Why should be they allowed to do so? He is not a doctor. So, its start from there. Then the General Practitioner (GP) they do the same and then there are doctors in the tertiary care also who are mis-handling the antibiotics’’

Indian doctor’s casual way In a survey made by WHO in 2005 reports that antibiotic consumption in India has gone up to seven percent annually, while reports also reveals that 53 per cent of Delhiites selfprescribe antibiotics; one in four skips the course once they feel better; and 18 per cent physicians prescribe antibiotics for common cold. Also, very powerful drugs, meant for hospital use, were being routinely dispensed, even for common infections.

Even the scenario dose not ends

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here as experts said Indian doctors are very much casual about using antibiotics even in children, say if a patient is doing well then they don’t want to change the medicine and let it to be continued. Now we are seeing multi-drug resistance organism which were initially only in hospital environment are now present in the community.

While it is believed that doctors must be aware of the havoc caused by these anti-biotic the first question that arise is why still they are prescribing them in such a huge manner, as Dr Mehta Says, ’’In the bigger sectors, yes they knew but in other pe-

According to Center for Disease Dynamics, Economics & Policy (CDDEP), One million infants die in the first four weeks of life every year in India. Over 190,000 deaths occur due to bacteria in the blood. And 30 per cent of babies die of ABR

ripheries they are not aware of this.

So we need to penetrate the peripheries more with the knowledge, hazards of misuse of antibiotics and we have to tell them to avoid it’’

Government’s Plan of action Recently, Health and Family welfare Minister Ghulam Nabi Azad during the Budget session of Parliament faced the fierce questioning on the rising tide of ABR and an urgent question hang over the future: What if antibiotics do not work anymore? Even the WHO during the 2013 World Economic Forum (WEF) in Davos, where WEF consider this as the one of the chief threats to human health for which the world is mostly unprepared to cope with.

Off course Government is talking about it but they should put some restriction as who should prescribe it or only hospital doctors can prescribe such higher antibiotics instead of local GP MCI and IMA, they should play more active role said, Dr Mehta.

Same way Dr Singh, believes that government is taking a step forward like most of the antibiotics and some of the drugs need doctor’s prescription actually while he insist on the fact that all the antibiotic should required a prescription from the physician .

India needs an antibiotic policy and a national registry, inclusion of ABR in medical courses, monitoring of pharmacies so that antibiotics cannot be sold without prescription and ensuring infection-control protocols in hospitals. We are in a dangerous zone where life can end in any unexpected way, ‘there is no antibiotic in the pipeline in the next 10 years. So we are finished if we don’t deal with this at this level. Stop the misuse of antibiotics’ said Dr Mehta.

End note In order to understand more about Critical Care we talk to heads of Critical Care divisions of major hospital.

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special focus CRITICAL CRITICALCARE CARE

New Technologies

Boost Critical Care

A National Coordinator for Dr Rosenthal’s, ‘International Nosocomial Infection Control Consortium’ (INICC), Dr Yatin Mehta, Chairman, Institute of Critical Care & Anesthesiology, Medanta, The Medicity, talks to Ekta Srivastava, about various aspects of Critical Care in India How the modern day hospitals are serving critical care to patients? What do you think of nursing homes which say they have all the facilities?

Critical Care is something where lot of revenue is involved; it is a very expensive settlement. If the patient is sick then there is lot of devices and experts being used in the care of patients. Now these small nursing homes they called themselves specialise in Critical Care with the set-up of few beds and ventilator and they think they are in business. That’s where things go wrong because they know that they could not handle the serious patients well and other than making them better they sometime end up giving them infections and making them sicker. And then they try to move them in tertiary care or bet-

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ter intensive care for better facilities by the time the patient’s conditions become more deteriorated. So the problem in India is that we don’t have quality care. There is no certification unless you really have a Journal of Clinical Investigation (JCI) or National Accreditation Board for Hospitals and Healthcare (NABH) accreditation which many of these set-ups don’t have. I think Medical Council should get tougher plus we need to improve the facilities through education and improve the level of doctors.

much of money is being spent on the equipment itself which is as equal to the cost of it. In order to improve the quality China is one who is doing it reasonably successfully, so if they can do it then what is the reason that we cannot do it .We are just stuck in pharmaceutical industries; we need to move in hardware’s also like monitory equipments, ventilators. We should start it but don’t expect much at the base.

Most of the equipment’s used are imported and very expensive. What’s your intake?

One of the major challenge that tertiary care hospitals like us faces is that patients come very late, and when they reach us they already been loaded with all antibiotic, have multi drug resistant organism, they are already very sick with multi-organ dysfunctions. Second

Yes most of the hardware’s are imported. Some companies have tried manufacturing but the quality has been not so good and that’s a pity because so

What are the challenges, that hospital are facing in delivering critical care in India?

problem is the cost, Intensive Care is very expensive because antibiotics and anti fungus are very costly. The average cost of the tertiary care hospital is around `40,000 to `50,000 per day. Now how the people will afford it unless the insurance goes up, like a middle class family cannot afford that, they sell their homes and property, that’s all they are doing that. Obviously the private hospitals are not running the charity, even if you try to help them by reducing your professional fees but the cost of the stuff which is being used in the patients and salaries of the staff have to come out. We have one to one nursing in our ICU’s; centralised AC; the filters to reduce the infections all that cost. I think government or semigovernment or private agencies should work towards this otherwise it will be very difficult to bear the cost.

How the community and district hospitals can take advantage of offering critical care?

They should resuscitate the patients may be incubate the patients if necessary then shift them either to private tertiary care hospital or to government university hospitals with better facilities. They should have mobile vans to shift the patients safely with the latest equipments and experts .

What are the latest technologies and devices available in critical care?

There are more sophisticated and efficient ventilators which can pump oxygen up to the rate of 200 per minute in patients with adult Acute Respiratory Distress Syndrome (ARDS), while we breathe at the rate of 12-15 per minute.

Then there is an Extracorporeal Membrane Oxygenation (ECMO), which is not used too much in India but it is increasing. Now we have ECMO conferences in which you do function of the heart and lung outside. This has been shown to improve the mortality. Dialysis technique has been improved now

Illness that requires critical care Any illness that threatens life requires Critical Care. Poisoning, surgical problems, and premature birth are a few causes of critical illness. Critical illness includes: Multiple organ failure, Kidney failure, serious injury etc.

Illness that affects the heart and all of the vessels • Myocardial infarction (heart attack) • Shock • Arrhythmia • Congestive heart failure Illness that affects the lungs and the muscles • Respiratory failure • Pneumonia • Pulmonary embolus Illness that affects the brain and the spinal cord and nerves • Stroke • Encephalopathy Infection caused by a virus, bacteria, or fungus • Sepsis • Ventilator-associated pneumonia • Catheter-related infection • Drug-resistant infection you can continue the dialysis even if the patient’s blood pressure is low. Then the patients whose brain has been affected because his heart is stopped, we cool these patients to improve the survival of the brain to reduce the oxygen consumption of the heart. Then transfusion inde-

cision has been improved, to treat the infections newer antibiotics are available , then there are many therapies like Early Goal Directed Therapy (EGDT), if patient comes with severe infection within six hours you start there group read therapy their survival is much better ,which is also improving in India.

What are the critical care facilities you have in your hospital?

Well, we have everything whatever is possible in any good set-up in the world with more than 200 beds making it largest in Asia excluding China. We have top end monitors, ventilators, one to one nursing, and our infections rates are quite low comparable to the best centre in the world. We have rooms with the positive pressure with which all the bacteria can go out and for infective patients we have negative pressure rooms to allow air to flow into the isolation room but not escape from the room, where the bacteria doesn’t infect other people. We are very good at air transporting the sick patients. We can transfer patients on ventilators with intra aortic balloon pump from all over India and neighboring countries.

We have highly advanced air rescue in the country to bring the patients in our own ICU’s where we can take better care of them. We have the Bed side CT machines, which means now you don’t have to move the patients from one place to another with heavy life support systems, now we need to move the machine because it becomes so compact and this is the only set-up in India which have Bed-sided CT scan machines.

What is your opinion about Critical care in India?

Critical Care is a vastly and rapidly growing specialty. So, I will say that the future is bright. We just need to do ethical practices; trained the doctors and practice good medicine, and then everyone will be happy including the patients.

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Leaders’ Speak special focus

‘Critical care is growing leaps and bounds’

Dr Omender Singh, MD, FCCM, Head - Department of Critical Care Medicine, played a central role in designing and developing the institutional Intensive Care Units and setting up the critical care medicine department in Max Healthcare since the hospital’s inception. He talks to Ekta Srivastava, ENN, about the role and goal of Critical Care in India What are the challenges that the hospitals face in delivering critical care treatment in India?

DR OMENDER SINGH

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Critical Care today is the requirement of the day. In India the basic problem with the Critical Care is inadequate number of beds. We have more sick patients and less number of beds. Second problem we are facing is now from the human resources. As Intensive Care Units (ICU) are manned by critical care physicians and they are trained specifically to treat critically ill patients. The programmes which are running in critical care in India have just begun in the last few years only. So, critical care infact is a new specialty which is evolving and we have huge demand of these kinds of services.

Other then this we are lacking good intra-hospital transport. For example the patients who have some trauma or illness, we do not have facilities like West that even if the patient get sick anywhere in the country, he will get treatment right there.

We as the critical care physicians are ready to transport such kind of patients but the challenge is we don’t have dedicated aircraft.

There is no dedicated space to land such aircrafts in most of the areas. At last I think we need more training centers like Max Healthcare that can produce more certified and trained critical care doctors to take care of

critical ill patients. Likely we also need trained doctors in tier II cities and peripheral hospitals. I think India should have more training centers. Unfortunately there is no government hospital which is running any critical care training programme.

How do you think technology helps in delivering Critical Care to patients?

Technology helps in improving the quality care especially during hospital stay. With the help of good monitoring devices you can optimise a critically ill patient and improve the patient’s condition in lesser period of time. Also with computerised prescriptions, drug errors become less. So in nutshell, hospital related complications and healthcare associate events become less.

Kindly tell us about Healthcare Associate Event?

This is a term previously used for hospitals acquired infection. It feels like hospital is a place to acquire all the infections.

But the kind of intervention mistakes, kind of devices being used, they may create infection, if not handled properly.

However, previous terms looks like once you entered the hospital you will get infection. That’s why Center for Disease Control (CDC) and Infection, National Association for Healthcare Quality has termed it Healthcare Associate Events.

What is the sphere of interest or inclination of going to be doctors? Do they have inclination towards CCU? Critical Care is a super specialty, so whether you are from medicine, physician anesthesia or emergency you need to undergo the training for two to three years to become the Critical Care specialist. It’s not easy to enter the critical care and of course it requires a lot of hard work, it is a very skilled job and a very challenging profile too.

Not many people prefer this specialty.

Associated hazards include prolonged

“Critical Care is a very skilled and challenging job; it is not a favourite profile for everyone.

Critical Care doctors have to be in stress all the time” stay in ICUs; always have to take care of the critically ill patients. But now the interest is growing, because hospital also realise that we need trained critical care experts to save patients and they are putting their best effort.

For instance, Max Healthcare has started training programmes, we have lots of fellowship programmes too that are accredited by the National Board of Examination. We have started our own Critical Care Fellowship and we are accredited by most of the society fellowships. We are also running our own training centers.

What are your plans to expand CCU in tier II and tier III cities?

Max Healthcare has already set up hospitals in tier II cities like Dehradun, Mohali, Bhatinda and we are also transferring some doctors and are ensuring that those critical cares should be manned by certified and trained doctors.

What are the latest technologies and devices that are being used in CCUs? We have almost everything which is available in US or in any third world country. Our ICUs are very well established in terms of infrastructure. And every new technology or say procedure which can make outcomes better we have in Max. This time we are preparing hypothermia devices. You must have heard about the people who get caught up in cold but after two days they are still alive that means in very low temperature body’s metabolism goes down and you may survive even longer though you may go in coma.

Some patients who get cardiac arrest

in hospitals following a procedure we bring them under extremely cold conditions for which we have specific devices, we put them under those machines and knock down the temperature from 32 to 34 degree for 24 hours and make patient to revive back. The unique thing about hypothermia device is that we can have a targeted cooling.

According to you, what is the present and future scenario of the Critical Care?

Critical Care is a field which is going to grow leaps and bounds in coming years.

With the existing healthcare, now we have more aging population who survive beyond the age of 60-70. India is the world capital of Diabetes. We have now more cancer patients and these kinds of patients at some point of time need Critical Care services. If you really want to deliver these high-end services then you need to focus more on Critical Care otherwise you may not succeed in giving quality care or good outcome.

What makes MAX different from others?

Max is a leading center for providing state of the art Critical Care Services in India and Asia. We have more than 150 ICU beds at Max Saket New Delhi with round the clock in-house Board Certified Critical Care Specialist. We also have keen interest in clinical research and contribute to about 25 to 30 percent publications in the field of Critical Care Medicine in India. We believe in providing care with Compassion, Comfort, Communication, Consideration, and Consistency with human touch.

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special specialfocus focus CRITICAL CRITICAL CARE CARE

Critical Care

An Amalgamation of Multiple Branches Specialised in Critical Care, Dr Rajib Paul, Senior Intensivist at Apollo Hospital; Hyderabad thinks that Critical Care is the backbone of medical and surgical treatment. Whilst in an interaction with Shreya Mukherjee he talks about other challenges and future prospects of technology in Critical Care What are the challenges that the hospitals face in delivering Critical Care treatment in India?

