The Hidden Hospital : July 2010

Pg. 43 Girish Rao MD & CEO, NOVA Medical Centers

The Monthly Magazine on Healthcare ICTs, Medical Technologies & Applications

volume 5 / issue 7 / July 2010 INR 75 / USD 10 / ISSN 0973-8959 www.ehealthonline.org

Online Revolution

Delivering Healthcare at the Doorstep Pg. 31

Digital Hospital Enhances Performance and Patient Safety Pg. 34

on the crest of a wavePg. 36 mHealth

A New Healthcare Delivery Tool Pg. 38

The Hidden Hospital -A New Paradigm

Pg. 8

Tajinder vohra Senior Vice President, Genpact

TECHNOgraphy eINDIA2010 Photography Competition

Showcasing the ICT Experience to the World In celebrating the true spirit of eINDIA2010, we invite amateurs and photographers to participate in the eINDIA2010 Photo Competition. We are looking for unique and innovative ideas captured on camera, depicting out of the box use of Information and Communication Technologies (ICT) for education, governance, health and developmental concerns. Show us how simple gizmos to the latest gadgets have enhanced the value and productivity of mundane activities and percolated its usage to villages and small towns and metros. Show the world how ICT has positively rendered to your life’s creative experiences, and that of others. CLICK and Send your entries now... Theme Harnessing ICT Potential for Development Selection Criterion Entries have to be unique and portray innovation in the usage of ICTs. We encourage entries to feature the use of ICTs at the grassroots.

Photo gallery will also be available on the website www.eINDIA.net.in

•

Don’t miss out on this exclusive opportunity to be a part of eINDIA2010, India’s largest ICT Event Last date for entry: 20th July, 2010

• •

Please Note • No images supplied in hard-copy will be accepted, only high resolution digital files will be accepted. • Acceptable entries will be from either digital cameras or electronic scans supplied on CD.

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All photographs need to be sent in high resolution JPEG format, 300 DPI. Entries will not be returned. Any combination of black and white, color or digital prints may be submitted. Only photographic processes will be accepted. All work submitted must be original, and completed in the last three years. A maximum of 5 entries per person will be accepted.

All entries must be correctly labelled with your name, contact details and the location at which the each image was taken. Provide details in the following format: Name.................................................................................................................. Address.................................................. State.................................................. Country.................................................. Post Code.......................................... Tel........................................................... Fax..................................................... Email .................................................................................................................. Photograph Description....................................................................................... …........................................................................................................................ …........................................................................................................................

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Eligibility Participation open to all above the age of 18. eINDIA2010 Photo Exhibition Outstanding photographs will be displayed at the eINDIA2010 Photo Gallery Exhibition at eINDIA2010 Conference to be held between 4-6 August, 2010 at Hyderabad International Convention Center, Andhra Pradesh, India

For queries, contact Sheena Joseph Mob: +91-9971841718

Visit us at eINDIA.net.in

contents

Volume 5 | Issue 7 | JuLY 2010 | ISSN 0973-8959 www.ehealthonline.org

PERSPECTIVE Hospital 34 Digital Enhances Performance and Patient Safety Gp Capt (Dr) Sanjeev Sood, Indian Air Force, Hospital and Health Systems Administrator

CASE STUDY the crest of 36 On a wave

Pg. 08

ZOOM IN A New 38 mHealth Healthcare Delivery Tool

cover story

08 the hidden hospital - A New Paradigm

EVENT REPORT

24 Converging Global Aspirations

Tajinder Vohra Senior Vice President, Genpact

IN conversation TECH TRENDS Low Down on 14 APicture Archiving and Communication Systems

POWER HOSPITAL

22 managing sugar

plays a leadership 28 “SAS role in business

Anurag Dubey, Industry Manager, Health IT and Healthcare Delivery Practice, South Asia and Middle East, Frost & Sullivan

IN FOCUS Medical 42 Nova Centers Establishing concept of day care surgeries

analytics” Ashit Panjwani, Executive Director – Marketing, Sales & Alliances, SAS Institute (India) Pvt Ltd

SPOTLIGHT Revolution 31 Online Delivering Healthcare at the Doorstep

> www.ehealthonline.org > July 2010

REGULAR FEATURES

46 NEWS REVIEW REVIEW | MONEY 48 NEWS MATTERS

Can we help make the Hospital Paperless?

Certainly!

Post Jobs Online for FREE @

www.ehealthonline.org Now a CAREER section specifically for professionals in eHealth, Health IT, Bio-medical Engineering, Medical Technologies, Medical Electronics, Telemedicine, Tele-health, Healthcare Operations and Administration. Employers can now give specific details for the positions available & Job Seekers too can finally get a clearer picture of what jobs are on offer for them. Get a clutter-free picture of the healthcare job market!!!

Get clicking on www.ehealthonline.org/careers to get started.

In the Right

Network

magazine reaches to all hospitals in the network of all major health insurers

For advertising opportunities: Arpan DasGupta, 9818644022, arpan@elets.in Rakesh Ranjan, 9953972742, rakesh@elets.in

> www.ehealthonline.org > July 2010

editorial

Volume 5 | Issue 7 | JuLY 2010 www.ehealthonline.org

Re-engineering Healthcare... Indian healthcare system is going through a transitional phase right now. Although the sector, as experts say, is growing at an exponential rate, it is also facing enormous challenges on its way. While medical technology and pharmaceutical development led the first two waves of improvements, using IT to manage and use information was the centre of focus for the third wave of the development. But Healthcare providers are still yet to realise the full potential of the ‘Process’ dimension, which can account for up to 70% of all hospital activities.

President: Dr. M P Narayanan Editor-in-Chief: Dr. Ravi Gupta Managing Editor: Shubhendu Parth

Although it is said that hospitals are unable to leverage their full potential and true value, it is also evident that healthcare has different levels of complexities and non-deterministic flows which make process optimisation tougher. In most hospitals, clinical processes encompass only 10-30% of the total processes, while non-clinical or back office processes make up the balance, where lies an opportunity of business process re-engineering, which can unlock hither to unknown potential of hospitals.

VP - Strategy: Pravin Prashant Product Manager: Dipanjan Banerjee (Mob: +91-9968251626) Email: dipanjan@elets.in Editorial Team: Dr. Prachi Shirur, Dr. Rajeshree Dutta Kumar, Shipra Sharma, Divya Chawla, Sheena Joseph, Yukti Pahwa, Sangita Ghosh De, Subir Dey, Pratap Vikram Singh, Gayatri Maheshwary Sales & Marketing Team: Arpan Dasgupta (Mobile: +91-9818644022), Bharat Kumar Jaiswal (+91-9971047550), Debabrata Ray, Anaam Sharma, Fahimul Haque, Ankur Agarwal, Priya Saxena, Vishal Kumar, Gaurav (sales@elets.in) Subscription & Circulation: Astha Mittra (Mobile: +91-9810077258, subscription@elets.in), Manoj Kumar, Gunjan Singh Graphic Design Team: Bishwajeet Kumar Singh, Om Prakash Thakur, Shyam Kishore Web Development Team: Zia Salahuddin, Amit Pal, Sandhya Giri, Anil Kumar IT Team: Mukesh Sharma, Devendra Singh Events: Vicky Kalra Editorial Correspondence: eHEALTH, G-4 Sector 39, NOIDA 201301, India, tel: +91-120-2502180-85, fax: +91-120-2500060, email: info@ehealthonline.org ehealth does not neccesarily subscribe to the views expressed in this publication. All views expressed in the magazine are those of the contributors. Themagazine is not responsible or accountable for any loss incurred, directly or indirectly as a result of the information provided.

Catch up in the ‘Cover Story’ of this issue on how Genpact leverages its proprietary scientific methodology, Smart Enterprise Processes (SEPSM), along with proven six-sigma and lean practices to deconstruct end-to-end hospital processes for meeting the goals of efficiency and while consistently delivering safe and high quality healthcare. The market penetration of Picture Archiving and Communication Systems (PACS) in India is gaining momentum owing to the growing popularity of digitisation at the level of hospitals and healthcare delivery centres. Look up the ‘Tech Trend’ section of this issue for a market insight of PACS and RIS in India. Last but not the least, ‘eHEALTH India 2010’ – the most definitive Indian event on healthcare ICTs, technologies and applications will once again bring together the entire community of health IT professionals, practitioners, end-users and decision-makers to engage over three power-packed days of active conferencing and networking, along with a vibrant exhibition to showcase some of the latest technologies that are on offer. Hope to see you at the event, between 4-6 August, 2010 at Hyderabad International Convention Centre!

ehealth is published by Elets Technomedia Pvt. Ltd in technical collaboration with Centre for Science, Development and Media Studies (CSDMS) Owner, Publisher, Printer - Ravi Gupta, Printed at R P Printers, G-68, Sector-6, Noida, UP, INDIA and published from 710 Vasto Mahagun Manor, F-30, Sector - 50, Noida, UP, Editor: Dr. Ravi Gupta

Dr. Ravi Gupta Ravi.Gupta@ehealthonline.org July 2010 < www.ehealthonline.org <

cover story

The Hidden Hospital - A New Paradigm In most hospitals, clinical processes encompass only 10-30% of the total processes. Non-clinical or back office processes make up the balance. Within this area lies an opportunity to dramatically decrease costs and increase efficiency through the adoption of alternative business models. Genpact’s Smart Enterprise Processes (SEPSM) is a unique methodology that enhances the efficiency of a hospital and enables it to deliver Tajinder Vohra Senior Vice President, Genpact

Genpact’s key hospital Clients USA > Miami Children’s Hospital > Saint Peter’s University Hospital > North Shore-LIJ (Long Island Jewish) Health system India > Ram Manohar Lohia Hospital > Lok Nayak Hospital > Lady Hardinge Medical College

safe and high quality healthcare.

hile the first two waves of improvements in the healthcare industry were led by technology and pharmaceutical development, the third wave has largely been focused on using technology to manage and use information. Healthcare providers have embraced these changes, albeit slower than in most industries, but are yet to realise the full potential of the ‘Process’ dimension which can account for up to 70% of all hospital activities. The processes deployed by healthcare providers have undergone very few changes as they remain relatively untouched by the tools and techniques, successfully used in other industries to drive efficiency and effectiveness. However, healthcare has different levels of complexities and non-deterministic flows which make process optimisation tougher. In most hospitals, clinical processes encompass only 10-30% of the total processes. Non-clinical or back office processes make up the balance. Within this area lies an opportunity to dramatically decrease costs and increase efficiency through the adoption of alternative business models. The hospitals are unable to leverage their full potential and true value – the “Hidden Hospital” - which can be unlocked by applying the correct tools and methods to their individual processes.

> www.ehealthonline.org > July 2010

Genpact, a global leader in business process and technology management, has introduced a new, proprietary methodology called Smart Enterprise Processes (SEPSM). This methodology enables continuous improvements in specific business processes across different industries by leveraging multiple tools like Lean, Six Sigma, IT, accumulated pool of knowledge and benchmarks. It makes the improvement process very deterministic instead of a discovery exercise.

Challenges faced by hospitals The Indian healthcare system faces some significant challenges: > Insufficient capacity Hospitals are experiencing severe capacity constraints which affect service quality, physician and patient satisfaction. The problems range from the lack of available beds, to Emergency Room (ER) overcrowding, to an increasing nursing shortage and delays in patient care. These problems constrain a hospitalâ&#x20AC;&#x2122;s ability to

The industry needs an alternative business model, which can positively impact financial and operational issues. Genpact leverages its proprietary scientific methodology, SEPSM, with a focus on improving processes between departments across three workflows: patient flow, supplies flow and cash flow.

Visit-to-Cash (V2C) SEP covers the entire cycle from the time a patient visits for a treatment to a hospital ultimately receiving the payment. V2C processes include: > > > > > > > > > > > > > >

Primary Care Physician to Pre-Registration Door to Diagnosis Lab - Order to Results Radiology - Order to Results Diagnosis to Disposition ICU transfer to Completion of care Medical prescription to Administration Intent to admit to Patient roomed Intent to discharge to Hospital room readiness Pre-operation to Transfer Out (OR) Warehouse/ Pharmacy to Point of Use (Medication/Medical Supplies) Patient access and on-boarding Utilisation review Administrative processes (billing, AR, AP)

develop new patient services and enhance revenue streams. > Sub-optimal operational performance Hospitals focus on improving departmental level efficiencies in delivering quality patient care. This siloed approach leads to multiple hand offs, inefficient use of infrastructure and can have potential patient safety issues. > In-effective cost and material management Issues such as overstocking and high stock of expiring and unused medicines, multiple points of storage and inability to track actual consumption add to a hospitalâ&#x20AC;&#x2122;s challenges. > Sustaining performance The lack of standard measurement systems to track performance of hospitals also impacts efficiency levels. Even in the best run hospitals, data and metrics are used only to diagnose past issues and not to predict and proactively tackle potential issues related to patient experience and safety.

