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Imaging Beyond Imagination High-Definition MRI will Redefine the Future of Diagnostic Imaging
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Contents Volume 6 > Issue 06 > JUNE 2011 > ISSN 0973-8959
Expert Corner
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“Radiology is the backbone of healthcare industry” Dr Harsh Mahajan, Medical and Managing Director, Mahajan Imaging
tech trends
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Browse the Cart for the Right ‘EMR’ Integrating EMR into the system needs expertise and decision to choose the brand along with a zeal to make technology as the backbone for the business in the rapidly increasing digital world
Zoom In
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”Patients are True Beneficiaries of Accreditations”
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Vibhu Talwar, Chief Operating Officer, Moolchand Medcity
COVER STORY
in focus
imaging Beyond Imagination High-Definition MRI will Redefine the Future of Diagnostic Imaging
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Integrated Approach to Healthcare Susheela Venkataraman, Managing Director, Internet Business Solutions Group, Cisco India
By Divya Chawla
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44
spotlight
30 The Net of Healthcare
By allowing doctors to have immediate access to the patient’s medical record, online healthcare services can become a new conduit for exchange of health information
Speciality
35
Cardiology Fast Forwarding to Integrated ERA
special focus
in conversation
EHR The Holy Grail
“Intelligent and easy to use machines provide opportunity for better human life”
EHR and PHRs will be accessible from anywhere and at any time thanks to Cloud Computing 3.0
By Vamsi Chandra Kasivajjala
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Ashwani Raina, General Manager–UIS & Radiology Syatems, Mindray Medical India
> www.ehealthonline.org > June 2011
The future will be dominated by digital technologies which will prevent, treat and finally cure the disease without expecting a blockbuster drug to be discovered
Applications
48 Smart Way to Safer Hospitals Holly Sacks, Senior VP – Marketing and Corporate Strategy HID Global
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Editorial
Volume 5 > Issue 06 > june 2011 ISSN 0973-8959
Technology on a platter
S
ince its inception in the 1970s, magnetic resonance imaging (MRI) has become one of the largest and most crucial segments of the imaging equipment market. Originally developed for imaging of the central nervous system, the scope of MRI applications has now expanded to include imaging of the entire human body. The growing clinical applications of MRI have been a result of continuous advancements in technology and increasing Tesla strengths. The enormous market growth in this segment has also been a result of the increased clinical applications. Other key factors fuelling growth include emergence of new cutting-edge technologies such as functional MRI (fMRI), MR Elastography and MR guided focused ultrasound (MRgFUS). The cover story of this issue targets the key purchasers of MRI equipment in India, across various hospitals and healthcare units and provides them with information about the overall MRI market and the latest and most upcoming technologies in this segment. To take the expert’s opinion, we also spoke to Dr Harsh Mahajan, Medical and Managing Director, Mahajan Imaging and the Honorary Radiologist to the President of India on various aspects of radiology, especially MRI. Being among the first ones to get MRI technology in India, Dr Mahajan’s inputs provided real value to the overall feature. The convergence of ICT based technologies and their implementation in healthcare have a huge potential to completely reshape the way the industry works. With an aim to go paperless, hospitals these days are increasingly adopting ICT solutions for implementing electronic medical records (EMRs) that help in maintaining both clinical and financial records of all patients. Having realised the benefits of EMRs, the decision to implement it can be quite complex because of the sheer number of products in the market place with a plethora of vendors. To help hospitals make informed purchase decisions, the tech trends section of this issue provides a complete EMR guide. Online healthcare is another key feature in this issue. This form of healthcare delivery is not a replacement to the conventional method but will compliment it in a big way. India’s advantage in this space is advancements in technology, growing phone and online user base, affordable resources, and global image and demand. Being in its infancy stages in India, online healthcare seems to have a promising future option to cater to the primary healthcare needs of urban and rural India.
Dr. Ravi Gupta ravi.gupta@elets.in June 2011 < www.ehealthonline.org <
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cover story
imaging Beyond Imagination Technological advancements and growing clinical applications have made MRI one of the most sought after imaging techniques By Divya Chawla
T
he imaging industry is at the cusp of a revolutionary growth owing to constant evolution of technology. The incessant growth has been a result of a combination of factors, which include the vital role of imaging in diagnosis and therapy and growing information technology applications,
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among others. Newer clinical applications continue to provide the requisite fodder for maintaining this dynamic growth. Since its inception in the 1970s, magnetic resonance imaging (MRI) has become one of the largest and most crucial segments of the imaging equipment market. Originally developed for imaging of the central nervous system, the scope of MRI applications has now expand-
> www.ehealthonline.org > June 2011
ed to include imaging of the entire human body. Dr H Satishchandra, Professor and Head, Department of Radiodiagnosis and Imaging, Bangalore Medical College and Research Institute, Medical Superintendent, Bowring and Lady Curzon Hospital says, â&#x20AC;&#x153;The prime concern of diagnostic imaging is to direct appropriate treatment at the earliest. MRI systems that improve image quality and
cover story imaging speed can ensure this, at the same time it is pertinent for the systems to be patient friendly.” The non-invasive MRI technique is capable of generating elaborate images of human body’s internal areas, through the use of radio waves and magnetic field. Advancements in technology have led to development of MRI systems that are used for effective diagnosis in the fields of cancer screening, neurosurgery planning, angioplasty and breast screening. Dr H Satishchandra says, “MRI has evolved from an unfavourable beginning in 1970s to an unrivalled imaging modality today. Apart from providing an excellent anantomical display in any plane with no radiation risk to the patient it has made strong inroads into noninvasive therapy.”
Surplus clinical applications The growing clinical applications of MRI have been a result of continuous advancements in technology and increasing Tesla strengths. The enormous market growth in this segment has also been a result of the increased clinical applications.Traditional bone scanning techniques are increasingly being replaced by whole body MR techniques that have splurged in the market. With reduced scanning times, whole body MR is a promising clinical application. The preferred machine for this application is the latest 3 Tesla equipment that provide scope for parallel imaging. MRI combined with Positron Emission Tomography (PET) is used in Functional MRI (fMRI), which is currently one of the most popular MRI techniques. The structural image is provided by
The global MRI equipment market is expected to reach US $7.4 billion by the year 2015, as per reports. Although, the market was stung by recession in the past years, yet it has flung back and achieved a good growth rate the MRI and functional image is provided by the PET, which results in superior imaging, particularly useful for brain neurological disorders. Functional MRI is a very powerful method to map brain functions with relatively high spatial and temporal resolution.
“With the advent of new and advanced applications like fMRI, MR Elastography and MRgFUS, MRI has revolutionised medical care” Dr H Satishchandra Professor and Head, Department of Radiodiagnosis and Imaging Bangalore Medical College and Research Institute & Medical Superintendent, Bowring and Lady Curzon Hospital
Experts suggest that the clear pictures of the brainstem and posterior brain, provided by fMRI, are difficult to view through CT scan, which makes it a better imaging modality as compared to the CT, for the brain. There is also a growing implementation of MRI in interventional radiology applications. MRI techniques are being used for image-guided minimally invasive procedures, such as biopsies. Cardiac and breast procedures are now mostly performed through MRI. MRI can distinguish tumours or other lesions from normal tissues and this has increased its popularity for intraoperative MRI for brain or spine surgeries. The American Cancer Society (ACS) approved the use of MRI to screen women at high risk of breast cancer. MRI has the ability to detect small abnormal breast lesions, which makes it an effective tool for detecting breast
June 2011 < www.ehealthonline.org <
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cover story
“From a buyer’s perspective, it is essential to understand the clinical application of various MRI sequences, as additional software into the machine is an additional cost to the buyer” Dr TBS Buxi Head – Department of CT Scan and MRI, Sir Ganga Ram Hospital
tumours. With advancement in cardiovascular magnetic resonance imaging (CMRI) has over the past few years, MRI appears to be a more sensitive test in detecting the most common form of stroke as well as for diagnosing haemorrhagic strokes. MRI for cardiovascular imaging breast imaging and so on are emerging as the most promising newer applications of MRI. Dr TBS Buxi, Head – Department of CT Scan and MRI, Sir Ganga Ram Hospital says, “The endeavor of almost all companies manufacturing MRI equipment has enhanced from routine anatomical body imaging to the physiological and metabolic aspects of the morbid pathology. The ushering of higher gradient field strength, adaptive coils with more number of channels, shorter sequences and digital transfer of data has resulted in super class images. Spectroscopy, tractography, functional imaging, diffusion-perfusion imaging not only help in early diagnosis but in many instances in characterization of disease processes and surgical planning. High strength MR machines with a number of newer sequences are now available in the market.” He further adds, “All of these sequences are not provided free of cost with the magnet, irrespective of the Tesla strength. Many a sequences which sound very lucrative are not really used in our daily practice. It is advisable to visit multiple centers using these sequences to understand the utility and functionality of each and then decide if it is of added advantage in the vendor’s setup.”
Redefined market trends The global MRI equipment market is expected to reach US $7.4 billion by the year
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2015, as per reports. Although, the market was stung by recession in the past years, yet it has flung back and achieved a good growth rate. The current growth can be attributed to continuous improvements in image quality and development of newer techniques, espe-
“Siemens Healthcare offers a wide range of products from Permanent Magnet 0.35 Tesla to 3 Tesla. Our USP is in unique applications like SWI, SPACE, GRAPPA and Angio studies with surface coils. Tim technology through, which one can enhance patient comfort and productivity is one of our major USP” Umesh Kumar KN Business Head – MRI Siemens Healthcare
> www.ehealthonline.org > June 2011
cially for imaging specific portions of brain’s complex structures. Growth is also being propelled by the widening scope of clinical applications, including promising applications such as MRI for breast imaging and cardiovascular imaging. The highly popular applications of MRI such as abdomen imaging and musculoskeletal imaging are currently gaining momentum. Sharing the Indian MRI market statistics, Umesh Kumar KN, Business Head – MRI, Siemens Healthcare, says, “MRI Market in India is growing fast at 13 -14 percent year on year. One of the reasons could be that the ratio between the population and MR installations is one of the lowest compared to the standard ratio in the world. However at the same time, increasing awareness towards healthcare is leading to the increase of awareness in the field of MRI.” He adds, “The current trend is upbeat and year on year the results are surpassing our expectations. The future is looking optimistic with the revolutionary MR PET being introduced in the industry, which is expected to take the MR market to a different level.” The newer 3T MRI systems have been gaining acceptance owing to the various advantages they offer over the conventional 1.5T systems. With 3T MRI minutest structures such as blood vessels as small as 200-300 micron can be viewed. 3T MRI systems have almost 3-4 times higher signal-to-noise ratio (SNR) because of which, they can precisely localise areas of activation, thus enabling accurate mapping of brain function. It also offers much faster and higher quality and resolution of spectroscopy. As per the latest trend, many 1.5T replacement systems are expected to shift to 3T systems.
