asia’s first monthly magazine on The Enterprise of Healthcare
eHealth Magazine
volume 8 / issue 06 / june 2013 / ` 75 / US $10 / ISSN 0973-8959
The
Healer of
hearts
Dr Ashok Seth, Chairman-Cardiology Council, Fortis Escorts Heart Institute
Feroz Ahmed Khan
Minister of State, IT, Science & Technology, Additional Charge of School Education, Medical Education, Govt of J & K
Dr K K Aggarwal National Vice President Elect, Indian Medical Association
Dr Indira Hinduja IVF and Infertility Specialist at PD Hinduja National Hospital
ehealth.eletsonline.com
volume
08
issue
6
contents
ISSN 0973-8959
68
10
cover story
Dr Ashok Seth
Country’s Medical Education Calls for Reforms
Chairman-Cardiology Council, Fortis Escorts Heart Institute
By Sharmila Das, Elets News Network (ENN)
cover story Dr K K Aggarwal, Vice President Elect Indian Medical Association
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Dr Vivek A Saoji, Dean and Principal, Bharati Vidyapeeth University Medical College
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MEDSIM – Medical Simulation Based Learning Using Virtual Patients
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eLearning in Medical Education
18
Dr Manju Chhugani, Principal, Rufaida College of Nursing, Jamia Hamdard
20
Rohit Kumar, Managing DirectorSouth Asia, Elsevier Health Sciences
22
Prof Prema Nedungadi, Center for Research in Advanced Technologies for Education (CREATE) Amrita University
Dr V Balasubramanyam, President: Bangalore Chapter of Indian Association for Medical Informatics
special feature - ivf How Fertile is India’s IVF? Cloning a Reality in Future Dr Firuza R Parikh, Director, Department of Assisted Reproduction and Genetics, Jaslok Hospital and Research Centre, Mumbai
71 28 30
IVF Promises a Bundle of Joy
Dr Aniruddha Malpani, MD, Malpani Infertility Clinic, Mumbai
32
Dr Kamini Rao, Medical Director, Milann
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38 40
Dr Manika Khanna, CEO, Gaudium Dr Shobha Gupta, Director, Mother’s Lap
radiology
46
Dr R K Mathur, Medical Director and Chairman, Department of Radiodiagnosis at Saket City Hospital
64
Dr Anand Gnanaraj, Consultant Interventional Cardiologist, Madras Medical Mission Hospital
66
Dr S K Parashar, President Elect and Chairman of the SC, Cardiology Society of India
tech trends
50 52 54
The Evolving Phase of Indian HIS Solution
55 56
Andy David, Senior Director-Healthcare (Asia Pacific & Japan - APJ), SAP
Vennimalai, CEO, Aavanor Systems Pvt Ltd Sarath Anand Jupalli, Managing Director, Shivam Medisoft Services Pvt Ltd
Sadananda Reddy, Managing Director, Goldstar Healthcare Private Ltd
Policy
72
Feroz Ahmad Khan, Minister of State (Independent Charge) Information Technology, Science & Technology Government of Jammu & Kashmir
asia’s first monthly magazine on The Enterprise of Healthcare volume
08
issue
6
june 2013
President: Dr M P Narayanan
Partner publications
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asia’s first monthly magazine on The Enterprise of Healthcare
Social Circle European Hospital@EuropHospital The magazine for healthcare professionals Prabhat Kumar@prabhatk29 Innovating Business Processes Via DreamSol :)
inbox Readers Speak As usual, the eHealth portal has been flooded with a range of comments from our distinguished readers. Few of these readers comments have been selected by our editorial team to be puslished in the magazine. Read on-
Telemedicine Africa@TelemedAfrica Telemedicine allows doctors to diagnose patients that are separated by distance by providing interactive healthcare utilizing modern technology and telecoms.
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Dr Ambalal Patel@DrAmbalal Protected account Treasurer, Doctor cell, Maharashtra Pradesh Congress Committee. Working for problems of Drs (Allopathy, Homeopathy, Ayurveda, Unani, ESI).
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RSP@ResilientSP We educate & empower black women regarding common but rarely discussed diseases of the reproductive system, such as#endometriosis #fibroids #pcos #infertility
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editorial
Improving Healthcare with New Technologies Telemedicine is one of the fastest growing verticals in the world. According to some reports, the telemedicine market in USA has grown from USD 4.2 billion in 2007 to over USD 10 billion in 2012. In India also this sector is witnessing a rapid growth, even though we don’t have access to the exact figures. Telemedicine is now being seen by noted healthcare experts in the country as the most viable way for expanding the reach and scope of healthcare in the country. All India Institute of Medical Sciences (AIIMS) Bhopal is now on the verge of offering two-way consultations. Once the system becomes fully functional, telemedicine service will be extended to even district hospitals in the state. Such telemedicine ideas are also being pursued by other government hospitals. Once better e-connectivity is in place, the potential of health information technology and telemedicine will be immense. In this issue of eHealth magazine, we are focusing on the important areas of medical education. We have interacted with a range of stakeholders to find out the main issues and challenges that are being faced by this sector. Until there are some serious reforms undertaken in the area of medical education, there cannot be any significant improvement in the quality of healthcare in the country. The scope of medical education needs to be enhanced through the usage of digital education tools. We are also having a special feature on IVF, which includes interviews of doctors and clinicians from Mumbai, Bangalore and Delhi/NCR. News of a 42 year-old woman in London hit headlines as she became the first in the world to give birth to a baby conceived using a pioneering IVF time-lapse photography technique to pick the best embryo. The technique monitors the growth of the embryo, to select the one which is most likely to result in a successful pregnancy. Now imagine the benefits that such cutting-edge IVF technologies can bring to childness couples in India. On 23-24 July, 2013, we are having the eINDIA 2013 event at Hyderabad International Convention Centre, Hyderabad. As you might know, last year’s eINDIA had been a great success, as many key stakeholders from the areas of Governance, Healthcare and Education, had gathered to discuss and deliberate upon the ways by which new technologies can be used for public benefit. This year also we are going to have a vibrant healthcare track at the eINDIA 2013. We hope that you will be there at the eINDIA 2013 to contribute to the discussions that take place.
Dr. Ravi Gupta ravi.gupta@elets.in
june / 2013 ehealth.eletsonline.com
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cover story
Country’s Medical Education
Calls for Reforms Medical education in India has been one of the most debated topics in healthcare fraternity. There is always an universal agreement that the stereotypical methods of teaching and learning should go away and reforms should take place. Where do we stand in making the reforms? Read on to discover By Sharmila Das, ENN
I
ndia has the largest number of medical colleges in the world. The number stands at more than 350, still quality healthcare is a day dream for most part of the country. A few experts say it is because of the inadequate number of medical and paramedic staffs, healthcare is not reaching to all. The medical colleges of the country are too facing challenges of lengthy accreditation procedure; un-updated curriculum etc and these challenges are making the medical colleges of the country ineffective in producing skilled and adequate number of medical staffs.
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Dr K K Aggarwal, MD, Padmashri & Dr B C Roy National Awardee, Sr Physician & Cardiologist, Board of Medical Education Moolchand Medcity, President Heart Care Foundation of India, Chairman Ethics Committee Delhi Medical Council & National Vice President Elect Indian Medical Association says, “I feel there should be a centralised entrance exam. NEERT should be implemented in its spirit. The accreditation process should be independent with no government control”. Dr V Balasubramanyam, President: Bangalore Chapter of Indian
Association for Medical Informatics, Professor, Dept of Anatomy, St John’s Medical College says, “We have moved from classroom didactic teaching to interactive distance learning and online learning”. Dr Vivek A Saoji, Dean and Principal, Bharati Vidyapeeth University Medical College, Pune says, “To ensure quality of medical education accreditation should be made mandatory to all medical colleges and health science universities. It however has to be done by an autonomous body and should be free of government control”.
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Cover Story
‘Every district must have a
medical or nursing college’ Dr K K Aggarwal gives a roadmap of medical education in India There have been a lot of discussions happening on the issue of poor Government control over the accreditation process of medical colleges. What are your thoughts on this. How do you think the situation can be improved?
the problem what are the steps a medical college can take? What are your suggestions?
I feel there should be a centralised entrance exam. NEERT should be implemented in its spirit. The accreditation process should be independent with no government control.
What are the strategies one should adopt in a medical college to keep up the curriculum updated as per requirement? I think medical teaching should have a uniform curriculum. Standard talks should be made available on the Net and should be updated in every three months. Best of the teachers’ uniform talks also should be there on the Net. Besides all skill workshops videos should also be uploaded. To make the curriculum be matched with the present day requirement every college should have skill based simulation equipment.
In doing so, what are the challenges one can face and how to overcome them? We need to make medical education more transparent. Can introduce other concepts in the MBBS course too. Medical colleges should share cost for Web based education, skilled based equipment should be shared within the same state. Medical college stu-
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Dr K K Aggarwal
Dr K K Aggarwal, MD, Padmashri & Dr B C Roy National Awardee, Sr Physician & Cardiologist, Board of Medical Education Moolchand Medcity, President Heart Care Foundation of India, Chairman Ethics Committee Delhi Medical Council & National Vice President Elect Indian Medical Association dents should be posted in other colleges to cover for best skill training.
The Indian hospitals are under-manned and we face challenges of lack of skilled medical and para-medical staffs in the country. To combat
Most doctors after passing the course do not get a placement and either tend to run away to other countries or look for a post-graduation. Post Graduation (PG) in family medicine should be automatic for those who do not get admission in a specialty branch. Every district must have two years post-graduation in family medicine and MD in family medicine should be compulsory for every government job and should be able to do it simultaneously with the job. A trained family physician should be able to treat 80 percent of the ailments.
It is said that, though we have the largest number of medical colleges (nearly 350), still quality healthcare or say healthcare is not accessible to us. How to rectify the situation? We still are deficient in number of doctors and nurses in the country. Also medical colleges are not uniformly located in the country. Every district must have a medical or nursing college.
How do you think Medical Council of India is acting on improving the scenario? There has been no elected council in the last few years and has been managed by board of governors appointed by the government. In the coming months new council is being instituted and hopefully things will become more transparent.