Typically hospitals address the above challenges by: >

Building new hospitals and expanding existing infrastructure > Deploying more resources â&#x20AC;&#x201C; physicians, nursing staff, equipments and technology > Increasing inventory levels of medical and non-medical supplies > Providing relevant medical training and financial incentives These solutions are capital intensive, possibly one time solutions and not always easily implemented. The current challenges demand nothing less than a fundamental rethinking of hospital operations to improve outcome, increase capacity and meet the growing demand of users. The industry needs an alternative business model, which can positively impact financial and operational issues.

July 2010 < www.ehealthonline.org <

cover story

Operation Theatre

Radiology

Emergency Room

Admission

Supplies Flow

Registration

Patient Flow

Laboratory

END-TO-END- A NEW WAY TO LOOK AT HEALTHCARE PROVIDER PROCESSES

Cash Flow Fig 1: This horizontal end-to-end approach improves business outcomes by optimising the three flows across hospital departments utilising a combination of delivery platforms.

Unlocking the Hidden Hospital Genpact leverages its proprietary scientific methodology, Smart Enterprise Processes (SEPSM), along with proven SixSigma and Lean practices to deconstruct end-to-end hospital processes into three horizontal workflows (Fig 1) â&#x20AC;&#x201C; with a focus on improving processes between departments: > Patient flow > Supplies flow > Cash flow This horizontal end-to-end approach improves business outcomes by optimising these flows across hospital departments utilising a combination of delivery platforms. This enables a hospital to consistently deliver safe and high-quality healthcare.

Key benefits

Patient Experience

Applying SEP in hospitals: > Delivers P&L identifiable impact using a tested and non-intrusive diagnostic and delivery mechanism leading to increased revenue and margins and improved working capital > Identifies and builds a roadmap for a best-in-class organisation by linking granular level processes to critical business outcomes > Provides measureable improvements in a short time span by simple yet scientific tools and methods > Standardises processes and procedures leading to significant improvements in the areas of care quality, costeffectiveness and patient satisfaction Some examples of how processes can be improved across the V2C cycle (Fig 2) include:

> Stitch-to-Cut cycle times impacting surgical suite availability can be improved by 4-6% in 90 days by improving the patient flow process > Patient walk times can be reduced by 20% by optimising process flow and ergonomics

Supply Management

> Pharma and non-pharma stock levels can be reduced within the first 90 days to prevent overstocking without impacting care-giving processes > Overall supply costs can be further optimised by 8-12% by moving from physician preference items to standardised supplies > Expiration of medication and obsolescence of supplies contribute 1-3% of operating costs of wards and can be reduced by 30% in 90 days

SEPSM delivers significant financial impact and superior patient experience ACROSS THE VISIT TO CASH CYCLE

Fig 2

> www.ehealthonline.org > July 2010

cover story Payments/Cash Management

> Potential exists to improve First Time Right in Billing by up-to 25-30% by fixing avoidable and manageable root causes > Payer denials can be significantly reduced by fixing upstream processes like patient referral systems

Business Impact Genpact has been implementing SEPSM methodology in the Indian healthcare industry with considerable success (Fig 3). The focus is on driving process effectiveness across departments by measuring leakages at each level of the end-to-end workflow and applying best-in-class benchmarks and practices.

The Road Ahead As the healthcare sector reinvents itself, it is clear that survival will now depend on not doing more of the same, but viewing challenges differently and applying newer paradigms to how hospitals are structured to deliver care. Hospitals will have to move from departmental ‘silos’ to ‘value flows’ and process thinking is going to be

SEPSM has proven to be an effective tool in developing and implementing a continuous improvement blueprint of hospitals’ key processes.

SEPSM Delivers Business Impact

fig 3

> www.ehealthonline.org > July 2010

the most important lever for hospital CEOs. SEPSM has proven to be an effective tool in developing and implementing a continuous improvement blueprint of hospitals’ key processes. This allows hospitals to focus on clinical excellence, while being able to get maximum efficiency from support functions. It shifts the focus from managing in silos to managing processes that can be resilient and delivers sustained results.

tech trends

A Low Down on Picture Archiving and Communication Systems

he market penetration of Picture Archiving and Communication Systems (PACS) in India is gaining momentum owing to the growing popularity of digitisation at the level of hospitals and healthcare delivery centres. PACS integration with Radiology Information Systems (RIS) allows hospitalsâ&#x20AC;&#x2122; radiology departments to store, manage and retrieve huge amount of medical imaging data generated from various specialised imaging applications. Further, PACS allows easy and efficient access to this medical imaging information throughout the hospital. A seamlessly integrated RIS/PACS solution can tremendously enhance the productivity of an organisation by bringing in efficiently managed solutions for multiple departments.

> www.ehealthonline.org > July 2010

The RIS/PACS market in India, though still in a nascent stage, is set to achieve greater heights owing to increased opportunities in the health IT space. Divya Chawla from eHEALTH examines the intricacies of the RIS/PACS market with a focus on the market size, opportunities and challenges and the evolving technologies and trends in India.

Implementation of PACS is complex and costly, hence it is imperative to have a business oriented approach and judiciously plan to be able to balance the expenditure with the benefits that the solution offers. It also requires substantial time and resource, which needs to be managed right from the beginning. Therefore, the decision making process for implementing PACS must begin with having a clear understanding of the business and its future requirements, simultaneously balancing it with the benefits expected from the technology. Further, it is important to have an idea about the additional infrastructure requirements and how the PACS system will interface with the legacy and heritage systems. All parties involved in the decision making process should have an adequate understanding of the traditional paradigms and procedures for the delivery of imaging services, from the acquisition of the image to the delivery of the final image product to the customer, that will evolve after implementing PACS. Effective PACS purchasing decisions are based on efficiently planning, procuring, implementing, and evaluating the new system. Financial risks can be minimised if the PACS procurement and implementation is aligned with the organisation’s business and strategic technology plan. To make the best decision, the organisation can hire a vendor-neutral IT consultant with PACS expertise. As the scope and benefits of PACS extend to other departments, apart from the radiology department, as well, it may be worthwhile to involve these departments in the decision making process. Planning, workflow redesigning, system configuration and training form major aspects of a PACS implementation. Hence an effective planning process should be followed by an efficient implementation process to realise full benefits of the technology.

can hence bring about a positive change in the way modalities are managed inside a radiology department. Two major aspects that drive the integration of RIS/PACS are protocols and database sharing. The transmission protocol designed for image management using PACS is Digital Imaging in Communications Management (DICOM) and the standard adopted for management of patient information is Health Level 7 (HL7). To be able to manage PACS imaging data, the PACS application must have a DICOM interface, as HL7 cannot directly read DICOM data. Older RIS/PACS systems consisted for separate databases for patient images and patient records, which caused duplicacy of records at times and which created problems in accessing correct records from the system.

An integrated RIS/ PACS allows for access to more complex data that can be used for advanced business planning, by providing crucial information on profitability of various modalities, efficiency of physicians, productivity levels of all employees, efficient time-management and patient throughput rates.

RIS and PACS Integration An integrated RIS/PACS allows for access to more complex data that can be used for advanced business planning, by providing crucial information on profitability of various modalities, efficiency of physicians, productivity levels of all employees, efficient time-management and patient throughput rates. Leveraging on an RIS/PACS integration

For complete integration the RIS and PACS components must have a single database. The RIS/PACS integration may be interfaced (brokered) or integrated (brokerless). In the interfaced RIS/PACS system, the RIS/PACS has a DICOM interface, known as a PACS broker or gateway, which is a separate device combining hardware and software that interprets DICOM

Ashish Dhawad Founder & CEO Medsynaptic Pvt Ltd

“PACS market in India is on the cusp of high growth in coming years and the improving infrastructure in the hospitals and availability of low cost bandwidth would give way to new models like PACS in cloud, HyperPACS etc. Evolution of PACS technologies will continue to keep vendors on their toes to provide more features and advanced visualization techniques while reducing the overall costs. Medsynaptic is in a unique situation to tap this growth curve and will continue to be a leading player and innovator in this segment. We offer a range of products in this segment including: Medsynapse PACS—true web based PACS (enterprise solution), Medsynapse RIS—Webbased radiology information system and MiniPACS—lighter version of enterprise PACS for small hospitals and diagnostic centers.”

July 2010 < www.ehealthonline.org <

tech trends Key International Players > Agfa > Carestream > GE Healthcare

> Deenanath Mangeshkar Hospital, Pune > Dr Shyama Prasad Mukherjee Hospital, Delhi

> Siemens

> Fortis Hospital, Mohali and Delhi

> Fuji

> G Kuppuswamy Naidu Memorial

> Vepro

Hospital, Coimbatore > Indraprastha Apollo Hospital,

Emerging Local Players Sanjeev CEO & MD Medsphere Technologies

“PACS market from being very obscure and expensive just few years back has become commoditised and more affordable now. This has happened primarily because of storage and servers costs coming down dramatically and similar things being experienced in the networking space. PACS is fast getting accepted as a vital part of integrated patient care. Another aspect that is making a big difference is the increased awareness of computers among people in general and less resistance to it’s adoption by doctors. Combination of all of these factors has brought this industry to a point where the market could boom. We offer a range of FDA approved and HIPAA and HL7 compliant products in this segment including Basic Telerad, Enterprise level Telerad, Basic PACS, Enterprise level PACS and RIS/PACS. We have done more PACS implementations in the country in the last 18 months than all the other vendors put together.”

> 21st Century Healthcare solutions > Medsphere

Delhi > Jehangir Hospital, Pune > Kidwai Memorial Hospital, Bangalore

> MedSynaptic

> KIMS, Bangalore

> Ashva Technologies

> LNJP Hospital, Delhi

> Karishma Software

> MS Ramaiah Memorial Hospital,

> Perfint Technologies > Sobha Renaissance IT Ltd. (SRIT)

Bangalore > Max Devki Devi Hospital, Delhi > Madras Medical Mission, Chennai

> Softlink International

> NIMHANS, Bangalore

> Srishti Software

> P D Hinduja Hospital, Mumbai > Rajiv Gandhi Cancer Institute,

Major PACS Implementations in

Delhi

India

> Ruby Hall Clinic, Pune

> Aditya Birla Memorial Hospital,

> Sahyadari Hospital, Pune

Pune > Breach Candy Hospital, Mumbai > Amrita Institute of Medical Sciences, Coimbatore > Apollo Hospital, Chennai > Christian Medical College, Vellore

data for the RIS. The drawback of PACS broker is that it requires its own database that further hampers data integrity. In an integrated system, the RIS has the capability to read th DICOM data, thereby eliminating the need for a separate database. The disadvantage of this system is that it does not allow replacement of a single part as the entire system is completely integrated. A brokerless system, still offers more benefits as compared to a brokerless system as it allows for complete integration of RIS and PACS.