Country trends The United States, Japan, and Europe collectively account for a major share of the global MRI market, as stated per reports. The impact of the global economic meltdown on BRIC countries (Brazil, Russia, India & China) has been limited, allowing governments to continue focusing on the implementation of long-term initiatives aimed at improving healthcare infrastructure. The Indian market, hence, has been experiencing significant growth. The large
cover story
new entrant in Indian MRI market, did remarkably well in 2010 crossing 12 installations since its introduction in 2008. We will soon be launching our new 1.5T MRI model in India and will be signing the distributor agreement very shortly.
Som Panicker Vice president – MRI Divison Sanrad Medical Systems
What is your perception about the MR equipment market In India? Presently, the Indian MR equipment market is growing at a rate of 20-25 percent and this is much faster than many of the developed countries in the world. In 2010 alone more than 200 units of MRI models are sold in India. Out of this, more than 65 percent were 1.5T, but permanent Magnets still have their own place and marketability with more than 40 units sold in 2010. Sanrad represents US based MRI research company, MDT, which had set up their manufacturing facility in Beijing, China and MDT MRI products have been well accepted in India within a short span of last 4 years . Sanrad (MDT) even though a
population base in countries like India and China attract growth because of their high population. Demand is anticipated primarily from stand-alone imaging facilities, and private hospitals, as compared to public hospitals. The Asia-Pacific market for closed MRI systems is projected to reach US $687.6
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Do you think permanent magnet MRI has a good future in India? We feel that in countries like India, there is still a lot of potential for permanent MRI as there is a huge requirement for cost effective MRI units, particularly in rural places. Refurbished permanent MRI is not a good solution because of shortage of spare parts for these units and quality problems due to aging. Our fast moving 0.3T Centauri 3000 is a very good entry level MRI system and it is a better solution than investing into refurbished MRI, which are more than 10 year old in technology and short coil life.
What are the various products offered by you in this segment? We have mainly two models 0.3T Centuari, 3000 which is the entry level permanent MRI and also 0.45T Mstar 4500, which is presently the highest strength open MRI installed in India. MDT had successfully developed world’s highest strength 0.7T permanent magnet Xstar, 7000 which will be ready for marketing by end of this year. MDT is the first permanent MRI developed with Higher Order Active Shimming, which will help to achieve a high homogeneity of the magnet. This will in turn result in high quality distortion free image specially diffusion and thin slice images. Al the models of MDT are equipped with this revolutionary technology. Our entry level 0.3T centuari 3000 is very economically priced whereas our premium model 0.45T mstar 4500 is still cheaper than most of the 0.35-0.4T competitor models.
Who are the key players in Indian MRI market? The Indian MRI market is dominated mostly by MNCs like GE healthcare, Philips healthcare and Siemens Medical solutions, but there are also important players in permanent MRI market like Sanrad. At present we deal with only permanent MRI models thus we do not have any direct competition with the above mentioned MNCs and we only can see Hitachi as our major competitor.
What are Sanrad‘s future plans in MRI segment? We will be introducing our brand new 1.5T model very shortly as we have to cater the needs of all kinds of MRI customers in India. We also have plans to introduce MR guided ultrasound ablation therapy system developed by MDT in near future. We hope to become the number one MRI company in Indian permanent MRI segment in next 5 years.
million by 2014. GE Healthcare, Siemens Healthcare, and Philips Healthcare remain the market leaders worldwide, with a global market share of almost three-fourth. Growing from step to step, the MRI has evolved as one of the most preferred imaging techniques. With growing clinical applications, especially for brain, breast and
cardiac imaging, MRI will continue to grow and evolve. Currently, MRI is also one of the fastest growing segments in the imaging market and the Indian market for MRI is enormous. Furthermore, the increasing Tesla strengths will provide enough impetus for growth, worldwide.
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Expert Corner
â&#x20AC;&#x153;Radiology is the backbone of healthcare industryâ&#x20AC;? Dr Harsh Mahajan is one of the most respected radiologists and a pioneer in the field of Magnetic Resonance Imaging in India. Felicitated with the Padma Shri for his exceptional work in the field of radiology, Dr Mahajan is also the Honorary Radiologist to the President of India. In an interaction with Shally Makin and Dhirendra Pratap Singh, he shared his perspective on emerging trends in radiology and threw light upon the challenges in the health sector in India. Excerpts:
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S
ince 1991, the Mahajan imaging centre has never looked back, and has achieved great heights over the years. Please, tell us about your journey so far. I did my MBBS from Maulana Azad Medical College and secured first position in Radiology. After passing out from PGIMER, Chandigarh, I worked as a senior resident in AIIMS. That was the time when old scenarios were changing, and radiology techniques such as ultrasound and CT were emerging. In 1987, I was awarded a Rotary Foundation International Scholarship and went to M.D Anderson Cancer Hospital at Houston, Texas, USA for a super specialist fellowship in Magnetic Resonance Imaging. MRI was at that time very new, even for the US. I did original research in cancer imaging using MRI and joined as a faculty of this hospital. After one year, despite a lot of allurements to stay back, we decided to come back to India with a dream of bringing the latest technology in India. Gradually in partnership we opened a centre at Green Park with first ever 1.5 Tesla MRI machine by GE. Unfortunately, our partner expired in 1998 and then standing alone in the market, we worked harder and opened around seven new centers. We also started nuclear medicine and Bone Densitometry Centre at Sir Ganga Ram Hospital, New Delhi. In July 2001, we started another MRI centre in Dehradun. In keeping with the same vision we got into a public private partnership with the Uttarakhand Gov-
> www.ehealthonline.org > June 2011
ernment to run the MRI centre at Doon Hospital, Dehradun which is the largest government hospital in Uttarakhand. The latest is a PPP based centre with Safdarjung hospital for sports injury. Do you think that public private partnership model is workable in India in the health sector? It is workable. A PPP project is a very tough project to pursue. We have seen the passion in the government towards health projects but their expectations are very high. They need the access of extraordinary machines at very minuscule rates. We need the PPP project to be financially viable as there is some resistance from medical side and no resistance from the administration side. Through such projects, a huge range of people can benefit by receiving service from very high level machines at low rates. Although we too have taken up projects with government, which need a lot of investment, but will recover in 7 to 8 years. It is not a lucrative deal to be taken rather a corporate social responsibility. Being a radiologist myself, my corporate identity takes up viable models. PPP deals have to be sweetened only when they succeed for future investment. Which are the various services offered at Mahajan Imaging Centre? We were the first to start MR spectroscopy. The latest machines in the center are MR tractography, MR mammography, CT coronary angiography, 4D ultrasound with tomography, PET-CT, CT-guided robotic biopsy, digital mammography and DEXA
Expert Corner
Dr Harsh Mahajan Medical and Managing Director Mahajan Imaging June 2011 < www.ehealthonline.org <
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Expert Corner What has been your role in promoting interventional radiology? The field of interventional radiology is still growing in India. However there are very few centres which train people. Government needs to put a lot of efforts in engaging private enterprise since itâ&#x20AC;&#x2122;s an expensive affair. Such a sector needs proper training, small centers and good amount of technology. With regard to interventional radiology, our centers have robotic CT guided machines and precise biopsies.
State governments are realising that healthcare is an important political tool for the elections. Recent elections have shown it. It will be worthwhile to make universal health insurance for the population at large in India bone densitometry, Open Standing MRI, Cone Beam CT, Pet CT, MRI, 32/64 Slice CT, CT-Angiography, 3D/4D Ultrasound, Colour Doppler, Mammography, Bone Densitometry, Guided - Biopsy, X - RAY and Nuclear Medicine. Our latest acquisition is Indiaâ&#x20AC;&#x2122;s first Cone Beam CT (CBCT) scanner, which has redefined dental and maxillofacial surgery planning and diagnostics. All our centers have PACS, which allows us to enter any case at any center in the country. Although it needs lot of investment as for radiology we need to keep the film for ten years as a record. We need to
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quickly penetrate technology in treatment of patients. The cost of PACS is coming down as the paperless system is feasible in larger systems. With the industry witnessing a constant change in terms of advancements, how do you upgrade your technology? Upgradation of technology has been the foremost thing of the centre. GE and Philips have been really helpful in contributing their bit of innovation and constant evolution over the years with great intensity. We also look forward to teleradiology in the near future.
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How do you see the radiology market in India? Radiology market is growing. If we really look at radiology and imaging sector, it is like the cottage industry. It is highly unorganised in India as compared to pathology. Radiology is very capital intensive. I believe with time players will get larger. I think overtime there will be shortage of radiologists and the government should think seriously in this direction. Radiology is the backbone of healthcare industry. Education, teaching and training is very important for not only for radiologists and technicians, but also for the population at large for the harmful effects of radiation. What do you predict will happen within radiology in the next 5-10 years in India? Radiology in India is evolving. But the challenge is to take radiology to the masses, districts and villages. PPP is the way forward. Because the government has infrastructure, there are district hospitals, equipped with manpower but are not delivering. With the partnership of private players, it would be possible to go to these places. We have our own satellite. With telemedicine
and teleradiology, we can benefit huge masses. We have local manufacturers and manufacturers like GE, Siemens, Philips, who are willing to invest in India in creating new technologies. All can be brought together. I believe that healthcare must reach to the masses and grass root level. India is one of the fastest growing economies in the world, still 30 percent Indian population lives below poverty line. These people have no basic healthcare facilities. Do you think that Government is serious for health access to all? I would say that the government is serious about making health accessible to all. Second, health is a state subject, even though the central government formulates policy, but ultimately the onus of healthcare delivery system is on the states. Different state governments have different agendas and different ways of implementing it. State governments are realising that healthcare is an important political tool for the elections. Recent elections have shown it. We have to bring mandatory health insurance in India. It will be worthwhile to make universal health insurance for the population at large in India. Goa, being a small state, has already done that. We need to create universal GDP with viable infrastructure. Who is your role model? For me, my father has been really my role model. He believes in transparency blended with great humanity. In medical field, Dr Prathap C Reddy and Dr Naresh Trehan, who took risk in the beginning to open up private healthcare in this country. Dr Devi Shetty is also my role model, whose human approach is very similar to my thought process.