Cover Story
Withstanding the Quality
of Medical Education “The Medical Council of India (MCI) should act as a facilitator to enhance the quality of medical education and health services rather than a regulator with a stick� says Dr Vivek A Saoji, Dean and Principal, Bharati Vidyapeeth University Medical College There have been a lot of discussions happening on the issue of poor Government control over the accreditation process of medical colleges. What are your thoughts on this. How do you think the situation can be improved? Regarding poor government control over the accreditation process of medical colleges I feel that there should be no government control over the accreditation process and it should be done independently by an autonomous body. Let me explain, at present the Medical Council of India inspects the medical colleges and recommends to the government to grant permission to start a medical college or increase its capacity. The Medical Council of India is a regulatory body or the body which governs the medical education in the country. This however is not an accreditation in real sense, which to me is a process of self evaluation and improvement in the overall quality and ensuring that the systems are in place. Medical Council of India is not directly responsible for quality control; it only ensures that minimum standards are fulfilled. At present the only accrediting agency in the country is the National Assessment and Accreditation Council (NAAC) which is an autonomous
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body of the UGC. NAAC accreditaties all the colleges and universities but the accreditation in voluntary and not many medical colleges has undergone the process. Some of my suggestions to improve the situation are to ensure quality of medical education accreditation should be made mandatory to all medical colleges and health science universities. It however has to be done by an autonomous body and should be free of government conDr Vivek A Saoji
trol. There should be a separate body to accrediate medical colleges and health science universities. Since accreditation is not mandatory many colleges may not volunteer for it so there should be some incentives for accredited institutes. There should be a separate list or directory of accreditated colleges so that the students are able to choose the best and lastly the parameters for accreditation should be realistic and comparable to the international standards so even if
our students want to go abroad they should not face any difficulty.
What strategies you have adopted in your college to keep up the curriculum updated as per present day requirement? We do curriculum review and updation in every three years. The updation is based on the feedbacks received from the faculty and students, current practices followed internationally i.e. evidence based and perceived needs of the students and society to deliver appropriate healthcare. However we have to follow the guidelines prescribed by the Medical Council of India. In our college, we are using information technology for effective delivery of the curriculum. We do regular needs assessment, seek feedback from the students & faculty & based on that make necessary changes, our emphasis is on self directed & lifelong learning, we do hope to make the difference but it is a long drawn process & we are still far from ideal.
In doing so, what are the challenges you have faced and how have you overcome those challenges? The biggest challenge in bringing about a change is convincing the faculty. It is the willingness of the faculty to adopt change which is most important.For that we conduct regular faculty development workshops. It has helped us a lot. Now not only are the faculties aware about new development but are ready to implement them. Secondly, resources may be a challenge. We have to work with limited budgets and limited recourses, here we priorities the needs and use the available funds in a judicious manner. Thirdly the students, sometimes they may not accept the change and they may not want to come out of their comfort zone. This again is overcome by conducting foundation courses and counseling the students.
The Indian hospitals are under manned and we face challenges of lack of skilled medical and para medical staffs in the country. To combat the problem what are the steps a medical college can take? What are your suggestions? As far as healthcare manpower is concerned we are definitely undermanned. Our doctor population ratio is very poor, but more important is that it is skewed. In urban areas there is a problem of plenty while in rural areas it is grossly inadequate. We no doubt need additional skilled healthcare man power, but again more important is to create the environment
A balance between numbers and quality has to be achieved. Then only we will be able to serve the underserved rural population and not just by increasing number of doctors in rural area where a doctor would go and work. So even if we double or triple our capacities to produce doctors but if they do not go in rural areas the purpose is defected. So I very strongly feel that it should not be looked up in isolation and just create the additional manpower but to look at the issue in holistic manner. We also have to ensure the quality of healthcare manpower that we are creating, as in many places it is of subordinate quality. A balance between numbers and quality has to be achieved. Then only we will be able to serve the underserved rural population and not just by increasing number of doctors. I completely agree with you that directly we are short in supply & secondly the quality is not assured. As said earlier we have to balance between the two.
Accreditation is one way to ensure quality. Now most important is we have to use technology both for training of manpower as well as for delivery of healthcare. Use of telemedicine, use of mobile phones, social media for rapid communication, and training of local people can help solve the problems of delivery, so also for training use of simulation, self learning modules etc. will bring in uniformity. More paramedical staff and giving responsibility to them about health education to masses, (providing clean drinking water, toilet training, immunisation, assisted deliveries, malnutrition etc) can dramatically improve the healthcare scenario; practicing preventive health also may help solve the problems to some extent. I strongly feel that simple measures and looking at healthcare delivery from a holistic perspective can address these issues.
How do you think Medical Council of India is acting on improving the scenario? Medical Council of India is doing its bit, but it is mainly bogged down in granting permission & giving recognitions. It has to have a quality assurance cell. It has to recognise good colleges, categories them and help them reach the next level. At present all of them are put in same category. Moreover at times there is conflict of interest between the Medical Council of India with government and it leads to policy paralysis. Some good initiatives by the Medical Council of India has not seen the light of the day. In last few years Medical Council of India has been riddled in controversies. It should also gain the confidence of not only doctors but the public in general. It should act as a facilitator to enhance the quality of medical education & health services rather than a regulator with a stick. In last few years it has done a lot of good work but more needs to be done and then we all have to strengthen the Medical Council of India.
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Cover Story
MEDSIM – Medical Simulation Based Learning Using Virtual Patients By Prof Prema Nedungadi, Center for Research in Advanced Technologies for Education (CREATE) Amrita University
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ith 330 medical colleges, India’s medical education domain is one of the largest in the world. At the same time, while our hospitals have upgraded laboratory techniques, installed Electronic Medical Records (EMR) solutions, medical education in India have not kept pace in using technologies in the classroom. Experts estimate a large number of deaths each year in hospitals as a result of medical errors. In the context of patient safety, the pedagogical usefulness of animations and interactive simulations in healthcare is most interesting to consider. Imagine a situation where hard to diagnose patient cases are electronically documented by experienced doctors and our future doctor students are allowed to practice and learn from them. Inspired by Amrita University Chancellor AMMA’s vision that research and development should directly benefit the society, MEDSIM aims to provide medically accurate case simulations and reduce medical error and improve patient safety. Under a research grant from DeitY, Government of India, the Center of Research in Educational Technologies (CREATE) at Amrita University along with faculty and doctors from Amrita Institute of Medical Sciences (AIMS) and CDAC Trivandrum are designing an innovative, scalable
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Prof Prema Nedungadi
and cost effective approach of using computer based medical simulation learning environment called MEDSIM to address this very issue. Computer based simulation facilitates learning through interactive problem solving and real time feedback but without the risk to patients. Amrita University has established itself as leader in simulation based development by successfully designing hundreds of virtual simulation based experiments for both schools and higher engineering education and the learning outcomes for thousands of students have been positively impacted through the computer based simulation approach.
The MEDSIM approach is aligned to the clarion call in the Medical Council of India (MCI) 2015 vision document that recommends immediate adoption of technologies like simulation in medical colleges. MEDSIM is being designed to provide an easy to use learning environment to replicate clinical scenarios and allow features such as practice and feedback for medical skills development, exposure to difficult to visualise procedures, protocols and case studies with state of art virtual patient cases. The system is designed to be relevant to the Indian environment and confirm to our MBBS curriculum. In MEDSIM, a medical student will interact with a virtual patient to obtain the history, conduct a physical exam and make diagnostic and therapeutic decisions. The student may pose questions to the virtual patient, order lab tests, and prescribe medicines. Students may review the results and responses before making diagnostic clinical and management choices. The student’s decisions have direct consequences on the virtual patient’s outcome.The pilot stage of the project will involve developing virtual patient cases with the guidance of doctors and real medical case histories in a couple of areas such as emergency medicine and critical care.
Cover Story
eLearning in Medical Education g By Dr V Balasubramanyam, President: Bangalore Chapter of Indian Association for Medical Informatics, Professor, Dept of Anatomy, St John’s Medical College
eLearning, a 25 million dollar industry in 2009 is expected to reach USD 107.3 billion by 2015(report by Global Industry Analysts, Inc.). Higher education or corporate education, we are moving from traditional teaching to technology enabled teaching, where information is available anywhere, anytime. Besides e-mail, medical education is becoming increasingly dependent on web based and mobile based learning. The pharma industry is probably the best user of eLearning for its sales force training, followed by equipment manufacturers. The NPTEL experiment involving VSAT based tele-teaching in engineering colleges was a noteworthy experiment which culminated in uploading valuable digital lectures into the YouTube. We have moved from classroom didactic teaching to interactive distance learning and online learning. Except for skills training, almost all aspects are now covered by eLearning method like case studies, patient logs, clinical decision support systems, virtual patients and medical video games. eBooks, eAtlases, product manuals, teaching databases have made inroads into medical education. Digital versions of several text books are already available across the world and these can be downloaded online for a fee. Besides there are several authentic online open source material maintained by reputed universities. Technology is an amplifier for medical
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Dr Balasubramanyam
education – just like a stethoscope is to a cardiologist. Mass open online courses (MOOC), have picked up momentum and is on the verge of getting recognition for earning academic credit points. Centralised and uniform content, easy and one point upgrade lower operational logistics make eLearning an excellent supplementary system of communication in medical colleges and attached hospitals. An online evaluation session in progress a St Johns medical college, Bangalore. Students are ready for e learning. Are teachers ready?
Medical e learning is just warming up in India. Teachers and students are increasingly approaching the web for teaching support materials like pictures, audio, videos, animations etc. Learning Management Systems (LMS) are beginning to find utility in India. St John’s Medical College, Bangalore and CMC Vellore have started using LMS to support and supplement traditional teaching learning process. MEDRC Edutech, Hyderabad has released a LMS for preclinical MBBS subjects in recent years and is avail-
able both as a web based as well as an in campus module. The Medical Council of India (MCI) in its notification dated 1st Dec 2008, has insisted that medical colleges must have a skill lab and adopt information technology in medicine. A group learning session using computers at St Johns medical college, Bangalore. Good content must create an immersive learning experience Although many colleges have the hardware component implemented to some extent, lack of good content material in all these institutions is a noteworthy deficiency.Content customised to our Indian medical curricula – across all the subjects - is the need of the hour. The present generation of students is very tech savvy and well versed with windows / MAC platforms. Besides they are also comfortable with the mobile platforms, Web 2 and social networking. This creates tremendous opportunities for the e learning industry, in particular the publishing industry to establish collaborative content development with teaching faculty. Access to research data is vital for higher medical education. While some journals are available on the Net, most of the others are available on payment – which is often very high. A consortium based approach for access medical journal is required. The HELINET consortium in Karnataka was a good
An online evaluation session in progress a St Johns medical college, Bangalore. Students are ready for e learning. Are teachers ready?