Integration Process An efficient RIS/PACS integration offers significant workflow improvements and the user must have a good understanding of the product to be able to choose the

> www.ehealthonline.org > July 2010

> Sree Chitra Tirunal Institute of Medical Sciences, Trivandrum > Tata Memorial Hospital, Mumbai > Vallabhbhai Patel Chest Institute, Delhi > Vikram Hospital, Mysore > Wockhardt Hospital, Bangalore

right solution and provider and achieve maximum from the integration. Completing an RIS/PACS integration requires active involvement of three parties—the RIS vendor, the PACS vendor and the client. It is imperative for all three parties to have a clear understanding of the final work, in absence of which the integration will not deliver its full benefits. The major challenges faced during this process include technological aspects, patient confidentiality and legacy systems. It is crucial for the vendors to have a complete understanding of the most efficient workflow for the integration coupled with the expectations of the clients. The final workflow must be decided in advance, on the basis of which the the timelines can be outlined. Also, the information available with

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tech trends

Anurag Dubey Industry Manager, Health IT & Healthcare Delivery Practice – South Asia and Middle East Frost & Sullivan

Vivek Kumar Verma Modality Manager -PACS-RIS Siemens Healthcare

“The radiology segment has taken the next step to upgrade image management and distribution, which is the need of the hour to improve productivity. As the IT infrastructure has developed quite fast in the country, it has helped to pave way for adopting IT based image management. It helps improve efficiency and allows seamless workflow that serves the patient quickly with high quality. The three main steps that have taken the radiology segment to next level for productivity gains include a radiologist’s ability to report from his workstation, the availability of patient exams and images in a Single Jacket, where previous reports and images are organised and accessibility of these reports to radiologists and physicians due to adoption of advance RIS systems available, and accessibility to patient images and reports across the network of physicians, radiologists, cardiologists and surgeons by adoption of IT in a seamless workflow that serves the patient faster, accurately and with high quality.”

Overview of PACS Market in India Major PACS Segments • Enterprise PACS – A Complete turnkey PACS with film-less operation • Modality PACS – Single-modality PACS such as ultrasound PACS, mammography PACS, Cardiology PACS etc Key features of PACS • Teaching repository • Automated offline centralized mechanism • Automated offline indexing • Disaster recovery functionality • Modality perform procedure steps (MPPS) • Medical grade display • Central archiving • Interoperability with other hospitals information systems • Teleradiology support • Interoperability with DICOM / Non-DICOM compliant • modalities • Scalable architecture Key market drivers For the Indian PACS market the key market drivers are the need for filmless environment, cost savings, better

> www.ehealthonline.org > July 2010

workflow through accessibility and availability, centralised storage, entry of local players, teleradiology services, increase in medical tourism, increasing competition amongst hospitals and increasing awareness and demand for quality healthcare. Market Restraints Some of the major market restraints are inadequate IT infrastructure (at referral doctors’ level) and low penetration of DICOM compliant modalities. The low growth of the PACS market, till now, may be attributed to high cost of installation (that is, cost of required software and hardware), low IT budgets of healthcare facilities, demand for films by patients and referral doctors, no clear RoI (perceived) and the attitude of healthcare facilities towards adoption of IT. Benefits of PACS The major benefits that a PACS solution offers include easy accessibility and availability of images, teleradiology services and cost reduction due to film reduction, increased productivity, faster transcription and reduced rates of repeated imaging.

Dr. Mallika Kapoor MD NextGen eSolutions

â&#x20AC;&#x153;NexGen eSolutions offers a range of exciting

RIS and with PACS must be understood to avoid functionality overlap. In case, there is an overlap, it is important to choose the product module that best suits the workflow. A good RIS/PACS integration must have the ability to maintain data integrity as inaccurate data can have huge impacts on patient care. To completely eliminate duplicacy of patient information and improve data consistency the DICOM modality worklist must be enabled. Further, the worklist for diagnostic interpretation must also be accurately managed, which can either be done by the PACS vendor or both the PACS and the RIS vendors. Also, the RIS/PACS integration must allow easy access to both images and reports of all prior diagnoses. The ability of the RIS/PACS integration must be tested under the most complex situations to ensure the efficiency of the system. Finally, the system must comply with all standards to be able to deliver the best to any radiology department.

enterprise technologies, and ability of PACS systems to be integrated with other imaging modalities. As the PACS technology has now evolved beyond being just a radiologycentric technology to a data management technology for various departments under a healthcare facility, the benefits it offers to the healthcare facility have multiplied. Further, increasing demand for advanced reporting and management capabilities owing to rise in imaging data volumes, coupled with technological advancements, and extending benefits beyond the radiology department to other modalities, are the major drivers for growth. Globally, the USA, Europe and Japan occupy the major chunk of the RIS/PACS market.

products in the RIS/ PACS segment including Hospital Information Systems (Hospilogix), which includes RIS; cathlab information system (Cardiologix) with a mini-PACS and scheduling solutions (Schedulogix). Further we have a MiniPACS product that is still in the testing stage. The major challenges that vendors in this segment face are price sensitive market, lack of standards,fragmented small hospital market and intense competition from international and domestic players.â&#x20AC;?

Market Insight The RIS/PACS market, the world over, is undergoing rapid expansion owing to the growing awareness about the benefits of digitisation in healthcare. The major drivers for this expansive growth are increasing adoption across imaging centers and hospitals, advancing communication and

July 2010 < www.ehealthonline.org <

tech trends

Sunder Natrajan CEO Ashva Technologies

With the rapid growth that we are witnessing in the radiology space and a significant shortfall in the availability of radiologists/ technicians, there is a definitive need for solutions that improves productivity and efficiency of both equipment and radiologists/technicians. There is immense data available that points out to the advantages of going digital. Ashva is the first Indian company to get its PACS FDA cleared. We have been recently recognised by Frost & Sullivan as the “Indian PACS Company of the Year 2009”. Ashva’s has more than a 1000 customers across its product range. From enterprise class radiology workflow (RadSpa) and PACS (EDGE) solutions to powerful radiology workstations (RADION), Ashva provides IT solutions to plug every need of the radiologist. New verticals such as orthopaedics, veterinary, dental, chiropractic are discovering the advantages of going digital and Ashva’s product line caters to these markets too.

cloud-hosted services for RIS/PACS. Other emerging technologies include Web based PACS, Thin client 3D rendering, Accurate Speech recognition for Indian accent and HyperPACS for hospital chains. Enterprise PACS solutions are creating the maximum excitement in this segment as it provides benefits to multiple departments in a hospital. With newer hospitals coming up, the RIS/PACS market has a great scope for growth in future. The good news is that now, the government has also realised the potential of IT and are implementing key IT solutions in most of their major healthcare projects. Emergence of health insurance and medical tourism has further compelled hospitals to adopt best solutions, which may act as a major factor towards fuelling growth or RIS/PACS. While the advantages of digitisation are well known in the developed countries, Total RIS/PACS Market in India developing nations like India are yet to realise the full potential of IT in healthcare. The biggest challenge that countries like India are facing is to extend the reach of these technologies, beyond the tertiary care hospitals and network of corporate diagnostic centres. India has a large number of independent Total PACS Market in India imaging centres that have still not adopted technologies like PACS, because of the high price tags attached to them. Cost-sensitive nature of the Indian market is the key challenge that vendors face to enhance the reach of their products. Healthcare ehealth research providers feel the need to balance the high costs with the benefits Although implementation of RIS/ it delivers to enhance productivity and PACS is an emerging trend in this market, efficiency as most organisations right now the next step would be the advent of have no budget for IT implementation. The Indian market for RIS/PACS is still evolving, and is yet to catch up with the global trends. However, owing to the increasing acceptance of healthcare providers towards IT implementation in various healthcare processes. The overall RIS/PACS market in India is estimated to be USD 7 million, of which PACS, valued at USD 6 million, accounts for almost 86 percent of the market pie. The remaining 14 percent is accounted for by RIS, valued at USD 1 million. The PACS market can be further segmented into—bundled PACS and modular PACS. Valued at USD 4.2 million, bundled PACS accounts for 70 percent of the overall USD 6 million PACS market. Modular PACS is still a smaller segment, accounting for the remaining 30 percent, valued at USD 1.8 million.

> www.ehealthonline.org > July 2010

power hospital

managing sugar MV Hospital is Indiaâ&#x20AC;&#x2122;s First Hospital for Diabetes, situated at Royapuram, Chennai. It was established by late Prof. M. Viswanathan, Doyen of Diabetology in India, in 1954 as a general hospital. In 1971 it became a hospital exclusively for diabetes care. Under Prof. M. Viswanathanâ&#x20AC;&#x2122;s professional and administrative leadership, the hospital has grown to achieve the status of a teaching institution of international excellence.

V Hospital for Diabetes situated at Royapuram, Chennai, was established by late Prof. M. Viswanathan, Doyen of Diabetology in India, in 1954 as a general hospital. In 1971 it became a hospital exclusively for diabetes care. Under Prof. M. Viswanathanâ&#x20AC;&#x2122;s professional and administrative leadership, the hospital has grown to achieve the status of a teaching institution of international excellence. The hospital along with the Diabetes Research Centre undertakes research and imparts postgraduate training in diabetology to doctors. It has, at present, 100 beds for the treatment of diabetes and its complications. Over the years, it has grown to be one of the largest referral centres for diabetes, with 2,00,000 patients registered to-date. It is recognised as an internationally known tertiary care centre for referral of diabetic patients requiring the opinion of a super-specialist and for diabetes management. The hospital has several unique features. The departments of the hospital include OPD, a sophisticated high technology diagnostic laboratory, facilities for major emergency and elective surgery, departments for early diagnosis of diabetic kidney and eye disease, Doppler studies and Biothesiometry studies for early diagnosis of Diabetic Foot complications, department of imaging and treadmill Stress testing for the diagnosis of Ischemic heart disease and establishing the prognosis, foot wear department and a modern ICU and casualty department. The staffing pattern of the institution includes diabetologists, physicians, surgeons and various other members of the diabetes health care team including highly qualified dietitians, specialist nurses and

> www.ehealthonline.org > July 2010

Hospital Specialities \\ Diabetes Care and Education

\\ Special Diabetes Counselling

in-house footwear manufacturing

\\ Diabetes Heart Evaluation

\\ Nutrition and Diet Counselling

unit for special needs of diabetic

\\ Preventive Diabetes Foot Care

\\ Impotence Clinic

patients with all types of foot

(Podiatry) \\ Diabetic Eye Care \\ Appropriate Dental Care for Diabetic Patients \\ Diabetes Neuropathy Clinic \\ State of Art Diagnostic Laboratory

assistants specially trained as diabetes health educators. The entire set up is an organisation built to provide modern outpatient and inpatient services to diabetic patients and their families. The hospital is recognised by several public sector undertakings and corporations and large private sector companies for the purpose of treating their executives and employees. Diabetes Research Centre The Diabetes Research Centre Foundation, Chennai, was started to promote research in the field of diabetes mellitus. Established in 1972, it was soon recognised as a research institute for undertaking advanced research in diabetes by the Indian Council of Medical Research. In 1983 it was recognised by the Department of Science & Technology

\\ Obesity and Lifestyle Counselling \\ Pain Clinic for special problems in diabetic patients like frozen shoulder

problems \\ Multi-disciplinary Diabetic Foot clinic with all surgical experts \\ Dia-Shoppe with products

\\ Special Yoga classes for diabetes control

and medicines for diabetes treatment

\\ Trained Orthotist and complete

(DST), Government of India, New Delhi as a research institute. The centre has been in the forefront of clinical and basic research in diabetes in this country. Today the Centre has research collaboration with several prestigious institutes and universities in USA, UK, Europe and Australia. Work done at the centre has resulted in nearly 500 original research papers including over 300 published in some of the most prestigious diabetes journals from USA and Europe. The Centre ensures appropriate translation of research findings into improvement in patient care and public health.

International Recognition & Related Activities M.V. Hospital for Diabetes & Diabetes Research Centre has been designated by

\\ Weight Management Clinic

the World Health Organization, Geneva as the WHO Collaborating Centre for Research, Education and Training in Diabetes in India. The Collaborating Centre forms part of an institutional collaborative network set up by The World Health Organization in support of its plan of action for the control and prevention of diabetes mellitus by evolving appropriate programmes at country, inter-country, regional, inter-regional and global levels as necessary.The World Health Organization and the Govt. of India for the first time have identified our centre for training of diabetes health care providers under the scheme of WHO Fellowship Programme in Diabetes Mellitus. WHO is sponsoring fellows including doctors and nurses for training at our Centre.

July 2010 < www.ehealthonline.org <

Event report

CommunicAsia2010 and BroadcastAsia2010 provided a strategic venue for the exhibitors by bringing buyers and sellers together from across Asia and highlighting the newest technology innovation in ICT, broadcasting and media industries.