Tech trends
Browse the Cart for the Right ‘EMR’ Integrating EMR into the system needs expertise and decision to choose the brand along with a zeal to make technology as the backbone for the business in the rapidly increasing digital world By Shally Makin
T
oday, the motto ‘turning digital’ is behind every successful management. EHR/EMR is the database of all patient records, which include both clinical and financial. This technology oriented process is best implemented when a system meets clinical, business, and administrative needs. The hospitals, nowadays, aim to adopt a paperless practice and a virtual assistant for keeping records. Writing prescription is again a time consuming task, therefore an ideal EMR should maintain formulary information by health plan, which provides drug-interaction, checking, allergy and patient education. Keeping a record for a billion people is a tedious work to maintain therefore a scalable process is required to streamline the process of maintaining information. Kiran John, Head - Marketing and Presales, SCIOinspire Corp, says, “EMRs store a wide range of information about patients including demographics; medical history: documentation of events, diagnosis, symptoms, treatment, outcomes, and test results – lab and imagining; associated documentation; and administrative information.
The implementation of EHR is done in two ways:
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Big Bang
Incremental or Modular
• All of core EHR components are deployed at once • More disruptive to practice • More rapid RoI • More rapid implementation • More resources required
• Specific components one module at a time • Less disruptive to practice • Longer time period to achieve RoI • Longer implementation process • Fewer upfront resources required
> www.ehealthonline.org > June 2011
Tech trends
Criteria to buy EMR software Software Provider
Product
Interfaces
Training
Maximum Laboratory Infor- Practice manage- Time required ment system number of con- mation System to proficiency current users Annual Rev- Product focus Hospital Infor- Cost accounting Cost per user system enues mation System On-site v/s Insurance Business form Solo practitionPharmacy Vendor site Corporation ers and Small Groups (6 or less) Public Private Office instruMedium Radiology Partnership ments groups (6-15) Capitalisation Number of Large Groups Outside ProvidInterfaces systems sold (>15) ers/Sites provided with system Number in curEnterprise Part of mainte- Additional cost rent use nance contract Years in Business
In addition to this, EMR information when stored properly (on scalable database architecture) can become a powerful information source for care analytics and risk identification and other clinical information systems can then be bolted onto/integrated with it such as CDSS, CPOE, LIMS, PACS, reminders and alerts etc.”
Integrating the system The sheer number of products in the market place has created a complex decision to be made. To invest in such a management system a buyer must answer few questions including: Which is the best EMR/EHR to be used? What is the cost of implementation
of EHR/EMR? What is the benefit of implementing such integrated system in your organisation?
Hardware & Software
Maintenance
Specific hardware requirements
Cost per year
Cost per user
Cost per user
Cost per workstation
Local, National/Regional
Upgrade frequency
Availability
Upgrade part of maintenance contract
Travel costs
Daily Rate
Stage 1: This phase is one of the most extensive and time consuming practice to assess in terms of IT in healthcare system. A hardware requirement analysis and staff analysis is done in this phase itself. The phased implementation is done in discrete modules such as lab order entry, messaging, E&M coding, preventive health maintenance, patient tracking, e-prescribing, etc. Proper workflow analysis is required to create flexible timelines. Stage 2: This phase includes appointing a house manager, reviewing the preparation for installation, map out workflows including the current staff and have proper communication processes identified. Stage 3: Investment to train staff and pre-
Naeem Ahmad, Manager-Business Promotion, Healthcare IT Practice, Akhil Systems, “Akhil EMR is an intuitive, state-of-the-art, and modern technology software solution. The main focus of this application is to bring uniformity and standardization in how various healthcare organizations maintain and share patients’ health records. A seamless integration is built between Akhil HIS and EMR to fill in existing gaps in Indian healthcare system reducing overall healthcare expense. The first version of the EMR has already been launched in the US market. The software will also be launched in India by July 2011.”
“The main focus of this application is to bring uniformity and standardization in how various healthcare organizations maintain and share patients’ health records.”
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Tech trends Dr. Karanvir Singh, Head of HIS Implementation, Sir Ganga Ram Hospital (SGRH), Delhi has been using TrakCare from Intersystems (USA) since 2005. The initial acquisition cost is `1 crore for the installation in the hospital. He adds, “We have already recovered the initial acquisition cost in financial terms. Benefits from EMR, i.e. continuity of medical records, etc. are not in financial terms but are in terms of better medical care. We have benefitted from that also.”
He strongly believes that, “We should not aim for an EMR that simply allows you to record patient data. Rather aim for a system that provides some level of decision support”
Sanveesh MV, Manager Systems, Apollo, Ahmadabad has Wipro as their provider for HIS, which contains minimal features of EMR. Since EMR is a part of HIS, there was no extra cost of installation. Introduction of EMR/ EHR into the hospital administration would be more affordable and form an essential part of HIT.
He feels, “Strengthening HIS functionality will result a better EMR system in the industry”
Dr. Neena Pahuja, Chief Information Officer, Max Healthcare opines, “We are in the process of implementing WorldVista, which is an open source EHR. Dell service has implemented it as an open source product. We have already started working on benefits tracking. As a first step, the data for KRAs to be tracked has already been baselined.”
She annotates, “There is no product that is ‘perfect’. Be open to changing your processes if you are implementing a product”
pare them to adopt new technologies, this covers the EHR system configuration, selection process and details of the goals that are archived based on the selection. Stage 4: Once the plan is finalised, the time lines are agreed by the vendor, then the staff training program is initiated and system testing is initiated. Stage 5: Post implementation, evaluation
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is carried and improvement plan is prepared and validated. Stage 6: This phase is modified to resolve issues and get staff feedback. Planning an EMR an organisation requires setting up a security technique; proper workflow and analysis to help assess practice’s IT readiness. The process is a success if the coordination between the software,
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hardware, and staff is synchronised. The EMR implementation needs workstations with large technological footprint and huge investments. The cost of the installation of EMR into the system depends on which brand you choose, the size of the administration and whether you purchase the system outright or buy it as a service. An EMR system should be well connected to third
Tech trends Kiran John, Head - Marketing and Presales, SCIOinspire Corp, “ Pricing depends on number of beds, modules being purchased, sophistication, present infrastructure, level of training required and so on, which then gets factored into a price range. The key inference being that the cost of implementing EMR is considerably lower today owning to these new technologies and will continue to decrease.”
“The key inference being that the cost of implementing EMR is considerably lower today owning to these new technologies and will continue to decrease”
EHR implementation helps an organisation to improve healthcare quality, reduce healthcare costs, prevent medical errors, improve administrative efficiencies, reduce paperwork, and increase access to affordable healthcare parties through an electronic interface. It is also seen that device communication can incorporate patient’s data more effectively. Once the product analysis is done, we need to look at process identification and analysis in order to analyse the benefits. The infrastructure of the organisation has to meet certain requirements: Ability to function with or without internet connectivity, maximum 3 seconds for screens to load, support dictation and handwriting, ability to access records from nursing home, hospital and home, all data and records, or a current copy, physically stored in my office and ability for multiple users to access charts simultaneously. The software is supposed to be coded with electronic remittance, ability to customise pick-lists for diagnoses, medications, diagnostic orders or chronic disease management along with flow sheets and documentation templates.
Rationalising Benefits EHR implementation helps an organisation to improve healthcare quality, reduce healthcare costs, prevent medical errors, improve administrative efficiencies, reduce paperwork, and increase access to affordable healthcare. There is greater patient safety, improved communication and perform-
ance, and the ability to access patient records remotely. It can also help in planning demographic health pattern for proper healthcare delivery. Kiran John adds, “EMRs also provide physicians and specialists a comprehensive view of patient information thereby reducing the medical errors, misdiagnosis, unnecessary utilisation, duplication of tests, and supporting P4P (pay for performance) models. At the aggregate level, easy access to comprehensive medical records are critical to lowering overall healthcare cost, fraud, abuse and waste in the system. With fraud and abuse become more complex and clinical in nature, having easy access to this information helps payers curb provider fraud considerably.”
Challenges On the other hand, there are certain obstacles, the healthcare professionals face while implementing an EHR system. There are factors regarding speed and technology dealing with different systems. The change in workflow needs to accommodate new technology along with cost for implementation. Presently, in India the healthcare system has recently introduced EHR and EMR. There is still a lot to be explored in the field. Although a lot of private hospitals are
maintaining EMR record but EHR practice still lags behind. Only a minuscule community of doctors is enthusiastic about the implementation of new technology. It is really important for government to take initiatives regarding the use of IT in rural health and encourage companies to project it forward. It shows that still a lot is to be done in terms of making the system aware about the new software and technology, which are reducing manual work. The system is largely implemented through computers, which is extremely cost-effective using non-proprietary technology which can be used even at national level without any further modifications. The initial cost of implementing shows the economics and the tangible benefits paying back the cost within 1-2 years. The open source EMR software is used in hospitals worldwide, which will support and upgrade. The software implemented is an enterprise level, and can save millions of taxpayers’ money if implemented at a national level. The whole process of implementation is not a one day affair. We all need to decide and revolutionize the way we deal with the record and storage of medical and patient records. As per the rules and regulations, the records need to be stored for at least a period of 2 years, in order to keep a track of it; this new software has given a chance to the medical professionals to keep a track of each and every case. Implementing EMR into the system with digitising and storing records in electronic form needs professionals to weigh cost and benefit equally by properly scrutinising the market and applying the perfect integrated system.