A group learning session using computers at St Johns medical college, Bangalore. Good content must create an immersive learning experience effort in this direction, piloted by the Rajiv Gandhi University, Karnataka. This system enabled all its affiliated colleges to have access to reputed international medical journals. The time has come for institutions and universities to identify authentic teaching websites for their students. Faculty need to interact with each other and create a list for this purpose. Some of the medical colleges have set up basic skills lab in the domain of high fidelity simulations. But this is not adequate. Traditional medical education is opportunistic – in the sense you learn as the cases come to the hospital. In high fidelity systems, customised learning is possible. Further it will be very useful to train students in these simulators before allowing them to handle real patients. MCI must specify the simulators that every undergraduate course must have. Further MCI and the national board of examinations must specify a list of advanced simulators for post graduate and super specialty courses. This must be made mandatory and institutions must be made to implement these within a particular time frame. These must be listed in the minimum requirements for approval of courses. eLearning has a tremendous role to play in evaluation during examinations. Universities must explore possibilities of having a certain percentage
of the evaluation online. Online MCQs alone is not eLearning. A number of assessment modules need to be prepared to test the reasoning and decision making ability of students by creating medical case scenarios. Evaluation in such scenarios is based on how candidate navigates through a particular case rather than whether he reaches a diagnosis. There is also scope for examining certain aspects of practical to be transferred to an online mode – details will depend on the subject. Visually rich subjects like anatomy, pathology, radiology and dermatology are lead subjects in this direction. By introducing a component of e – evaluation, an element of objectivity can be brought into the exam system. There is a strong divergence of views among the teaching faculty regarding eLearning. The younger generation teachers seem to embrace technology more positively and are generally more comfortable with handling telecommunication equipment. There is a strong need to create awareness about the potential of medical eLearning as a system of education. For example MCI can instruct all regional training centers to include eLearning as one of the topics in the basic workshop on educational technologies being conducted regularly. Besides there is scope for research and development to identify different strategies that can be implemented on a long basis. For example my own trials with a variant of the Khan Academy model has evoked a good response from my students. One of the best ways of improving adoption of technology in medical education is to incentivise research and development in this field. Institutional managements have a large role to play. Innovative teachers must be encouraged and sent for medical education conferences and CMEs, besides making them publish their work in reputed journals. Lastly institutions must encourage teachers to collaborate with industry to take medical eLearning forward.
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cover story
Nursing Profession in Transition India produces the largest number of nurses, yet we have the highest child and infant mortality rates. Where lies the short circuit ? True, India produces a large chunk of nurses and we prepare them for the whole world but unfortunately they are not adequate for our own needs. Today we have 0.75 nurses per thousand people. Ideally it should be 12.12 per thousand. In India, the demand for nurses outstrips supply. The developed world (US, Australia and New Zealand) entice our nurses with lucrative packages. We need to reconsider what nurses are offered in India. Nurse to doctor ratio in India is 1.5 : 1 and ideally it should be 3 nurses per doctor. UK has the best record of 5.54 nurses per doctor. Every year 45,000 doctors graduate from 362 medical colleges and comparatively the turnover of nurses is low. I contradict the other statement that India records the largest number of infant mortality. There is no accountability for private hospitals and the definition parameter also differs. Mortality rate is high but certainly we are not at the bottom of the list. There is a flaw in accountability.
How do you rate the quality of nursing education in India ? Nursing in India has been historically neglected. However, things are gradu-
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ally improving. Today we have 3.5 year diploma in midwifery, 4 years of B Sc nursing, 2 years of M Sc nursing and then PhD in nursing. There is also a bridge course. Nursing education and colleges continue to be governed by Indian Nursing Council and it is still managed by the 1947 ACT. Some of the nursing colleges are certainly exemplary while others are outright deplorable. They stand for namesake only and quality of education is equally poor. Unfortunately, such colleges are mushrooming.
Four years for nursing education is almost parallel to medical education ? Is there so much of education really required ?
A true crusader for the nurses and nursing education in India, Dr Manju Chhugani, Principal, Rufaida College of Nursing, Jamia Hamdard shares her views with Shahid Akhter, ENN
40 percent of the entire syllabus, foundation science of nursing can be
Nurses are not subservient to doctors, nor should they be stigmatised. Both are different professions with different roles slashed down. Only the part they are going to apply should be taught. A good chunk of the syllabus is at par with medical education which is really not required. We need to do away with the exhaustive curriculum, theory based studies. Just as doctors take a Hippocratic Oath, nurses take a pledge to do their best for their patients. Often called the Florence Nightingale Pledge, the nurs-
ing oath is often administered at graduation ceremonies. Nurses assume additional responsibility with negligible autonomy and authority.
Can you identify some of the roadblocks in nursing education? The nursing profession is badly lacking in proper representation at key decision making forums. We have exhaustive, theory based curriculum.
Lack of clinical facilities and mushrooming of nursing colleges are few of the major roadblocks.
Remedial measures that you may like to suggest ? • Competency based training with adequate clinical practice • There should be a check on the growth of mushrooming colleges that are diluting the quality of education. • Provision of ‘family nurse’ to meet the growing needs of the growing population. It should be a 1 ½ year course.
• Introduction of PG courses as introduced in Vellore Medical College. • Introduction of skill labs • Licensing and re registration of licensing • Establishment of nursing directorate at the Centre and state • Virtual training and telemedicine • Strengthening the clinical capacity of the faculty • Establishment of nodal centers
How true is saying that nurses are heaven sent ? Nursing
binds
human
society
with a bond of care and affection. Nurses are the most valuable resource of National Health Services. Nursing is born out of great struggle and hardship. The lady with the lamp withstood tremendous amount of pressure and brought not only acceptance but also recognition to the noble profession. Nursing over the years have undergone metamorphosis. Now they are involved in research, projects, handling high tech equipments and using computers in patient care. In short- Nurses are heaven sent.
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Cover Story
Medical eLearning Comes a Long Way eLearning is not new in India; in fact, today it has become quite common. However, when it comes to medical education, the picture is slightly different, as clinical eLearning is yet to take a giant leap into the digital world. Rohit Kumar, Managing DirectorSouth Asia, Elsevier Health Sciences reveals the scope of clinical eLearning in India to Sharmila Das, ENN A digital system for medical education is currently evolving in India, even though the pace of change is quite slow. As a medical eLearning solution provider, how do you find the status of medical education in India? Medical education has been growing over the last few years. New colleges have been added. For last two-three years, there has been an increase in the seats in the existing colleges. This rise in the number of seats is enabling more students to become doctors and helping in bridging the healthcare
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facility gap in our country. I believe that things are on track; even allied healthcare facilities have been improving, because every doctor needs nurses to assist them. So we have seen improvement in this sector.
It is well known that medical colleges of the country have not been able to produce the adequate amount of efficient medical staff in the country. How do you see Elsevier making a difference in this area? We publish clinical eLearning solutions for the fraternity and thus we can make a difference in providing quality learning and helping people to become better professionals. So that’s the role we see ourselves playing. We bring better validated medical content authored by reputed medical professionals which helps to make better professionals.
What is your vision for Clinical Learning, your flagship product, in India? What kind of response are your solutions receiving in India? Our vision for clinical learning was to help the students to learn through a very interactive medium, which in some ways amounts to complementing classroom teaching. The focus area that we came up with is skill development. Here the need of technology is to complement and not to compete. We entered into partnership with Maulana Azad Medical College. Many senior doctors have put their time and effort for producing validated clinical learning modules. The response we have been receiving for our clinical learning modules is very encouraging. The challenge is that people were not expecting anything in this field. The category of interactive e-learning for medical colleges was virtually non-existent and hence it will take it will take some time to take off. Wherever we have demonstrated the capabilities of Clinical Learning, professors and students
The government medical colleges are not lagging behind that much when it comes to eLearning. However, infrastructure wise the private colleges are better alike have agreed on the quality and necessity of such a solution. For such a new initiative to be adopted, it does take time to build consensus between the teachers, students and administrators. It will take some time form a consensus to emerge for adoption. I feel that’s okay and I think eventually we will make progress.
How many colleges have taken up your eLearning solutions? Have you tied up with any association? There are approximately 20 medical colleges that have taken up parts of our eLearning solutions. I would say it’s very early for the medical colleges to adopt the eLearning content. If you see, in other verticals like engineering where technology has been adopted relatively earlier than the medical education segment has. For example, you will see the IIM entrance exam (CAT) went online a few years ago, but the medical exam has gone online only now. However, the change is happening in its pace. We can say, five years down the line every college will follow some or the other eLearning content. More and more people are getting access to Internet, smart phones, laptops and tablets. That is starting to reflect in the way content is delivered and consumed, be it generic or academic.
What are the challenges you have faced in providing eLearning solutions to the colleges? How did you overcome those challenges? The challenges typically related to people’s mindset. The next challenge
is infrastructure, Internet connectivity and technology connectivity in colleges especially in medical, dental and nursing colleges. They still don’t have proper computers to use. There is a provision by AICTE that says a new college should have 30 to 40 computers with proper labs. Sadly that is still not a pre-requisite in a medical, dental or nursing college. There is a large infrastructural gap in medical colleges. Then there is the issue of business model, we need to have a mindset that allows us to pay for products that are available online. When you see a book on the shelf you are ready to pay the price, but when you see it online you want it for free.
Are the private colleges keen on adopting eLearning solutions? In my opinion, the ratio of colleges that are in favour of eLearning solutions and those that are not in favour is 50: 50. I feel the government medical colleges are not lagging behind that much when it comes to eLearning. However, infrastructure wise the private colleges are better than the government owned colleges.
What are your future plans? We are currently following a subscription model. That model will see the first test, maybe later this year. However, we are molding our solutions according to the market need. Our main flagship product remains clinical learning. We will keep adding new content to it. The current content that we have developed is about 250 modules and will be adding more in the days to come. June / 2013 ehealth.eletsonline.com
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Special Feature IVF
How Fertile is Fertility revolution has emerged as the ‘wild west’ of medical science. Breakthroughs in the science of sexuality and reproduction have become routine. They seem to have touched the epitome of genetic bewilderment. More and more ways of making babies are emerging, ever since the birth of the first test baby in 1978 By Shahid Akhter
F
ertility clinics are on the rise and have become a fertile turf for web of technologies that promises the power of parenthood by way of IVF – the milestone of assisted reproductive technology(ART). Disappointed couples have reasons to smile and they need to thank the researchers who keep tapping the technology. Modern lifestyle imposes tremendous pressure to put off child birth. Today, the age of the woman does not matter. The age of the egg is what concerns the doctor at IVF. Freezing of the sperm, the egg and the ovaries have already demarcated procreation from romance. Scientific advances in sperm and egg preservation techniques mean that an increasing number of babies around the world are being born from eggs and sperms that were once frozen. These time bound babies are programmed to click by the clock. The science of sexuality is greatly unregulated and seems to have bypassed all ethics and antiquated laws. Countries are at conflict with each other over questions of surrogacy, nationality and acceptance of the child born in a foreign country. There is no restriction on the export or import of sperms. Aren’t they hidden nationalities encroaching alien territories ?