The most important challenge is the shortage of staffs. There are not too many experienced or trained critical care specialists in India. The courses have started very recently that is only for last five years in India. There are very few recognised courses in India.

Now-a-days every big hospital has ICUs and especially multi-specialty hospitals. In some hospitals, 25 percent of the beds are ICU beds that mean a huge number of intensive care doctors are required. Thus, man power is a major problem. Good trained nurses for CCUs are not there. General Nurses cannot work in CCUs Infrastructure is based on the money part of it.

What are the latest technologies and devices that are being used in CCUs?

Dr Rajib Paul

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Almost all CCUs whether small or big will have some basic instruments like bed side monitors, which monitors patient’s heart rates blood pressure, oxygen saturation in the valves plus some other monitors to monitors of special pressures what we call Invasive pressures for both blood and heart.

Along with that, mostly good ICUs will have ventilators and dedicated dialysis machines, ultra sound machines,

dedicated X-ray machines. Advanced ventilators are also available in most of the tertiary care ICUs.

According to you, what is the present and future scenario of Critical Care?

First of all Critical Care is an evolving branch. It is an amalgamation of multiple branches in a sense that one doctor may have to do a work of cardiologist at one time and work of a nephrologists at other, even same time like a physicians. So, the doctors may have to do multi-focal roles because the patient is in ICU and the doctor cannot call other doctors every time to diagnose the patient. Future of critical care what I see is the nodal point of hospitals. Most hospitals of these days are building in two things.

That is preventive healthcare Which is not only for good quality but also for volume and number generation for us. More preventive health checks ultimately leads to a broader base for hospitals. At the same time hospital with a backbone of a very good and strong CCU gets trust of the patients around the corner. It increases the reliability quotient among the patients.

What is the sphere of interest or inclination of going to be doctors? Do they have inclination towards CCU? Whole concept of Critical Care is developed around metro cities and urban cities. In that sense Critical Care is a comprehensive approach. Making a room with ventilators and monitors is not critical care that is only called Intensive Care Monitoring bed. Critical Care Unit requires trained intensivists along with junior intensivist, trained critical care nurses, physiotherapists, respiratory therapists, IT professionals who looks after Critical Care patients particularly.

Then it requires in-house pharmacists to take care. So, in such scenario we want more trained doctors to come

up. The new generation is not taking up critical care because it is a very labour intensive work. You have to have a very challenging mind. You have to be with the patient continuously both mentally and physically. It is a very dynamic field. The patient who is stable in the morning can start sinking at night. If someone is at home in night

Pradesh, at first only Hyderabad had CCU but now Vizag, Vijayawada have also started forming Critical Care Societies which ultimately is governed by the central society but they also have unit societies or city societies. All these societies are making Critical Care more comprehensive. People come to know about it, more interactions

“My personal opinion is technology is always subservient to human mind. Critical Care instruments help you in better management but ultimately the decision has to be taken by the intensivist� the doctor should have the full grasp of the patient when he gets call from doctors at night. You have to have a strong love for the field in order to sustain.

Second is the burn-out factor which is pretty high. A recent study shows that burn-out factors among intensivists are the highest because of continuous physical and mental fatigue. Doctors burn-out within 5-10 years of medical care. They start moving out as private practitioners. At present the remuneration in India are not so good. All these factors together draw back people from critical care approach. Only anesthetists are the ones who prefer to go to the critical care department mainly because usually they work in OT from there they shift to CCU. However, if remuneration increases in India over coming years then some doctors would take up critical care and will find a job or career out of it.

What are your plans to expand CCU in tier II and tier III cities?

Critical Care medicines are doing very good in India. In small cities they are forming Critical Care Societies in small towns. All top in cities in India have CCU. They have regular meetings, presentations and interactions with city doctors. If you take example of Andhra

happen and slowly critical care evolves in those areas.

How do you think technology helps in delivering Critical Care to patients? them. We all look for new gadgets and instruments and every day new technology and instruments are coming but the person who is taking charge of those gadgets are far more important than the gadgets and instruments. The hospitals should give more importance to the intensivists and second importance to the gadgets.

What CCU facilities are available in your hospital?

We have Intensive Care Monitoring.

Presently our system works on structured units. We have different medical care units like surgical Intensive Care Unit, Cardiac Intensive Care Unit, cardio-classic Intensive Care Unit, Pediatric Intensive Care Unit and Urinary Intensive Care Unit. All different specialties’ have their own Critical Care Unit and each is manned by a Critical Care specialist. This is the structure which we are running at present in future we may start developing units with different types of patients in one unit.

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special focus

CRITICAL CARE

Microprocessor Technology

Advancing Critical Care Vice-President of Indian Doctor’s Forum (IDF) and an Anesthesiologist, Dr Abhay Patwari, Farwaniya Hospital, Kuwait, shares his experience and knowledge of specialisation that is often overlooked by patients in Critical Care How are modern hospitals providing Critical Care to patients?

Critical Care in India. What is the present and future of critical care in India?

A proper well-planned and designed CCU with adequate well-trained staff and equipment has to be established and commissioned. The establishment of a CCU is very capital intensive and requires large amount of fund. A CCU is not a primary admitting department but one that provides service. Some CCUs have an open-door policy where in the primary physician/surgeon continues to follow his patient in the ICU. Some CCUs have a closed door policy where in the CCU takes over complete management of the case until the patient is ready for discharge.

The number of Critical Care beds is not sufficient to cater to the demand.

It is possible that some lives are lost for non-availability of care. The lack of trained manpower is another constraint. Lack of funds for establishment and then maintenance of CCU is a severe impediment. CCU care is very expensive and patients cannot afford it unless there is universal medical insurance. With liberalisation of economic policy and recognition of hospitals as industry and the entry of corporate in medical care – the quality and availability of CCU services is vastly improved. However, the rural areas suffer badly due to lack of facilities and bad connectivity.

What are the latest devices and technologies available for the CCUs? With advances in microprocessor technology, a plethora of equipment is now available to perform life-supporting function as well as monitoring of vital parameters and there is no end in sight as far as innovation is concerned. Every year more sophisticated and expensive equipment is introduced.

How community and district hospitals can take advantage of Critical Care?

To establish a CCU at every community and district hospital is an impossible proposition. They must have basic resuscitation capabilities and

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Dr Abhay Patwari

Government should introduce licensing and inspection by a committee to assure that all life saving equipment and medication is available and functioning in the hospital. It should take cognizance of any irregularity or malpractice if reported tie-ups with a regional tertiary referral hospital and efficient transport system. They could stabilise the patient at their end and then transfer them to a step-up CCU at a larger hospital or a tertiary care hospital.

They could be equipped with some simple ventilators and monitors to tide over the crisis.

What are the challenges faced by the hospitals in delivering

What are the Critical Care facilities you have in your hospital?

In Kuwait, the CCUs are under the Department of Anesthesia. We have 35 beds in the CCU which is the largest in the country. Both the ICUs are well equipped and staffed. On an average, we have about 50 admissions per month and the mortality rate is about 15-20 percent which is at par with international standards. ICU care is free and therefore sometimes misused for prolonging life in terminal cases.

An organ harvest and transplant programme is active and cadaver donors are used.

special focus

CRITICAL CARE

Indian Society of Critical Care Medicine Bridge Gap

W

ith its growing need and coming up as a super specialty, all is not good in medical paradise as with the growing demand there has a huge shortage of trained and dedicated human resources in critical care. The main work force in the Cardiac Care Units and Intensive Care Units are majorly MBBS doctors, who are physicians, anesthesia or from emergency. As critical care being a specialty in itself has to train these doctors according to the work pressure and procedure of the critical cis that too during their work in critical care.

Recently to bridge the gap between the hospital and the specialist in critical care, Indian Society of Critical Care Medicine (ISCCM) has come up with the Post MBBS course, fellowship courses and certificate courses.

Even major hospitals like Max, Apollo, Fortis, Medanta and many more too had started running their in-campus courses recognised by National Board of Examination and ISCCM. Whilst experts think that though they don’t become the critical care specialties but they do get adequate training in critical care. The main reason which most of the critical care experts are thinking about not so many students taking it as a specialty is low remuneration and ICU stress.

In order to make critical care to reach to the community hospitals experts says that government should design courses which should not be as extensive as required for tertiary care centers but they should focus, like IGNOU is planning to have one and two year post MBBS critical care diploma particularly in the second-

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Future challenges for Critical Care Corporatisation, government passing the buck to private sector, poorly trained professionals because of booming education sale in medical field , high cost of medicine and equipment, brain drain, high turnover, new diseases epidemics, antibiotic resistance Nosocomial infections, crisis of confidence between public and profession are the major challenges in the development of the Critical Care ary care and community care health centers. So that kind of approach can help in getting critical care in the primary and secondary care level.

So that these doctors should spend some time in tertiary care hospitals for hands on training and for theories can be provided by other recognised societies.

Excerpts from some of the leading medical professionals.

Dr Narendra Rungta,’’ Courses in critical care that are being run

by ISCCM has already has made a difference to the Indian Patients and Hospitals .Almost 80 percent meaningful ICUS in our country are manned by doctors trained in various courses run/sponsored by ISCCM during last 15 years . We (ISCCM) are the focus in the world of critical care medicine in the World.’’

Dr Omender Singh, “These courses have been started by National Board of Examination (NABH) and ISCCM. After these courses now we don’t have to trained doctors in ICU’s in the future. Because if you want to provide quality care treatment to the more critically ill patients then you need to have more certified doctors

in critical care round the clock, 24*7, 365 days especially in secondary and primary health care services.’’

Dr Abhay Patwari, “Very few structured courses for critical care are available in India right now. Certificate course in critical care medicine is one of the largest courses in the country. In Diploma or fellowship in critical care the number of students is less than as compared to Indian Society course. At present, that is the only way to get trained people in ICU. In the long run, we are looking forward to more structured courses to come up in which the doctors will be specially trained for critical care. The course presently is of one year course on Anesthesia technology but we require more structured course to get specially trained doctors for CCU’’.

Dr Yatin Mehta,’’Each specialty goes through these stages until a time comes when it is recognised as a fullfledged specialty in its own right with its own science, structured training programs and certification. Certificate provided by the ISCCM will definitely help in securing a job in preference to a person with ICU experience but no certification’’.

ISCCM, Focus in the World of Critical Care President of ISCCM, Dr Narendra Rungta, belives that ISCCM will give a big boost to Critical Care in India and strengthen the human resource need of Critical Care Medicine in our country in coming years. In conversation with Ekta Srivastava, ENN Critical care involves a lot of technology and therefore is dependent on finances. So do you think there are limitations to the growth of this branch in community hospitals?

Absolutely not! The growth potential is unlimited, finances will have to be raised either by the government or corporate or the community itself because Critical Sickness ultimately is the disease where patients will have to go to ICU and depend on evidenced based modern day medicine. We are running training courses for MBBS doctors, Nurses and will also collaborate with other likeminded organisations and universities to create more work forces in country to assist community and district hospitals.

As elected s the President of ISCCM, what new changes and development are you trying to bring?

Decentralisation of administrative process of ISCCM, starting courses and programs which will help the semi urban and rural population of the country, taking Critical Care to places.

We have declared war against Tropical Fever Syndrome (Malaria, Dengue, Scrub Typhus, Leptospira etc); we are also trying to take Asian, SAARC and Asia Pacific societies of Critical Care Medicine together. Our focus area will be rural parts of India and areas like Andaman, North East, Chhattisgarh, Rural Rajasthan, Haryana, and Bihar,

that the end consumer can benefit?

This is a million dollar question which government and industry has to address. Government should promote research in low cost equipment, remove duties, and subsidies such treatment facility creation. Industry should depend more on volume than huge margins. ISCCM job is to train HR, create standardised guidelines and promote research.

What are the challenges that hospitals face in delivering critical care in India?

Jammu and Kashmir where there is very little critical care. We have for the first time started critical care course for nurses. As of this year ‘War against Tropical Fever’ will be the theme of ISCCM which is celebrated on 9th of October of 2013.

What are the new researches undergoing in ISCCM? On collection of India Intensive Care unit (ICU) seen status, Tropical fever syndrome, are already on. New guidelines on antibiotics, sedation are being constructed. The new thrust is on research in India, of India and for India in the field of Critical Care Medicine.

How the hospitals can get costeffective medical devices so

Cost, compensation, security to doctors and nurses, massive load during post monsoon, staff shortages, and very poor state security despite laws are the major concerns and challenges. Politicians are happy to be taking populist approach and corporate invasion of medical services.

Nursing homes, booming now days but somewhere they will not be able to give all the facilities. Do you think law should be formed against this?

Its government duty to regulate standard facilities. At the same time regulations should be constructed by professionals at the professional platforms and not in board rooms of corporate to make it difficult for doctors running smaller nursing homes in semi-urban and rural areas who are giving bulk of 90 percent services to population.

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xxxx expert speak

‘India is ready for healthcare cloud services’ Elaborates Sid Nair, Vice President and Global General Manager, Healthcare & Life Sciences, Dell Services, In conversation with eHealth team What are the trends in the healthcare industry pertaining to the use of IT? Last year the government decided to increase the public spending on healthcare from 1.4 to 2.5 percent of GDP over five years which is good yet very low.