Converging Global Aspirations

ommunicAsia is recognised as one of the premier business events in Asia for the global information and communications technology (ICT), broadcasting and media industries. Held in Singapore from 15 - 18 June this year, the event, CommunicAsia2010 and BroadcastAsia2010 has caught the eyes of the industry when it recorded 15% more international attendees that includes overseas attendees from 100 countries and regions made up to 56% in comparison to 49% last year. There were 55,150 local and international industry visitors, conference speakers and delegates, and were close to 2,000 exhibiting companies from 57 countries and regions at the event. As the event saw more overseas visitors this year the expectation is a double digit growth from a year ago. “The increase in overseas attendees, particularly those from the Asia Pacific region, reflects the anticipated rebound in IT and media spending and how companies are ready to invest for further growth in Asia,” said Stephen Tan, Chief Executive, Singapore Exhibition Services (SES).

Premiere of innovative products and technologies Organised by the Singapore Exhibition Services (SES), one of the most innovative exhibition and conference organisers in Asia, CommunicAsia aimed to seek the best returns on investments and to determine the best value and latest

> www.ehealthonline.org > July 2010

convergent technologies and applications, since 1979. Into its 21st year, CommunicAsia2010 highlights the newest technology innovation in the ICT industry in the like of today’s digital convergence landscape. Products being showcased ranges from the latest technologies in applications, solutions to hardware. NTT DOCOMO showcased their latest smartphones for the Japan market, including their new separable phone. Yahoo! showcased the new Alcatel One Touch Net mobile, its first handset fully integrated with Yahoo! applications and designed to provide an integrated approach to communicating using a Yahoo! platform. Skype, a first time exhibitor at CommunicAsia2010, showcased several applications at their booth and announced the availability of Skype on three Sony Ericsson smartphones based on the Symbian platform. Inmarsat’s IsatPhone Pro service, its first global handheld satellite phone, premiered worldwide at the show this week. ZTE unveiled the ZXY10 T700, the first integrated HD videoconferencing terminal. In addition, mobile application stores were also unveiled by Infindo, Telekom Malaysia (TM), M1, NTT DOCOMO and Research in Motion (RIM) among others.

Spotlight on 3D at BroadcastAsia2010 3D technologies dominated the exhibition at BroadcastAsia2010. International and local exhibitors such as AV8 Media, Cine Equipment, Harris Corporation, Panasonic and Sony Electronics announced their latest professional equipment, solutions

and technologies for broadcasters and production companies. The ‘live’ 3D showcase by exhibitors Broadcast Pro, Dayang, Evertz, Panasonic, Maestro, Ross Video and SeaChange brought 3D to life through the specially created content and gave visitors a feel of the upcoming technology. Panasonic, a regular exhibitor at BroadcastAsia, presented an actionpacked display of live Muay Thai and entertainment demonstrations that were

There were exciting launches by exhibitors from Asia, like Altek Corporation, DIGILINK, NTT DOCOMO and ZTE, as well as leading international players viz. Inmarsat, Skype and Yahoo! recorded in 3D and instantaneously beamed on projectors above the booth. Panasonic showcased their latest range of professional equipment and camcorders, including the world’s first professional, fully-integrated Full HD 3D camcorder that records to SD card media. Sony Electronics returned to the show with cutting-edge 3D and high-definition (HD) broadcast and production solutions. The company also unveiled Singapore’s first HD OB trailer built for national broadcaster Mediaorp at BroadcastAsia2010.

Underlining Asia’s vast potential for growth Exhibitors and visitors at the event were impressed with the business opportunities in the region as Asia continues to remain resilient with vast potential for growth. “CommunicAsia2010 enabled us to meet with over 300 potential and existing

customers who hail from regions of Asia Pacific, Africa and the Middle East, a significant increase of more than 40% compared to around 200 meetings in 2009,” said Thong Poh Wah, Director (PR), Asia Pacific Marketing and Strategy Department from Huawei Technologies Co., Ltd. According to Mervin Wang, Head of Marketing Services, Sennheiser Asia, Sennheiser has been exhibiting at BroadcastAsia annually to meet new customers, and to renew business relationships. Even year 2010 has seen good visitorship at its booth. Further to that, Ken Clark, General Manager International, Fiji TV observed, “Fiji TV will be setting up new TV stations and are looking at purchasing new equipments. At BroadcastAsia and CommunicAsia, I get to hold valuable and quality meetings with exhibitors. My first trip here is definitely a very fruitful one.”

Conferences and workshops The CommunicAsia2010 Summit and BroadcastAsia2010 International Conference featured over 150 conference sessions and workshops and an impressive line-up of over 200 veteran industry speakers from leading companies and organisations addressing various pertinent issues and challenges affecting the ICT, broadcasting and media industries and provided trade visitors with valuable insights on industry trends and growth opportunities. Over 1,400 speakers and delegates participated in the CommunicAsia2010 Summit, BroadcastAsia2010 International Conference and the Creative Content Production Conference. Following to the success of the current event, CommunicAsia2011 and Broadcast Asia 2011 will be held at new venues Marina Bay Sands and Suntec Singapore respectively from 21-24 June 2011.

July 2010 < www.ehealthonline.org <

indiaâ&#x20AC;&#x2122;s Largest ICT Event 4â&#x20AC;&#x201D;6 August, 2010

Hyderabad International Convention Centre Hyderabad, India

Venue eINDIA 2010 HICC Hyderabad

Host State Partner

Organisers

Co-organisers

industry partners

Country Partner

TRAC KC HA

J Satyanarayana Chief Special Secretary Dept of Health & Family Welfare, Government of Andhra Pradesh

0 eINDIA 2 Secretari010 at G-4,

Se Noida - 2 ctor - 39, 0 Ph: +91-12 1301, UP, India 0 Fax: +91- -2502180-85 Email: info 120-2500060 @eINDIA .net.in

SPECIAL SESSIONS

LTH IND I A HEA 20 -e 1

l National Health IT Infrastructure l Healthcare Reforms through ICT l Hospital Automation & Systems Management l EMR & Medical Informatics l Medical Imaging, RIS & PACS l Shared Services Infrastructure & Hosted Models l Clinical, Bio-Medical & Drug Information Systems l Telemedicine & Tele-health l Online and Mobile healthcare l Technology Standards and Interoperability Issues

KEY TOPICS & THEMES

0+ 2L0EGATES

DE am Progr ies Enquir jee

Baner Dipanjan @elets.in an nj dipa 8251626 6 9 +91-9

/ orship Spons ies: ir u q n E ition s.in et el Exhib n@ a, arpa

0k+ 5 rs e p a e

gupt Arpan Das 644022 +91-9818

l Reform, Transform, Perform – charting technology

blueprint for the future of Indian healthcare

Del Registegate enquration Priya S iries a

l ‘Hospital CIO Conclave’ – technology strategy for

xena +9 199 registra 99349399 tion@e INDIA.n et.in

next generation hospitals’ l ‘Health Secretary Conclave - transforming public health through technology’

50+

top healthcare organisations

Key Speakers Sam Pitroda Advisor to the Prime Minister Government of India

J Satyanarayana Chief Special Secretary, Dept of Health & Family Welfare, Government of Andhra Pradesh

Sangita Reddy Executive Director Apollo Hospitals Group

A Babu CEO, Arogyasree Health Care Trust Government of Andhra Pradesh

Dr Neena Pahuja CIO, Max Healthcare

Dr Ashok Kumar DDG & Director, Central Bureau of Health Intelligence, Government of India

Dr Karanvir Singh Consultant Surgeon & Head-Medical Informatics, Ganga Ram Hospital

Dr Shakti Gupta Professor & Head, Dept of Hospital Administration, AIIMS

Group Captain (Dr) Sanjeev Sood Indian Air Force

Manish Gupta CIO, HCG Enterprises

Sandip Basu Thakur Associate VP (IT), AMRI Hospitals

U K Ananthapadmanabhan President, Kovai Medical Centre & Hospital

Dr Thanga Prabhu Clinical Director-HCIT, Wipro GE Healthcare

Dr Pavan Kumar Consultant Cardiologist & Head - Telemedicine Master Centre, Nanavati Hospital, Mumbai

... AND many MORE

www.eINDIA.net.in/ehealth

in conversation

â&#x20AC;&#x153;SAS plays a leadership role in business analyticsâ&#x20AC;? Established in 1997 as a wholly owned subsidiary of SAS Institute Inc., SAS India offers superior software and solutions for analytics across various industry verticals. In conversation with Divya Chawla from eHEALTH, Ashit Panjwani, Executive Director â&#x20AC;&#x201C; Marketing, Sales & Alliances, SAS Institute (India) Pvt Ltd, shares insights into the business of health and life sciences vertical of SAS.

What are your views on the health IT market in India vis-avis the global market? The health IT market in India is reflecting a good growth rate and the growth trends of India and the western countries are almost comparable. Some of the challenges that the health and life sciences industry face include pricing, pipeline pressures, date of expiry, and soaring drug development costs, among others. Also, intellectual property rights pose as a major challenge for these organisations. As a result of these challenges, these organisations have been key adapters of information technology to overcome these challenges. So these are really exciting times for health IT vendors, especially SAS as most of the healthcare organisations within the top 500 fortune companies work with us. These healthcare organisations see tremendous amount of value involved in the solutions we offer. There is a great opportunity in this market for the kind of solutions that we offer, especially for business analytics and we are seeing some excellent growth rates. Please provide an overview of SAS and its presence in the healthcare vertical in India. Do you feel growth in the healthcare vertical is as dynamic as in other verticals? SAS is the number one privately held company and the leader in the field of business analytics. We serve more than 45,000 customers, worldwide. In India, we have been present for the last 10 years and play a leadership role in the field of analytics, here as well and account for more than 50 percent of market share in this area. Health and life sciences is one of our key verticals and we have been working with major customers in this area, both globally as well as in India. We cater to various verticals or sectors within the life sciences sector including pharma, clinical research organisations and health insurance providers, among others. SAS has been extremely excited to work in this market and the kind of response that we have got from this market is extremely encouraging. In terms of analytics and data management, every vertical has different drivers for adopting our solutions. For instance, banking and finance vertical may have risk-management as a motivating driver. As far as health and life sciences space is concerned, it has a number of motivating factors for adopting our solutions. First is that with our solutions, these organisations are able to drastically reduce the drug launch time. Secondly whatever submissions they make through us

> www.ehealthonline.org > July 2010

are all FDA compliant. Also, the kind of analytics we have, helps organisations derive great amount of insights with the huge clinical data that is generated. Please tell us about the solutions you offer for the health and life sciences space. The health and life sciences industry faces key challenges and one of them is the time taken by a drug manufacturer, right from the clinical trials phase to the time it is launched in the market. The reason why this process is so time consuming is because the result analysis involves huge amount of data management and analytics. To be able to compress this time cycle, the data management process must be highly efficient, as data management takes more than 65 percent of the trial time. By compressing this cycle, drug manufacturers can launch their product sooner in the market sooner, which results in a quantifiable advantage for them. The second challenge is how to automate the entire drug discovery process, which can be addressed through our solutions. The third area is physician targetting, which is another challenge faced by the organisations. SAS forms a channel for FDA submissions, which considerably reduces the time taken for organisations to launch their products. We also support various compliance standards like CDISCâ&#x20AC;&#x201D;Clinical Data Interchange Standards Consortium, which is a standard for clinical data management.

Ashit Panjwani Executive Director â&#x20AC;&#x201C; Marketing, Sales & Alliances SAS Institute (India) Pvt Ltd

Do you have plans to venture into the hospitals and diagnostics space, as well? We certainly have plans to extend our solutions beyond the life sciences and the clinical research verticals. One of the key areas is health insurance, which is extremely interesting and we are planning to get into this segment for sure.