Indian Fertility Clinic A great attraction for everyone Since the advent of the first test tube baby in 1978, there has been an exceptional boom of fertility clinics across the world. The reproductive science has made rapid strides by way of techniques that may lead to a baby. Fertility clinic appeals to the medical entrepreneurs who can invest as little as a crore and flag off an IVF centre with the basic setting to begin with. In absence of law and no requirement of permission, it becomes all the more lucrative for anyone to embark on the project. The IVF clinic charms the foreign visitor. The country has moved on from medical tourism to fertility tourism and a world class treatment is assured at an affordable price. Indian centers charge 1/5 of what may cost in Europe or the US. Given the tourism potential and India’s prowess in the frontiers of reproductive science, they make an attractive package for anyone seeking in fertility treatment. There are around 1000 IVF centers spread across the nation that are part of the five billion dollar industry.
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India’s IVF ?
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Special Feature IVF
India’s first scientifically documented IVF baby Harsha, was born Dr Subhas Mukherjee
was the
first person
in the world
on August 6th, 1986, in Mumbai, through the collaborative efforts of the ICMR’s Institute for Research in Reproduction and the King Edward’s Memorial Hospital
to use
> gonadotropins for ovarian stimulation prior to ovum pick-up in an IVF treatment cycle > the transvaginal route by colpotomy for harvesting oocytes > freezing and thawing of human embryos before transferring them into the uterus that led to the successful birth of Durga
world’s first IVF Baby
Louise Brown, was born on July 25, 1978 in the UK
The world’s
second and India’s first IVF baby, Kanupriya,
was born on October 3, 1978, in Kolkata, through the efforts of Dr Subhas Mukherjee and his two colleagues
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Indian middle class are entrapped in a dilemma. On one hand they have failed to conceive and are desperately looking for solutions but the concept of ‘in vitro’ (child being created out of the womb) is slightly unacceptable. Many find it hard to disclose that they have conceived through IVF. However, the need for a baby outweighs the process!
India: Surrogacy capital of the World India today caters to about 20 percent of the world surrogacy market and is hailed as one of the fastest growing destinations in the world. In league with US health care standards, many Indian hospitals have earned Joint Commission International Accredition.
ICMR guidelines for surrogacy:
A surrogate mother can be procured through references from
relatives, doctors or semen banks However, negotiations between the couple and the surrogate mother must be conducted independently Payments of surrogate mothers should cover all genuine expenses associated with pregnancy. Documentary evidence of financial arrangement for surrogacy must be available Advertisement regarding surrogacy should not be made through the Assisted Reproduction Technology (ART) clinic. The responsibility of finding a surrogate mother, through advertisements or otherwise, should rest with the couple, or a semen bank A surrogate mother should not be over 45 years of age. Before accepting a woman as a possible surrogate for a particular
Germany has banned all research on embryos produced in that country but permits the use of embryos brought from abroad Foreigners prefer Indian donor sperms because of easy availability and it continues to be illegal in India to reveal the identity of a donor to children who are born from a sperm donation
couple’s child, the ART clinic must ensure that the woman satisfies all treatable criteria to go through a successful fullterm pregnancy In Indian context, a known person as well as a person unknown to the couple may act as a surrogate mother No woman may act as a surrogate more than thrice in her lifetime Due to so much darkness in the law of each part of globe we in India are helping childless couples to navigate through the dark emotional passages of surrogacy, egg donation and embryo donation.Surrogacy law in India is still in the premature stage and is coping up with the world position. India is part of the club of very few countries who have permitted Commercial Surrogacy.
Sperm Banks Designer sperms and donor eggs are the most sought after duo in the deal called fertility. They may not be on your next shopping list but sure in the listing of life, they may require a relook and you may love to visit the genetic shopping mall. Besides infertility, sperm storing may be an option for various reasons, like people going in for chemotherapy or other high risk surgeries or medications that may impact the sperm. People in Israel support the idea of creating an official sperm bank for the Israeli soldiers. And fertility experts across India confirm this emerging trend. Dr Iqbal Mehdi of Cryobank, the Delhi’s oldest sperm banks, says “At present, I have over 150 frozen samples from defence backgrounds, mostly army men,� he confirms. At Mumbai’s Malpani Infertility Clinic, the oldest sperm bank established in 1990, Dr Aniruddha
Malpani has seen the number growing among those from naval backgrounds. “There isn’t a sizable Army base here, but yes, the number of people from naval backgrounds, especially those who sail for long periods, has grown,� he confirms. These precious shops are not to be found everywhere. The US may account for over a thousand such banks. In India it may not me more than a hundred. Largely unregulated and fiercely guarded, most sperm banks prefer anonymity. Can anyone figure out if the claimed sperm is from a prisoner, noble prize winner, a crazy school drop, drug addict, chain smoker or anything up and down the ladder? Sperm banks can be the epicentre of deadly diseases and genetic disorders like the Michigan case. A handful of screening is done to rule out a select set of not more than a dozen diseases, what about the entire entire world of disorders? There is no law to account for the health of such children nor there is any limit to the number of offspring per donor. IVF boom in India calls for strict norms and laws to regulate and protect the industry. Scientific societies around the world have drawn up guidelines to regulate the safe and ethical practice of IVF,
The Risks Babies today are born with over 200 chemicals in their bloodstream ! Matter of concern for everyone. High dose IVF is not just expensive but comes with an element of risk as compared to low dose IVF. Nearly 30 percent of IVF patients experience at least a mild case of . ovarian hyperstimulation syndrome (OHSS). Less than five percent of IVF pregnancies are ectopic, which means that the fertilized egg develops outside the uterus, usually in the fallopian tubes. [source: American Society for Reproductive Medicine]
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27
Special Feature IVF
Cloning a Reality
in Future
Padma Shri Dr Indira Hinduja delivered India’s first test tube baby at KEM Hospital, Mumbai, in 1986. She is also credited for the country’s first baby by an oocyte donation technique back in 1991. Honorary IVF and Infertility specialist at PD Hinduja National Hospital and Medical Research Centre, Mumbai. In conversation with Rachita Jha, ENN Please share with us how has IVF technology advanced over the years? In vitro fertilization or IVF has been in the medical sciences since 1978 and is currently on the frontiers of medical technology and innovation. During my practice in 1984, the equipments like incubators and microscope needed for the procedure were not solely dedicated for IVF and media needed were prepared in-house. There was scarcity of good drugs needed for the treatment that lowered the chances of pregnancy. Disposals, injections were not freely available and other instruments like catheters were sterilised and reused many times. Technology has now advanced by leaps and bounds. Technique of retrieving the oocytes and transferring the embryos into the endometrium has advanced. ICSI (intra cytoplasmic sperm injection) has now replaced IVF. Now facilities like Intracytoplasmic morphologically-selected sperm injection (IMSI) which allows selection of the best sperm to be used for injection has lead to an increase in the pregnancy rate. Machines like polscope help to determine the quality of the oocyte and embyroscope help to assess the em-
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Dr Indira Hinduja
bryo quality in real time, have proved to be a boon to this field. The advent of Preimplantation Genetic Diagnosis (PGD) now allows us to select the best embryo free of any inherited disease. These were only a few of the advances and with active ongoing research in this field sky is the limit. Also people are becoming more aware of this technology thanks to the media exposure which was not present during the initial days. Each year we see the arrival of new techniques or technology advancements that help doctors offer more options for parents-to-be. The sector is doing extremely well and the evidence is on the improved success rate that stands close to 50 percent today. The technol-
“India has the best state-ofthe-art technology and techniques in IVF compared to anywhere in the world�
ogy in future is sure to become more patient friendly as the quality of facility and success rate improves in the coming years.
Have you witnessed an increase in the number of patients opting for IVF? Yes definitely. Today there are patients coming up with different kinds of infertility problems that were unheard of previously. Drastic changes in the lifestyle and the associated stress has taken a toll on the overall reproductive health of the people, because of which there has been a steady rise in the number of couples visiting the infertility clinics. A combined effect of technology, awareness campaigns and specialty clinics has brought IVF in the mainstream of treatment options for infertility in India, more so that the techniques are now very well known even in remote areas. Thus today among majority of the popular techniques and specialities, IVF is one of the top in the list. The concept of infertility is not new; it is only the techniques, results and applications that keep changing. And this demand and need for better success rate is also ushering progressive technology breakthroughs in reproductive sciences.
Tell us some of the critical elements in IVF for a facility? The most important component is the drugs to grow the eggs in the woman, followed by the technique of collection of the egg. Recently new methods of egg and sperm screening and studying if it is normal or abnormal have been introduced that has really improved the success rate. We can now predict certain disease and probability of genetic disorders in the embryo using latest techniques. This has revolutionised the IVF practice. The next important aspect is to transfer the best embryos which needs critical evaluation from the number of embryos obtained. There has also been an increase in the number of drugs that
improves the quality of the endometrium. We can now have known insight on the potency of the endometrium to grow - empowering doctors for better decision-making.
Please tell us some of the exciting projects in IVF that researchers are working on? We are now working towards improvement of the results and quality of the embryo and eventually the baby. Reproductive sciences are now being used in the treatment of other diseases. The origin of stem cell therapy came from the unused embryo obtained from IVF that was used as a treatment of majority of diseases. Now due to ethical issues to use embryonic stem cells, research is ongoing to develop new ways to develop stem cells that have embryonic stem cell characteristics. Maybe, the future belongs to cloning and many research organisations are already doing pathbreaking work. There is a lot of research being done in this field in India as well, and this will surely be the next exciting phase of IVF or Assisted Reproductive Therapy (ART). We are now putting our efforts in understanding the reason behind women failing to conceive - and we are on the point of breakthrough in that.
Is India comparable to the world in the delivery of IVF services? We are comparable to anywhere in the world, and in fact are a step ahead in terms of practice and number of patients we cater with hand-on-experience. Facility wise as well, we are in no aspect inferior to the rest of the world. India has the best and state-of-the-art technology and techniques available compared to anywhere in the world. In some aspects we are better and in some we are at par. That is the reason for the rise of medical tourism in the IVF and ART sector, because we offer world class quality of service and expertise at better cost advantage.