Globally, the US economy has spent upwards of 16 percent of GDP, and we see similar trend with all the other economies as well. Most other developed world countries spend close to 10 percent of their GDP on healthcare.

The second data trend is the global IT spend in healthcare which is close to 50 billion US Dollar. Of this, about USD$1 billion comes from India as per Gartner.

Indian healthcare market will grow at upwards of 17 percent year-on-year and will scale up from USD 53 billion or so in 2011 to about USD 80 billion+ in 2013. But again, the growth will come primarily from basic services itself. US market is over USD 2.3 Trillion in comparison and we are seeing lots of innovation. India spend is growing quite faster when compared to global services growth of about five percent and

sid nair

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India has potential to grow at 20-30 percent given the scope for penetration. So from a trend perspective, India should invest in getting basic IT systems in place. The market size that we have estimated in India, primarily of providers and physicians, include 45,000 hospitals of which 26,000 are private hospitals in urban areas. And if we consider the segments with respect to the number of beds, there are about 1,000 hospitals with more than 100 beds and these are our target audience as they generate almost 80 percent of the market. It’s a very disperse and fragmented market with IT focus mostly on non-clinical processes and data points. This is contrary to the global perspective where the attention is more on clinical systems like EMR, EHR and others.

How is Dell taking part in this healthcare opportunity in India?

India is a big market for us, and of the 14,000 employees worldwide just on the services side, we have 7,000 employees based here. So from that perspective, we will continue to have our presence and we will continue to source talent and capabilities in the country. Even Philippines is a big market from which we are supporting customers globally. We want to leverage on the capability that we have already built in India and prospect new opportunities. So one, we are looking at more hiring in India to support our global customers. When we look at the offshore mix in different industries, traditionally offshoring in healthcare industry is very low because of regulation

“In India, we will be introducing our solutions on cloud-based platforms.We’ll offer a host of applications including an HIS system, ERP and an EMR application on cloud” and compliance in the US, however that is changing slowly. Now that we have adequate capability built in India, resources who understand the healthcare system, we want to begin the business with Indian customer base as well. In India, we will be introducing our solutions on cloud-based platforms. We’ll offer a host of applications including an HIS system, ERP and an EMR application on cloud. HIS on cloud will cater to non-clinical needs, while ERP on the cloud will address finance and HR requirements. An EMR application will cater to the core clinical requirements. So, it will be a stack of all the three together covering most of a hospital’s requirements. This will be a subscription based system based on pay per use, thus converting big one time investment into smaller operational expenses.

Tell us more on your cloud based services offered in healthcare?

Our healthcare cloud business is a very profitable business in the US and we understand the technology very well.

There are 70 hospitals that run on our cloud in US. Apart from that we also have a large physician network that is operating on cloud which we host and is primarily aimed at outpatient popu-

Dell Unified Clinical Archive (UCA) The Dell UCA integrates with leading PACS systems. This customised solution has three components. First, the Clinical Data Management layer aggregates patient data from all PACS, HIS and specialized imaging applications. It offers a choice of multiple VNA software partners to best meet your requirements and needs. The Clinical Archival layer features on-premise (with the DX Object Storage Platform) and cloud deployment picture archive options that can be used independently or as a hybrid, ensuring disaster recovery and instant scalability. Finally, the Clinical Collaboration Portal allows easy access, secure sharing and integration of clinical data across a variety of platforms in a patientcentric repository. This facilitates both image integration in Electronic Medical Records and image sharing through a Health Information Exchange.

lation. EPIC is also a popular EMR that we host for community hospitals and we also offer DR services on the cloud.

We also have our imaging archiving business on the cloud and have over 6 Billion images on the cloud. That is a major part of our business and we have launched it in Europe as well. We can bring it to India at an appropriate time.

We understand data privacy and security and are compliant to all the needful guidelines for the same.

What kind of response are you expecting from the Indian market on your solutions?

I hope it will be an encouraging response because there are price points that we are going to come at to make it affordable and that is why we are going the cloud way. We are hopeful that, with the IT readiness already there in many of the hospitals in India, it should not be an issue. We are expecting the market to adopt HIS on cloud solution and then progress to ERP adoption.

Then, in a couple of years, when the market is ready, we can look at bringing EMR on the cloud. We understand the needs of the Indian market, so we strive to offer the products that they need and then scale as the market gets a little more mature.

What is your plan for the next five years?

We are going to launch a new solution with HIS and Cloud and aim to gain considerable share of the market in the next two years. This will be followed by the introduction of the EMR stack, followed by digital archive imaging service. We want to grow the cloud business and plan the way forward for introduction of new products ahead of the curve.

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tech trend zoom in

A Journey With a Mission ‘Our procedures are designed to accommodate a smooth process flow for application change request, performance finetuning, upgrading, bug fixing and other such requirements’ says Sadananda Reddy, Managing Director, Goldstar Healthcare Private Limited (GHPL)

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Our Strength • Proven credentials in providing complete package of Information Technology solutions and allied services • Over 2 decades of “Hands-on” exposure in healthcare industry • experience in implementation of HIS in India and Overseas • Domain expertise across various disciplines of healthcare industry • GHPL leverages this professional expertise to facilitate their ‘clients’ assessment and requirements of hospital IT and management solutions • A better understanding of the client’s needs for customisation since experienced hospital administrators are an integral part of the team • Have more than 200 person-years of IT experience in application development and IT infrastructure

Goldstar Healthcare Private Ltd (an ISO 9001:2008 certified, Microsoft & IBM Partner) Goldstar Healthcare Private Limited (GHPL) was founded by Sadananda Reddy - Managing Director, Gold Star Healthcare Private Limited (GHPL).

He is a postgraduate (Masters in Hospital Administration) from American International University of Management and Technology. He began his healthcare career journey with Apollo Hospitals Group as Assistant in Materials and rose to the stage of General Manager (Operations). This tells the loyalty, the tremendous effort he has put in to cross, challenging milestones in achieving the organisational goals was established in 2006 with a motive to provide healthcare and hospital management consulting and information system solutions. The blend of more than 100 years of healthcare and hospital experience made the company provides real-world solutions for every facet of healthcare organisations.

Whether organisation need to plan/ procure the equipment, improve operational performance, develop process and setup systems in place, enhance quality, implement a turnkey, assists in accreditation preparation, outsourcing solutions/guidance, biomedical engineering support and strategic plan for HIMS software solutions, our comprehensives approach ensures a seamless solution.

Our experience in multiple platforms and an unparalleled depth of expertise on the leading edge technologies is key differentiators. We help organisations to define and implement solution fast, efficiently and cost-effectively to gain the maximum benefit from technology and quickly realise a return on investment.

With the vast knowledge and experience in hospital industry, Goldstar Healthcare Private Limited has developed the HIMS solution on MS .Net platform to provide end-to-end features to hospital management.

We work with our customers to: • Define the solution architecture • Bid the solution • Validate solution against requirements • Deploying the solution across your organisation • Continuous support for the solution Goldstar Healthcare Private Limited’s HIMS provides comprehensive application that integrates various functions to enhance the operational efficiency, making it one of the most effective healthcare software developments. It is a web-based Hospital Information System (HIS) covering clinical, administrative and financial areas of a healthcare set-up. The modules are designed to help healthcare organisations reduce costs, streamline administrative processes, improve quality of care (clinically and administratively), and raise the standard of the hospital at par with the NABH accreditation.

Goldstar provides turnkey solutions exclusively into healthcare sector from specialty to tertiary sectors. The comprehensive healthcare solutions for every facet of your healthcare business plan with a focus on continuous review of technology absorptions, technical up gradations, accreditation standards across globe and provide financial solutions more feasible without compromising quality.

We also ensure optimal utilisation of facilities through innovative design and best utilisation of resources, networking various elements of healthcare delivery system and bringing in latest and feasible global technologies in line with the international players by customising the same to the local requirements.

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launch pad zoom in

Allengers Launches ‘Rollx DR’ Digital Mobile Radiography System

A

llengers has introduced RollX DR another new variant of their mobile DR system. This unique model was launched at IRIA 2013, Indore where it received a very encouraging response. The RollX DR has been specially designed to meet the demand of a cost effective mobile digital radiography system. With its unique fully integrated image acquisition system ( IntegraX ) the specialist can set the imaging factors and also review the image acquired then and there.

Salient features 15 KW generator ( MARS-15 ), 17” touch console, Integra X - Integrated image acquisition system, 14”x17” Flat Panel Detector (Wired / Wireless), LAN connectivity with DICOM printer, Operates on just 15 Amps/ 230 Volt standard wall socket, Full DICOM 3.0 connectivity, Windows based user friendly work flow.

Viroblock Launches New Face Mask

Viroblock SA, a Swiss start-up, presented new data at ICPIC 2013 in Geneva, showing that their face-mask containing proprietary novel cholesterol depletion technology traps and kills over 99.9995 percent of H1N1 flu viruses (swine flu), 99.999 percent of H5N1 flu viruses (avian flu) and 99.997 percent human corona viruses on pass through air. Aimed at helping protect people from these

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respiratory pathogens, the mask is up to one hundredtimes more effective than a similar mask without Viroblock technology. The company will now start direct sales in Switzerland and is looking for distributors in other countries.

“Aerobiology tests for face-masks simulate real life situations, in which the user is exposed to viruses coming in. The mask helps prevent transmission from and to the person wearing the mask.” commented Dr Thierry Pelet, CSO at Viroblock. “The stringent testing demonstrates the efficacy and speed at which the cholesterol depletion technology works”.

Aerobiology tests, carried out in high

security laboratories, create a mist of viruses on the outside of the mask, a pump is used to draw air and viruses through the mask, and finally testing for live virus occurs on the inside of the mask.

“We believe that our protective face-mask can help protect healthcare, agriculture and security workers effectively, with added advantages of comfort of wear and easy identification,” said Dr Jamie Paterson, CEO of Viroblock.

Viroblock SA is a CTI Certified Swiss start-up located in Geneva, Switzerland. Founded in 2006 and supported mainly by Swiss investors, the company is focused on developing a unique antiviral technology based on cholesterol depletion. Viroblock’s first product is an anti-viral face mask and other air filtration products are planned.

HAEMOSEIS 256

3D Vasculography

The Future of Cardiovascular Diagnosis, Management and Prognosis.

Haemoseis256 3-Dimensional Vasculography is a device which can generate a complete cardiovascular physiological profile of the patient. It measures systemic and myocardial blood flow along with pulmonary pathology and renal insufficiency. It is intended for use in cardiovascular screening and diagnosis.

3D Vasculography employs advanced patented technologies of Transarotic Signal Wave Modulation (TASWM) and Flow Turbulence Accelometry (FTA) to measure and record minute changes in the cardiovascular system every millionth of second and provides more than sixty vital cardiovascular physiological and functional variables, which directly aids the doctor in making decisions not only in cardiac care but also in other areas of medical practice.

Teaching and Training Medical Students

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des-sca2013/02

Applied Fields...

tech trends

RADIOLOGY

Imaging the Since the first X-ray machine installed in India in Lady Hardinge Hospital, New Delhi in 1918, Indian radiology has walked through many evolving phases. Tele-radiology, interventional radiology, neuro-radiology and the like were included in radiology with several technology upgradation

By Sharmila Das, ENN Radiology is the cornerstone of any hospital. An efficient radiology department increases patient satisfaction as a result of its ability to improve patient care. Radiology is now the key diagnostic tool for many diseases and has an important role in monitoring treatment and predicting outcome. The anatomical detail and sensitivity of these techniques is now of a high order and the use of imaging for ultra structural diagnostics, nanotechnology, functional and quantitative diagnostics and molecular medicine is steadily increasing. Over time, a well-run radiology department adds significant patient volumes, which, of course, favourably enhances the hospital’s bottom line regardless of whether the hospital is not-forprofit or for-profit. All these developments have necessitated the establishment of a well equipped, well qualified radiology department in every hospital.

According to a report published by Millennium Research Group (MRG), the Indian market for diagnostic imaging systems is currently witnessing a strong growth rate each year. In 2011, the diagnostic imaging market witnessed an average growth rate of nearly nine per cent. It also predicts that the market would reach almost USD 830 million by 2016.

Radiology equipment Earlier machines were single phase self rectified x-ray machines with air-cooled rectified valves with cones and cylinders. The tables were mechanically or manually operated with crude spot film devices, etc. One was lucky to get access to a 200 or 300 mA unit. In Delhi, upto 1952, Irwin Hospital and Lady Hardinge Medical college had the only well-equipped radiology departments while Safdarjung Hospital languished with only one 100 mA unit.

At present, there are scores of well-equiped departments in Government and public institutions and there are over a 100 private clinics. Similarly, all the metropolitan cities have scores of well-equipped centres.

It appears that there are about ten thousand 500 mA units in India today; 100-500 mA units are about 30,000 and less than 100 mA units may be about 20,000. The annual demand for conventional x-ray machines is in the vicinity of 1500 (though it appears that demand is going down). There are about 350 CT scanners all over the country with a demand of about 50 per annum. There are about 50 MRI scanners and the anticipated demand is 20 per year.

Source: Radiology Education Foundation

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Next Revolution

Dr Rakhee Gogoi HOD-Radiology & Imaging, Paras Hospitals Over the years I have seen a lot of changes. With latest MRI equipments we could now see good number of patients coming to us.