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THE PREMIER GLOBAL PLATFORM FOR E-DEVELOPMENT Presents
2011
EXPO 1-3 August 2011 | The Ashok, New Delhi, India EVENT Highlights l Power packed thematic sessions on governance and health l Exposition on e-Governance and e-Health technologies l Platform for exploring new business avenues in government and health sectors l Awards for excellence in governance and health standards across the globe l Opportunities for networking with key international government influencers
Why participate? l Meet top level decision makers, experts, leaders and stakeholders in ICT arena on governance and health from across the world at one platform l Great networking opportunity with policymakers from different countries, analysts, experts, ICT entrepreneurs l A platform to engage with colleagues and experts handling similar ICT projects from all across the world l Expo to showcase cutting edge developments in ICT l Sharing of best practices and knowledge
l ICT entrepreneurs, Industry representatives and experts
EXPO eWorld Forum expo will feature an elaborate exhibition and demonstration area where leading international ICT4D players in eGovernment and eHealth sectors, manufacturers, suppliers and service providers will present their latest products and services. Professional service providers, IT vendors, consulting firms, government agencies and national/ international development organisations involved in e-Government, e-Agriculture, Telecentre, Municipal IT and e-Health domains are encouraged to participate in the exhibition.
delegate profile l Ministers of different countries from world over l Secretary/Chief Secretary level officials from various departments from India and abroad l Key Decision-makers from governance and health institutions l Officials from bilateral and multilateral agencies l Representatives from NGOs and civil society organisations
CO-Organisers
supporting partner
Launch of the eWorld Forum 2011 by Shri Kapil Sibal, Honâ&#x20AC;&#x2122;ble Minister of Communication and Information Technology on 20th April 2011 at The Claridges, New Delhi
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Award Categories ICT Innovations in Governance • Best Government to Citizen (G2C) Initiative • Best Government to Business (G2B) Initiative • Best Government to Government (G2G) Initiative Theme based Awards in Governance • ICT enabled Financial Inclusion Initiative • ICT enabled Agriculture Initiative • ICT enabled Municipal Initiative • Innovative Grassroots Telecentre Initiative • Best m-Governance Initiative • Best Practices in Electronic Delivery of Services (EDS) • Best Cloud Computing Initiative • Best Rural Broadband and Connectivity Service Provider • Best Public Safety and Security Agency • Best Urban Governance Initiative • Best Power IT Initiative • Best State Data-Centre • Best Intelligent Transport System
Provider • Best Innovation/ invention in Taxation (including GST) Policies through ICT • Best use of ICT for Public Sector Units (PSU) • Best e- district Initiative • Best Information Security providing Agency • Most Effective Food Security (including PDS) providing Agency • Best Rural Governance Initiative ICT Innovations in Healthcare • Best Government Policy • Best Civil Society/ Development Agency Initiative • ICT enabled Hospital • ICT Enabled Diagnostic Service Provider • ICT enabled Health Insurance Initiative • Most Affordable Healthcare Provider • Best Medical Technology Innovation • Best PPP Initiative • Best m-Health Project/Programme • Green Hospital Initiative
• Green Laboratory Initiative • Best Use of Social Media in Healthcare • Best online Healthcare Provider • Most Innovative Technology for Healthcare Inclusion • Excellence in Care Delivery through Innovative Use of Technology • Healthy State ICT Innovations further Millennium Development Goals • Best ICT initiative in Eradicating Extreme Poverty and Hunger • Best ICT initiative in Promoting Gender Equality and Empowering Women • Best ICT initiative in Reducing Child Mortality • Best ICT initiative in Improving Maternal Health • Best ICT initiative in Combating HIVAIDS, Malaria and other diseases • Best ICT initiative in Ensuring Environmental Sustainability • Best ICT initiative in Developing a Global Partnership for Development
Key Speakers at eworld forum 2011
Kapil Sibal Union Minister of Communication and Information Technology, Government of India
Shankar Agarwal Additional Secretary, Department of Information Technology, Government of India
Jyotiraditya Scindia Minister of State for Commerce and Industry, Government of India
R S Sharma Director General, Unique Identification Authority of India (UIDAI)
Hon. Tassarajen Pillay Chedumbrum Minister of Information and Communication Technology, Mauritius
Walter Fust President of Globethics.net Geneva
Ranjith Siyambalapitiya Minister of Telecommunication and Information Technology, Sri Lanka
B Bhamathi Additional Secretary, Ministry of Home Affairs, Government of India
Dr Ajay Kumar Joint Secretary Department of Information Technology Government of India
Sharda Prasad Joint Secretary and Director General Employment and Training, Ministry of Labour and Employment, Government of India and many more...
For Programme Enquiry Contact: Ankita Verma, Mobile: +91 8860651646, ankita@elets.in For Business Enquiry Contact: Ragini Srivastava, Mobile: +91 8860651650, Jyoti Lekhi, Mobile: +91 8860651634, sales@elets.in (for further details visit our website www.eworldforum.net)
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Vibhu Talwar Chief Operating Officer Moolchand Medcity
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“Patients are true beneficiaries of accreditations”
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oolchand has been one of the foremost healthcare providers for over five decades now. Can you reflect upon Moolchand’s journey over the years? For over five decades we have been providing healthcare services to three generations of Delhites with care and dedication. Our vision at Moolchand is to create a truly unique institution that delivers world-class healthcare with a conscience of trust. As a result, Moolchand has built an outstanding legacy of touching people’s lives. Millions of people owe a debt of gratitude to and share a special bond with Moolchand due to its unparalleled legacy of philanthropy. We have played an instrumental role in the development of institutional healthcare services and have long-term relationships with the government and leading corporates. We pride ourselves on having a range of comprehensive offerings to meet the healthcare needs of institutional clients. In addition, we have worked with multiple institutions to develop offerings tailored to their specific needs. Our commitment to redefine healthcare has resulted in Moolchand winning innumerable awards and accolades for quality and excellence over the years. As a result,
patients can count on consistent and extraordinary quality. At Moolchand, we take pride in being differentiated by our DNA of uncompromising ethics and our tradition of ‘seva’. For Moolchand, healthcare is not a business, but a vehicle to make a difference and create a better world. We do understand that modern healthcare is expensive and are focused on being more affordable to our consumers than other hospitals of equivalent quality. On an average, how many in and out-patients does Moolchand get daily? Generally, we receive 30-40 patient requests for IPD cases and get 300500 OPD cases on daily basis. What are the various technologies currently installed at your hospital? What portion of your budget do you set aside for technology installation? At Moolchand, we are using the electronic medical records (EMR) as computer-based medical records for our patients. We are India’s first multi-specialty hospital to get connected with Akhil Systems Pvt. Ltd. for an integrated hospital management system (HMS) process. We use ‘lotus Notes’ as a knowledge management portal whereas now we do have a separate intranet portal based on sharepoint named as Veda. We do have the facility for online appointment system on our corporate
website and barcoding technique to reduce medication errors in laboratory testing methods. Our Laboratory has been upgraded with a series of fully automated diagnostic equipments like coagulator, ESR, cyto— centrifuge, bio safety cabinet and steam sterilizer. Our external counter pulsation (ECP) department at Moolchand Heart Hospital has been upgraded with new ECP therapy system from USA. A new sleep lab has been launched at Moolchand to treat sleep related disorders. The state-of-the-art Moolchand Renalcare and Dialysis has been established comprising 30 stations. A state-of-the-art Cath lab has been designed in our OT complex. Our Blood Bank has recently been upgraded with refrigerated centrifuge machines, higher capacity -40* deep freezer for blood storage and plasma bags from USA. Our Operation Theatres are equipped with cameras and first to use the telemedicine facility at our Centre for Telemedicine. Out of the annual financial budget of our hospital, we have kept aside 5 percent for technology upgradation. What are your views on hospital accreditation in India? What are the various accreditations that Moolchand has received? Healthcare industry is witnessing a metamorphosis, and we all are a part of this change. Now-a-days patients require world-class facilities, state-of-the-art infrastructure,
Vibhu Talwar, Group COO of Moolchand Healthcare Group, has played a pivotal role in the transformation of the hospital. In the capacity of a COO, he has developed deep expertise in the healthcare quality, systems and process development, operations excellence and organisation design and development. In conversation with Divya Chawla, Vibhu talks about Moolchand’s journey and how it has positioned itself as the most preferred healthcare provider in North India
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Specialties and Services • Moolchand Women’s Hospital • Centre for Fetal and Genetic Medicine • Fertility & IVF • Centre for Cosmetic Surgery • Gynaecology • Gynaecological Oncology • Mother’s Nest (Birthing Centre) • Centre for Neonatology • Specialty Clinics -Adolescent -Cancer detection -Infertility -Menopause -Reproductive endocrinology • Specialty Diagnostics -Bone densitometry -Colposcopy -Mammography • Wellness Programs -HealthCheck healing environment and above all knowledge of their rights. As a healthcare service provider, the accreditations help us develop and maintain a culture that benchmarks excellence. Accreditations are not limited to the national boundaries but also go beyond it. For instance Moolchand’s passion for excellence has been recognised by JCI, the highest benchmark for quality healthcare worldwide and by NABH (National Accreditation Board for Hospitals and Healthcare Providers) in India. Moolchand successfully meets the international set of 1,150 stringent standards covering patient safety, continuity of care, continuous quality improvement, medication management and patient and family education. Needless to say, patients are
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the true beneficiaries of the accreditations, not only do they receive excellent care and safety but also avail the services of the credential medical practitioners. In fact, accreditations are nothing but certified and reliable information on infrastructure, facilities and quality of care. Moolchand’s quest for quality has been recognised by many awards and accreditations such as ISO, NABH, IMC Ramkrishna, Asia-Pacific Quality, CII-EXIM Bank, Rajiv Gandhi National Quality, Century International Quality ERA, JCI and NABL. It is indeed a matter of great pride that Moolchand has become India’s first comprehensive JCI and NABH accredited hospital. Our quest for quality is not just limited to winning awards and accreditation but also run deep in every Moolchandite. What is the role of medical tourism in the growth of the Indian healthcare market? Medical tourism is a concept which is growing now-a-days; allowing people from various countries to visit India for medication and at the same time providing them with an opportunity to discover the rich Indian heritage. The infrastructure of Indian hospitals is world-class and the costs of treatment are significantly lesser in comparison to other Asian countries, making it the most sought-after medical tourism destination. India as a medical tourism destination provides internationally trained physicians, who are globally acclaimed for their unmatched quality. What is most interesting to note is that India has 6,40,000 physicians with more than 20,000 physicians being produced every year. Moreover, Indian doctors undergo rigorous capability building by perform-
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ing every surgery many times over. All this contributes in making India a preferred medical tourism destination. At Moolchand, we offer a comprehensive programme to meet the special needs of international patients. The International Services Centre at Moolchand is focused on ensuring a supportive experience for international visitors and assists with airport pickups, meals, translators, billing and any special need of our guests. We understand the stress international visitors face in receiving overseas medical care. We have structured our programmes to ensure that they do not have to worry about anything beyond the excellent and compassionate medical care. Our international guest care managers have extensive experience in caring for international visitors in terms of medical care, communication essentials, financial information, stay, trips and tours, and much more. What is the role of operations management in successful running of healthcare delivery centres? What are the key opportunities and challenges in this space? Operations management is the strategic implementation of programmes, techniques, and tools for reducing costs and improving quality of healthcare. Effective use of operative management tools outcomes into improved quality of care, reduction in medical errors, better utilisation of existing beds, increase in patient throughput and volume of medical/surgical patients, reduction in bottlenecks and waiting times in departments like ED and ICU, reduction in staff overtime and increase in staff satisfaction and finally improves the financial performance of the hospital.