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29
Special Feature IVF
Dr Firuza R Parikh, Director, Department of Assisted Reproduction and Genetics, Jaslok Hospital and Research Centre, Mumbai, discusses the challenges being faced by the IVF industry in India
Techniques That Have Revolutionised IVF Tell us your views on the latest advancements/techniques in IVF technology, and how has the success rate changed with introduction of new treatment modules? Many advancements in the field of IVF have contributed to its popularity. One such technology is Intracytoplasmic Sperm Injection. This technology allows a single sperm to be injected into the human egg. This technique is particularly useful for men with very low or no sperm, those with low or no sperm motility and those with abnormal shape of sperm. Jaslok hospital had the first pregnancy in South East Asia with this technique way back in 1994. This technique has revolu-
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tionized the treatment of male factor infertility. Since then we have introduced many other novel techniques like Laser Assisted Hatching where a laser guided opening is made in the shell of the embryo in order to allow the embryo to hatch and implant in the womb. This technique is useful for older women undergoing IVF/ICSI. More recently at Jaslok, we have perfected the technique of magnifying a single sperm 6000 times in order to select sperm with good morphology for ICSI. This technique is called IMSI or Intracytoplasmic Morphologically Selected Sperm Injection. This technique is particularly useful for those couples where the male partner has
severe abnormalities of sperm structure and in those couples who have failed ICSI cycles in the past. Currently we are helping couples who are carriers of genetic diseases to have healthy children using the technique of Preimplantation Genetic Diagnosis (PGD). In this technique a single cell is removed from the developing embryo using micro manipulation techniques. This cell is then evaluated for genetic defects. If the cell is healthy then that embryo is transferred into the mothers womb resulting in a healthy pregnancy. We established the first PGD lab in India way back in 1999. Today we are setting up a more sophisticated lab to help couples afflicted with single gene disorders such as
practitioners. Tell us your views on the availability and cost of these in current times? The Indian Government can make IVF more affordable and cost effective if some of the customs duty that IVF equipment, instruments and disposables incur is removed or reduced. This reduction in cost can be passed on to the infertile couple thus helping them to try IVF several times more successfully. The import of hormone medication is the only way forward currently as many local brands currently available may fall short of international standards. If the Government were to make concerted efforts in standardizing locally manufactured medication, there would be a dramatic fall in the cost of IVF. From the doctors’ perspective, we can make IVF more affordable by
B thalassemia. We will also have the ability to test the embryos for other diseases such as sickle cell anaemia, Duchennes Muscular Dystrophy and other neurological conditions.
How has the cost of technology changed over the years, do you expect the technology to become more affordable in the coming years? The cost of technology has not shown a downward trend. This is because IVF technology depends on imported equipment and disposable items which are not manufactured to perfection in India. Also the hormone injections are imported. All these attract duty, the cost of which has then to be passed on to the patient. Unless these items are exempt from duty, I do not see how the cost can be brought about effectively without compromising on quality.
The availability of drug, equipment and media has been a challenge for many
“If the Government were to make concerted efforts in standardising locally manufactured medication, there would be a dramatic fall in the cost of IVF” pooling IVF cycles in the same time period, adhering to protocols and keeping our patients interests’ at heart at all times.
The options that IVF offers is very exciting for the patients and has led to increase in demand for designer babies and sperm bank. Tell us your views on the demand for the same in India? The word designer babies is a misnomer and in reality a designer baby does not exist. It is a word to be used
with caution because it can imply that a baby can be created at the whims and fancies of the doctor and the couple. The only scientific application of a designer baby is the one I have discussed using the application of PGD. In this technology a genetically healthy baby is the goal, particularly when the parents are carriers of diseases such as chromosomal abnormalities and single gene disorders. Every reputable IVF clinic will have it’s own sperm bank. Although couples have some preferences for their baby, most of these are limited to their baby’s complexion, height and built. IVF practitioners should not encourage couples asking for traits such as beauty, coloured eyes or a baby of a particular gender. This would cause unwanted hype and is detrimental to the interests of a couple. The Indian Society for Assisted Reproduction (ISAR) has been a key driver for promotion of ART. Tell us some of ethical guidelines that have been laid down for IVR lately to address unwarranted public outcry. ISAR was started in the early 90s to gather like minded professionals in the field of ART so that IVF could be promoted and taught in a scientific way in our country. I was the President of ISAR from 2002 to 2005 and was also on the drafting Committee for Guidelines for the practice of ART in India which was set up by the ICMR. These guidelines have described gold standards for IVF in our country. These include the type of equipment to be used, methods of evaluation of the infertile couple and to the selection of the egg and sperm donor. Bodies like ISAR and FOGSI need to work very closely with ICMR so that a gold standard in IVF is set up and the same standard of care is available from Kashmir to Kanyakumari. Guidelines involving the surrogate mother and intended parents need to protect the surrogate mother, the intended parents and the child.
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31
Special Feature IVF
IVF Promises a
Bundle of Joy Instead of wasting time with ineffective procedures that score low on success rate, many patients are opting to go for IVF, to maximise their chance of living their dream of healthy baby g
By Dr Aniruddha Malpani, MD, Malpani Infertility Clinic, Mumbai
I
n the past, In-Vitro Fertilisation (IVF) was often the method of last resort for infertile couples. There were very few clinics which had the equipment and expertise to offer this advanced technology; the success rate was poor; and there were many myths and misconceptions about what was involved in the treatment. After recent spectacular advances in reproductive technology, IVF has now become the treatment of first choice for solving many infertility problems, because of its high success rates. There are now large number of IVF clinics, which means that this treatment is easily available.
Demand-driven Growth
“Technological innovations which simplify IVF and make it less expensive are going to be very important” 32
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Infertility affects about 15 percent of all married couples, which means it is the most common medical problem in the reproductive age group of 20-45 years. And, given the fact that India has over 1 billion people, a conservative estimate means that there are about 20 million infertile couples in India. Currently there are over 500 IVF clinics in India – and the number is increasing by leaps and bounds, to keep pace with the ever-increasing demand. Technology is an enabler in this field and India has remained on the
cutting edge of IVF technology, with all the latest advances which are available globally readily available in leading Indian IVF clinics. These include blastocyst transfer, embryo biopsy for pre-implantation genetic diagnosis (PGD), and cryopreservation using vitrification. Because so much clinical data is generated in an IVF cycle, IVF clinics use electronic medical records(EMRs) to help the store and analyse this data. This allows them to track their pregnancy success statistics and ensure better quality control. With the help of a patient portal, IVF clinics can also share this date with their patients.
Challenges IVF is a procedure driven technique that requires prescribed set of quality checks. The lacuna in the current system of practice by many clinics is that there is little quality control, which means many IVF clinics have very poor success rates. In addition, there is a talent crunch in this field; most of the medical colleges in India today do not offer IVF training as part of the MD degree for gynaecologists except for few. Thus many of the MD gynecologist who are entering practice have no exposure to IVF at all during their postgraduate training. Also, there are very few trained embryologists available in India. The embryologist is the key specialist who runs the IVF laboratory; and without skilled full-time embryologists, the success rates of any IVF program are going to be poor. There is a remarkable lack of transparency; and patient education and counselling leaves a lot to be desired.
Regulations Push Hopefully, the passage of a law to regulate IVF clinics by the Government of India will provide much needed regulatory oversight and legal protection. This will help in providing some degree of transparency
Infertility Impacts Tourism Dr Anitha Mani , Director, GIFT, Cochin
India in general and Kerala in particular is a favorite and fertile destination for European visitors. Kerala’s equable climate, natural abundance of forests and the cool monsoon season are added charms for tourist travelling to the southern most tip of India. Kerala is perhaps one of the few places on earth where a temperature of 24-28 degrees is maintained during a period of continuous rain. This prevalence of moisture in the air and on the surface of the skin makes it the ideal place for natural medicines to work at their highest levels of potency. Couples who undergo IVF/ART needs to be present for 3- 4 wks. There are 2 benefits by clubbing fertility treatment with tourism, one is that they will be less stressed out & thus better success with IVF. Stress a big factor in infertility. Second is the cost of travel & stay can be also be utilised for a holiday and thus not wasted just for medical purposes. Most of the couples coming from western countries enjoy the stay thoroughly, especially at our center in Cochin. Thirdly, the land is famous as an Ayurvedic centre, blessed with numerous medicinal plants and provides the continuity and consistency of Ayurvedic medicines needed for effective treatment procedures. The same herbs with the same potency are available year after year across every season. Given the fact that Kerala’s alcohol consumption is highest in India, there is spurt in male infertility. Late marriages lead to decline in woman’s infertility rate.
and quality control, as IVF clinics will need to be registered. This will also help in improving the confidence of patients in Indian expertise. India has the opportunity to be a global leader in this space and reproductive tourism is booming. It is also important for infertile couples to invest in Information Therapy, so they are sure they are getting high quality treatment. The focus should be on patient education, to create awareness of the need for specialised IVF services from experts.
New Beginning There is a huge gap between demand
and supply and this will need to be filled. At present, IVF treatment is still very expensive, which means it is unaffordable for the vast majority. Technological innovations which simplify IVF and make it less expensive are going to be very important. A major problem today is the fact that most Indian infertile couples cannot afford to pay for IVF treatment, which is very expensive. If medical insurance companies start providing coverage for infertility treatment, this will ensure that this very cost effective method of building a family becomes much more easily available to all Indians.
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33
Special Feature IVF
Every woman enjoys the right
to give birth
Regulated and standardised IVF centers are the need of the hour today. ICMR has set ‘national guidelines’ to regulate ART. These are simply guideliens. Dr Kamini A Rao, Medical Director, Milann, shares her experience
How does the lifestyle impact fertility? Lifestyle is one of the greatest problems facing society today. The deleterious effects of an unhealthy lifestyle affects not only the capacity to reproduce but also increases the risk of chronic health diseases. Factors that are causing so much concern today are - Choices of excessive smoking, drinking alcohol or a caffeine overload, fast paced, hectic work schedules, junk food leading to increase in weight, career demands leading to postponement of the decision to have a baby, erratic sex life and such like are turning out to be the “bane” of fertility professionals. A report conducted by the International Institute of Population Sciences shows that infertility is growing at an alarming pace, especially in the cities. upto 13 percent of ever-married women aged 15-49 years were childless in 1981 (rural 13.4 percent and urban 11.3 percent) which increased to 16 percent in 2001 (rural 15.6 percent and urban 16.1 percent). Over half of married women aged 15-19 years were childless in 1981, which increased to 70 percent in 2001.
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Dr Kamini Rao
Infertility treatment can be very demanding and can create a great deal of physical, emotional and psychological stress for a couple.
In women, hectic lifestyle and job stress contribute to conception problems. A very common cause is polycystic ovary disease (PCOD), a condition characterised by excess production of hormones and lack of ovulation. There are others as well such as genital tuberculosis (a chief factor in rural India) fallopian tube defects, endometriosis, a condition characterised by abnormal growth in the woman’s reproductive system, multiple partners and STDs that may permanently destroy the woman’s reproductive system, obesity, use of certain medication, and smoking and alcohol consumption.