The radiology department of Paras is a comprehensive one that’s actually benefitting patients. Earlier we used to produce radiology reports in a day or two, now with coming of upgraded machines and technologies the turnaround time has reduced significantly. With such quality machines there have been wonderful changes for betterment. There are wonderful CT scan machines, the waiting time of the patients has also decreased, and diagnostic has improved. Moreover, with the significant development of medical technology and medical equipments we can now see how the cell is working inside the body. This is enormously helping the doctors and radiologist to perform their work better giving better care to patients.

Now everything being in cloud we can say that the Radiology is also seeing a huge scope working through cloud based software.

However in India still now web based solutions are doing very well. Although I feel now there is very less demarcation between cloud and web based solutions. In this regard, tele-radiology has been doing wonderful contribution to the growth of Indian radiology. With tele-radiology, a person can have the reports sitting at the comfort of a home and the radiologists too do not have to rush to hospitals to see the reports. For performing tele-radiology procedures we use different web based solutions and we are very happy with the present web based set up. Having said that, I know in days to come everything will be cloud based and we will be incorporating such solutions in matching our requirement. Paras is shortly coming up with two new set ups in Bihar and we will be connected and working through tele-radiology in Bihar. We have taken up all the advanced machines that have improved our workflow. We are now planning to upgrade our MRI machines. I feel this is the time when we need to play with the tide. With all the machines in place, we are doing all type of cases including the angiograms and all. There is no doubt of the benefit of using 3Tesla MRI machine reason being we are in the process of acquiring this soon.

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tech trends

RADIOLOGY

Better Radiology for Better Care

“Implementation of PACS systems for better reporting turnaround times/ archival of images, higher utilisation of IT in radiology have advanced the overall functioning of radiology in India’ says Eshwar Chandra, General Secretary, AP State Chapter of IRIA. In conversation with Sharmila Das, ENN As they say Radiology is the cornerstone of every hospital, how do you see the role of Radiology or Radiography in modern healthcare?

Radiology has become the cornerstone of diagnosis and management in the current era of evidence based medicine and specialised healthcare and there cannot be a hospital which does not have a well equipped radiology department. Radiological methods play a key role in both in diagnosis and management in emergency care, trauma, oncology, intensive care departments, to name a few. Interventional radiology will evolve to have a greater role in offering less invasive therapies as compared to the standard surgery.

Radiography will increasingly become digital and we may not see the current X ray film cassette based systems in the near future.

ESHWAR CHANDRA

In interventional radiology, there has been an increasing trend by the young radiologists to take up this specialty.

Advances in better hardware and devices have made these procedures safe and simpler to perform 44

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As a secretary of Indian Radiology & Imaging Association, how do you think the role of Indian Radiology & Imaging Association (IRIA) is? What are the core areas of radiology IRIA caters to?

IRIA is a non profitable organisation of qualified radiologists whose main role is to protect and preserve the interests of the members. IRIA caters to the young radiologists/post graduates need of education by conducting regu

lar monthly scientific programmes, annual continuing medical education programs (CME’s), guest lectures by visiting faculty etc. IRIA also assists governmental and nongovernmental organisations in matters pertaining to radiology in policymaking and implementation. IRIA is also active in the community in organising health camps and disseminating radiology information to both clinicians and lay public.

“Implementation of PACS systems for better reporting turnaround times/archival of images, higher utilisation of IT in radiology including paperless/filmless departments, speech recognition systems for report generation, increasing use of handheld devices to view and report radiology images in the emergency setting are some advances”

In today’s era, there have been a lot of technology advancements happening in Radiology like 4D imaging and 3 Tesla MRI. How well equipped Indian hospitals are in embracing these technologies?

the emergency setting. Teleradiology has been a major boon for providing radiology services to smaller centres in rural and underserved areas. Teleradiology has propelled the growth of subspecialisation in radiology.

Technological advancements keep taking place at a rapid pace in today’s world. All most all the advances are launched in the Indian market simultaneously along with the global markets in view of the huge receptive market and excellent radiologists always ready to embrace new technology. Most high end/corporate hospitals in the cities are able to upgrade to the newer technologies and take advantage of their benefits. However their implementation in the rest of the country takes place very late or not at all due to the cost of these equipments and lack of trained personnel to perform and interpret the studies.

Apart from the above technology advancements, what other innovations have come up in this space?

The other innovations related to the increasing trend of sub specialisation in radiology which offers better radiology services, implementation of PACS systems for better reporting turnaround times/archival of images, higher utilisation of IT in radiology including paperless/filmless departments, speech recognition systems for report generation, increasing use of handheld devices to view and report radiology images in

Do you think association like yours should take steps to help district hospitals to embrace the latest imaging in radiology?

What is your opinion on this?

The government should encourage penetration of radiology services to the districts. Radiologists can partner with public and private players and follow the well established public private partnership model in providing advanced diagnostic services. IRIA can provide advisory role in equipment selection, regulations, logistics and teleradiology services.

According to you who are the forerunners of Indian Radiology and what are the contributions they have made?

Dr Arcot Gajraj from Chennai, Dr Kakarla Subba Rao from Hyderabad, Dr SK Sharma from Kolakata and Dr Sudarshan Aggarwal from New Delhi have been pioneers of modern radiology in India. Dr Gajraj was a great teacher and academician. Dr Kakarla Subbar Rao brought the best practices of medicine and radiology from USA to India and skillfully combined administration and radiology to be an excellent director of Nizam’s Institute of Medical Sciences, Hyderabad and health advisor to the

Government of Andhra Pradesh. Dr SK Sharma pioneered the entrepreneurship in radiology and was successful in the public-private partnership model in West Bengal. Dr Sudarshan Aggarwal placed India on the global radiology map by not only bringing state of the art radiology equipment to India but being an Indian brand ambassador in his interactions with numerous national and international radiology societies.

Speaking about tele-radiology and interventional radiology, what are the new technologies coming up in tele-radiology and interventional radiology?

In tele-radiology, we see lot of companies based out of India developing robust systems for local consumption as well as to the rest of the world. Cloud computing which does away local server storage and vendor neutral architecture have been major advances.

Speech recognition systems with integration in to PACS servers are being increasingly used for report generation. In the future hand-held devices will be increasingly used to view the images, especially in emergency setting by both the radiologists and the clinicians.

In interventional radiology, there has been an increasing trend by the young radiologists to take up this specialty. Advances in better hardware including 3D rotational angiography suites, better catheters and devices have made these procedures safe and simpler to perform.

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tech trends

RADIOLOGY

Interventional Radiology Is an

Improved Procedure

“Interventional radiological procedure has an overall advantage over surgical procedures for the patient as the body part is not removed” says Dr Pradeep Muley, Head & Senior Consultant Interventional Radiologist, Fortis Hospital, Vasant Kunj, New Delhi

What have been the most notable achievements in interventional radiology in the last decade?

Interventional radiologists are specialists who use various imaging and catheterisation techniques in order to diagnose and treat vascular issues in the body. Interventionalist techniques include injecting arteries with dye, visualising these via x-ray, and opening up blockages. The rapid new development of imaging technologies, mechanical devices, and types of treatment, have certainly been beneficial to the patient and without surgery various diseases can be treated like uterine fibroids, uterine adenomyosis, opening of blocked fallopian tubes, varicocele, chronic pelvic pain (pelvic congestion syndrome), varicose vein in leg, opening of blocked arteries, bleeding from

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mouth due to tuberculosis in chest.

The most recent development is treating enlarged prostate by non –surgical method called as prostatic artery embolisation.

ally, financially and physically – interventional radiological procedure have an overall advantage over surgical procedures for the patient as the body part is not removed.

What are the benefits of interventional radiology over traditional surgery?

What are the challenges in its advancement as a medical sphere? What are the measures to overcome them?

Interventional radiology is performed under local anesthesia. It requires only a tiny niche in the skin and no surgical incision of abdomen is done.

Recovery period is very short than from any open surgery. Virtually no adhesion or scar formation has been found. But in surgery adhesions are common. Using interventional radiology even two medical problems can be treated in one sitting. It is less expensive than surgery; it ensures short stay at the hospital. Emotion-

The development of Interventional Radiology leads to tug - war between surgeon and interventional radiologist. If patient has uterine fibroids, the gynecologist offers only removal of uterus not the non-surgical method called uterine artery embolisation.

While these practitioners can be in competition with each other, cooperation and communication are the most advantageous methods to deal with these “turf wars.” All of the in-

Technology Snapshot:

terventionalists are needed to deliver the best medical care to patients, now and in the future.

Since when has Fortis hospital, Vasant Kunj, Delhi been operating an interventional radiology department and what issues does it address?

The Interventional Radiology department is my brain child and since its inception in 2005 I have been taking care of the entire function here. I am assisted by a team of trained nurses and practicing radiologists. Having done my specialisation in Body & Neuro-interventional radiology from KE M Hospital Mumbai, AIIMS, Delhi, Johns Hopkins Medical Institute, USA and Singapore General Hospital, I wanted to device techniques which required minimal surgery and takes less

of patient’s time in hospital. Through the technique of Interventional Radiology, I am using a number of techniques here including uterine artery embolisation for fibroid/adenomyosis, varicose vein, infertility treatment for opening of blocked fallopian tube, varicocele, enlargement prostate, bronchial artery embolisation for bleeding lungs, chemo embolisation of liver tumor, lower limb blockage of artery.

How is interventional radiology a very effective way to treat varicose vein? How is it better than other means of treatment?

Varicose vein of legs is common, affecting 1-15 percent of adult men and 20-25 percent of adult women. The most common symptoms are pain, swelling, heaviness in leg, fatigue, prominent and dilated veins in leg

The interventional radiologist makes a small nick in the skin (less than a centimeter) at groin, inserts a catheter, identifies blocked artery by using angiography with contrast medium injection and then use balloon or inject embolisation particles (polyvinyl alcohol) that block the tiny vessels or open a diseased artery by balloon veins and some time venous ulcer.

The diagnosis is done by general examination and ultrasound Doppler study which can show the exact site of disease in the form of damaged valves and dilatation of veins.

The Radiofrequency Ablation (RFA) is the latest and most effective, patient friendly and non-surgical treatment for varicose vein using RFA machine. Under Doppler ultrasound vision, a radiofrequency catheter is inserted into the abnormal vein and the vessel treated with radio-energy, resulting in closure of the involved vein causing collapse of the thick veins.

This non-surgical treatment is better than any surgical treatment.

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tech trends

RADIOLOGY

Technology

Advances Radiology ‘The high-end diagnostic monitors help radiologist navigate and look at images at nano levels without losing the resolution’ says Dr Harsha Chadaga, Head- Clinical Operations and Lead Neuro-radiologist, Columbia Asia

Interventional radiology Interventional radiology is being pursued as sub-specialty over the last two decades and being applied not only for definitive treatment but also for palliative care. Its scope is from head to toe. Some of the examples being:

DR Harsha Chadaga Indian Radiology has gone through a paradigm shift in delivering quality imaging. What other developments has the segment seen?

In the last decade there has been a sea change in equipment profile, support technology and training, impacting significantly the quality of radiology services. Modern equipments provide in-depth and detailed information of human anatomy, sophisticated software enhance the acquired image and helps build high resolution images which help the radiologist provide an accurate diagnosis. The high end diagnostic monitors help the radiologist navigate and look at images at nano levels without losing the resolution. Today fusion images from multiple modalities are possible, images at multiple level (slices) and technologies like MRI- PET and HIFU have com-

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Neurovascular application - Aneurysm coiling, AVM embolisation, CCF embolisation.

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Carotid - Carotid Stenting

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LUNGS - RF ablation of lung tumors, tracheal Stenting, Bronchial artery embolisation in Haemoptysis. Abdomen - RF ablation is solid tumors, Peroperative and chemoembolisation, Endovascular treatment for GI bleed. Bones - RF ablation, Vertebroplasty

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Angioplasty and stenting in peripheral vascular diseases

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Endovascular stent grafting for aortic aneursyms and dissections

pletely changed the landscape of radiology practice.

Tell us about your Radiology department. What are the new radiology devices you have introduced lately?

Columbia Asia Radiology Group has been established with an objective to provide easy access to expert and reliable radiology services. The group provides reporting, peer reviews, education programms and research services. 40 radiologists located across the Columbia Asia group of hospitals are connected on a secure (HIPPA compliant, FDA approved) virtual platform and report over a 1000 images a day for 36 clients across the Indian Subcontinent, in addition to serving its own hospitals spread

across the country. The group also runs educational programmes which includes a post graduate radiology course recognised by National Board of Examinations (DNB) and FRCR 2B course in association with Royal College (UK) examiners.

What are the new cloud based software your hospitals has for tele-radiology?

We also a pilot of our tele-radiology operations using cloud and found it to be operational satisfactory. The financial feasibility and network reliability at this point has stalled us from progressing further on tele-radiology. Nevertheless it is just matter of time before cloud becomes the main stay making the operation cost effective and secure.

expert speak

‘At the heart of healthcare’

Pioneer in advanced Cardiac Arrhythmia services and key person in Interventional Cardiology, Dr (Prof) Mohan Nair, Chairman, Cardiac Sciences, Saket City Hospital (SCH). In conversation with Shahid Akhter, ENN

We are prone to heart disease for various reasons, including genetic. Is this a myth or a frightening reality ?