July 2010 < www.ehealthonline.org <

in conversation Please enlist some of your major clients in India. We work with a number of customers in India such as Clinigene, Novo Nordisk, Novartis, Wyeth, GSK Pharma, Ranbaxy, QED Pharma, and several others. We work with both global clients as well as Indian clinical research organisations. The level of IT penetration in healthcare in India is still catching up. Please share your views on the scope of growth of solutions like PheedIT in India. PheedIT solution is a flagship product for clinical data management. IT penetration in healthcare in India is low, however, IT penetration within the clinical part of an organisation is extremely crucial because there is no other alternative for managing data. With IT, the entire process of data management and analysis is going to be extremely time consuming. SAS is already an able organisation that creates data in FDA format, which reduces the cycle time. Time is extremely important while launching a product in the market, as other drug manufacturers might be planning to launch a similar product in the market. The advantage that SAS offers is that it not only helps organisations in data management, but it also does highend analytics, which is an integral part of launching a drug in the market. Please share your experiences on the recent deployment of PheedIT at Clinigene. Clinigene is a very valued customer of SAS and they use our solution PheedIT for complete end-to-end clinical data management. When a drug goes through various processes of a trial cycle, a huge amount of data is generate, which needs to be analysed and this is the kind of challenge that Clinigene was facing and by deploying PheedIT, they have been able to overcome this challenge to a huge extent. Other challenges that Clinigene was facing were patient recruitment and motivating

â&#x20AC;&#x153;We plan to keep the right focus with customers and offer the kind of analytics that can benefit our customers. We want to help our clients in their journey towards embracing our solutions.â&#x20AC;?

patients to come back for clinical trials, how to manage data and how to use these results for deciding the launch cycle. With PheedIT, Clinigene not only reduced the trial time, but also overcome various other challenges attached to launching drugs in the market. What is the approximate investment required to adopt your solutions? The amount of investment depends upon what exactly the organisation wants, the stage at which they are and what exactly they want to do. Our team works with these organisations to analyse the amount of work required. We work with both aspirational organisations and organisations that have established themselves. So there is a value proposition of an emerging organisation and an established organisations. What strategies do you follow to maintain your footprint in the health IT space? Our focus has always been on the customer and we will continue to do that. This approach, we believe, will itself take care of the competition. what are the major opportunities and growth prospects do you see in the Indian market? A great opportunity is generating an enterprise-wide solution for health and life science customers. Another opportunity that we see is in the area of drug development and how our solutions get deployed for drug development processes. Third area is clinical data

> www.ehealthonline.org > July 2010

integration as a lot of data gets generated during various processes and how this data can be integrated for analysis. what are the major challenges in the field? We have been fortunate enough to not encounter any major challenges. But some of the basic problem faced is the culture of the organisation, which is extremely important. Converting a manual process to an automated process is difficult and requires some amount of cultural change. Secondly, maintaining the quality of data is a challenge and thirdly, the source in which the data exists may pose some difficulties, but all these can be overcome. What is the importance of regulatory standards in this space? There are various global regulatory bodies and all the pharma companies are following the standards laid by these bodies. There is FDA and CDISCâ&#x20AC;&#x201D;which looks into the technological aspect and ensures that the clinical data provided is in the right format. These bodies on the whole ensure that the data provided is accurate enough to be used for drug development. Best part about SAS is that whatever we do is compliant with the standards laid by all these regulatory bodies. What are your plans for future growth? We plan to keep the right focus with customers and offer the kind of analytics that can benefit our customers. We want to help our clients in their journey towards embracing our solutions.

spotlight

Online Revolution Delivering Healthcare at the Doorstep

Couth Infotech partners with pinkWhale Healthcare to develop an integrated personalised online healthcare solution platform www.pinkwhalehealthcare.com divya chawla explores.

he Indian healthcare sector is suffering from an acute shortage of healthcare professionals and facilities delivering quality healthcare services to the citizens. According to a survey carried out in 2008-09, India has only around 85,000 doctors, who practise modern medicine and 1.5 million nurses to serve its more than one billion population. The country falls short of 28,000 health centres including 20,855 sub-centres, 4,833 primary health centres and 2,525 community health centres. While the government hospitals are over-burdened and lack adequate number of professionals to serve the patients, the private sector is highly-priced and unregulated. A potential solution to bridge this gap is online healthcare, which has emerged as a very important tool for offering healthcare services that can be accessed by patients across the globe.

Online healthcare connects patients and doctors via Internet services. Specialised health portals have been developed that offer customised health services that are accessible to all. People log onto online healthcare portals for consultations, booking appointments, maintaining their health records, and getting second opinions, among various other services offered. A recent initiative in this space is the launch of www.pinkwhalehealthcare.com, an integrated personalised health solutions platform. Developed by pinkWhale Healthcare in partnership with CouthIT, the portal offers a range of online healthcare services that can be accessed by anyone from anywhere at anytime. “CouthIT was established in 1999 and is based in Hyderabad, India. We have two business units: Embedded Software Group (ESG) and the Application Software Group (ASG). ESG focuses on embedded middleware technology associated with speech, audio, and video applications and primarily works with OEM companies around the world. ASG has domain expertise in healthcare and data-mining with specific focus on developing Internet applications that are scalable. ASG primarily works with small and medium companies based out of the US and more recently, we started working with domestic companies, as well. We have developed several online healthcare applications for our customers based in the US. These applications were designed for student health centres in universities, primary care centres, and small-scale community hospitals. Our customers benefited immensely by outsourcing their development activities to CouthIT”, explained Dr. Krishna Nagarajan, Chief Executive Officer, CouthIT. Talking about pinkWhale Healthcare Pvt Ltd, Dr. Anita Shet, Chief Executive Officer, pinkWhale Healthcare said, “pinkWhale Healthcare Services Pvt Ltd (‘pinkWhale’) headquartered in Bangalore, India, is an initiative in the eHealth space with a goal to make quality healthcare easily accessible anytime anywhere.

July 2010 < www.ehealthonline.org <

spotlight

Dr. Krishna Nagarajan Chief Executive Officer CouthIT

It was incorporated in May 2009 and the healthcare portal went live on 23rd of May, 2010. pinkWhale (www. pinkwhalehealthcare.com) has created an online healthcare system that allows consumers to virtually connect with the doctors and specialists, to get immediate medical advice, using the latest technologies. pinkWhale is proud to be one of the few Internet service companies which is led by women entrepreneurs, who have a proven track record in the medical, technology, process, sales and marketing. pinkWhale has made and will continue to make strategic partnerships with various service providers of global repute to be able to provide premium home-based healthcare services.” Throwing light on the initiative, Dr. Krishna Nagarajan said, “the web

medical professionals, and very high cost of healthcare. In developing countries, healthcare is not accessible to the entire population and they lack basic infrastructure. We have our foot in both these worlds. How we leverage information technology based healthcare, here in India, can serve as a role-model for the rest of the world. We have our challenges–gaining acceptance from medical fraternity, interoperability, broadband coverage across the country, and funding. But there is awareness and convergence across quarters in addressing these challenges in a systematic manner. With the widespread use of mobile phones, deployment of 3G and Wi-Max services, and leveraging India’s IT expertise, we are bound to see some very innovative, creative, low-cost healthcare IT based solutions coming out of India.”

portal, www.pinkwhalehealthcare.com, was launched by PinkWhale Healthcare on May 23, 2010. CouthIT is the development partner and our Application Software Group developed this portal for PinkWhale Healthcare. This portal provides innovative features such as interacting with doctors via phone, chat, and even video, facility to organise healthcare records in a systematic, interoperable system, scheduling homebased diagnostics tests, etc. To my best knowledge, this is the first application of its kind to be launched in India.” Dr. Anita Shet added, “pinkWhale (www. pinkwhalehealthcare.com) is an online healthcare system that allows consumers to virtually connect with the doctors and specialists, to get immediate medical advice, using the latest technologies.”

> www.ehealthonline.org > July 2010

Services Offered by the Portal The portal offers five major services: Call a Doctor Web Consult Personal Health Records Home-based Diagnostics Expert Opinion According to Anita Shet, “pinkWhale provides the consumers quick and secure access to medical experts and helps them maintain their own personal health records. The online medical advice can be obtained via a secure online chat, or over phone through the IVR services, consumers can also opt to discuss with any of the specialists for an expert/ second opinion using the secure online application from anywhere. The PHR system is one of pinkWhale’s proprietary products which have been designed by a team of medical experts and technologists. Consumers can now upload and update all their medical records (scans, test reports, prescriptions, etc.) in one single place and access them from anywhere on the go. It is a very comprehensive, easy-to-use solution, which also has features like SMS alerts that help the user be informed regularly of their health status and appointments. pinkWhale enables value added services like home-based diagnostic services to the consumers at an affordable and discounted price. PinkWhale as part of its team has general physicians with clinical experience from the industry reputed hospitals. The specialists consultation panel comprises of highly acclaimed and recognised medical professionals of different specialisations who consult in accredited hospitals in India and abroad. pinkWhale believes that its service will compliment the present healthcare system and aims to revolutionise the way primary healthcare services are being delivered and managed.” > > > > >

Technology Talking about the technology behind the portal, Dr. Krishna Nagarajan explained that, “PinkWhale web portal

Anita Shet Chief Executive Officer, pinkWhaleHealthcare

“Recently, I heard an eminent speaker say that IT has failed to deliver in two key areas: healthcare and education. There is a great push now to make IT work in healthcare – both in developed and developing countries, especially in areas such as telemedicine. The developed countries have an ageing population, not enough medical professionals, and very high cost of healthcare. In developing countries, healthcare is not accessible to the entire population and they lack basic infrastructure. We have our foot in both these worlds. How we leverage information technology based healthcare, here in India, can serve as a role-model for the rest of the world. We have our challenges–gaining acceptance from medical fraternity, interoperability, broadband coverage across the country, and funding. But there is awareness and convergence across quarters in addressing these challenges in a systematic manner. With the widespread use of mobile phones, deployment of 3G and Wi-Max services, and leveraging India’s IT expertise, we are bound to see some very innovative, creative, lowcost healthcare IT based solutions coming out of India.”

was developed using Joomla content management system (CMS), which enables you to develop feature-packed, comprehensive, online applications. PinkWhale’s application leverages on LAMP technology that consists of Linux, Apache, MySQL, and PHP, which when combined, is an effective ‘enterprise solution’ that is very popular in the Internet world as it works on open source guidelines. We at CouthIT leveraged our technology experience in PHP, MySQL, and Apache to create cost-effective and robust applications that can scale well. We are just as comfortable with designing and creating custom applications/ modules from scratch. CouthIT’s domain experience in healthcare with successful deliveries for the US market played a crucial role while developing key modules such as Call a Doctor, Web Consultation, Managing Health Records, Home Based Diagnostics, and Expert Opinion providing a unique patient and provider perspective.” Dr. Shet said, “The innovation uses advanced Web-based technologies

(Joomla & LAMP - Linux, Apache, MySQL, and PHP) and telephony to develop a unified eHealth management platform aimed at overcoming traditional barriers to healthcare access, including geography, mobility and time constraints. The other technologies used in our overall solution are Interactive Voice Response System (IVR), Instant Messaging (IM), Web collaboration tools, secure online payment and SMS alerts to ensure simple and easy access. pinkWhale having a team with strong technology background was able to conceptualise the overall solution and plan to use the right technologies to come up with the apt solution. CouthIT perfectly complimented pinkWhale with a strong technical execution team with world class project management capabilities.”

Business Model While several platforms for delivering online healthcare are now run by companies around the world, the business model for these differ depending on the type of services offered. Throwing light

on the business model for pinkWhale, Dr. Shet said, “pinkWhale aims to address the market in 2 ways—Business to Business (B2B) and Business to Consumer (B2C). In the B2B model, the target would be groups of consumers such as employees of a company or apartments and gated communities. This market would be addressed by packages offering a combination of services (such as multiple calls and chats) along with bulk discounts. To address the retail market, there would be options of charges per call or per chat and packages offering a combination of services. Consumers would pay by credit or debit card through the phone or Internet and avail the services. The other avenues of generating revenue would be through fees for consultations with specialists on the pinkWhale panel and home collection of diagnostic samples for which booking would be done though the pinkWhale website and the services would be provided by a partner. The PHR would be available as a stand-alone option (as a separately priced product) or as part of the packaged services.”

July 2010 < www.ehealthonline.org <

PERSPECTIVE

Digital Hospitals Enhance Performance and Patient Safety GP capt (Dr) Sanjeev Sood, Hospital and Health Systems Administrator serving in indian air force, Jodhpur, provides useful insight into the benefits achieved

Gp Capt (Dr) Sanjeev Sood Indian Air Force

due to successful digitisation of a hospital in the USA.

The Indiana Heart Hospital is revolutionising cardiovascular services in central Indiana, providing the state’s only 24-hour cardiac emergency room, a cardiologist on-site 24/7/365, all-digital technology allowing for faster, more efficient care, and a team of caregivers with a passion for your life.