Does great advances in sperm and egg preservation techniques mean an increase in number of babies? While the concept of a designer baby does seem exciting, it is not just the scientific parts that need refining. The current techniques of genetic modification introduce genes at random places in the genome. Many genes have more than one effect. The effect we intend may be accompanied by
Special Feature IVF
others of which we become aware only later as well as the fact that it may be more than one gene that is responsible for a particular trait. In addition is the all important moral and ethical distinction between treating or preventing disease and enhancing traits? Some think that we should pass different moral judgments on enhancement from those we pass on therapy. They say that while therapy is justifiable, enhancement is not. Having said all this, there have been several instances reported of how a child was conceived to save its sibling suffering from a near fatal disorder.
How does the cost of IVF in India compare with that of US and Europe? The average cost of an IVF cycle in the US is USD12,400 (varying between 12000 to 15000$ depending upon individual clinics) according to the American Society of Reproductive Medicine. In the UK, the cost varies between £1,000 to £10,000+. In India, the average cost of an ivf cycle varies between 1.25 to 2 lakhs INR depending upon individual clinics. This compares very favourably with the IVF done in the West where the average cost per cycle will be over 5 lakh INR. The costs will obviously be about 25 percent - 50 percent more if surrogates or donor gametes are used. India has proven to be a very popular destination for meditourism for this purpose.
Each country has its own IVF laws and protocol. How about India? The problem of infertility is very real affecting upto 10 – 15 percent of the reproductive age groups today. With changing lifestyles, this will continue to increase. Regulated and standardised IVF centres are the need of the hour today. Indian Council of Medical
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Over 1500 IVF babies born in Milann and this includes South India’s First Baby through Laser Assisted Hatching Research (ICMR) has set ‘national guidelines’ to regulate ART but these are still simply guidelines. However in 2012, the Government has, for the first time in the history of infertility treatment in India, finalised a draft law. The draft law prohibits In Vitro Fertilisation (IVF) clinics from advertising for surrogates on behalf of infertile couples and seeks to create Assisted Reproductive Technology (ART) Banks to do the advertising for commissioning parents. These banks will screen surrogate mothers and donated sperms and oocytes for infections while ART clinics will simply offer ART services. The Bill allows only 21 to 35-yearolds to be surrogate mothers and says no woman would act as a surrogate for more than five successful live births in her life, including those of her own children. The Bill guarantees legal protection to parents, surrogate mothers and children and mandates legally enforceable agreements between the stakeholders. Any violation would be a cognisable offence punishable with imprisonment and fine.
Does the long term use of drugs used in IVF impact the health of mother or child? With regards to the long term safety of these medications, the relationship between fertility drugs and epithelial ovarian cancer is controversial, and causality has yet to be proven. How-
ever some studies have shown a small increase in the risk of borderline ovarian tumours. Indeed, a working knowledge of the many adverse effects associated with these medications is essential to any physician prescribing ovulation induction agents, in order to ensure maximum patient safety, compliance and understanding. As regards breast cancer studies are again controversial. Some reports indicate that although the drugs seem to reduce breast cancer risk in young women, the risk goes up when they get pregnant. The study found that women who took the drugs and did not get pregnant had a slightly lower risk of developing breast cancer before age 50. Those who took the drugs and reported a pregnancy lasting 10 weeks or more had a slightly increased risk, but that risk was little different than the risk of women who never took fertility drugs at all. Whatever studies show the increased risk also state that the increase is extremely small. The coming years and more research will hopefully give us more insight.
Most of the sophisticated techniques and technologies that are used today may impact the child’s life as he or she grows? Thousands of babies have been born all over the world today who have been conceived by ivf. In the general population around 2.5 percent of babies are born with some form of birth defect, while in IVF this may rise to around 3.5 percent. It must be stressed that the majority of babies born through IVF are healthy. While this small increase in the risk of birth defects and learning disabilities have been identified, IVF babies continue to be some of the most wanted and treasured children on the planet. Couples are counseled regarding these facts before they embark on their journey through an IVF cycle.
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It is the world‘s first EIT (electrical impedance tomography) device intended for Product characteristics and advantages everyday clinical use, which depicts the regional distribution of the ventilation volume - Continuous information about the regional distribution of ventilation, represented in the lungascontinuously right at the bedside. This makes it possible for the dynamic images, curves andpatient‘s parameters physician- track the impact of ventilation therapy in real time. PulmoVista 500 is ready Trend mapping of changes in end-expiratory lung volume - Mechanical may without lead to lung damage and even sepsis if incorrectly for use within minutesventilation and works radiation. applied. Information about the regional ventilation distribution is thus of vital importance for the therapy of mechanically ventilated patients.
Product characteristics and advantages - Monitoring with PulmoVista 500 is non-invasive and does not require - Continuous information theX-rays regional distribution ventilation, represented radiation in contrastabout to chest and CT (Computed of Tomography) scans. as dynamic images, curves and parameters FurTHEr InForMaTIon: - Trend mapping of changes www.DraEGEr.CoM/PulMoVIsTa500 in end-expiratory lung volume - Mechanical ventilation may lead to lung damage and even sepsis if incorrectly applied. Information about the regional ventilation distribution is thus of vital importance for the therapy of mechanically ventilated patients. - Monitoring with PulmoVista 500 is non-invasive and does not require radiation in contrast to chest X-rays and CT (Computed Tomography) scans. FurTHEr InForMaTIon: www.DraEGEr.CoM/PulMoVIsTa500
special feature
Infertility Specialist, Laparoscopic Surgeon and founder CEO at Gaudium, Dr Manika Khanna has an array of awards and ovation to honour more than 4000 successful IVF treatments. Hailed as the youngest infertility specialist and an honoured philanthropic at heart, she is on a mission to serve the childless couples. In conversation with Shahid Akhter, ENN
‘We deliver the
joy of parenthood’
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According to reports, every fifth couple in India is childless and infertility has risen by 50 percent in the country. Reasons behind the escalation? Today career planning culminates in late marriages and this often bypasses the healthy reproductive age. Chronic stress kills fertility. Sperm count has diminished to the extent that WHO had to redefine their guidelines, setting the minimum count to 20 million. However other factors, like, increase in radiation levels, pollution, lifestyle, etc., are equally accountable. In India, diabetes and TB are rampant and many are victims of tubal factor infertility. Add to this the graphic rise of Polycystic Ovary Syndrome (PCOS) hormonal disorder that involves multiple organ systems within the body.
How different is the pregnancy conceived through IVF ? How do you resolve the chances of multiple births ? Pregnancy remains the same. IVF refers to In Vitro Fertilisation which translates into ‘in lab conception’. Here the fertilisation takes place in a petri dish, where several eggs are retrieved from the biological mother. Following fertilisation, the best of embryo is transferred to the mother or a ‘surrogate’ uterus through a catheter. In order to enhance the chances of success, some IVF centres implant three or more embryos. Consequently, IVF babies are high order pregnancies and they carry the high end mortality risk, birth defects, premature delivery and low weight. In Europe, single embryo is the standard procedure and in the US, single embryo is recommended in women under 35. Multiple births are resolved by way of Blastocyst Culture where the embryos grow in nutrient rich culture for five days (earlier it used to be three). Now the healthiest one is harvested and implanted. There are other means of screening like the
Genomic Hybridization, a technique that screens the five day embryo for abnormalities that may lead to failure.
Who is an ideal candidate for IVF and should it be the first choice for the couples struggling for a child ? In males, if the sperm (semen analysis) is normal and in females if the tubes are not blocked, the couple should explore other options like normal contact cycle and IUI should be considered first. IVF benefits women with blocked fallopian tubes and those infertile men who cannot overcome with IUI treatment. In IVF the embryo is trans-
tion of the couples. Unanswered questions, doubts and queries will breed confusion and this will add to stress. We emphasize on harmony to prevail so that the problem is discussed and a solution chalked out. Our overall success rate is around 50 percent and so far I have successfully catered to over 4000 IVF treatments.
How does the cost of IVF in India compare with that of the US and Europe ? The government rates are possibly the cheapest in AIIMS. Under similar parameters and services, I can safely say, Indian IVF centres charge any-
“We have only one aim and that is to deliver the joy of parenthood. And we ensure that we leave no stone unturned to achieve the same. After all, everyone deserves a one of their own” ferred to the uterus via the cervix, IVF does not require open, clear fallopian tubes. Similarly, men with low sperm count or no sperm (azoospermia) or malformed sperms or low sperm motality can have their sperm extracted from their vas deferens. Sperm is then injected into the egg using ICSI and the chances of pregnancy is much higher. IVF may also help those with unexplained infertility. IVF can help those who want their eggs or sperms to be frozen and activated as and when they want. Advances have been made in sperm and egg preservation. Besides IVF, it benefits so many, like those in the army and navy or career conscious couples who may want to have their eggs and sperms stored in a designated bank for future use.
What is the IVF success rate at Gaudium and its USP ? At Gaudium we begin with a counselling session where we do our best to answer all questions to the satisfac-
where between 1/3 and 1/4 of their counterparts in the West. This is the reason there is a good influx of foreigners who find India as a good IVF destination.
Can this be a factor in the promotion of medical tourism ? Certainly, it is already there and in a big way!
Each country has its own IVF and surrogacy laws and protocol. How about India ? As of today ICMR guidelines are in place and we follow that but soon we will have full fledged laws. Hopefully they emerge soon from the Parliament. Countries like UK and US are very open to surrogacy laws. However, Europe is divided. In some places commercial surrogacy is not at all considered legal. Precisely for this reason, when a foreigner approaches us, we begin with the nationality and their respective laws.
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Special Feature special feature: IVF cath lab
Pursuit Called
Parenthood Mother’s Lap IVF is dedicated to every aspect of infertility treatment. Dr Shobha Gupta, Director, shares her exprience with Shahid Akhter, ENN
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Infertility is on the rise. What exactly constitutes infertility and who is most affected? Fertility, in its broadest sense is defined as the ability to conceive and have children. It is the actual level of reproduction based on the number of live births that occur. Conversely, a couple can be labeled as infertile if they are unable to get pregnant after 12 months of trying. Women who get pregnant but are unable to stay pregnant can also be termed infertile. Infertility is a major clinical problem, affecting people globally. Statistics may vary with geographical location and socio economic status but the over all scenario is alarming. According to an ICMR estimate, 60-80 million couples suffer from infertility every year and out of these 15-20 million are said to be from India. In Indian framework, 40 percent of the infertility problem is attributed to males, 50 percent to females and the rest are causes common to both. The males are considered a major contributory factor to infertility. Male infertility can be attributed to as varicocoele, cryptorchidism, infections, obstructive lesions, cystic fibrosis, trauma, and tumours. Add to this ‘oxidative stress’ that play a vital role in sperm damage and deformity.