Generally, hospitals face challenges in healthcare operations management in the absence of a mechanism to capture, analyse and present real-time performance about clinical and financial processes. To improve the quality of healthcare, for optimal clinical and financial outcomes and real-time performance optimisation, the solution is to create an in-built notification and alerting mechanism. This benefits by providing an opportunity to recognise and respond to the event on immediate basis and react proactively, also it enables clinicians to significantly improve clinical outcomes while reducing mortality, length of stay and avoiding the increased costs associated with treating complications. What are the future plans, in terms of growth at Moolchand Medcity? At Moolchand, our game plan is to emerge as one of the top 3 healthcare services providers in North India. We aim to grow by developing a portfolio of hospitals and Medcities. We plan to expand with more green field acquisitions, which are in line with our strategic plan. This transformation has already begun at Moolchand Trust’s landmark South Delhi campus, which is being developed as India’s largest city centre medical destination. It is envisioned that Moolchand will emerge as a premier medical hub in North India in the near future. To encourage medical tourism, we are working on a pattern to streamline international patient fraternity as a separate desk so that their work doesn’t get suffered with other regular patients. This will enable us to bring down the patient waiting time to almost nil to provide quality care at the earliest.
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Scope of Telemedicine at Moolchand Telemedicine aids caregivers in collection and transfer of still images, medical data, and live video and audio transmission By Vibhu Talwar
T
elemedicine usage is positive for patients as well as economy. It helps countless number of patients avoid nursing hospitals and homes allowing them to stay productive with less healthcare costs. Itâ&#x20AC;&#x2122;s benefits not only are availed in a single field but also across fields like radiology, psychiatry, cardiology and oncology. Telemedicine also helps in diagnosis and treatments that include patient and physician education, tele surgery and medical administration video conferencing among healthcare providers.
Moolchand Telemedicine Centre Moolchand has ehealth tools available to suit a range of customers, from single users to state-based healthcare services. The Moolchand Telemedicine program covers 50+ specialties. Our telemedicine services are used across India and also internationally. Moolchand is the only multispecialty hospital in North India and 1 of only 9 hospitals in India, selected by the Ministry of External affairs, Government of India to be part of its prestigious Pan-African eNetwork project. The Pan-African eNetwork project is one of the single largest infrastructure projects in independent Africaâ&#x20AC;&#x2122;s history (a US $110 million project that covers the entire continent). Through our eHealth service suite, Moolchand will provide real time consultations, treatment and advice for patients in 53 African countries and will upgrade the clini-
cal skills and knowledge of practicing medical personnel through continuing medical education in 50+ specialities. Earlier, the concept of telemedicine was alien to us and we could never imagine that such kind of thing would come into being. But, now with technological advancements this concept has gained momentum. The usage of various telecommunications by medical institutions and physicians for providing healthcare to their patients makes us wonder how technology can change our lives for better. Some common methods utilized include the internet, satellite and ordinary telephone lines. At Moolchand, telemedicine is utilised for Government of Indiaâ&#x20AC;&#x2122;s ambitious Pan Africa
project, where our physicians train and share critical information with their caregivers. Surgeries like laparoscopy are performed in huge numbers in India whereas in countries like Africa they are rare and uncommon. Inadvertently, this knowledge sharing helps in driving the business along with fostering healthy physician relationship across countries.
AUTHOR
Vibhu Talwar, Chief Operating Officer, Moolchand Medcity, New Delhi
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in focus
Integrated Approach to Healthcare Essential to countries such as India is an integrated health system, which addresses both the response and preventive aspects of health By Susheela Venkataraman
I
n many parts of the world access to healthcare is denied to large groups of people for several reasons including physical, financial and social causes. While on the one hand the global population of youth is increasing, so is the number of the elderly, creating new dimensions to the kind of health issues faced. As people migrate to urban areas the pressure on urban systems increases. Overcrowding often leads to infections and incidence of new diseases. New ways of working and living also give rise to new forms of illnesses. All of the above increase the need for better healthcare delivery even as countries face a shortage of clinicians, healthcare workers and infrastructure, when required and where required. Outdated and outmoded healthcare systems are still prevalent, posing a severe challenge to governments and communities. Better health outcomes call for addressing several other related issues such as water, sanitation, nutrition, pollution, awareness, education, occupation and economic well-being. As care becomes more complex, it requires a specialised workforce to deliver services often across geographically dispersed areas. This means healthcare managers need to communicate and collaborate in better ways without increasing costs or reducing the effectiveness of human interaction. While advances in research, treatment, and processes have strengthened the healthcare system, accessing them requires interaction between multiple sites. This creates new challenges and increases pressure to improve operational efficiency. Therefore the medical fraternity requires constant updating of skills, learning and education, which is in sync with changing technology.
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The health ecosystem as it exists today, is immensely complex encompassing primary, secondary and tertiary care providers, suppliers of drugs and other products, social workers, patients and their families, not for profit organisations, insurance agencies and the government. Unless this ecosystem works in close synchrony, the health needs of the society and various communities cannot be met.
High quality communication is critical Poor communication among various healthcare workers impacts productivity and patient safety. It also has cost implications. Problems in communication stem from the fact that healthcare industry still clings to outdated methods of communication. Reasons why communication fails also include necessary personnel not being identified, located or not available to respond in a timely manner.
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Many types of communications take place among clinicians, and between clinicians and patients. Technology can be applied to facilitate all these communications in a highly collaborative and mobile environment. While collaboration as a way of working is not new to the health system, it is becoming more of an imperative as the priorities of the industry and customers change. Better efficiencies and effectiveness could be achieved through closer collaboration within the ecosystem.
Integrated health system Essential to countries such as India is an integrated health system, which addresses both the response and preventive aspects of health. A good response system must allow for early detection of health conditions. It must also provide high quality infrastructure, focused on those in need, for the identification of a disease trend and containment
IN focus
Technology can be applied to facilitate all these communications in a highly collaborative and mobile environment of infection. The system must enable rapid dissemination of information, provide for emergency response and empower patients and their families to take charge. A preventive system meanwhile must allow detection and diagnosis besides providing information to create awareness. Empowerment of such systems is required along with the availability of other support systems such as vaccines, drugs and rehabilitation therapy for containment of infection, through community action. An integrated health system must also ensure skills refresh for clinical staff and health workers, while addressing their issues related to geographical
spread. Clearly, high-quality data is central. Focus must shift to stitching together all the information residing in several silos, to help people interact and work together closely. The availability of Information and Communications Technology (ICT) infrastructure and tools makes it easy for such collaboration to become a reality.
Connected healthcare Today, a â&#x20AC;&#x2DC;connectedâ&#x20AC;&#x2122; approach is required to be applied to the healthcare sector as organisations align technology and operational needs to support and streamline information flows. With increasing emphasis being placed on prevention and health, there will have to be a radical change in processes so as to optimise delivery of services, reduce medical errors and control spending. These processes must be centered on patients, who play an active role in deciding the most appropriate course of treatment for them. Ongoing education will have to be an integral part of the agenda for the medical workforce. Healthcare organisations will need an integrated network to help various
departments to collaborate, learn and communicate effectively. Across the globe, governments and healthcare systems have initiated broad healthcare improvement programmes, which require a secure, reliable, and increasingly interactive infrastructure to automate transactions and expedite the flow of healthcare data. This paves the way for a future in which all healthcare stakeholders can respond to patients more efficiently, expand preventive healthcare initiatives, and boost the overall health of communities. Several technology solutions exist for the many mechanisms that may be used to deliver collaborative care. However, the ability to combine or integrate all of them in a manner that is relevant to the specific situation and issues to be addressed, would determine their successful adoption.
AUTHOR
Susheela Venkataraman, Managing Director, Internet Business Solutions Group, Cisco India
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sPOTLIGHT
The Net of
Healthcare By allowing doctors to have immediate access to the patientâ&#x20AC;&#x2122;s medical record, online healthcare services can become a new conduit for exchange of health information By Dhirendra Pratap Singh
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hile the internet has been considered to be a rapid and valuable source of information to a majority of the worldâ&#x20AC;&#x2122;s population, advancements in mobile communication have made the world smaller with the advent of wireless technologies. The convergence of wireless communication, wireless sensor networks and other ICT based technologies could impact healthcare options to a larger extent amongst other industries and reshape the scenario as a whole.
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The healthcare industry by itself has seen a transition from the traditional paper based records to electronic records. Now, another revolution in this field has been the incorporation of wireless technology. The increasing cost to plug in wired devices has paved way for the usage of wireless technologies in several hospitals. There has been a need to get fast information due to the number of healthcare regulations in place, ever escalating healthcare costs and the rise in technology savvy patients. In rural areas, there is shortage of healthcare infrastructure, which has raised an enormous amount of concern in the recent past. Considering all these fac-
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tors, it has become pertinent for the healthcare industry to consider incorporating ICT in order to have a better tomorrow and survive the challenges of today.
Health services through internet Services offered by online health portals range from creating and maintaining personal health records to selling health insurance policiesâ&#x20AC;&#x201D;the list of services is unlimited. The sheer convenience of such services is one of the major factors leading to the rising popularity of online healthcare in India. There has been a gradual change in mindset as even
SPOTLIGHT traditional healthcare providers are now moving towards offering services through the internet. The use of online healthcare can make communication more effective and efficient, ease diagnosis and help achieve a higher quality of patient care. Online healthcare is in its infancy stages in India and looks to be promising future option to cater to the primary healthcare needs of urban and rural India. This form of healthcare delivery is not a replacement to the conventional method but will compliment it in a big way. India’s advantage in this space is advancements in technology, growing phone and online user base, affordable resources, and global image and demand. With growing occupational health issues in urban population, growing 50 plus population and healthcare supply issues in rural areas, eHealth can play a big role in the government’s vision of access to quality healthcare for all. While this is going to be the next big revolution in healthcare delivery, there are challenges like regulatory changes required in India enabling this form of healthcare delivery to be as efficient as the conventional method.