America’s largest industry, healthcare, is struggling to contain cost, unacceptably high medication errors and improve quality. Thousands of healthcare facilities world over, private and public, attempt to do it. Not all are as successful as Indiana Heart Hospital (IHH), in Indianapolis, Indiana, which offers complete integrated cardiovascular care, including heart surgery, bypass surgery, angioplasty, outpatient cardiac rehabilitation and more. As one of Indiana’s top-100 cardiovascular hospitals, The Indiana Heart Hospital is revolutionising cardiovascular services in central Indiana, providing the state’s only 24-hour cardiac emergency room, a cardiologist on-site 24/7/365, all-digital technology allowing for faster, more efficient care, and a team of caregivers with a passion for your life.

The challenges Heart disease is the number one killer in the United States and globally, and in a cardiac crisis each minute matters to salvage the myocardium. Indiana Heart Hospital (IHH) is a new cardiac digital hospital that wants to save lives by radically cutting the time it takes to treat a heart attack, door to needle time. In addition, this for-profit hospital must make sufficient profit for its investors to remain economically viable. Decisions are being made constantly by physicians, nurses, administrators, and other employees. Some decisions must be made very quickly, so the necessary data and information must be available at the right time and place in seconds (Embedded real time business technology). Also, the hospital must be managed efficiently.

> www.ehealthonline.org > July 2010

The solution IHH is the first wholly digital hospital in the United States. At the heart of the hospital information system, there are 18 terabytes (in 2005; today more) of data stored in a network of IBM Shark servers. The shark servers enable the storage of both historical and real time data. When a patient arrives at the hospital, his or her medical records can be retrieved and displayed on a screen in 15 seconds; so quick decision can be made on what treatment or investigations the patient needs to undergo. The results of any new test are immediately added to the patientâ&#x20AC;&#x2122;s electronic medical records. Of the various applications available for planning and analysis, especially in the financial area, IHH uses software solution provided by mezzia. com. The software also enables improved communication within hospital, as well as generating meaningful information for financial and operational decisions. The data and software tools are accessible to all authorized staff. All doctors, for example, have pocket-size wireless tablet devices for data access, entry, and communication at the point-of-care. The digital system enables doctors to type in and send orders to the pharmacy or to testing laboratories using electronic templates CPOE (Computerized Physician Order Entry). All records are digital, including X-ray films and use PACS. The hospital communications and collaboration systems (Centricity, from GE healthcare) eliminate delays in the supply chain management. Doctors and other employees can consult each other, make quicker joint decisions, and locate experts quickly when needed (even outside the hospital). Centricity runs across 60 Compaq servers with Window NT and 600 laptops and other devices. Some data can be accessed by touch screens to increase speed. In addition,

there is a computer next to each patient room. Medications are tracked by more than 100 wireless barcode scanners to eliminate patient misidentification and threat of any spurious drugs. New devices and technologies are added all the time (e.g., sensors for vital sign monitoring). The inputs from such devices go directly to the patientâ&#x20AC;&#x2122;s electronic chart (near the bed) as well as to the medical records. The electronic chart enables nurses to enter patient status in real time and also verify the output of the automatic vital signs monitoring. The doctors also enter data into the system when visiting the patient â&#x20AC;&#x201C; no more scribbled notes in the hospital. An example of digital applications in the use of digital pens that overcomes the problems of doctors with poor handwriting (see Logitech.com).

The results All this enables nurses to stay longer with patients, increasing their safety. The digitisation contributes to a 40 percent reduction in average length of stay at hospital (ALOS), 75 percent reduction in medical errors (adverse events), and significant increase in the number of patients treated in the

hospital (bed turnover interval, which helps in profitability). Also, all computer transactions create an audit trail that increases accountability. In addition, having more consistent data to analyse promotes best practices that make the hospital more efficient and patients safer and healthier. Finally, the system helps the hospital to comply with government regulations like HIPAA of 1996.

Lessons for Indian hospitals Not many Indian hospitals have been as successfully able to implement ICT solutions in their facilities as IHH, and those who have implemented, have not been able to fully incorporate and integrate in their work culture and achieve seamless, paperless and filmless environment. Further, the use of mandatory bar coding by suppliers shall help in checking fake drugs and facilitate efficient inventory management. Thus, technology can be a big facilitator and enabler, if not panacea for all problems afflicting Indian healthcare industry. If adopted judiciously, it can enhance operational efficiency, contain costs, and improve decision making and quality of healthcare delivery.

July 2010 < www.ehealthonline.org <

case study

On the crest of a wave Fortis Healthcare succeeds in doing Peripheral Atherectomy operation for the first time in India, reports Sangita Ghosh De

t was an uncovering step in India recently taken by Fortis Healthcare Ltd, when a peripheral atherectomy operation was performed by Dr Atul Mathur using a two special catheters technique viz. Cather (outback) and Atherectomy Catheter (Silverhawk). According to Fortis, this is the first time that this technique has been used in India to treat a patient with blocked arteries. In the technique, the patient did not have to undergo any surgery or stenting, which is usually happened in these cases. Atherectomy, which termed as a non-surgical procedure to open blocked coronary arteries or vein grafts by using a device on the end of a catheter to cut or shave away atherosclerotic plaque, has been in much regular practice in the west but yet to catch up in India. Atherectomy is gaining much sought after trust from endovascular specialists as a therapeutic treatment in the peripheral arteries. According to the experts, atherectomy has several advantages that make it uniquely suited for the peripheral circulation. In particular, traditional percutaneous coronary treatments such

According to Fortis, this is the first time that this technique has been used in India to treat a patient with blocked arteries. In the technique, the patient did not have to undergo any surgery or stenting, which is usually happened in these cases. as angioplasty and stenting are not as successful in the process due to several in-process complications. Restenosis has been a major problem for angioplasty and stenting alone. The SilverHawk Atherectomy device has favourable applications in niche patients, support studies. Research says that the use of atherectomy is effective in the peripheral vessels in patients who meet the criteria of symptomatic peripheral vascular disease (limb-threatening ischemia or functionally limiting claudication) and cannot be treated by standard angioplasty techniques alone, i.e., balloon angioplasty would be ineffective or is contraindicated and have an eccentric lesion that does not dilate with conventional balloon angioplasty, or vein bypass graft stenosis.

> www.ehealthonline.org > July 2010

Initiating the process Anjali Sharma (name changed), a 61 years old patient suffering from Hypertensiveness, Diabetics, Hypothyroid, had a sudden onset of weakness and pain in her right leg. The patient had already undergone a bypass surgery in 1999 and therefore, had a weak heart with low pumping capacity (E.F. 25%) and had an irregular heart rhythm. Over and above pulses in her right leg were also absent. Therefore, surgery was declared as a risk factor for the patient. An urgent Doppler test of the right leg showed a clot in the blood vessel supplying blood to the right leg. The patient was given medication to dissolve the clot (streptokinase) for 24 hours and a repeat Doppler test was conducted, which revealed restoration of flow on the right side.

However, an Angiography of the leg confirmed 100% blockage of the main blood vessel supplying blood to the right leg. The patient was then taken for angioplasty to the right leg. But during the operation the wire was repeatedly going outside the true channel into the wall of the vessel. Then a novel Cather (Outback) was used to reinsert the wire beyond the blockage into the true channel. Once the wire was across the blockage, another specialised Atherectomy Catheter (Silverhawk) was used to cut out chunks of cholesterol and clots from the vessel to create a clear passage. These two special catheters were used for the first time in the country. Although this operation was performed for the first time in India, Silver Hawk device around the world has already revolutionised the treatment of patients with blocked arteries in the legs, especially patients with poor heart function, who are not advised for further surgery. With the use of this device patients with blocked arteries in the legs can have a better quality of life by angioplasty alone, without undergoing the stress of surgery. If the operation is done with the help of Cather (outback) and Atherectomy Catheter (Silverhawk), there is certainly no need of stent placements to clear the clots in the vessels.

Road to rise Having been the first to perform the operation in the country, Fortis is now in the process in conducting workshops to train the medical staffs across Fortis Hospitals and some other centres of India. According to Dr Atul Mathur, being a non-surgical operation, the technology in the process enhances success rates and increases patient comfort avoiding critical stages, which could have been faced in a normal surgery. Of late, Fortis Healthcare network has an over 12000 bed capacity across 68 hospitals in seven countries and has expanded its Indian operations to 48 properties in 16 cities across 12 states and expanding fast with newer practices to enhance patient comfort

Dr Atul Mathur Director Interventional Cardiology, Fortis Escorts Heart Institute (FEHI)

“This treatment is recommended for totally blocked legs to avoid amputation of foot” The uniqueness of using catheters’ technique – Cather (outback) and Atherectomy Catheter (Silverhawk) This new technique using catheters’ technique – Cather (outback) and Atherectomy Catheter (Silverhawk) allows a non-surgical treatment of leg blockage, where normally a surgery is done and when the patient is advised of not going for any surgery Time taken for the surgery and expected time for the recovery The surgery takes two hours and the patient takes nearly 48 hours to recover

The cost involved The cost is approximately INR 2.5 lakh Role of technology The technology of using Cather (outback) and Atherectomy Catheter (Silverhawk) in this Peripheral Atherectomy operation enhances success rates and increases patient comfort Target patients profile for this surgery This treatment is recommended for patients with totally blocked legs so as to avoid amputation of foot. There is huge scope in India.

The potential, trend and pace of progress in India We are within one year of other leading countries

Plan of expansion We recently conducted a workshop to train our collegues in other Fortis Hospital and some other centres of India as well.

and hinder less workflow in operations. With the 2010 acquisition of a strategic stake in Parkway Holdings Limited, the healthcare major has now become Asia’s largest private healthcare network, now with a presence in Brunei, China, India, Malaysia, Mauritius, Singapore and the UAE, confirms Fortis. The Fortis network has a large number of international

accreditations, including eight JCI (Joint Commission International) and six NABH (National Accreditation Board for Hospitals) certifications. The network’s capability covers multispeciality hospitals and super-speciality centres that provide tertiary and quaternary healthcare to patients in the major medical specialities.

July 2010 < www.ehealthonline.org <

zoom in

mHealth A New Healthcare Delivery Tool Healthcare services are making use of the fast-growing mobile market to reach out to consumers in the remotest Anurag Dubey Industry Manager, Health IT and Healthcare Delivery Practice â&#x20AC;&#x201C; South Asia and Middle East Frost & Sullivan

ay-to-day technological changes are strengthening healthcare delivery services. Some of the key examples could be keyhole surgeries, robotic surgeries, remote consultation, point-of-care diagnostics, and dissemination of information through various media like Internet, mobile, television etc. With the evolution of new healthcare delivery formats, customers have the benefit of being informed about various disease conditions in time, saving time and treatment costs, have improved accessibility, and choice of service providers.

The Mobile Way Mobiles have been one of the breakthrough technologies with fastpaced growth in terms of adaptation and usage. In developing countries like India,

areas and to empower them with information and connectivity for better use of services.

mobile technologies have impacted the consumers in a big way, by empowering them with being connected on the move and extending the reach to remotest locations. India is currently the second largest in terms of mobile subscribers after China. The mobile subscriber base in India is expected to grow from 354 million in 2009 to 815.3 million by 2015, at a Compound Annual Growth Rate (CAGR) of 17.7 percent. The major factors for this growth are affordability, competition and utility. Mobile penetration in urban areas has reached nearly 60 percent, whereas in rural areas it is less than 10 percent, indicating its future potential. Telecom operators are focusing on connecting rural areas and fueling mobile technology adoption by providing attractive and affordable tariff plans for these consumers. Using mobile communication technology to provide

> www.ehealthonline.org > July 2010

healthcare services or health information is one of the newest tools of healthcare delivery â&#x20AC;&#x201C; termed as Mobile Health or mHealth.

The mHealth potential unleashed Healthcare services are making use of this fast-growing mobile market to reach out to consumers in the remotest areas and to empower them with information and connectivity for better use of healthcare services. In India, various companies have already started pilot programs of mHealth. Some of the key potential areas of application of mHealth advantage are: > Disease surveillance and tracking > Remote data collection and patient monitoring > Education and awareness > Healthcare worker training

Disease Surveillance and Tracking The Ministry of Health and Family Welfare, Government of India, has designed various National Programs for some of the key disease areas. This has been done to keep a close watch over outbreaks and spread of communicable diseases and create awareness about prevention of such diseases. Often the outbreaks of communicable diseases happen in clusters spread across different areas. It is essential to get the information of such outbreaks on time, in order to contain and prevent them from taking the shape of an epidemic. Use of mHealth applications in such situations could help timely capture and sharing of disease incidence information to prevent further outbreaks. For example, in Andhra Pradesh, incidents of Japanese encephalitis were tracked and reported using mHealth applications, which helped the Government take informed decisions of prioritising areas for vaccination.