Indians are genetically more prone to developing cardiovascular problems than any other ethnic group in the world. It is exceptionally prevalent in the Indian sub-continent and is upto four times more common than some other regions of the world. Scientists are researching to find out a precise genetic mutation that affects Asian Indians.

In the West, heart attacks are usually reported in the elderly ( 60-70s age group) but in India, it happens at least a decade early thus resulting in an alarmingly growing number of young people are being affected.

How popular is preventive cardiology? How is the influx of people who turn up for routine check ups?

There is a lot of emphasis on executive health check and many good plans and packages are offered but today such check ups are passé. Random screening may lead to unwanted tests and treatments. At times it leads to over diagnosis which tends to turn healthy people into patients. The usefulness of such preventive tests for healthy people is controversial and debated in the West. In the US, there

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‘Driven by a Credo “You First”, Saket City Hospital is a fast emerging healthcare center that promises highest level of quality amidst technology that is truly world-class and futuristic’ is a tendency to curb them and so called annual physical tests are increasingly falling out of favour with most of the doctors.

Instead, what we offer is a focused check up which is based on preventive services and interventions that are patient specific and have proven effectiveness.

For example, after reviewing the patient’s health risk and accessing various parameters such as age, body weight, family history of heart disease, kidney damage, diabetes, cervical cancer etc; precise medical tests are recommended. If you have a fam-

ily history of heart disease, we would be concerned about high cholesterol, high blood pressure, diabetes, smoking and other cardiovascular risks, and will run you through a tailored preventive cardiology checkup that can be of benefit to you and other members of your family.

Besides the routine angioplasties and bypass or valve surgeries, do you have any advanced heart failure clinic equipped with high end devices like Ventricular Assist Device (VAD) ?

Heart failure clinic is in the pipeline and shortly we will be having a very fast track approach in this direction.

In case of heart attack, time is a crucial player. The attack is triggered when blood and oxygen flow to the heart becomes totally interrupted by blockage in any of the coronary arteries. Disruption of oxygen prompts chest pain, pressure or shortness of breath, nausea and other symptoms.

VAD is not as of now available in India. It is a mechanical device or pump used to support heart function to maintain the blood flow. It helps during or after surgery, until the heart recovers and can handle the blood flow on its own. It also comes to the rescue when one is awaiting heart transplant. VAD is very likely to be introduced in near future.

What technological advancements have been introduced lately at Cardiac Care Centre, SCH and what sets it apart?

A top-notch cardiac department is not just about a pool of best cardiologists but also a high end cath lab and the best of technological support. It is very important for the cardiologists to get accurate images of the heart.

We are equipped with Philips Ingenia 3 Tesla MRI scanner with 4D Multi Transmit Technology. Besides patient comfort and detailed imaging, it provides perfusion and non contrast peripheral angiography.

The other technological marvel is the dual energy, ultra fast CT scanner from Philips iCT 128 (256 slice/ sec).

Besides brief scan time and a great detail, it comes with lowest possible radiation dose.

The software automatically selects the lowest possible radiation. Stent Boost is another Philips software that helps in fluoroscopy based assessment of stent scaffolding.

In the emergency, again keeping the importance

“Today at the Saket City Hospital, we have the technology to diagnose or rule out life threatening causes of acute chest pain, in not more than three minutes. The urgent need in case of a heart attack is to restore the blood flow in the culprit region, as quickly as possible”

MOHAN NAIR

of timely intervention, as soon as a the patient has had his ECG the results are sent to the concerned cardiologists’ smart phone instantly.

We offer a full range of cardiac services, with our state-of-the-art noninvasive laboratory performing 3D echocardiography, Stress echocardiography; Transesophageal echocardiography.

The department has good track record of performing primary angioplasty & stenting in acute heart attack patients.

Our lab also has latest 3D mapping technology to offer treatment for complex arrhythmias and is a designated center of excellence in this field. Heart Center also includes the Cardio-Thoracic & Vascular surgery division that caters to the entire spectrum of Cardiac surgical procedures.

What new ways or breakthroughs have emerged to save the heart ? Have you adopted any such new technique?

Aortic valves are surgically implanted but now in the US and Europe, these valves are being replaced without open heart surgery. It is delivered via a catheter, where the stent opens and pushes the old valve out. These valves (Core Valve/ Edward Sapien Valve), are ideal for patients who need surgery but are at high operative risk. These are expensive, FDA approved but not yet sanctioned by Drugs Controller General of India (DCGI). These valves of the future will soon be appearing in India and our junior colleaues are already undergoing Transcatheter Aortic Valve Implantation(TAVI) training in Belgium, US, Canada and France.

Absorbable Stents is another innovative device to treat coronary artery disease. It takes around two years to dissolve and there is no metal left behind. It is three times as expensive as the best available medicated stents; therefore we will have them on our shelf but its not a priority.

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cover story EXPERT SPEAK

Building Digital Health Infrastructure “The benchmark that I often keep is that it should be totally paperless,” says Ashokaan VRS, Group CIO, Columbia Asia Hospital, Banglore. In conversation with Sruti Ghoshal, ENN How upgraded is your hospital in terms of using EMR and HIS? I would say we are fairly well automated. The benchmark that I often keep is that it should be totally paperless.

We are on the verge of achieving this where OPD has become 95 percent paperless and in patient department it should be 60 to 70 percent paperless.

What are the solutions you have adopted and from whom you have taken such solution?

There are four major applications that run through the entire eco-system and are more or less common to all scenarios with little modifications. The first is Cap 21 which is a home grown ERP system. The second is allied system, which manages the entire work floor.

The third one deal with radiology and it has been designed by the company with whom we have partnered for six years now and the fourth is again Cap 21.

In your opinion how costeffective is the market for health IT in India?

Health IT market in India is not costeffective.Cost-effectiveness comes from different perspective, how affordable to use or how beneficial it is.

If you ask me from the point of view of

“The USP of our hospital is that patients don’t carry their records, that’s the biggest selling point that all the patient records are digitised”

What are the latest medical devices the hospital has introduced recently?

From the speciality perspective many new devices have been deployed. The endoscopy which connects to the integral organs and we have the cath lab imager. In terms of the departments in the hospitals, all the verticals are automated in terms of information flow, expecting the key departments like Operation Theatre which are still handled manually.

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ASHOKAN VRS

benefit then I would say that it is not closely connected and makes it highly resource constraint. So when you deploy these solutions they are quite expensive and not that well integrated.

You cannot have an integrated healthcare solution.

What is the USP of your hospital?

The USP of our hospital is that patients don’t carry their records, that’s the biggest selling point is that all the patients records are digitised and it is available across all the departments, the patient doesn’t have to go running up and down to find the concerned department.

What are your future plans for expansion?

As per IT is concerned we have laid out our objective for next couple of years. We are going through transformation journey. We shared our IT roadmap with Infosys a year and a half before. At this point, in Karnataka, we are having core key projects, the top five would be intelligence and analytical reporting space, information assurance programme to bring more IT enabled people to operate.

Next we are looking at the new set of platform for implementing IT that can bring change in the ERP system and much more integrated with the medical devices. The main focus is on centralisation of the healthcare which would help people.

s 3rd International Exhibition on Health, Medical Equipment & Hospital Infrastructure

“Leveraging Technology for Transforming Standards of Healthcare...”

Gujarat University Exhibition & Convention Centre

Highlights of Hospital Tech 2012 CII’s Flagship exhibition on Medical Equipment and Healthcare Infrastructure Over 70 exhibitors Participated the event leading companies like Force Motors, Siemens, DePuy Medical, Draeger, Zimmer, Omron, Attune, Mahindra & Mahindra, Hosmac, Easy Care, Janak Healthcare, Kopran Laboratories, Kimberly Clarke, Meditek Engineers, United Surgicals and ISS Integrated Facility Services to name a few……..

“Health & Hospital Conclave 2012” was held along with the exhibition Some of the leading professionals from healthcare fraternity at Health & Hospital Conclave were: Dr Rajiv Modi, Cadila Pharmaceuticals; Dr Vikram Shah, Shalby Hospitals; Dr Vivek Desai, Hosmac; Dr Abhijat Sheth, Apollo Hospitals; Prof (Dr) K V Ramani, IIM Ahmedabad; Dr Sajan Nair, Narayana Hrudayalaya Hospitals; Mr Nandakumar Jairam, Columbia Asia Hospitals; Dr Bharat Gadhavi, HCG Hospitals; Dr Nitin Shah, SAL Hospital; Mr S Srinivasan; Siemens; Mr Vishnu Kalra, J&J, Singapore; Mr Sanjay Banerjee, Zimmer; Mr Arvind Gupta, SBI; Dr Adheet Gogate, HealthBridge Advisors; Mr Ishwar Dutt Sharma, Apollo Munich Health Insurance Co. Over 100 plus senior level delegates attended the conclave.

Exhibitor Profile Hospital Equipment / Surgical Products Diagnostic/Laboratory Equipment Medical consumables/ Disposables Rescue and Emergency Equipment Facility Management & Support Services Communication and Information Technology Medical Waste Management systems Hospital furniture, Equipment & Fabrics Energy Saving Devices Yoga & Fitness Centres

Ambulance/ Medical Vans Medical Gas / Air conditioning Financial Institutes / Private Equity Construction and Engineering Interior Designing / Consultancy Firms Lighting and Electricals Hospital Accreditation Security Systems Healthcare Institutes Health Insurance Companies

Visitor Profile Doctors Surgeons Veterinarians Pathologists / Biochemists Microbiologist Therapist Hospital Owners / Directors / Managers

Hospital Administrators Investors for Healthcare Industry Medical Service Providers Distributors Dealers & Retailers Government Agencies & Officials NGOs / Defence

For further details please contact Alpa Antani Head - Trade Fairs (WR) Prakash R. Boga Executive Officer alpa.antani@cii.in prakash.boga@cii.in Confederation of Indian Industry (WR) 105 Kakad Chambers, 132 Dr Annie Besant Road, Worli, Mumbai 400018.

Tel: +91 22 24931790 Extn 438 | Fax: +91 22 24939463 / 24945831 | Mobile : +91 9821024284

Expert Speak

Technology Shapes the Future

of Healthcare

“With technological innovations making its way through, India is also eager on adopting innovations and is definitely taking a step forward in shaping the healthcare system,” says Dr Vishal Gupta, VP/GM, Cisco Services & Healthcare Business Unit. In conversation with Sruti Ghoshal, ENN It is said that telemedicine is the way to bridge the urban-rural divide in Indian healthcare.

What is your opinion? How do you find the scope of telemedicine services in India today?

Telemedicine is about providing equitable assets to healthcare. No matter where the doctor is and where the patient is telemedicine can bridge that gap. We know that 70 percent of the population still lives in villages, only about 10 percent of the specialists are in the villages and about 20 percent primary doctors in those villages. The government tried to introduce a rule whereby doctor had to serve a particular village but that didn’t work out.

So the only way out is to introduce innovations in the ICG HIS space, this will enable the doctor to operate from wherever they want to be and bridge the gap.

I think in India there is a lot of scope for telemedicine services. We call it tele-presence or care at a distance where our main aim is to make it more user friendly and affordable and something which can be used at scale rather than making it more technologically complicated. So the need is huge in India with 25,000 primary health centres and most of these PHCs are not equipped with specialists and many of them don’t even have a pri-

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mary doctor and for this reason the villagers have to go to the district hospitals and in the process they lose a lot of time. The challenge is if the person doesn’t get the help at the right time then the cost increases exponentially.

Till now how many states have taken up your healthcare solutions?

It has been deployed in parts of Karnataka, Madhya Pradesh, and in the Tibetan settlements of Bihar and Chhattisgarh. We think the horizon of telemedicine should spread out to more states as the need is there in every part of India and just because a state doesn’t have proper healthcare system the people shouldn’t be devoid of the essential treatment. The need for healthcare doesn’t go away just because you can’t build a hospital there. This creates a lot of social unrest and a lot of challenges.

Give us an overview of care at a distance programme launched

by CISCO. We had three fold focus when we launched care at a distance programme. One, the interface between the patient and the doctor should be very interactive; they should feel they are right next to each other so that the trust is built. We have also worked on providing clarity in the video manag-

“In China people have a single health card.

Whenever they visit any hospital this card helps them to know where the reception is and likewise information. But when it comes to India there are so many doors to knock to reach to the desired location” ing the low bandwidth issue. Second, for telemedicine to scale, it has to integrate with all the medical devices. If the medical devices like stethoscope, blood pressure or an ECG could be integrated then the proper diagnosis can be done. The third challenge that we faced was how to make these things very easy to use. We designed it in such a way that the doctor could set it up in one click and also allow the patient to check on the availability of the doctors.

Apart from telemedicine you have HIS products and solutions too. What are the new

of many countries like China, Turkey etc. the advantage of cloud is that instead of deploying systems in every hospital cloud will accelerate it faster.

For example we were given the responsibility of deploying cloud system in the Sichuan district which had undergone a natural calamity and didn’t have any proper healthcare system.

So there was a centralised system with which the other hospitals were connected. Now they are planning to go completely paperless where every data will be stored in a card. All the procedures are taken care by that single card. So we can jump start an entire generation with much more elasticity and at a much lower cost.

Do you think the healthcare facilities in the government hospitals can be made better with HIS and telemedicine?

VISHAL GUPTA

products and solutions you have introduced in the HIS space?