Technology trends With the increasing aging population and healthcare requirements in rural areas, technological advancements have led to the development of databases that provide ready to use healthcare information. These databases provide information on pivotal clinical studies, development in disease management to the physicians while few others provide A-Z information regarding diseases, health and drugs to patients. Examples of these include WebMD and Epocrates Rx. Telemetry: This refers to the use of a wireless technology that is used to monitor patients with the use of radio waves. However, the usage of this technology has some guidelines in order to prevent the interference of other radio waves with telemetry signals as this can be hazardous to the life of the patient. A recent development in the area of wireless patient monitoring has been the introduction of the GE CARESCAPE Telemetry Platform that is capable of simultaneously leveraging and coordinating cell phone, Wi-Fi and other wireless technologies on a single platform.
Online healthcare is in its infancy stages in India and looks to be promising future option to cater to the primary healthcare needs of urban and rural India. This form of healthcare delivery is not a replacement to the conventional method but will compliment it in a big way We have seen how online services have revolutionised delivery of services in communication, banking, trading and transport industry, which again cater to a vast population. Healthcare too needs to adopt best practices from other industries. Access to medical records at a single click for consultants, as well as patients helps deliver quality care and avoid medication errors by quickly reviewing past medical history. The end goal of the healthcare ecosystem in India, to adopt online healthcare services, should be focused on providing benefits to the citizens at a transactional level and easy availability of personal healthcare information in a high secured way.
Bluetooth: These are user-friendly networks for communicating through cellular phones, PCs and personal digital assistants and falls under the wireless personal area network (WPAN). This technology is lowpriced, consumes lesser power and is all set to replace the currently existing forms of wired connectivity. WiFi: Wireless fidelity (WiFi) is yet another revolutionary technology that has been in use to boost efficiency and enhance care in hospitals. These wireless networks provide secure infrastructure and flexible access than wired solutions. RFID: Radio Frequency Identification (RFID) is an enabling technology that uses
Dr SB Bhattacharyya President, IAMI and Head - Health Informatics, Tata Consultancy Services
Online Healthcare is a rapidly emerging segment in the healthcare delivery process propelled greatly by mHealth. It is bound to radically transform the way healthcare services are provided by both individual and institutional care providers and paid for by the payers while permitting the state to regulate it all in real-time. With patients able to exchange health-related information with their providers instantly irrespective of their physical location, compliance with treatment protocol requirements and increased adherence to wellness-requirements are expected to accrue. Better care can be provided as errors of omission and commission are minimised while maximising efficiency and productivity.
radio frequency waves to monitor tagged objects and personnel. The principal components of the system include the RFID tags and the reader apart from the software that is being used. RFID has been used both in pharmaceutical industries and hospitals. RFID covers a wide array of applications in healthcare ranging from tracking medical devices such as pacemakers and defibrillators to monitoring patient safety and quality assurance applications. Software Applications: Software applications are an integral part of the hospital en-
June 2011 < www.ehealthonline.org <
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sPOTLIGHT
Nitin Mathur Business Head, Health PA
Healthcare has for long been one of the most searched subjects online. However, online healthcare was limited to users scanning content on medical conditions. The last couple of years in India have seen the emergence of new and innovative ventures, with strong local content and services, ranging from doctor-on-call services, online diet planning, ‘Find a hospital and doctor’ services, sales of discounted diagnostic packages etc. However, the industry is still in its infancy, as businesses are figuring out what really works online, India being a large but unique healthcare market. Ventures and services that confer higher convenience (assist in finding a doctor or hospital) or a cost advantage (example- finding cheap diagnostic packages) will be the ones that prevail, judging by how other industries in the online space in India have evolved. vironment that can assist the healthcare providers with their point of care applications. Palm OS: This typically represents an operating system that has a touch screen graphical user interface. The wide range of applications in the system along with ease of use and lower memory requirements has been considerably gaining importance across the
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healthcare industry over the past few years. Pocket PCs: Microsoft first developed an operating system for hand-held devices which was very similar to the well known Windows version. This was known as Windows CE. However, these require larger storage capacities when compared to Palm OS and hence are less preferred as opposed to the easy to use Palm systems in healthcare. Laptops: These are similar to the desktop PCs in terms of functions and appearance. However, these are easily transportable in a hospital environment and if connected with a WLAN, can enhance functionalities in both administrative and patient care environments. Tablet PCs: This is a relatively newer development and carries the same function as a laptop but is equipped with a touch screen and a pen based capability. This enables the user to directly write prescriptions instead
ing costs. Realising the benefits of wireless technologies, several healthcare providers are resorting to using electronic medical records (EMR) and electronic health records (EHR). The e-prescription and EMR markets are estimated to reach US $166.7 million in 2013, says Frost and Sullivan. Wireless and online technologies considerably reduce burden on nurses and therapists. Technologies such as PDAs (Personal Digital Assistant), smart phones and UltraMobile PC (UMPC) can also aid in patientcentric healthcare by providing details of patients including clinical histories, lab reports, ongoing and past treatments and so on.
Poor medical infrastructure There are not enough hospitals, doctors, nurses and para-medical staff in the country
A rising concern across public healthcare systems and healthcare insurers is the rising costs of delivering care to patients. With the ever escalating treatment and therapy costs, it is indeed favourable for the industry and hospitals to adapt to mobile and online means of patient care of the more tedious process of printing the entire document and later writing on it. Microsoft again has been a major provider of tablet PCs.
Rising costs A rising concern across public healthcare systems and healthcare insurers is the rising costs of delivering care to patients. With the ever escalating treatment and therapy costs, it is indeed favourable for the industry and hospitals to adapt to mobile and online means of patient care. A considerable amount of investment in pharmaceutical industries goes into drug discovery and development. Although several drugs are being developed, only a few get into the market while others still remain at the research and development phase. Implementing wireless applications into these stages of clinical R&D could significantly reduce time up to 30 percent whilst also sav-
> www.ehealthonline.org > June 2011
to meet the growing healthcare needs of the people. India can absorb one lakh doctors per year and we only produce 18,000. Poor healthcare could severely impact economic growth. India needs 7,415 community health centres per 100,000 population. We have less than half the number. Worse, at the healthcare facilities we do have, the basic staff is not in place. Only 38 percent of our primary health centres have all the required medical personnel. In the 3,043 CHCs that we do have, only 440 have a pediatrician, only 704 have a physician, only 780 have a gynaecologist and 781 a surgeon. So not only is the infrastructure inadequate, we don’t even have the staff to use the existing infrastructure. We need 76,622 midwife nurses (one per PHC and seven per CHC). We have planned only for 44,143 and only 27,336 -- barely half the requirement -- are in place. Thus, the Indian healthcare sector is suffering from an acute
sPOTLIGHT shortage of healthcare professionals and facilities delivering quality healthcare services to the citizens. According to the NCAER, in nearly 20 percent of cases rural households travelled more than 10 km for treatment. In Meghalaya, in 54.56 percent of rural illness cases and in Orissa in 33.47 percent of rural illness cases, patients travelled more than 10 km. Even when patients do get to the health centre there is no guarantee that the staff will be present. According to a survey by the Jan Swasthya Abhiyan, only 38 percent of all PHCs have all the critical staff. A survey by the International Institute of Population Sciences found that only 69 percent of PHCs have at least one bed, and only 20 percent have a telephone.
Opportunities Asia Pacific has been characterised as a region that has significantly low quality healthcare when compared to the western world. There are opportunities galore for online and mobile healthcare due to the deprivation of quality health to those in the underprivileged areas. The introduction of web cameras and internet in rural areas along with other mobile technologies can aid in extending health services in these areas. Another area would be to improve healthcare surveillance in rural areas. With the advent of mobile technology in the rural areas, efforts can be taken to provide real-time monitoring of health related issues. SMS alerts can be used to target people in areas where clinics and healthcare workers are limited. Last year, Bihar State Government has announced to give free mobile phone services to its doctors in an attempt to reduce truancy. Many government doctors neglect their official duties by practising privately on the side. The main purpose of the move is to be able to get in touch with the doctors at any time. Their movements will also be tracked by a system. Similarly, for the first time in India, a mobile phone doctor-to-patient service called ‘Doctor on Call’ was launched. The 9 to 9 service that provides live interaction was pioneered by BPL Mobile, Mumbai’s leading mobile service. Data collection is yet another area that is of vital importance in healthcare. Data collection programs can be offered through
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smart phones, mobile phones and PDAs than manual entry which can contribute to bridging the gap that exists in the current scenario. Implementation of remote monitoring applications can improve the outcome of various chronic diseases whilst also opening newer avenues of treating patients in an outpatient setting. Usage of mobile phones can be helpful in improving communication amongst the healthcare providers to enhance patient care. This can also be used to monitor the incidence and outbreak of infectious diseases. The use of mobile phones as a point-of-care device can enable patients to receive diagnosis and treatment assistance at their homes and villages itself thereby averting expensive hospital visits. The fragmented state of the healthcare services in India today leaves a lot of room for innovation and a potential for aggregation from a patient’s perspective. There is a great push now to make IT work in healthcare–both in developed and developing countries, especially in areas such as tele-
> www.ehealthonline.org > June 2011
medicine. 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. There are some 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. Although healthcare needs still require visiting a doctor, it is still worthwhile to have minor issues sorted out virtually. By enabling patients to video conference with their physicians and allowing doctors to have immediate access to the patient’s medical record, online healthcare services can become a new conduit for exchange of health information. With the widespread use of mobile phones, deployment of 3G and Wi-Max services, and leveraging India’s IT expertise, we will be able to see more innovative, creative and low-cost healthcare IT based solutions.