What is the ideal time for baby ? Is there any gender divide? The prime time for reproduction is mid 20s. This is the time when you need to plan your motherhood. Unfortunately, career does not go hand in hand with the reproductive age. The ideal time to have a baby is upto the age of 32. Beyond this age, fertility potential takes a nose dive and it declines rapidly. Sperms don’t age as does the egg but the quality and quantity get affected.
Does the use of contraceptive pills affect the fertility ? Yes, they do tend to damage fertility. The pill manufacturers may as-
sure ‘no long term effects’ but the research suggests that women who have used pills are more likely to face problems with conceiving. The powerful hormones take time to wear off and are believed to disrupt the reproductive system for a long stretch of time.
At Mother’s Lap, how exactly do you address infertility ? In harmony with the infertility treatments, Mother’s Lap IVF Center is designed to address most of the fertility problems under one roof. For the comfort of the patients, all the facilities are available here and this is not only
in harmony and enjoying their relationship with each other .
What is Mother Lap’s success rate in overcoming infertility ? Achieving pregnancy depends on various factors like quality of the embryo, lab facilities, doctor’s methods of treating, and body acceptability, factor of the patient. We believe that there is success when the patient achieves pregnancy and also delivers a healthy child. Our success rate is 50-60 percent in IVF, 15-20 percent IUI and 60-70 percent in surrogacy. The number of patients or cases that we entertain each day is fixed at
“
Every couple has the biological right to have children. Mother’s Lap is dedicated to making this a success and a reality” economical but time saving for the patient as well, We are very serious about counseling and ensure that the patients have the peace of mind which is most essential. The medical staff and the clinic personals are available round the clock. At Mother’s Lap, we help the couples to maintain harmony and balance between their mind, body and soul through meditation, healing music therapy, balanced diet charts. Stress is a big culprit in robbing fertility. There are studies that indicate that patients undergoing IVF experience high levels of stress, depression and anxiety. They ultimately damage and disrupt hormonal balance between pituitary, ovary and uterus leading to inability to ovulate healthy mature eggs and inability to implant fertilised eggs. In males, the sperm count is compromised. Based on the couple’s preferences, we have a set of stress relieving programes that tends to shift the couple’s focus from conceiving a baby to living
10. This ensures that there is sufficient time for both of us.
How does the cost of IVF in India compare with that of other countries? Can this be a factor in promotion of medical tourism ? Certainly India is a healthy choice for surrogacy and IVF treatments. The cost difference is huge. The average IVF cost varies between `1.5 to 2 lakhs as compared to around 25,000 USD in the US. Even in Bangkok it amounts to `3 lakhs. It is expensive in the West for various reasons, like insurance cover. Secondly, here, we usually place two to four embryos in the uterus at one time or cycle but in the West, the standard protocol is a single embryo in each attempt. It is not just the cost factor which attracts a foreign patient. The quality of service and the technical lab that we have is at par with the best. Medical tourism is already a growing sector in India. Low priced health care procedures have a global appeal.
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Vision of Gurumurthy K T
‘All infertility solutions under one roof’
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electing the right infertility clinic is an arduous task. One needs to ensure that the clinic has a good quality control, besides strong ethics. Do ensure that the clinic is well equipped with the latest technology and is replete with a wide range of infertility remedies. It can be very overwhelming when the couples are faced with trying to make a decision that will have such an important impact on their life.
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There is no dearth of fertility clinics to choose from and the options are simply endless. Base Fertility is the only organization providing 100 percent solution for infertility through IUI, IVF, ICSI, Surrogacy, Egg Donor, Sperm Donor and Embryo Donation. Base Fertility welcomes all the childless couples from throughout the world. We begin with proper consultation. We are very particular about understanding the
precise problem of the couple and suggesting the best possible solution. Gurumurthy K T, who is the founder of Base Fertility Medical Science Private Limited, is a relentless philanthropist who is dedicated to the cause of childless couples and helping them in all possible ways – expert advice, best of medical options and the whole gamut of advanced technologies that can help the childless couple. Besides creating the aura of hope
The great success story of Base is the baby born on February 01 2013 to the Sandalwood actress, National award winning, MLC and Chairperson of Karnataka Chalanachitra Academy Tara Anuradha W/o H S Venu Cinemotographer
and helping the childless couples, orphans, widows, physically challenged persons and others seeking medical assistance, Shrusti Global Medicare and Research Foundation was established to look after the welfare of the under privileged. At Base we have the following reproductive technologies available
IUI/IVF/ICSI TESA/MESA/PESA Surrogacy Egg/Sperm Donor Frozen Embryo Transfer Laproscopy Surgery Hysteroscopy Surgery Gynaec Care
Antenatal Care Maternity Service Genetic Labs Histopathology Andrology Lab Hormone Analysis Bio-Chemistry Cytology/Hematology Besides the array of technologies, Base is blessed with a team of well experienced doctors who are ever willing to support the infertile couple with individual care and attention. Latest in the list of our success stories is the care and cure of infertility issue of Sandalwood actress, National award winning, MLC and Chair-
person of Karnataka Chalanachitra Academy Tara Anuradha W/o. H. S. Venu Cinemotographer. Base Fertility Pvt Ltd No.940, Shani Mahatma Temple Road, Behind Indira Priyadarshini Park, Vijayanand Nagar, Near Mahalakshmi layout Busstop Bangalore – 560 0 096 Mobile: +91 9343434383 / 9343431303 gurumurthykt@gmail.com www.basefertility.com
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Pushpanjali Institute of IVF and Infertility (PII) Promises Parenthood g By Dr Sowjanya Aggarwal, MBBS, MS Fellow in Minimal Access Surgery & RM Gynaec Laparoscopic Surgeon & Infertility Specialist
P
ushpanjali Crosslay Hospital (PCH), a 350 plus bedded super specialty hospital, serves to provide the highest quality of healthcare to a broad mix of local and international patients, and is amongst the few hospitals in the region to have accreditation by National Accreditation Board for Hospitals and Healthcare Providers (NABH). PCH has several highly specialised centers of excellence that comprise multispecialty treatment facilities for example Pushpanjali Institute of IVF and Infertility to treat infertility.
Dr Sowjanya Aggarwal
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The centre is NABH accredited, ICMR approved, NARI registered and also ISAR and FOGSI accredited. PIII’s specialises in every aspect of ART of making babies through comprehensive services in IUI, IVF-ICSI, PESA, surgical sperm retrieval, donor eggs, surrogacy and fertility enhancing endoscopic surgeries. Pushpanjali Institute of IVF and Infertility has state-of-the-art facilities for IVF-ICSI, fully functional advanced infertility laboratory for diagnostic and therapeutic tests. PIII trains doctors in ART techniques and conducts research to provide the best infertility treatments in India. We recognise that infertility is one of life’s most difficult challenges, both medically and emotionally. Worrying about never having a child, undergoing invasive treatments and procedures, and handling the financial impact of treatment add dimensions unfamiliar to many patients, especially those who have had limited medical concerns before their fertility care. We encourage you to become an educated, active member of your treatment team so that together we can make the best healthcare decisions for you and your family. In India, it is estimated that approximately 15-20 percent of all fertile age couples suffer from infertility. This figure is on the rise because of increased pollution, stress, competitive work environment and a hectic and fast paced lifestyle. The cause or causes of infertility can involve one or both partners.
Factors responsible for infertility Generally in about one-third of cases, infertility is due to a cause involving only the male partner. In another one-third of cases, infertility is due to causes involving both the male and female. In the remaining one-third of cases, infertility is due to a cause involving only the female.
Causes of male infertility A number of things can affect sperm count: • Ability to move (motility) or ability to fertilise the egg. • Abnormal sperm production or function due to undescended testicles, genetic defects. • Problems with the delivery of sperm due to sexual problems, such as premature ejaculation. • General health and lifestyle issues, such as poor nutrition, obesity, or use of alcohol, tobacco and drugs • Frequent exposure to heat, such as in saunas or hot tubs, can elevate your core body temperature. • Both radiation & chemotherapy treatment for cancer can impair sperm production, sometimes severely. • The closer radiation treatment is to the testicles, the higher the risk of infertility. • Age: Men older than age 40 may be less fertile than younger men. In females, the causes could be: • Irregular ovulation or egg production, hormonal imbalance
• Tubal block • Problems in uterus like fibroids, adhesions, synechiae congenital anomalies, chocolate cyst of ovaries • Unexplained
What happens first? The first consultation is conducted with both partners together and consists of 30 minutes of “in-person appointment”. During this time, the information provided will be reviewed to determine the most appropriate clinical procedure and preliminary testing for cure. During this consultation, couples can ask and receive answers to the many questions they may have on their minds. After investigation, cycle management determines how the specific need of individual couples can be met. The treatment so recommended varies from one couple to another.
Success rates At Pushpanjali, we are committed to providing the best chance of achieving the dream of parenthood through our consistent investment in our world leading science and individualised care. And our success rates show we are able to live up to that promise. Pushpanjali has consistently provided the best possible chance of success for couples, compared to the average of other clinics, in Delhi and NCR.
What is the scope of fertility enhancing endoscopic surgery? Laparoscopy- It is a surgical procedure that involves making very small cuts in the abdomen, through which the doctor inserts a laparoscope and specialised surgical instruments. The patient may be advised for this to help in diagnosing the cause of infertility. Some causes of infertility, like endometriosis, can only be diagnosed through laparoscopy. In addition laparoscopic surgery can treat some causes of infertility, allowing patient a better chance of getting pregnant either
naturally or with fertility treatments. Hysteroscopy- It is designed to allow the doctor to view for defects located inside the uterus such as polyps, fibroids and adhesions and treat them at the same time and enhance the chances of their conception.
What is PESA/TESE? Percutaneous Epididymal Sperm Aspiration (PESA) and Testicular Sperm Extraction (TESE) techniques are used when sperm is produced in the testes but the sperm cells cannot enter the seminal fluid. With TESE, the sperm is extracted directly from the testis and with PESA it is aspirated from a tube lying next to the testis. The decision to use TESE or PESA will depend on the diagnosis. The sperm is then injected into the egg using ICSI.
What are the treatments available other than IVF?