Remote Data Collection and Patient Monitoring Collection of information related to various healthcare programs is essential to understand their effectiveness, challenges and monitor the outcomes. The use of mHealth applications for this data collection is more effective and enables real-time decision-making than the usual paper-based system. This can lead to changes in policies and programs, where needed, to make them more effective and efficient with proper allocation of resources. For example, a Personal Digital Assistant (PDA)-based system was developed to support Auxiliary Nursing Midwife (ANM) to help them organise house visits to collect health data and initiate utilization of available health services by the population. Similarly, mHealth applications have been useful in remote patient monitoring to help healthcare professionals keep track of health statistics of patients in remote locations. For example, mHealth applications have been developed

that allow patients in remote locations to record their health statistics and share with their consultants. Recently developed applications will enable remote health workers to send text and images for diagnosis, and treatment recommendations via mobile phones.

Education and Awareness mHealth applications are being widely used to disseminate information about various disease conditions, their prevention and cure. The most common form being used is the Short Message Service (SMS). These are highly effective for the remotest locations, where the availability of health workers and health facilities is poor. It helps the population staying in such locales to become aware and stay updated about various diseases conditions. It helps them take informed decisions about maintaining health. Amongst other technologies, SMS has provided cost-effectiveness, better outreach and ease-of-use. It has been used most effectively to educate the population about AIDS, maternal and child health, reproductive health, etc.

Healthcare Worker Training The problem of availability of healthcare professionals/workers at the grassroots level has always been a major challenge for the healthcare system. In order to fill this void, an initiative to educate and train the local health workers was taken up. For example, under the National Rural Health Mission, the mandate for an Accredited Social Health Activist (ASHA) in each village was formed. Health workers need to be educated and trained about various health topics in order to take informed clinical decisions. Use of mobile technologies to train them and keep them connected in the healthcare network empowers them to perform effectively and efficiently.

mHealth applications have been useful in remote patient monitoring to help healthcare professionals keep track of health statistics of patients in remote locations.

Next Steps To reap the maximum benefit from mHealth, all the stakeholders, namely, governments, private healthcare providers,

July 2010 < www.ehealthonline.org <

zoom in

technology providers and NGOs, need to team up to set some standards, share experiences and best practices from pilot projects undertaken in most developing countries. With the 3G network in place, some of the issues related to data and image transfer in case of remote treatment and diagnosis will be addressed. Some of the key takeaways as the next steps towards mHealth initiatives would be as follows: > Population behavior change needs to be focused towards adoption of mHealth applications in rural areas > Telecom operators would need to address the problem of unreliable and weak mobile network services in remote/rural areas > Need to address the limitations of mobile phones with reference to connectivity with various medical devices, data transfer, data security, data interpretation and the scalability of operations > The training of users at the grassroots for using mHealth applications has to be effective for best results > Other issues also exist related to language, bandwidth, logistics, compatibility, ease-of-use, etc > A framework or infrastructure needs to be designed to manage and evaluate such programs in order to improve their efficiency, effectiveness, scalability, and sustainability

Impact of mHealth Benefits Achieved Globally With the mHealth initiatives undertaken across developing and developed countries, the outcomes have proved that there are many benefits of using mobile applications to provide healthcare services and information. It has been proved that mHealth applications ensure efficiency and effectiveness in the healthcare services and information delivery. Some of the key benefits achieved from the outcomes of various projects globally are: > Helpline services and information SMS about health conditions improved awareness and resulted in higher subscriptions and usage of helpline numbers. > The use of handheld devices for data collection resulted in effective disease tracking and disease management > Cost savings were reported in disease surveillance programs due to reduced paper usage for periodic collection of information > SMS reminders about treatment regime, medication dosage, and appointments at a health center resulted in improved attendance and effective treatment outcomes

Key Projects Undertaken So Far: The Acute Encephalitis Syndrome

> www.ehealthonline.org > July 2010

Surveillance Information System (AESSIMS), Andhra Pradesh: project was an effective example of disease and epidemic outbreak tracking. Handhelds for Health: is an initiative to collect information for Disease Surveillance and Public Health Programs. Tamil Nadu Health Watch: was launched to track disease incidence in four districts in Tamil Nadu as a plan under post-tsunami relief efforts. Media Lab Asia Community Accessible and Sustainable Health System (Ca:sh) project was aimed at improving maternal and child health. It involved collection of medical and demographic data using Compaq iPAQs in Ballabhgarh, Faridabad District, Haryana, India. Freedom HIV / AIDS project: Mobile Care, Support and Treatment Manager (MCST) â&#x20AC;&#x201C; Freedom HIV / AIDS project is the largest social initiative that used mobile phone applications and tools to create awareness about HIV / AIDS to under-privileged communities. Under this project the MCST was developed to address the health needs of people with HIV / AIDS. Ericsson and Apollo Telemedicine Networking Foundation (ATNF) agreed to work together with the initiative of delivering telemedicine over WCDMA / HSPA (Wideband Code Division Multiple Access / High Speed Packet Access) technology. TeleDoc â&#x20AC;&#x201C; Jiva Healthcare Project: was a pilot project launched in 15 villages of Haryana, which focused on providing remote consultation and prescription services through handheld devices provided to health workers. A Mumbai-based medical equipment company, Maestros Mediline Systems, along with Vodafone, rolled out an ECG application for BlackBerry handsets, which will help remote monitoring of patients. Nokia piloted HealthRadar in collaboration with Manipal University in the state of Karnataka. This project was designed for disease tracking by enabling near real-time information access.

in focus

Nova Medical Centers

Establishing concept of day care surgeries Day care surgery or Ambulatory Surgery is a concept that is heralding change in ways of thinking and performing surgeries in the field of medicine. Established in May 2009, Nova Medical Centers has been a pioneer in the field of day care surgeries and has been responsible for increasing awareness about the option of single day surgeries, Sangita Ghosh De of eHealth explores.

ith the growing concept of day care surgeries and its fast increasing adoption rate by the medical centres, Nova Medical Centers, the specialised day care surgery centre, has recently opened its second centre at Sadashivnagar, Bangalore. The inauguration of the new centre is part of Nova’s plan of establishing their presence across the country. Nova Medical Centres plans to develop 25 such centres across India by 2012. Commenting on the scenario, Girish Rao, MD&CEO, Nova Medical Center said, “The openning of the second centre at Sadashivnagar is a reflection of our

commitment to making world-class surgical care more accessible. Even as the urban populace grows busier, day care surgery centres will enable them to avail surgical care without having to spend too much time.” Day care surgery or Ambulatory Surgery is a concept that is heralding change in ways of thinking and performing surgeries in the field of medicine. At a day and age where life is governed by time, the option of availing quality surgical care in the span of a day is a blessing for individuals and their families. Daycare surgeries represent the fact that a patient does not stay overnight at a healthcare centre and gets discharged

> www.ehealthonline.org > July 2010

in within a day. As a patient is treated in an outpatient setting, it is also known as Outpatient Surgery. Researches say that around 70% of the total surgeries performed globally are day care surgeries and this trend is also on the rise in India recently. In India, almost 60% of all surgeries can be done in a day care mode as the current infrastructure supports. In day care surgeries, in just one year, Nova has completed 650 surgeries in Bangalore.

The genesis Day care surgery has been into practice for quite some time in developed countries like the US. In fact it’s become

“Technology and equipments play crucial role in day care surgeries” Nova Medical Centers is a multi speciality surgical centre, where the cost of the surgery depends upon type of the procedure and duration, which usually ranges between INR 5000 – INR 1,25,000.

Girish Rao MD&CEO Nova Medical Centers

What is the total market size of day care surgeries in India? What is Nova’s business model? The day care surgery market in India is pegged at INR 1819 crore of the overall surgery market at INR 4600 crore. Nova’s unique business model is based on a partnership between the company and a team of 40 established surgeons from multiple specialties. In each centre, which costs approximately INR 8-10 crores, a surgeon with atleast 10 years of experience is invited to be a partner and has to make a minimum investment of INR 5 lakh and maximum upto INR 10 lakh. Also at Nova, a surgeon doesn’t have to share his professional fees, in fact, as an addition as a partner he has a share in profits of his respective centre. What are the types of day care surgeries that Nova offers? At Nova we can perform over 700 surgeries covering specialties like General Surgery, Gynaecology, Orthopedics, ENT, Opthalmology, Plastic & Cosmetic Surgery, Pediatric Surgery, Urology, Gastrointestinal procedures and Dental.

Nova Medical Centers at Koramangala, Bangalore has so far conducted close to 650 surgeries in various specialities in just one year of operations. Nova is a multi speciality surgical center, the price range depends upon type of surgery done, which usually ranges between INR 5000 – INR 1,25,000, where a patient can save up to 30% to 40% of the ammount he would spend in a corporate hospital, because the model is efficient and capital expenses incurred during a hospital stay are eliminated at a day care center. What is the role of technology and equipment in day care surgery in terms of quality and delivery? Technology and specially designed equipments plays a very crucial role in day care environment, as advanced technologies and instruments for surgery are bare essentials for any day care surgery success. And because of these advance technologies and instruments doctors can now perform various complicated and complex surgeries in lesser time with better efficiency and accuracy. Also

the latest technology helps in quicker recovery. What are the opportunities and challenges in day care surgeries in india? In India there is immense opportunity for day care surgery as there is a huge requirement for cost effective healthcare in the country. With the GDP growing at the current rate, healthcare expenditure will simultaneously expand in the next 5 years. Day care surgeries will hugely bridge the gap between the demand and supply gap by providing cost effective and superior care. The challenegs as in getting skilled surgical staff is quite a big problem. Fortunately, India has a large pool of surgeons who have a vast expertise and knowledge. As we expand and move from the big cities we need to explore the best to the available capacity. What is the plan of expansion in India, and in abroad, if any? Right now the expansion plans of Nova are purely focussed within the geographical boundaries of the country. We plan to open up 25 such centres across the country by 2012. In the coming months we are planning to open two centres in Mumbai and two in Delhi. Among the other cities identified for expansion into the top 10 cities in India include Chennai, Coimbatore, Hyderabad, Kolkata, Pune, Amritsar and Jaipur.

July 2010 < www.ehealthonline.org <

in focus

Pointing to the advantages > Pre-booked date > Shorter waiting lists > Earlier mobilisation > Minimal disruption of patient’s personal life > Earlier return to normal environment > Reduced risk of cross-infection > Less psychological disturbances in children > Lesser chances of cancellation of Nova Medical Centers are equipped with the best of technology and equipments in day care surgeries

increasingly popular all over the world for many reasons. Firstly, with the advances in technology, doctors have been able to perform minimally invasive surgical (MIS) procedures, secondly, the newer drugs used for anaesthesia allow patients to recover consciousness very quickly, so that they can go home soon after the surgery is over, and lastly, since modern painkillers are more powerful, patients experience much less pain after the operation and they can successfully relieve the pain themselves by taking these medications at home. Studies worldwide have shown that day care surgery delivers the same high quality care as that given to hospital patients are much economical. On an average, research conducted in the USA has shown that procedures at day care surgery centres cost 50% less than those at hospitals, confirms Nova. In the modern day hospitals, a post-operative patient is discharged as soon as the critical period or immediate post-operative nursing needs have been met with. This is evidenced by the establishment of plenty of day care surgical centres in the West. Day care surgery has been defined by the Royal College of Surgeons as when the patient is admitted for investigation or operation on a planned non-resident basis and who nonetheless requires facilities for recovery. This definition excludes upper and lower GI endoscopies, outpatient procedures

emergency surgeries

such as flexible cystoscopy, and minor superficial surgery under local anaesthetic. The cases are usually carried out under local, regional or General Anaesthesia (GA) or monitored anaesthesia. Facilities and standards of care in the day care surgical unit must be comparable to those provided for in-patient. The patient is to be formally admitted to day care unit, full work up and documentation is to be done and there should be facilities to observe the patient for 12 hours and with the possibility of admission.