Specialty
Cardiology
Fast Forwarding to Integrated ERA The future will be dominated by digital technologies which will prevent, treat and finally cure the disease without expecting a blockbuster drug to be discovered By Shally Makin
M
ark wouldn’t have been alive today, had the cardiac scanner trial not been conducted by his doctors. The report revealed a major blockage in his coronary arteries and he was operated without any further delay, which saved his life. The digital world has generated amazingly detailed, three-dimensional images through sophisticated computer and IT infrastructure. In 1816, stethoscope was one valuable patient assessment device used to monitor every heart beat. The breath sounds diagnose the condition of heart and provide information regarding the patient’s ventilation-perfusion relationship. However,
since then there has been great development in the medical field. Traditionally, the treatments were performed via face to face evaluation by specialists and trained staff. No one would have imagined that there will be a day when a doctor will be just five minutes away. At the time of cardiac arrest, the immediate aid one needs is the CPR and today the ambulance has got it on wheels for the patient. This way the whole healthcare delivery system is turning towards digital processes. Today the evolution in device technology, increased demands in healthcare system and larger public acceptance of networks and communications has shown a paradigm shift in the sector. Since 1977, with the advent of inter-
ventional cardiology, the cardiologists have received various devices to examine the pace of heart and its functioning. Cardiac treatments nowadays are inclining towards technological innovations. The myriad data elements such as cardiology images, ECG waveforms, lab results, patient histories and hemodynamic monitoring and procedure data are successfully integrated to deliver care. For cardiology, the complications lie in the assimilation of relevant patient data and follow up of patient throughout the gamut of care. Several researches, innovations and devices have proved to provide treatments, which are less invasive, faster and successful. The massive campaign started by the IT infrastructure to implement digital processes and image updating has standardised the process to help meet key goals including trimming costs, optimising quality and increasing efficiency. Cardiology is a very sensitive department which needs effective integration of various information systems. The continuum of cardiac devices purposely needs a ‘DICOM like’ standard, which enables the transfer of images regardless of vendor and hemodynamic equipment such as Sensis, by Siemens Healthcare. This sector is now following the path of radiology with the introduction of a large number of devices using technologies, including capnography (method for patient monitoring of ventilation, pulmonary dead space and blood flow), PADnet, wireless technology in Cardiac
June 2011 < www.ehealthonline.org <
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Specialty telemetry and advanced cardiac monitors like ANSI/AAMI EC13.
“Medtronic’s Care Link Service advanced technology includes a patient monitor that enables patient to ‘connect’ the implanted device in”
Industry presence Global interventional cardiac devices industry forecasts to reach at US $15.7 billion by 2015 at a high CAGR of 9.9 percent during the analysis period 2009-2015. It is estimated that remote monitoring could decrease the 5-year costs of standard device monitoring by US $2100 to US $3000 per patient. The industry is greatly emphasising into incorporating patient data, which includes cath lab reports, echocardiograms and/or vascular services. Then we need to merge the patient’s ancillary services, including cardiopulmonary, rehabilitation and implantable cardioverter defibrillator (ICD) follow-ups to access and potentially input patient data into the CVIS. The cardiovascular information system (CVIS) is the patient and department management tool to facilitate the management services effectively with detailed statistical data and not merely an information capture device. Philips Healthcare has purchased Tomcat’s software, which connects with different clinical information systems and with systems from other vendors. It also provides scheduling, staff and resource management, cost capturing, generation of reports and statistical information. There are presently various products in the market with great success rate; latest products including AirStrip CARDIOLOGY, MUSE Cardiology system by GE Healthcare, CARE cardiology software by i2i solutions and InstaCath by Mediff technologies. The technological revolution has brought a cost effective plan for cardiac treatment and improved delivery of health. Such devices target to avoid routine follow-up visits such as integrity check. A decrease in patient follow-up visits and early identification of problems can lead to a reduction in hospitalisations. Fully automated remote monitoring capabilities will probably be included in all upcoming IECDs, which will shift the emphasis from a device-oriented to a patient-oriented monitoring, allowing a new broader multidisciplinary approach. The devices attached with alerts and transmission of patient information to center and interpretation would ul-
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Milind Shah, Managing Director, India Medtronic
TECHNOLOGY REAPING BENEFITS DOWN THE LANE User friendly interface
Fully automated remote monitoring
Cost effective
Decreased follow up visits
Potential Benefits
Reduce the time for treatment
Proper storage and networking
Reduction in hospitalizations
Increased productivity timately reduce the time for treatment. IT in Cardiology improves patient care, workflow and other key metrics. Implementing a system, such as CVIS, however, is a multi-faceted process that requires hospitals to analyse particularly store and network. Designing the storage system requires close collaboration between cardiac imaging and IT.
> www.ehealthonline.org > June 2011
One of the most advantageous aspects of connectivity in cardiac telemetry is the videoconferencing and echocardiography equipment which enables real-time transmission of echocardiograms from the remote center to the cardiologist at the referral center. Milind Shah, Managing Director, India Medtronic says “Medtronic’s Care Link Service, remote
Specialty
Cardiac treatments nowadays are inclining towards technological innovations. The myriad data elements such as cardiology images, ECG waveforms, lab results, patient histories and hemodynamic monitoring and procedure data are successfully integrated to deliver care monitoring of Medtronic heart device, helps improve patient care and reduce the healthcare costs. This advanced technology includes a patient monitor that enables patient to ‘connect’ the implanted device in heart to doctor’s clinic via a standard phone line. This allows the doctor to conduct a routine checkup or review a special situation no matter where the patient is. When directed by the doctor, the patient simply needs to
connect the monitor to a regular phone line, push the start button, and hold the antenna over the heart device. The monitor automatically transmits the data, turning itself off when the transmission is complete.” He adds, “This technology reduces healthcare utilization costs compared to standard in-office follow-up. Clinical trials have established that remote monitoring helps in quick and efficient
decision making, reduces hospitalization days and in the process helps in saving costs for the patients.”
Step ahead The voluminous data, which include images, ECG recordings, etc has now exploded and needs to be organised as cardiology today has reached to a tipping point. Still cardiology is in a dearth of IT and its application to offer new and improved models to build an efficient solution to cardiology informatics. Government needs to shed its suspicion towards the private sector and involve them proactively for various PPP initiatives through a well designed concession scheme, simultaneously the private sector needs to sacrifice a bit of the profits in expectation of huge volume through these initiatives. Remote monitoring and tele-cardiology is in penury of guidelines as it presently incurs multiple legal issues.
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special focus
EHR
The Holy Grail EHR and PHRs will be accessible from anywhere and at any time thanks to Cloud Computing 3.0 By Vamsi Chandra Kasivajjala
T
hink how exciting it would be to be able to take a medicine personalised for you which can cure a common cold in ten minutes or pneumonia in 4 hours or just eradicate hereditary diseases including Diabetes Mellitus, Schizophrenia, Alzheimer’s, RLS, etc. This is not fiction but a vision to make the impossible possible.” Eons ago, invention of language and writing tools saw the beginning of personal healthcare information being captured for important people mostly Emperors, Kings and Pharaohs; great scholars like Hippocrates, Susrutha, Peseshet, Esagil-kin-Apli, Rhazes, IbnSina, etc. documenting symptoms, remedies and various surgical and anatomical observations. It is said that the great Hippocrates captured personal health information so as to ensure that adverse reactions/interactions did not occur or recur based on the medications given. And this was way back in 440 BC, so Electronic Health Record (EHR) is not a new concept. An EHR (also electronic patient record (EPR) or computerised patient record) is a record in digital format that is capable of being shared across different healthcare settings, by being embedded in network-
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connected enterprise-wide information systems. Such records may include a whole range of data in comprehensive or summary form, including demographics, medical history, medication and allergies, immunisation status, laboratory test results, radiology images, vital signs, personal stats like age and weight, and billing information. Its purpose can be understood as a complete record of patient encounters that allows the automation and streamlining of the workflow in healthcare settings and increases safety through evidence-based decision support, quality management, and outcomes reporting.” Medical technological advances like Genomics, Proteomics, RNAi, 256 Slice CT, elastic Ultrasounds, etc. are generating Terabytes of data, which needs to be converted into information and from that information it needs to be transformed into knowledge, which will then essentially save lives.
The Present 2011 is truly a watershed year, due to various reasons, but the most important of them being: • Kind of visibility that HITECH (ARRA) Act has given EHR/EMR to deci-
> www.ehealthonline.org > June 2011
sion makers globally. • Cloud Computing is the buzz word of the IT industry • Evidence based medicine, clinical decision support tools and vocabulary servers have truly come of age and are easy to implement and easier to integrate with • HIE (Health Information Exchanges) and patient portals are making a mark • In India, more and more citizens are having access to insurance and the payers are demanding structured clinical documentation as a part of the discharge summary which includes diagnosis, surgeon notes (if surgery is involved), progress notes, clinical events like lab and rad tests and their results, medication and IV details, etc. • Also, in India most of the providers are going in for accreditations like JCIA, NABH, NABL, CAP, ISO, etc. which also forces them to provide structured documentation as a part of their audits. • Medical tourism is picking up in India and slowly global standards for clinical documentation such as CCD (Continuity of Care Document) are slow-
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special focus
The history of Medicine so far can be represented by the below diagram. 3300 – 3000 BC
1000 BC
500 – 460 BC
9th Century AD
11h Century AD
Ayurvedic & Egyptian Medicine
Babylonian & Hebrew Medicine
Chinese, Greek & Roman Medicine
Persian & Islamic Medicine
European Medicine (Medieval)
12thCentury AD
1676 AD
1847 – 1865 AD
1882 AD
1895 – 1899 AD
European Medicine (Early Modern)
Microbiology
Germ Theory, Early Genetics & Eugenics
Bacteriology
Radiology & Psychiatry
1901 – 1929 AD
1928 AD
Serology & Virology
Penicillin
1998 AD Embryonic Stem Cell Therapy
2003 AD Human Genome Project
2012 AD Cloud Based EHR
ly catching up. Due to the above reasons and more, EHR/EMR is truly a must buy on every CIO/CXO’s shopping list. And in India, unlike its Western (USA, Western Europe, Australia) and APAC counterparts; focus was more on revenue related aspects like billing, charge posting, interfacing with finance (AR and GL), but now slowly aspects like clinical documentation, order entry, structured reports from EHR like discharge summary, case notes and more are becoming common requirements. Similar to the Western countries, the need is stemming from the acute pressure from payers and patients alike. After all, a typical educated patient searches Google or Bing on the symptoms’ and probable diagnosis before he visits his/her doctor. Today it is common that an expectant mother and her husband have more questions to ask compared to what a doctor had to answer a decade ago. This means the need for more patient education material and access to patient portal and PHR are becoming a necessity than want. Welcome to the age of Healthcare Information Technology!!!