We have come up with a lot of solutions in this space. We have come up with an offering called connected healthcare.

In connected healthcare we validate the HIS system on our infrastructure.

We make sure the HIS system runs on a very fast processor or on cloud so that they are easy to access. Security is another key factor where we have to ensure the right data being accessed by the right person. So CISCO has a

lot of security assets which are enabled in these aspects. We have also worked on collaborative healthcare system whereby a number of doctors can collaborate and provide solution to a patient.

Experts say he future for cloud HIS solutions will capture the markets soon. What is your opinion on this?

In healthcare system cloud is very powerful. We are working with heads

In China the HIS system has made their life much easier. They are carrying out around 1000 OPDs per day with so much ease. The Indian government’s response to these solutions is always very positive but in action it remains to be of seen how long it takes. But of late the government has been taking up initiative and in the 12th planning commission a huge amount of fund has been allocated to the healthcare system.

Till today medical education lacks technology. Do you have any future plans of extending your solutions to the medical institutes?

In medical education the core focus is on teaching. Many times, these institutes lack cases for the students to learn. In that case we can broadcast a particular surgery to many people.

For example if a cardiologist is conducting a heart surgery he can always broadcast it at a time to three different places, i. e to the patient, medical institutes, to other doctors as well.

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POWER HOSPITAL

‘Snoring is not a sign of prosperity’ ‘People have this notion that snoring is a sign of prosperity, but it is actually a lifestyle disease and can lead to bigger problems,’ says Dr Devinder Rai, Vice Chairman, Department of ENT, Sir Ganga Ram Hospital. In conversation with Kartik Sharma, ENN Please tell us about Sir Ganga Ram Hospital and its operations in healthcare?

Sir Ganga Ram Hospital is a very old and one of the renowned hospitals which is shifted from Lahore to India and has been serving the community relentlessly. The hospital also has a social commitment in which we provide free beds. These commitments are followed very seriously with the best ever equipments and the best of the doctors. The hospital always has a vision to be in the technological edge as well as expertise.

We also conduct training programmes. We have people in post graduate training in almost every specialty. We have full fledged department of ENT and we have lots of consultants. We have state –of- art equipments with robotic surgery, with image gadget surgery we have got everything which you think of in any department in the world.

India market is little different from West. While competing in terms of innovation and quality how do you manage to give an affordable treatment to Indian people?

We have got free beds where we do not charge anything and vaccine is

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almost non- chargeable, there is an under-privileged section too and the other categories like the semi- nursing home, single room and the suite for the people who can pay. So across this system we have a huge range of cost structure to help the society.

We are following the legacy of serving the society whole-heartedly.

Our hospital is totally different from the corporate hospitals. Gangaram hospital runs by doctors and not by the corporate. It is run by a trust and the trust gives full credence to doctors to run the hospital, it is the vision of the doctors and it is the trust which allows us to do it. Overall it is a fantastic hospital.

How are you leveraging ICT? We have eMedicine, we use telemedicine. Many times we have

programmed surgery including live surgery at times, and we do conduct video conferences too. So this is the technology enhanced healthcare model that we are following. We have fantastic library with computers to access anytime.

What will be your agenda with Eurosleep in India?

It is about management and treatment of snoring and sleep apnea.

There is certain thought process behind it. Coming to the aspect of lifestyle, people have this notion that snoring is a sign of prosperity which is actually a lifestyle problem and can lead to bigger problems. One of the problems which cause the snoring is sleep disorder and it has accentuation towards other disease process like cardiac or neurological attack.

Can snoring be actually stopped?

It is actually very difficult to stop snoring. Most of the people snore but what can be prevented is sleep apnea. Sleep apnea is a common disorder that causes your breathing to stop or get very shallow. Breathing pauses can last from a few seconds to minutes. They may occur 30 times or more an hour.

What can be done to spread awareness about these diseases?

Yes, awareness for the sleep apnea started in 1995/1996. It was one of the big initiatives. Since then many media houses organise so many much panel discussions on the issue and many media houses have written about it.

Thankfully, awareness is coming.

Awareness about it very crucial.

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zoom in

Mobile DR System to Be a Boon for

Critical Care Departments g

By R K Narang, Executive Director – Sales, Allengers Medical Systems Ltd

A

llengers, Chandigarh since last 25 years have paved the way to the need of the hour medical equipments.

Allengers Mobile DR Systems would be a boon in the way the hospital handles trauma patients by increasing the multidisciplinary approach and improving working relationships within the trauma, emergency, ICU and wards.

Allengers, Mobile DR range (MobilXDR and RollXDR) has been very well appreciated not only for its features but also because of its value for money price bracket.

The Prompt examinations via Mobile DR also have direct benefits to the patient as well. Digital images deliver faster diagnosis as such shorter waiting times, quicker treatment thus saving precious lives, as prompt diagnosis is a recipe for prompt treatment especially where time is crucial.

The use of the Mobile DR system facilitates immediate patient management based on instant digital images, diagnosis and less repeats, resulting in lower levels of patient anxiety. This makes interacting with the patient or his attendant a much smoother and positive process for the concerned staff.

The quicker examinations through a Mobile DR are much less traumatic to a child who is afraid and in pain. Attendants of the patients are also relieved by not carrying films to and from the x-ray rooms anymore and are at ease at how little time the imaging examinations now take, es-

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pecially when their ward is critical.

Allengers-RollXDR Such kinds of Mobile DRs would be a valuable asset to any existing or upcoming medical set-ups where top priority is being given to the critical needs of patients.

Allengers-MobilXDR

R K Narang

Allengers both MobilXDR and RollXDR have been such designed in order to suit the individual needs of any type of center whether big or small. Apart from these mobile wonders Allengers also has a range of fixed DR models suiting various application and procedural needs.

The attributes which makes the Mobile DR an indispensable unit in ER, Trauma, ICUs and Wards are: • Instant images for immediate assessment • On a daily basis, the use of Mobile DR greatly speeds up the throughput of trauma patients thereby reducing treatment time.

• Examinations are swift with high definition digital images produced within seconds after exposure.

• The immediate reproducibility of images enables trauma assessment teams to act instantly on the clinical information. For example, doctors can interpret fractures immediately in the emergency/ trauma room.

• Also this accelerates diagnosis and treatment plans as the patient is not required to be transferred to dedicated x-ray rooms.

• With images displayed on the integrated monitors, retakes can be immediately undertaken and additional image views can be chosen.

• Radiographic images are produced so quickly and without processing delays that the trauma team now can concentrate more on the treatment than on waiting for the images to start treatment.

• Images can be archived directly at the patient’s bedside.

event report

MEDICALL 2013 Chennai: Beyond Hospital &

Medical Equipment

T

he hospital industry is an important component of the value chain in Indian healthcare industry rendering services and recognised as healthcare delivery segment of the healthcare industry, which is growing at an annual rate of 15 percent. The size of the Indian healthcare industry is USD36 billion today and is estimated to be a whopping USD 280 billion by 2022.

MEDICALL is India’s premier Medical Equipment Expo and the first real “supermarket” for hospital equipment and supplies. Its comprehensive range of exhibits includes Hospital Information System, solutions, surgical and examination furniture, rescue and emergency equipment, diagnostic / laboratory, OT equipment dental / ophthalmology equipment, medical disposables and cleaning equipment.

After having established its presence convincingly for the second time in Ahmedabad from 8th to 10th February 2013 the 11th Edition, MEDICALL 2013 will be held in Chennai from 2nd to 4th August 2013. It is slated to bring together the best in the business of ICU and operation theatre equipments, refurbished equipments, trolley, wheel chairs, cots and other furniture, hospital linen and laundry, hospital charts and stationary, office automation equipments, printers dealing with pamphlet and file designing, communication equipments, medical disposables etc.

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Attractions at MEDICALL 2013, Chennai MEDICALL 2013 will have South Africa along with Sri Lanka as visitor countries, the latter having been one at last year’s hosting too. Hence exhibitors at MEDICALL 2013 can look forward to confirmed buyer delegations from both these countries. This lends an international character to the event.

B2B Buyers and Sellers meet will be organised during the Expo. Day - 1 of the Expo will be named” India —Sri Lanka Buyers Day” and Day-2 of the Expo will be named “India — Africa Day”. Exhibitors can meet the delegation on a one-to-one basis by fixing a prior appointment.

There is also an expo titled

Archimedes dedicated entirely to Healthcare Infrastructure.

The MEDICALL Innovation in Healthcare Awards would be presented to the most innovative manufacturers in the medical field. There are three categories of Awards: Hospital Entrepreneurship – Innovation in Business Models & Market in Product In, Healthcare Delivery and Medical – Equipment/Diagnostics/IT. Hospitals will be invited to be a part of this awards function.

The concurrent conferences with MEDICALL 2013 under the banner of “Everything They Failed to Teach You at Medical College” helps hospital owners to update their management skills.

Medical Imaging Going

Through Transition

TV Sivakumar, CEO, AmbalSoft InfoTech Private Ltd, shares his experience of medical imaging industry Tell us about your journey. What made you venture into this field??

I have been associated with medical ICT from 1995 onwards. I worked for Abbott Labs and Carl Zeiss Meditec in the USA and contributed to many projects. I came back to India and setup a consulting company in 2000 and ran it successfully till 2008. In 2009, I decided to pursue my dream of starting a medical software product company and started AmbalSoft. India’s healthcare industry is in rapid transformation adopting ICT and we want to be part of this growth.

Give us an overview on the Capture IT Pro series. Which are the hospitals who have deployed your technologies?

Capture IT Pro is a medical imaging and documenting software useful to record medical procedures and surgeries. It can interface with medical instruments like; HD/SD Endoscopes, Microscopes Analog

TV Sivakumar devices etc and record video, take images pertinent to medical procedure. Recorded video can be played back to patient to make them understand more about their problem or the treatment planned/ given for them. This helps in Evidence Based Medicine (EBM) practice. Document-

‘India, the global knowledge hub, needs a solid regulatory body like FDA / EC and must put quality healthcare as top priority reform to win global reputation. International standards like IHE must be customised to Indian subcontinent for easy adoption. We are part of a group of companies working towards forming IHE-India’

ing the procedure is also useful for Insurance Claiming and presentation purposes. Capture IT Pro can connect with all types of HD Endocsopes and can record video in 1080 pixle High Definition quality. It can also convert images to DICOM format and send to PACS for centralised storage. Capture IT Pro bridges the gap between analog medical devices and PACS / DICOM server.

We also have ColpoITPro for Colposcopic procedure documenting software and OptoITPro software for ophthalmic microscopic surgery documentation. We have more than 850+ installations all over the world. All major hospitals in our country are using our product.

How do you think ICT can revolutionise healthcare especially in India?

ICT is the answer to revolutionise healthcare demands in India. Like how Banking and Railways advanced

by ICT, days are not far for Healthcare domain to realise full power of ICT and transform to next level. ICT can greatly improve quality of medical care by providing critical information at right time at right place, centralised healthcare management systems, EMR systems, Telemedicine support and increased interoperability between medical systems. When put to effective use, ICT can decrease treatment cost and save lives.

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9th india’s premier ICT Event

The 9th eINDIA (www.eINDIA.net.in), to be convened with the theme of ‘Building a Knowledge Society’ will be held on July 23 — 24, 2013 at Hyderabad International Convention Centre (HICC), Hyderabad, India and hosted by Government of Andhra Pradesh and Andhra Pradesh Technology Services Limited (APTS). The summit is being organised by Elets Technomedia Pvt Ltd. The two-day summit will serve as a platform for knowledge exchange between the key stakeholders who are active in the fields of Governance, Education and Health.

programme chair of eINDIA 2013

Leaders at eINDIA 2012

N Kiran Kumar Reddy Chief Minister Government of Andhra Pradesh

Sam Pitroda Advisor to the Prime Minister of India on Public Information Infrastructure & Innovations

Killi Kruparani Minister of State for Communication & IT, Government of India

Ponnala Lakshmaiah IT Minister, Andhra Pradesh

S S Mantha Chairman, All India Council for Technical Education (AICTE)

Prof H A Ranganath Director, NAAC

and more ...

SMS

Sanjay Jaju Secretary, IT & Communications Department, Government of Andhra Pradesh It gives me immense pleasure to announce and welcome the 9th eINDIA Conference, Exhibition & awards. I am happy about the consistent and synergised endeavors of the organiser in engaging the government as well as the private sector in the development activities of the information and communication technology in conjunction with sectors like Education, Healthcare and Governance.

We have taken good learning experiences from all the past eight chapters of eINDIA conference, orgainsed at dfifferent locations of the country. I am happy that Andhra Pradesh is hosting the 9th edition of eINDIA Conference, Exhibition and Awards

Who Should Attend?

The Hon’ble Chief Minister of Andhra Pradesh is the Chief Guest The Hon’ble IT Secretary of Andhra Pradesh is the Programme Chair Dignitaries from Ministry of Communication and IT, Government of India Secretaries from various government departments in Andhra Pradesh and other states Administrative officers from foreign governments eIndia Health Summit will bring the crème-de- la- crème of the healthcare fraternity who will share their insights on crucial subjects like government initiatives in healthcare, multi specialty hospitals, telemedicine solution, health insurance and many more.