The new beginning Established in May 2009, Nova Medical Centers has been a pioneer in the field of day care surgeries and has been responsible for increasing awareness about the option of single day surgeries. The medical centres are equipped with the best in terms of technology and equipment and the management and advisory board include experienced professionals who are amongst the pioneers in the field of day care surgery. Nova develops, acquires, owns, and operates ambulatory surgical centres in partnership with physicians across India. Nova provides leading physicians from diverse specialties with comprehensive ultra-modern facilities comprising doctor’s offices, operating rooms, diagnostics, imaging, health check up area, pathology laboratory, and a pharmacy. By specialising only in day care procedures,

> www.ehealthonline.org > July 2010

Nova improves the patient experience, increases operating efficiency, and offers unparalleled quality and affordability.

The business model Nova is funded by the GTI Group, a New York based private investment company, and New Enterprise Associates, a leading global venture capital firm. Nova’s business model is based on a partnership between the company and 40 established surgeons from multiple specialties in each centre. Each centre has 4-5 operating rooms and is equipped with state of the art equipment to undertake surgical procedures. The pre and post operating beds/rooms are all equipped with gas lines, monitoring equipment, defibrillator and are supervised by duty doctors and trained staff. Although the focus is on day care surgeries, each centre has provisions for overnight stay including doctors and nurses as well. In addition to surgical facilities, the centre has outpatient consulting rooms and diagnostics also. Patient care and safety is core to Nova’s ethos. Nova’s doctors and facilities utilise the latest technologies including surgical techniques, advances in anaesthesia and equipment. According to Nova, it can perform over 700 surgeries in General Surgery, Gynaecology, Orthopedics, ENT, Opthalmology, Plastic & Cosmetic Surgery, Pediatric Surgery, Urology, Gastrointestinal procedures and Dental through day care surgeries.

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Ayursundra to open first-of-its-kind lifestyle clinic in Guwahati

Dr. Abhijit Hazarika

Simanta Das

CEO, Ayursundra

Chairman, Ayursundra

Ayursundra Healthcare will soon be a name to reckon within healthcare field in North East India. Promoted by conscientious Europe based investors and NRIs and experienced local healthcare professionals, Ayursundra is expected to change the way healthcare services are delivered in the North East region of India. Ayursundra will start off with a diagnostic cum lifestyle centre in Guwahati. The diagnostics cum lifestyle centre will be launched in August 2010. Simultaneously work has started on creating a truly state-of-the-art multi-specialty Ayursundra Hospital and tertiary care unit, designed by the renowned hospital designer Uday Bhanu Mahapatra from EFNAR, New Delhi, to be launched thereafter. Everything at Ayursundra, right from appointment scheduling to patient medical records, to dispensing of medicines in pharmacy and diagnostic reporting by lab and radiology departments is planned to be ICTenabled so as to ensure transparency,

efficiency, accuracy and patient delight. “The basic idea is to create in our North East region a state-of-the-art healthcare infrastructure incorporating world-class best practices, which we have seen and experienced in Europe, run with Indian skills & ICT systems”, said Simanta Das, Chairman, Ayursundra. The Ayursundra promoters found their ideal ICT solution partner in Mumbai based 21st Century Health Management Solutions (21CHMS), who shared a similar vision with their futuristic Enterprise Apex HealthNET solutions. The 21CHMS holistic approach and state-of-the-art solutions matched Ayursundra’s vision for improved healthcare in India, especially when it came to implementing best practices and SOPs across the chain. “The business processes in healthcare become even more complex because of the anxiety factor and dependency of the consumer or patient on the service provider and perceived lack of choice. Unlike in other service sectors, the patient is not seen as a consumer by the

> www.ehealthonline.org > July 2010

service providers. Also, the patient is very often an unwilling customer and does not know what he needs, what constitutes good service or how much he should be charged. This confusion and anxiety is vitiated because of galloping costs of specialised diagnostics and treatment and lack of transparency or standards. This has resulted in lack of trust between patient and provider. Except those covered by health insurance, most people never budget for expenses on healthcare. Hence it is very important for well planned ICT systems to restore transparency, standardization and trust in healthcare ” opined Mr Satish Kini, Chief Mentor of 21CHMS. “ICT-enabling of healthcare is very different ball-game compared to other service sectors like BFSI or even Hospitality. I have met very few IT professionals who understand the complexity of what a healthcare system needs. We found this to be the case even amongst the big software giants in India who all had a “software project “approach to Healthcare systems. Of course , there is also the problem of healthcare professionals not willing to understand how ICT can help them improve“, confessed CEO, Dr Abhijit Hazarika. “Our Enterprise Apex HMIS incorporates best practices across the enterprise which ensure superior patient care, helps doctors, nurses and medical technicians to be productive yet accurate and management to manage by exception proactively with timely MIS. Web-based appointments, RFID for tracking patients and mobile assets, alerts and alarms to help nursing and clinicians, sms reminders, are some of the basic tools that will be used to achieve this” said Ravi Mani, Chief Solution Architect of 21CHMS.

news review

Johnson Medical, Sweden announces JV with Trivitron Healthcare Trivitron Healthcare, one of the largest medical technology solution providers of Indian origin has recently announced its alliance with Johnson Medical, Sweden to manufacture high end and mobile modular OTs and Pendants. Through this tie up, Johnson Medical will manufacture Modular OTs and Pendants by setting up its manufacturing facility in Trivitron Medical Technology Park. Johnson Medical, Sweden is one of the leading global medical solution providers specialising in Operating Room Solutions which includes of Medical Gas Piping, Sterile Operating Rooms, Heat Ventilation and Air Conditioning and other services. Trivitron has set up South Asia’s first Trivitron Medical Technology Park to manufacture MT products of highest standards in a cost effective manner in India for India and emerging markets of the world. According to Dr. G. S. K. Velu, Managing Director, Trivitron Group of Companies, “With Johnson Medical we found an ideal partner and this joint venture offers an excellent strategic fit and further strengthens Trivitron’s commitment to provide cost effective MT solutions to healthcare providers in India and emerging markets of the world.” Further to that, Englam Yeo, Managing Director, Johnson

Medical, Singapore Office said, “We have identified Trivitron which has created a first-of-its-kind, world class medical technology park in Chennai, India. This will be the first facility in India for the manufacturing of the most advanced modular Operation Theatres, Mobile OTs and Pendants and production of the same is expected to commence by the end of 2010.”

July 2010 < www.ehealthonline.org <

news review | money matters

Fortis Healthcare plans to raise Fresh Fund Fortis Healthcare Ltd has lined up its fund-raising plans as it prepares for a possible takeover battle for Singapore-based Parkway Holdings. The healthcare major plans to raise an aggregate amount of up to INR 2,750 crore through issuing of fresh securities and has approved increasing the borrowing limit to Rs 6,000 crore. Fortis has also raised Rs 380 crore from an arm of GIC Special Investments Pte Ltd, the private equity arm of Singapore Government state investment firm and $100 million through the issuance of foreign currency convertible bonds (FCCBs) to fund the Parkway stake purchase. The acquisition of Parkway by Fortis is the largest overseas acquisition by an Indian company in the healthcare sector. The acquisition of a strategic stake in Parkway Holdings Limited increased Fortis’ network, now with a presence in Brunei, China, India, Malaysia, Mauritius, Singapore and the UAE.

NEA Eyes USD 50M Deals in healthcare chains

US-based private equity firm New Enterprise Associates Inc. (NEA) is betting big on the Indian healthcare story as it eyes investments in specialty hospital chains. Globally, nearly 40% of its total assets under management of USD11 billion is invested in healthcarerelated sectors and it proposes to attach a similar significance to its play in India. NEA, which had raised a USD2.5billion global fund in January, may allocate 15% of this fund to India investments. NEA, closed an investment in Nova Medical recently. It is learnt that the firm is evaluating investment deals in the range of USD10-USD50 million in smaller hospital chains across Indian states.

Nova Medical raises funds from NEA, GTI Group Nova Medical Centers, incubated by GTI, the specialised day care surgery centre, has completed its second round of private equity funding by raising the capital required for its Rs 250-crore project of expanding 25 centers in the country. This investment has been jointly facilitated by two US based venture capital firms, GTI Group and New Enterprise Associates (NEA). Nova has been conceived and incubated by GTI LLC. The initial round of funding saw Nova Medical Centers raise USD 3.5 million from GTI LLC. The GTI Group continues to be the largest shareholder in Nova.

ICICI Venture may sell I-Ven Pharma to SPV Partner Dr Reddy’s ICICI Venture, India’s largest private equity player, is looking at selling I-Ven Pharma Capital Limited, a Special Purpose Vehicle, to Dr Reddy’s Labs (DRL), its exclusive partner in the SPV. ICICI Venture has invested Rs 100 crore and holds 100% stake in I-Ven Pharma, created in 2005 for the purpose of funding research, development and commercialisation of pharma products by DRL for the US market. It was the first deal of its kind in R&D funding in the Indian pharma sector. ICICI Venture has been on an exit mode from a few of its portfolio firms. It has exited from diagnostic chain Metropolis Healthcare in a secondary transaction with Warburg Pincus. It was also reported about ICICI Venture’s plans to exit from Ranbaxy Fine Chemicals and to offload part of its stake in Arch Pharmalabs through the latter’s IPO expected later this year. ICICI Venture has made significant investments in the lifescience and healthcare space. Recently, it announced an investment of Rs 120 crore ($27 million) in Star Health and Allied Insurance Company Limited from its latest fund.

> www.ehealthonline.org > July 2010

news review

QED Pharmaceutical picks SAS Clinical Data Integration to help clients implement CDISC standards SAS, the leader in business analytics software and services, has announced that QED Pharmaceutical Services has licensed SAS® Clinical Data Integration to enable its drug development clients to more easily form partnerships with key biopharmaceutical companies. The win at QED, a global contract research organisation (CRO) with offices in India and the United States, continues the strong market momentum for SAS Clinical Data Integration. SAS, the leader in business analytics software and services, offers a comprehensive portfolio of life sciences software solutions for pharmaceutical, biotechnology and medical device companies.

“The availability of SAS Clinical Data Integration has made it possible for QED to efficiently implement complex data standards such as the CDISC standards. The overall value created by SAS Clinical Data Integration to both QED as a service company and our clients by making them attractive partners and ensuring regulatory compliance is tremendous,” said Dr Ramana Kuchibhatla, QED founder. According to Sudipta K Sen, Regional Director South-East Asia, CEO & MD SAS India, “The new deployment strengthens our commitment as a partner to help organisations in taking accurate decisions and to create an impact on their business goals.”

July 2010 < www.ehealthonline.org <

news review

Siemens Launches SIERRA Dose Reduction Initiative in Computed Tomography In a continual commitment to patient care and radiation reduction in computed tomography (CT), Siemens Healthcare has launched SIERRA (Siemens Radiation Reduction Alliance) and has established an expert panel to advance the cause of dose reduction in CT. The new Low Dose Expert Panel includes 15 specialists in radiology, cardiology and physics, who are internationally recognized for their publications on the subject of CT dose. The panel’s objective is to generate proposals for how manufacturers may continue to develop their technology and to help users better adapt their procedures in order to bring about further dose reduction in CT. “Our aim as a leading innovator in the field of computed tomography is to reduce radiation exposure for all typical CT examinations below 2 mSv, which is as low as the average annual dose due to naturally occurring background radiation. We are committed to doing everything we can to help our customers reduce doses in CT without compromising the diagnostic quality of the examination in any way,” said Sami Atiya, PhD, CEO, Computed Tomography, Siemens Healthcare. Excellent image quality is vital in CT, but it is also important to keep the patient’s radiation exposure as low as possible. Siemens Healthcare has already introduced measures to help its customers consistently achieve this goal. Now, Siemens wants to take on a more active role in this field and has convened a panel of experts expressly to develop new ideas for dose reduction in CT. Siemens will develop a low dose educational program in close collaboration with institutions. Trainers specialising in dose reduction technology will be available to work with customers to train personnel, optimise scan protocols and implement dose reduction procedures. Siemens intends to use the discussions to spur the development of new features for CT scanners and training programs for its customers.

> www.ehealthonline.org > July 2010