The Future Whether you call it Gartner’s CPR Generation 5 or take a leaf out of Michael Crichton’s Next or it could be our favorite Jurassic Park movie. The future of EHR and PHRs will be based on Clinical Genomics and Proteomics; drug delivery will have Nanotechnology as an integral part; Robotic surgeries will be a common phenome-
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non; petabytes of data will be crunched in a matter of minutes if not seconds. This is OUR FUTURE! The future EHRs will be based upon the following core components: • A clinical inference engine which can compute all kinds of interactions including drug to drug, drug to food, drug to lab, drug to diagnosis, drug dosage alerts, drug to gene, drug to allergy, and more. • Inbuilt vocabulary server which can understand whether you call CABG, coronary bypass, coronary bypass surgery, coronary artery bypass graft or open heart surgery. The systems will have the ability to understand patterns and match them without human intervention. • Online interfaces to Insurance company systems to ensure that the meds or other orders are covered and this will be handled almost instantaneously. • Crunching engine – which will have the capability to process Petabytes of data to provide the right Evidence based medicine and well defined Pathways which use the state of the art clinical knowledge management, workflow and business rules engines. • A seamless graphical user interface with inbuilt speech recognition and facial recognition technologies, which would ensure that the clinicians do not have to look at their monitors while trying to communicate or while diagnosing their patients. • Repurpose engine, which would be able to provide true contextual search, for example: if a Cardiologist searches for ’CAR’, the top results would be to do with Cardiology such as Digoxin or Warfarin;
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Atrial Fibrillation or Tachycardia; Acute Myocardial Infarction or Ischemic Cardiac diseases. And, also the engine would be able to provide the interfaces over browsers or any kind of mobile communication devices. • Communication server which would be able to print reports, fax them, send SMS alerts and even call users or patients based on rules. EHR and PHRs will be accessible from anywhere and at any time thanks to Cloud Computing 3.0. The probability of giving the wrong medications or an anaphylactic reaction occurring due to a drug-allergy reaction would be miniscule. Most of our mobile devices would have auto medication dispensing units built into them especially for geriatric patients and which are connected to our PHRs seamlessly. Our vital signs would be monitored unobtrusively and paramedics would arrive before a serious medical mishap occurs. The world of ‘Minority Report’ is probably not too far away. True social computing in combination with tele-presence will make the future of telemedicine much more than what it is today. And it goes without saying that, all the information would be provided through EHRs and PHRs.
AUTHOR
Vamsi Chandra Kasivajjala , Head, Healthcare Products and Application Services division, Religare Technologies
in conversation
Ashwani Raina General Managerâ&#x20AC;&#x201C;UIS & Radiology Systems, Mindray Medical India
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> www.ehealthonline.org > June 2011
in conversation
“Intelligent and easy to use machines provide opportunity for better human life” Mindray Medical is one of the leading global manufacturers and suppliers of highquality medical equipments. Having started its India operations from January 2007, Mindray has already established itself as a leading player in patient monitoring and life support, in-vitro diagnostics and medical imaging segments. Ashwani Raina, General Manager– UIS & Radiology Systems, Mindray Medical India talks with Dhirendra Pratap Singh about his plans for the domestic market and reflects on current issues in this industry
H
ow have you seen the advancement in the field of medical electronics over last few decades? Which areas of healthcare have benefited the most through such technologies? Medical electronics has reformed to a great deal in last few decades. We have seen tremendous technology breakthrough across many product lines. Healthcare providers have worked closely with clinicians and designed equipments, which match their needs for patient care precisely. They are not only looking at the current problem but also future prediction and cure. Today, doctors get quick qualitative and quantitative information with ease. The doctors can make accurate and correct decisions and they feel much more confident. Introduction of HIS, PACS are examples of how healthcare is getting benefitted in a big way through IT. Equipments have become smart and small, easy to carry, and pleasing to patients. Intelligent and easy to use machines provide opportunity for better human life. Imaging field have seen a lot of benefits – we are able to get accurate information for a small lesion and scanning time is really short. Patients feel painless during examinations. We at Mindray do scanning with lower dose, which is good for patient’s health. Breakthroughs have happened
in imaging field and we have seen Nobel Prize winners for CT and MRI modalities. What is the portfolio of medical equipments and devices that you are currently offering in India? We are offering ultrasound, color Doppler, hand-carried color Doppler devices. In radiology imaging products, we are offering DR and MRI, PM and life support – patient monitors, anesthesia Systems, OT tables, surgical lights, pendants and defibrillators. In IVD product segment, we are offering hematology analyser, random access chemistry analyser, clinical chemistry reagents and veterinary solutions across product lines. A number of medical equipment companies are setting up R&D and manufacturing base in India. Do you have similar plans in this country? I am quite optimistic about India’s story, especially in healthcare. We have our R&D centres in US, Europe, China and are keeping a close watch on India too. We are in India for last six years and have seen terrific growth across product lines. Today, top customers use our products and their feedback is very critical for us. In fact, Indian customers’ inputs and feedback are part of our product development and while designing new products. Many top doctors across the country have attended our forums and their feedback is valuable for us.
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in conversation
In radiology imaging products, we are offering DR and MRI, PM and life support – patient monitors, anesthesia Systems, OT tables, surgical lights, pendants and defibrillators. In IVD product segment, we are offering hematology analyser, random access chemistry analyser and veterinary solutions across product lines What has been your marketing and business strategy in India? Are you working through your own resources or through local distributor/reseller network? We have our direct operation in India and have our direct team
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present in most states. To have a better reach and support to end customer, we have exclusive and dedicated specialised distribution network for each product line. We work as team with our distribution to ensure that localisation and service support is given promptly. We
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maintain sufficient inventory of spares in India in different zones for our customers. We are very actively participating in conferences, trade shows and conduct local CMEs. We have team of dedicated application specialist across product lines to ensure our users
use the machines to optimum. Demonstration equipments, a key requirement for business is maintained in a healthy way and we can confidently commit to customers on the same. We have tripled our organisation in last one year and will continue to recruit talented people and strengthen our distribution network too. We shall open more branch offices in India in coming years. For easy access customers can reach us through toll free number 180010-20-300. We have niche products in each segment, which allows us to compete in every market. Just to name a few in imaging segment—MagSence 360 MRI with powerful gradient of 25mT/m, 0 percent eddy effect, the first ’inScan technology’ shows more care for patients, is easy to use, and saves at least 40 percent time in scanning. Exams can be performed by a touch screen on the system itself. M7 Hand diagnostic color Doppler, Reddot award winner product, is an extremely powerful system and is becoming customers’ choice. It can do Volume 4D and for cardiology, has qualitative tools like TDI, TVI, FreeXros. What are the existing regulatory hurdles and bottlenecks for medical device companies operating in India? What will be your wish list from government authorities for boosting this industry? I don’t see many hurdles at this point of time for operations and on the hindsight many opportunities await in India in healthcare sector. Market growth coupled with company strategy and product mix makes it exciting.
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Applications
Smart Way
to Safer Hospitals Contactless smart card technology has been used for many years in other industries and is now helping solve some longstanding thorny issues in the healthcare sector By Holly Sacks
O
ver the past few years, the healthcare sector has become increasingly dependent on information technology. Contactless smart card technology has been used many years in other industries, and is now helping to solve some longstanding thorny issues in the healthcare sector, safeguarding patients and staff and protecting confidential patient information. Hospitals in Scandinavia were early adopters of this technology, and Germany has
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recently issued healthcare smart cards to its entire 80 million-strong population. In the UK, many hospitals are now waking up to the benefits of using contactless smart cards to control physical access to their buildings and logical access to the IT systems that house confidential patient data. In the past, it was relatively easy for an intruder to walk unchallenged around a hospital, accessing areas meant only for authorised staff. In rare cases, this led to security breaches where babies were removed from paediatric wards. Contactless smart cards
> www.ehealthonline.org > June 2011
are addressing this physical access problem by using encryption to offer differing levels of building access to certain staff. For example, a cardio-thoracic surgeon would require access to the operating theatre, while a registrar might need access to all the wards in the hospital. Medical professionals can also use their smart card to access sensitive patient data on a network. So as well as safeguarding the security of patients’ personal information, using a smart card for logical access can also create efficiencies in terms of time. If a doctor can access crucial IT systems with just a smart card, this saves on time wasted in remembering and entering usernames and passwords and frees up more time for patient care. It also helps healthcare professionals to demonstrate that they are storing and managing patient details in a safe and secure way to comply with the Data Protection Act. Smart cards can come in contact or contactless form, and can offer three levels of security—single, dual or three-factor authentication. With single-factor authentication, using the card on its own will give access to a system or open a door. Dual-factor authentication—the most common level of smart card authentication in UK hospitals—adds on an extra level of security in the form of a PIN code. Three-factor authentication goes a step further, using a PIN and an extra security measure such as a biometric scan. Contactless smart cards are traditionally used for physical access control and are now being
Applications adopted for logical access control as well. One surprising area where this technology is making an impact is infection control—a topic that is never far from the headlines. We’ve all seen the bottles of antibacterial hand gel that now stand at the doorway to every hospital ward, and no one can have missed the government swine flu posters that landed on every doormat across the country. Just think about a doctor on her morning ward round. In just a few hours, a doctor could see as many as 20 patients on five different wards, accessing different areas of the hospital and different computer systems as she goes. With this many potential touch points, it’s easy to see how infection can be spread. Contactless smart cards—where the card is passed in front of a reader device—are playing a key role in limiting this spread of infection. After all, if your pass card never touches the reader, it can’t spread germs. With these many advantages, adopting contactless smart technology seems like a no-brainer. But some hospitals are still using
the most basic form of secure access control – the magnetic stripe or ‘mag-stripe’ card, where magnetic data is stored on the back of the card. While mag-stripe cards are cheap to produce, they can end up more expensive in terms of maintenance. Magnetic stripe cards come in contact with the reader when inserted, and any debris that collects on the card inevitably ends up inside the reader and on its contact pins. They are also susceptible to magnetic interference and wear and tear, constant swiping through the card reader causes the stripe to deteriorate and eventually fail. This type of card is also very restricted in terms of its data storage capacity compared to that of smart cards, some of which now have up to 164K of memory. But perhaps their biggest disadvantage is that they are very easy to clone. You can even buy a mag-stripe reader from a high-street store that will let you take data off one of these cards and use it to create an unlimited number of clones. It’s fair to say that the cost of upgrading to contactless smart cards can be a barrier
to deployment for some hospitals, where funding priorities can mean that management has to choose between upgrading physical and logical access systems and having another 30 patient beds. On the other hand, is it really possible to put a price on effective infection control or security in a maternity ward? When you weigh up the costs of contactless smart card technology against the benefits, it can offer outstanding value to the healthcare sector, saving time and money, protecting patients and staff and safeguarding their personal data. Portable and secure, contactless smart cards are fast becoming a valuable tool for safeguarding physical security and guaranteeing the privacy of sensitive electronic information.
AUTHOR
Holly Sacks, Senior VP – Marketing and Corporate Strategy HID Global
INSIGHT INTO THE BUSINESS OF HEALTHCARE
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5/24/2011 5:41:09 PM
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