It is the biggest platform for most eminent health experts, policy makers, researchers, solution developers and technocrats from across India and beyond, to meet & share the knowledge about the latest developments in Health Information Communication Technology (HICT) and interact with the stakeholders in the entire continuum of care about the challenges and opportunities in the healthcare sector.

Highlights · • • • • • • •

Biggest networking event for leaders in health from around the country Health Secretary Conclave Hospital CEO/CIO Conclave and Health Leaders’ Conclave Convergence of who is who of the health sector Extensive media coverage for the Summit during and after the event Expo & Exhibition for showcasing best practices in healthcare domain eINDIA 2013 Award for innovation and excellence in healthcare Power Sessions on diagnostics industry, dominance of multi-specialty hospitals, health CIO conclave, health insurance etc. Special sessions on Health India Awards, business models in telemedicine, healthcare policy and exciting healthcare solutions available in India

Components

Conference Host Partners

Awards

State Partner

Expo

Leaders of private sector companies that are actively collaborating with the government in the area of e-Governance CEOs, CMOs, CFOs, CIOs, CTOs of healthcare organisations Health Secretaries and senior government officials Senior administrators, HODs and business managers of hospitals Investors from private equity and venture capital firms Vendors and suppliers of hospital materials, technologies, equipments and devices Healthcare consultants and experts

Award Categories for eIndia Health Summit 2013 • mHealth Project of the Year • PPP Initiative of the Year in Healthcare • Civil Society/ Development Agency Initiative of the Year • Health Insurance Initiative of the Year • Hospital Information System Provider of the Year • Innovative use of Technology by a Hospital • Innovative Use of Technology by a Diagnostic Service Provider • Health Management Information System (HMIS) Provider of the Year • Telemedicine project of the year For award nomination, paper submission or participation as a delegate Log on to eINDIA website http://eIndia.eletsonline.com

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Zoom in

A True HIS 2.0 Solution

Razi Ahmed, Country Manager / CEO – India, Mazik Tech Solutions a subsidiary of MazikGlobal Inc speaks about the unique features of their Health Care product Kindly brief us about your product the ‘MazikCare’?

MazikCare is a very comprehensive but simple to use HIS System built as a vertical solution on MS Dynamics AX platform. It is an integrated platform based solution encompassing all the clinical (Doctor, Nurse, Wards, ICU, OT), Administrative (Front Office, Scheduling, eMRD, etc.), Support functions (Pharmacy, CSSD, Nutrition and Food & Beverage, House Keeping etc.), ERP (MM, Financials, HR etc.) and out-of-box BI. It has template & rule based input for consistent, measurable role based output (reporting, MIS and decision systems etc.)The product has configurable screens, fast to deploy, near complete as-is application and scalable architecture for supporting new process integration, new application development etc.

The USP of the product is: • Detailed & Elaborate module listing with “inbuilt workflow’s • Out-of-Box BI • Analytics & Decision Systems like Activity Based Costing etc.

• Global practices for Indian Ecosystem • Web enabled, deployable in both Central & Decentralised model, Cloud ready • Truly a HIS 2.0 product • Can be scaled out into smaller modules to meet market requirements

ules have become very important today.

For Example:Manipal, Fortis, Columbia Asia, Care Hospitals etc.

The constant need for Multi-Speciality hospital beds is growing by the day in India. We still are, with all the investments happening in this sector, looking at approx. 1 Bed per 1000 patients.

Boutique Hospitals are booming…

Speciality Centres are growing… with all these, IT Systems are critical not just to enable but to drive business.

What is your opinion on the opportunities of using MazikCare in India?

We already have started engagements with various healthcare service providers and have received very positive response. The India-nised product will be ready in the next few weeks and then the go-to market.

From existing brown field opportunities, hospitals are replacing their legacy systems with newer systems since the business is driving the IT outcome.

Hospitals today want the application on flexible &latest technology platform at minimal investments and minimal deployment efforts. Also, the earlier so called “back office or non-core” mod-

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So far how has been the response you have received for your product in India?

What are your marketing strategies for Indian market?

We have planned to market MazikCare both direct and indirect route &closely working along with Microsoft Health-

Razi Ahmed Care and Public Sector team. We are jointly approaching to big opportunities.

We wish to work with the healthcare ecosystem to complete the solution sets.

What is your market analysis on Indian market?

Healthcare demands in India are growing at an exponential rate. Life expectancies and income levels are on the rise.

The healthcare industry in India itself is expected to grow at a rate of 20 percent annually, meaning that rigid, legacy systems will not be able to sustain the face of such demand. Healthcare organisations, especially clinics, small hospitals and long term care facilities need solutions that are light weight, intuitive and role-based. By building directly onto the Microsoft stack, MazikCare offers an immediately identifiable, familiar EMR that meets government requirements, provides the right visibility and an organised, attractive User Interface.

Additionally, mobile applications and the cloud-offering make this a highly flexible solution that can be used across multiple clinics and facilities.

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Get Quick Treatment

for Broken Elbow

Quick medical treatment and surgery are needed to avoid worsening of elbow fracture after any injury Dr GK Agrawal, HOD Orthopaedics, Fortis Hospital, Shalimar Bagh, New Delhi

T

wenty five-year-old Priya Kukreja (name changed), a young working professional, never thought of unexpected health exigencies at her age – until she accidently slipped on ice and broke her elbow. Instead of wasting any time or resorting to home remedies to relieve her of pain, her parents simply rushed her to the hospital to get immediate medical attention. This saved her elbow.

Complicated fractures with multiple bone pieces were detected on X-ray when the young lady was examined. Immediate medical attention was required as there was pain, swelling, deformity and restricted movement at the right elbow.

Dr GK Agrawal

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A complex operation was performed, and bone pieces were fixed with special plates and screws. After three months of the procedure, she is now able to move her arm normally.

This would not have been possible if any delay or wrong treatment would have been provided to the patient.

It was only prompt action from her family as well as timely medical treat-

• Avoid depending only on home remedies • Get immediate medical attention • Consult an expert orthopaedic doctor ment and surgery that did not let her case become worse.

The elbows are one of the most important parts of the upper limb and its fractures can become quite troublesome if you don’t treat them properly. Complications such as loss of movement, deformity and stiffness can arise due to elbow fractures.

These can happen after a fall or hit on the elbow, and could be accompanied by sprains and dislocations.

Some people think home remedies can cure the pain, swelling or stiff-

ness after an accident and do not bother to go to the doctor – leading to more suffering and a possibility of a worse scenario. It is best to consult an expert orthopedic specialist for any such injuries, rather than be sorry later.

X-rays, CT scans and MRI scans can show the entire picture and the extent of damage to the bones. If there is not much harm to the bones, increasing early movement is emphasised, or moderate treatment such as sling, cast or splint is used. Displaced or unstable fractures more likely require surgery to realign and reconstruct the damaged bones.

It is important to unite the bones in a proper position with the help of surgery performed by expert specialists. The joints have to be reconstructed in a perfect manner so that the bones do not fit like a jigsaw puzzle after an accident, but as they are supposed to be. This only can lead to normal functioning after the procedure.

As there are various types of elbow fractures such as radial head and neck fractures, and olecranon fractures; it becomes very important that correct identification is done by the doctor before going in for surgery.

Implants, fragment excision, open reduction and internal fixation, and bone graft are among the various surgeries that can be done to correct the bone deformities.

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Specialty

Future Belongs to Minimally

Invasive Spine Surgery

“Lifestyle changes have made even the young generation prone to spine problems such as slip disc, back pain, recurring neck pain, spasm,” says Dr Arun Bhanot, Chief of Spine Service at Paras Hospitals. In conversation with Sharmila Das, ENN What is the role of spine surgery in treating a patient?

Spine surgery is currently an emerging sector. A few decades ago, Orthopedics and Neurosurgical fields were a part of general surgery and the same surgeon would perform abdominal, neurosurgical and orthopedic operations. However, with advancements in these fields, these specialties got separated and became independent subspecialties of medicine. Similarly, spine surgery is now evolving from neuro and orthopedic surgery.

However, confusion and myths regarding management of spinal problems still persist among people. Many are clueless about whom to consult (whether ortho or neuro) for their spine problems. Others are scared of spine operations, if advised, assuming that they will get paralysed, which is far from reality. There is hardly any chance of paralysis (less than one percent) with modern spinal operations for routine indications, whereas success rate of spinal interventions is more than 90 percent.

What kind of spine department you have created at Paras Hospitals and what are its goals?

At Paras Hospitals, we have a very good team of trained and highly skilled spine specialists and a research associate. With such a team, we are build-

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ing one of the best spine departments in Northern India. Lifestyle changes have made even the young generation prone to spine problems such as slip disc, back pain, recurring neck pain, spasm, etc. I personally feel that spine being an emerging field and people having various misconceptions about it, with proper infrastructure and staff in place we should start spreading awareness about modern spine treatments and their high safety and success rates. We need to make people realise that despite having spinal

The timeframe for improvement may range from a few weeks to months.

Prolonged medication is not advisable either, as this may risk damage to kidneys, liver, or stomach, leading to bigger problems. In case medical treatment and rehabilitation fail, the spine doctor has to take a call whether surgery is needed or not.

Today technology and training of the doctors have enhanced the safety standards to an extent where we can operate a 90 year-old patient with more than 90 percent safety margins.

The unique feature of our spine department is Keyhole Endoscopic Spine Surgery, which is basically a day care spine surgery ” problems one can actually lead a good quality life by timely intervention by a trained and dedicated spine doctor.

What is the percentage of patients who need to undergo spine surgery?

Not everybody suffering from a spinal problem requires a spine surgery.

In fact, 80-90 percent patients do not require the surgery. In a majority of cases, proper counseling, timely medical intervention and therapies help.

We have had patients who were lying in bed for four-five months due to spinal fracture before they were brought to us. We gave minimally invasive treatment to them that involved treating the patient’s spine through five to six small holes in back and placing supportive screws and bone cement through those holes. Within a day or two the patient was able to stand on his feet.

Which minimally invasive

Case in point

procedures are available in your spine surgery department?

The unique feature for our spine service is the Keyhole Endoscopic Surgery for slip disc which is the main procedure to treat slip disc these days and most of the big hospitals do not have this facility in North India. It’s basically a day care spine surgery, whereby a small eight millimeter keyhole is created in the patient’s back and the patient can even watch the entire procedure on screen as it is done under local anesthesia. We put high resolution cameras inside the body to keep a track and also talk to the patient continuously which keeps us informed if we have touched any sensitive nerve or not. Post operative recovery is fast with little pain as the cut is very small and the patient can get back to routine life within a few days.

Then we have the procedure of cementing, known as Kyphoplasty, for

Today technology and training of the doctors have enhanced the safety standards to an extent where we can operate a 90 year-old patient with more than 90 percent safety margins. We have had patients who were lying in bed for four-five months due to spinal fracture before they were brought to us. We gave minimally invasive treatment to them that involved treating the patient’s spine through five to six small holes in back and placing supportive screws and bone cement through those holes.

Within a day or two the patient was able to stand on his feet old age patients with fracture in their spine. We put bone cement to heal the spine by creating small keyholes to reconstruct the fracture area. Sometimes we need to place screws and rods in the affected area, which can also be done through minimally invasive procedure.

In addition, we perform all types of complex microscopic and open spine surgeries to correct spinal stenosis, spinal deformity and infections as well as run a spine pain clinic where we treat spine patients with image guided injections.

What kind of setting is required to perform spine surgery?

Usually, we need a rehabilitation team to support us. Whether we give

medication or perform surgery, the patient needs exercise therapy anyway.

This apart, we need high-resolution cameras, endoscope, specialised instruments and equipments in the hospital to facilitate excellent results that we are talking about.

What kinds of advancements have happened in spine surgery in India in terms of technology and manpower?

We are witnessing the emergence of big hospitals, like ours, where we can have state-of-the-art infrastructural facilities to support advanced treatments. The advanced diagnostic facilities are also important and go hand in hand in improving the outcomes.

July / 2013 ehealth.eletsonline.com

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Cover Story Expert speak

‘Cancer survivors

are cancer overriders’ Outlook and approach to cancer has changed and improved dramatically.

Dr Sudarsan De, Chairman Oncology & Senior Consultant, Galaxy Cancer Institute shares his views and vision with Shahid Akhter, ENN

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Cancer prevalence in India is pegged at 2.5 million ? Reason behind this steep escalation in the recent past ?

Yes, cancer graph is alarming. one million new cases are diagnosed every year in India. At any given point of time there are 2.5 million people affected by cancer.

Today cancer diagnosis has improved and more patients are coming forward and this accounts for the steep rise. The other reason for rise in figure can be attributed to polluted air and water, deteriorating quality of food ( additives, preservatives, insecticides, pesticides, fertilisers, hormones, coloring agents, et al), industrialisation, packaged food, use of plastics, fasts food, high fat intake, low consumption of green vegetables) and finally lifestyle changes. The causes are varied and various, but a good many of them are within are immediate control and the choice is yours.

Unlike other diseases ( eg diabetes or CVD), cancer is feared and almost associated with despair and death. How do you allay this fear ?

Gone are the days when cancer was synonymous to death. Unlike diabetes or CVD, cancer does not linger and one is not required to live with it for life.

Today cancer is highly curable. The patient and the family need to garner courage, come up for diagnosis and early treatment. They need to dispel the myths associated with cancer.

How good is our understanding of Cancer ? Research is enormous but still it seems we still don’t fully understand it.

Quite true. Despite enormous research and advancements, cancer continues to be elusive and we can term our findings as ‘preliminary’. It is a multi factorial disease triggered by lots of chemical phenomenon leading to mutation of genes. We have understood few of the things at molecular level but down the

“Cancer is more curable than chronic diseases like diabetes or asthma. The result greatly depends on the morale of the patient, who needs to have the mental strength to emerge a winner” lane, say within a decade, cancer will be decoded, the mutation pathways identified and blocked.

tations are few and far so it can’t be a test for everyone. These tests are mostly done for predictive reasons.

What are the common modalities of cancer treatment ?

Is proton beam radiation really better than the standard Xray radiation treatment ?

Treatment of cancer can involve surgery, radiation therapy, chemotherapy, immunotherapy and the combination of modalities. Surgery is the oldest form of effective cancer treatment and it continues to be an option. Usually modalities are combined and this is tailor made to match the precise tumor characteristics.

What is the role of Radiation Therapy in management of cancer and how does it kill the cancer cells?

In India 65-70 percent of cancer requires radiation therapy. Here, highenergy radiation ( X rays or gamma rays) is put to use to shrink the tumors and kills the cells. The radiation is either sourced externally from a distance ( external beam radiation therapy) or may be placed within the body near the cancer cells (brachytherapy).

Today, newer techniques of radiation therapy focuses precisely on the tumor bearing area and spares the normal tissues.

Do you recommend genetic testing ? Has it established any medical value?

Genetic testing is not for everyone. It is recommended only for people with certain types of cancer running in the families. Most cancers are triggered by gene mutations that develop during a person’s life time. Inherited mu-

Proton beam is the latest toy in cancer cure. It is the next generation treatment and has the potential to outwit the most resistant tumors, besides it is very precise in targeting and has other unique features like high safety standards and so on. So far it is not available in India The downside is its price and the area that it occupies. Commercially it is being prepared and in days to come it will be there.

Any message that you wish to convey to the cancer patients ?

Cancer is not just curable in early stages but also advanced stages. I need to add that it is more curable than chronic diseases like diabetes, asthma or CVDs. The result of the treatment entirely depends on the morale of the patient.

He needs to have mental strength and the spirit to win. Millions have overpowered cancer and sure you will. Attitude matters and resolution counts.

There is prevailing myth that biopsy is the cause for the spread of cancer.

Absolutely not. It is just an essential part of the diagnosis, nothing more.

Often people are inclined to think that they must have done something wrong and cancer is the punishment of doom. Well, cancer is just is a disease like any other and certainly not doomed. It is better cured than other diseases.

July / 2013 ehealth.eletsonline.com

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eventevent report report

Healthcare Summit 2013 &

Some Thoughts

E

-18, a division of Network 18 Media and Investments Limited, in association with the news channel CNN IBN, organised Healthcare Summit 2013 on 31st May, at Hotel Oberoi, New Delhi.

The knowledge seminar was organised with the aim of creating a thought provoking platform where the Government, medical professionals and the healthcare industry will interact, debate and evaluate the right growth format for India’s healthcare system. In doing so, the event highlighted the current healthcare landscape, opportunities & challenges ahead and the role of government and private players to ensure that healthcare is assessable, affordable and accountable for all.

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Speaking on the occasion, Prof Samir Brahmachari, Director General, CSIR, Govt of India says, “We need to make healthcare reach to all and for that we need to make lowcost models and that can happen with the use of technology. We need PPP model; we need good engineers to produce low-cost services for healthcare. We need to build new models, if we wish to build quality healthcare which should be appropriate, accessible and accountable at the same time”.

Naresh Trehan, Chairman, Medanta-The Medicity says, “Government is making some effort, but we should make efforts to go to our roots.

We can train the ASHA workers, up-

skill them and we all know that it is not rocket science to work towards clean water, to build basic infra-structure. We should start creating innovative science for India”.

Dr Ashok Seth, Chairman, Fortis Escorts Heart Institute says, “Cost-effective service does not mean high technology services, for that the healthcare stakeholders need to believe in one another and start developing healthcare”.

The one day conference witnessed presence of all the stars from healthcare fraternity. Names like Ajay Bakshi, Ameera Shah, Rana Mehta (PwC), Praneet Kumar, Prof K Ganapathy have graced the occasion with their inspiring thoughts on delivering quality healthcare.

news

drugs

Government to Ban More Drugs Even as the industry has raised serious concerns over banning of three key medicines including anti-diabetic drug pioglitazone, the government is evaluating suspension of more such drugs with serious side-effects, mainly those which are not allowed for sale in their originating countries.

Recently, the health ministry has banned sale of anti-diabetic drug Pioglitazone, pain killer Analgin and anti-depressant Deanxit because of the health risk associated with these medicines. The drug controller’s office is also considering Buclizine, an anti-allergic medicine often prescribed for stimulation of appetite in babies, among other such medicines for suspension of manufacturing and sale in India.

Dr Reddy’s Launches Rise in Use of Designer Drugs Alarms UN The UN drug control agency on Wednesday sounded the Epilepsy Drug in the alarm on the spread of designer drugs, which are sold openly and legally and sometimes result in deadly highs, while US market JDrug maker Dr Reddy’s Laboratories Ltd has launched lamotrigine extended-release tablets in the US market following approval by the FDA on 25 June. Lamotrigine is a generic version of GlaxoSmithKline Plc.’s lamictal XR used in the treatment of epilepsy.

According to US-based healthcare information service provider IMS Health, the lamictal XR brand and its generic had combined US sales of around $300.5 million for the 12 months ended April. Dr Reddy’s lamotrigine tablets will be available in 25mg, 50mg, 100mg, 200mg, and 300mg dosages.

reporting that global drug use generally remains stable.

Such substances “can be far more dangerous than traditional drugs”, the agency said in a statement accompanying its annual report. “Street names, such as ‘spice’, ‘meow-meow’ and ‘bath salts’ mislead young people into believing that they are indulging in low-risk fun”.

A six-page summary of the report by the UN Office on Drugs and Crime warned that “the international drug control system is foundering, for the first time, under the speed and creativity” of their proliferation

Ranbaxy drugs safe, Australian drug regulator After the UK drug regulator, the Australian drug regulator has also said that the drugs marketed by Ranbaxy Labs are safe.

“At present, there is no evidence that any of the products in the Australian market manufactured by Ranbaxy are of an unacceptable quality or that there is a danger to consumers,” a spokesperson for the Australian Therapeutic Goods Administration (TGA) told ET. The spokesperson further said that the Australian drug regulator was part of a multilateral inspection team involving the World Health Organisation and inspectors from the United Kingdom, Ireland, Germany, Canada and Singapore in 2008 to investigate these matters.

“The conclusion at the time was that there was no cause for concern for products in those markets,” he added. Besides, the TGA also independently tested samples of Ranbaxy products and found nothing to suggest unacceptable quality or a danger to consumers.

Diabetes Drugs may be Linked to Cancer of Pancreas Global drugmakers said they would cooperate with an independent review to address concerns of a potential link between widely used diabetes medicines and pancreatic cancer and other safety problems.

The American Diabetes Association (ADA) this week called for a new evaluation of clinical data on drugs used to control blood sugar for patients with type 2 diabetes.

They include Merck & Co’s $4 billion a year Januvia franchise, Novo Nordisk’s Victoza, and Byetta and Onglyza from Bristol-Myers Squibb Co and AstraZeneca Plc, among others.

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news

technology

Spain Hosts the World’s First Google Glass-Monitored Surgery We’ve heard doctors’ predictions for using Google Glass in healthcare, but in Spain, some surgeons have put the “augmented reality” technology to the test.

The Digital Journal reports that a chondrocyte transplant operation was carried out in Madrid using Google Glass to allow experts in the US to live-consult the procedure in real-time, streaming it on the Internet.

A 49-year-old man underwent the procedure for cartilage injuries at Madrid’s 108-bed CEMTRO Clinic, which was monitored simultaneously at Stanford University, while also being streamed to 150 doctors in the US, Europe and Australia. Pedro Guillen, who performed to surgery, told Reuters that he was comfortable wearing the glasses.

Smartphones Could Warn About Impending Heart Attack Zak Holdsworth, a Silicon Valley digital entrepreneur, and Kiwi is helping bring such technology to market. A new smartphone being developed is set to revolutionize the way we manage healthcare by warning people of impending heart attack.

Nano-thin silicon heart-and blood-monitoring “tattoos” on people’s arms, which will send a signal to a smartphone if the data indicates a health problem are the basis of the new technology. Zak Holdsworth reckons that heart patients will be sporting the “tattoos” on their arms within five years, and in 10 years of time people could be sporting the technology inside their hearts.

MC10 is the Boston-based technology company behind the tattoos and is now investigating the potential of microchips that are being inserted via catheter on to the heart’s inner lining from where a signal will be sent to the patient’s phone.

Brain-Computer Interfaces Make New Tasks As Simple As Waving A Hand Small electrodes placed on or inside the brain allow patients to interact with computers or control robotic limbs simply by thinking about how to execute those actions. This technology could improve communication and daily life for a person who is paralyzed or has lost the ability to speak from a stroke or neurodegenerative disease.

University of Washington researchers have demonstrated that when humans use this technology – called a brain-computer interface – the brain behaves much like it does when completing simple motor skills such as kicking a ball, typing or waving a hand.

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Dassault Systèmes Introduces a New Industry Solution

Dassault Systèmes, the 3DEXPERIENCE Company, announced the launch of a new industry solution experience for pharmaceutical and biotech companies, “Licensed to Cure for BioPharma.” Based on Dassault Systèmes’ 3DEXPERIENCE platform, the new solution transforms the way biotech and pharmaceutical companies manage product and process complexity by smoothing drug variation, enabling easier and faster expansion into new markets, all while managing increasing regulatory requirements.

CureHealth Launches New Test for Cancer Detection

CureHealth Diagnostics has unveiled new dimensions in early detection of cervical or lower genital malignancies.

CureHealth announced a launch of a novel HPV detection technology in India in technical collaboration with IncellDx, a California based medical health technology company developing advanced molecular diagnostic technologies for detection and monitoring of life threatening diseases such as cervical cancer, breast cancer, HIV/AIDs, hepatitis, and organ transplant rejection.

news

initiatives

Johns Hopkins University Ties up with IIHMR, Jaipur Begining this October, Indian students interested in Public Health will have an opportunity to join a prestigious international post-graduate programme at a low cost.

The Johns Hopkins Bloomberg School of Public Health of the U.S. will be offering its Master of Public Health (MPH) degree programme in collaboration with the Institute of Health Management Research (IIHMR), Jaipur. The course will involve studying both in India as well as the US, as students will get a chance to travel to Baltimore, Maryland, U.S., for the winter semester at the Johns Hopkins Bloomberg School of Public Health in January 2014.

The first batch of 60 students will start their course, being offered to students from India as well as those from other low and middle-income countries, at the IIHMR campus here in October this year. “The course is approved by the All India Council of Technical Education (AICTE), Government of India under foreign collaboration. The degree will be provided by the Johns Hopkins University,” he said.

The Impact Of The iPad On The Daily Clinical Duties Of Radiology Residents While the iPad is being used for intraoperative procedure guidance, percutaneous procedure planning, and mobile interpretation of some imaging examinations, the majority of radiology residents are using it primarily as an educational tool, according to a study published online in the Journal of the American College of Radiology.

“Some sectors of the medical community consider the iPad to be a revolutionary tool in health care delivery, with many use scenarios focused on medical imaging. The purpose of our study was to assess residents’ use patterns and opinions of the iPad as a tool for radiology education and clinical practice at an academic medical center,” said Justin W. Kung, M.D., co-author of the study.

Facebook Boosts Organ Donation Social media site ‘Facebook’ boosted the number of people who registered themselves as organ donors 21-fold in just one day, according to a new study by Johns Hopkins researchers.

The report, published in the American Journal of Transplantation, indicates that social media may be a successful way to make people more aware of the organ shortage in the U.S. The rise was seen in May 2012 when Facebook developed a way for people to share their organ donor status with friends. The socialnetworking site allowed users to make their status official on state department of motor vehicle websites by providing easy links.

Govt to Launch National Health Portal The government has introduced and implemented various health schemes and programmes and this includes a much awaited National Health Portal (NPH) scheduled to be launched on October 2013. The portal is intended to plug in the healthcare gaps through the effective use of IT. Speaking at a roundtable discussion on the NHP project, Dr Sarbadhikari Nath Sarbadhikari, Project Director, said the threefold objectives of the National Health Portal are to improve the health literacy of the masses in India, improve access to health services across the nation, and decrease the burden of disease by educating the people on the preventive aspects of disease.

Apollo Hospitals Plans to Set Up 10 Telemedicine Clinics Abroad

Talking to reporters on the sidelines of ‘3rd International Conference on Transforming Healthcare with Information Technology’ here on Friday, Apollo Hospitals Group Chairman Prathap C Reddy said the proposed telemedicine clinics would be coming up in Ghana, Nigeria, Oman and Abu Dhabi, among others. However, there was a need for more hospitals in the country in view of the growing incidence of non-communicable diseases and the Group intended to use its financial resources here.

On the move to divest stake in the Apollo Healthstreet, a healthcare BPO, he said ‘we are not looking for investors. We are looking for somebody who is in that business’ For more News log on to htttp://elets.eHealthonline.com

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