Egg, Sperm and Embryo donation Some couples may need to consider the use of donated eggs, sperm or embryos. Deciding to undergo treatment using donated eggs, sperm or embryos will raise personal issues and requires careful consideration. Sperm donation It may be offered to couples with a sperm disorder or those with a high risk of passing on a serious genetic disorder. Our sperm donors are carefully chosen, healthy men aged from 18 to 40, all of whom are screened for Hepatitis B and C, HIV. We try to match the donor with the male partner as closely as possible, with similar skin complexion, race, height, hair and eye color. Donor insemination can either be used alone or in conjunction with other procedures like IVF. Surrogacy Surrogacy is an arrangement in which a woman carries and delivers a child
for another couple or person. The intended parent or parents, sometimes called the social parents, may arrange a surrogate pregnancy because of homosexuality, female infertility, or other medical issues which make pregnancy or delivery impossible, risky or otherwise undesirable. The sperm or eggs may be provided by the ‘commissioning’ parents, but donor sperm, eggs and embryos may also be used. A gestational surrogacy requires the implantation of a previously created embryo, and for this reason the process always takes place through IVF. It is not a simple process and requires commitment and dedication from all parties. Surrogacy requires that all parties wanting to enter into a surrogacy arrangement must: • Undergo counselling and assessment prior to treatment • Have a written legal agreement between the intending parent(s) and the proposed surrogate. The legality and costs of surrogacy vary widely between jurisdictions and is controlled in India according to ICMR guidelines. IVF AND INFERTILTIY services offered at PIII are: • Intra Uterine Insemination (IUI) • In-Vitro Fertilisation (IVF) • Intra-cytoplasmic Sperm Injection (ICSI) • Male Infertility- Andrology Clinic • Surgical Sperm Retrival- TESA, MESA, PESA • Cryopreservation (Freezing of semen, Testicular tissue and Embryos) • Slow Freezing and Vitrification • Sperm Banks • Donor Program (Semen, Oocyte, Embryos) • Fertility Enhancing Endoscopic Surgery- Laparoscopy/ Hysteroscopy • Surrogacy • Laser Assisted Hatching • Blastocyst Culture • Frozen Embryos Replacement • Psychosexual Clinic
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Radiology
Brightest Doctors
Go for Radiology Dr R K Mathur, Medical Director and Chairman, Department of Radiodiagnosis at Saket City Hospital, talks to Shahid Akhter, ENN, about the new advancements in the field of radiology
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Is medical imaging the fastest growing segment of healthcare?
With the upsurge in Imaging, has the role and responsibility shifted or changed?
What technological advancements has your hospital introduced lately?
Patient diagnosis and management through the creation of medical images using X ray , Ultrasound, Computed Tomography(CT) and Magnetic Resonance (MR) have immensely changed how we practice medicine over the last three decades, Medical imaging has recorded the fastest growth among all the major specialties of medicine attracting the best talent amongst doctors. Photographic (Digital) recording of conventional radiographs has come a long way. Once upon a time (during the early days of imaging) it would take no less than ten minutes of exposure time for a head CT. Today CT scan of the whole abdomen can be obtained in a few seconds. The radiation dose in CT has also reduced to a few Millisieverts (mSv). The black & white films have given way to colorful cross sectional images which provide a wealth of diagnostic information. 3D images help in planning of surgery. High spatial resolution helps in delineating fine anatomical detail. High contrast resolution helps in differentiating subtle changes in soft tissues. Today there are a number of opportunities to explore the human body by way of imaging.
Today the referring physicians and surgeons need greater interaction (clinical interface) with radiology. Radiologists too need to comprehend the clinical problems and finally, it will not be an exaggeration to say that the radiologist is expected to be able to connect at different levels and with almost all the medical specialties. Advances in imaging have created new areas of sub-specialisation and a new specialty Interventional Radiology which utilizes image guidance to perform diagnostic and therapeutic procedures.
We are the first hospital to introduce Philips Ingenia 3 Tesla MRI scanner with 4D Multi-transmit Technology. The wide bore of this magnate reduces claustrophobia and provides a comfortable environment for the patient. This magnet brings to the patients and clinicians an unmatched quality
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Today, with more and more screening options available, there are conflicting opinions on the most appropriate examination protocol? It is true that a wide choice of investigative options are available to the clinicians, however, the pathway is generally clear in the choice between Ultrasound, CT, MRI etc. keeping cost and safety in mind. Chest X-Ray still remains the investigation of choice in screening for TB, CT is the investigation of choice for chest abdomen, acute stroke and trauma. MRI is the procedure of choice for evaluation of Brain and Spine.
Technology has outpaced our imagination by providing exquisite images of the human body which help in early and accurate diagnosis in total body imaging which can only be achieved at a high field strength. Its capabilities include detailed imaging of the brain with Multivoxel Spectroscopy, Perfusion and non-contrast Peripheral Angiography. It also has special software of whole spine screening, Joints, Abdomen, Pelvis and Breast. We also have the latest dual energy CT scanner from Philips iCT 128 (256 slice/sec). This state-of- the-art ultrafast CT scanner allows images to be acquired in the shortest scan time with great detail at the lowest possible radiation dose. CT Coronary Angiography for example can be done with prospective
Dr R K Mathur
ECG gating with a dose of 3 mSv compared to 10 to 12 mSv in older scanners an approximately 75 percent reduction. The reduction in dose can also apply to pulmonology and follow up scans and a software which uses dose modulation automatically selects the lowest possible radiation for a particular body region. Our team of Radiologists are highly experienced in performing multiple procedures like MRCP (for screening the biliary tree and gall bladder for stones), Prostate imaging, Perfusion imaging and Spectroscopy. We also offer state-of-the-art Bone Densitometry or DEXA for screening and detection of osteoporosis, a common but infrequently recognised problem in middle aged women.
How do you handle Pediatric Imaging? Seems tricky and Challenging. Sedating kids may add to safety concerns? Kids need to be cajoled, their attention diverted, and at times we have to resort to sedation and anesthesia. Moreover, our state-of-the-art, ultra fast Philips iCT 128 ensures dose modulation especially in children and in follow up scans.
A lot of your time is spent in educating and training the next generation. How do you see the transformation? It is a highly satisfying and rewarding experience. The best of students opt for radiology and it is the most satisfying career. Once I was a student and now I am training the young Radiologists. The time lapse has transformed the scenario. Three decades ago, it was the era of black and white and we had to struggle a lot with the plain films. Today in the digital era diagnosis is much easier with multiplanar images and mind boggling details in 3D. A sea change from the days of plain X-Ray. Passing on the baton to the next generation and preparing them for new challenges brings a lot of responsibility and professional satisfaction.
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Indian Diagnostic
In The Eyes of a Leader
Suresh Vazirani-Chairman & Managing Director, Transasia Bio-Medicals Ltd, speaks about the changes of the diagnostic industry. He feels that quality and superior customer service has helped them create a niche for the organisation
What is the mantra behind Transasia Bio-Medical’s success? Transasia Bio-Medicals Ltd stands for quality and service. It gives a sense of pride that we are today accepted as India’s number one diagnostic company. Our three decades of commitment to healthcare has been possible because of the six stepping stones that have become the ethos of the organisation: Innovation - Focus on indigenous production and improving our services to serve our customers more effectively. Quality– We strive to deliver excellence through standardised, consistent solutions. Reliability- Our products are globally accepted and trusted. Customer satisfaction– No compromise is accepted on providing prompt and effective after sales service to our customers thereby ensuring a high satisfaction index. Affordability– Our aim is to provide solutions at affordable prices so that the much needed diagnostic and preventive service can reach millions of our country. After sales service– With a highly trained team of 150 engineers, we focus on providing efficient services.
What were the challenges you faced while establishing Transasia as brand in the face of big foreign brands and how did you overcome it? Thirty years back technology was
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Suresh Vazirani
Doctors are today in the drivers’ seat and have become more specific for their requirements. Patients too today are better read and demanding. not as advanced as it is today. There was not much emphasis laid on indigenous research and development. As a country we relied mostly on imported technology. Products from the West have always been widely accepted. It was a challenge to change the mindset of the
customers. From the beginning we laid emphasis on a ‘no compromise policy’ where quality and customer service is concerned. I started with marketing of a Japanese automated blood cell counter. It did take some time for people to accept automation. However, at that time i. e. in 1980s and early 1990s these machines were relatively expensive. Only a few pathology labs and top hospitals in big cities were able to afford them. That’s when I focused on in-house research, development and production. That way I was able to provide automation at a relatively cheaper cost. I backed my production unit with a stringent after- sales service and that helped me soon create a place at the top in the sector.
How collaboration with foreign companies is helping Transasia in terms of R&D, product range and reach? We are still on a growth path and are planning to manufacture many more products in different segments. All our collaborations are with companies who think the way we do. We have judiciously partnered with companies who believe in delivering excellence. That gives us the competitive edge. As a result we are able to reach the length and breadth of the country in providing quality results in varied segments.
What is your roadmap for strengthening Transasia’s global presence? From the beginning, Transasia has followed the policy of ‘local for global’. We have already spread our footprints across the globe and are expanding network in more than 90 countries and having our direct presence through acquision of local companies in USA, Italy, France, Russia, Czech Republic & Turkey. Bringing all the subsidiaries under the umbrella of ERBA group will assure our customers of the deliverables that Transasia has carved a niche for. This will further strengthen the faith that our associates have in us. Experience, expertise and technology go hand in hand. We plan to strengthen our employee base and recruit the best brains. Providing the most affordable, highest quality solutions has been the focus of Transasia. We aim at reach-
ing the remotest of the areas globally and providing world class healthcare at reasonable costs.
In your three decades of experience, what are the changes you have seen in the diagnostic industry? Over the last three decades, the Indian Diagnostic Industry has grown by leaps and bounds. Medical need is high today. Lifestyle changes have led to more and more people requiring medical treatment. This has thus led to an increase in demand for the diagnostic industry. Lab technicians and doctors have also become more technology savvy. Today, they are more open to accepting innovations. Doctors are today in the drivers’ seat and have become more specific for their requirements. Patients too today are better read and demanding. This has lead companies to ideate and provide new solutions for example point
of care for the patients. Also increasing number of companies are entering today in the diagnostic segment. Along with foreign investments we also have local players who have got into research. To counter competition, companies are also laying emphasis on training and development of their staff particularly the ones in direct contact with the customers. The government has played a vital role in encouraging the healthcare sector. As a result, even the diagnostic industry has benefited. Government has encouraged Foreign Direct Investments (FDI) as well as indigenous research thereby promoting the sector. With cut-throat competition, companies are using different ways to lure customers. Awareness for different products and their features is generated through offers, using media as a promotional tool.
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covertrend tech story
The Evolving Phase of
Indian HIS Solution
Indian healthcare is now more receptive to adopt Hospital Information System (HIS) & Health Management Information System (HMIS) in their infrastructure. The market for HIS & HMIS is too growing fast with emergence of customised solutions. By Sharmila Das, ENN
H
ospital information system (HIS) is essentially a computer system that can manage all the information to allow healthcare providers to do their jobs effectively. These systems have been around since they were first introduced in the 1960s and have evolved with time and the modernisation of healthcare facilities. The computers were not as fast in those days and they were not able to provide information in real time as they do today. The staff used them primarily for managing billing and hospital inventory. All this has changed now, and today hospital information systems include the integration of all clinical, financial and administrative applications. Sarath Anand Jupalli, Managing Director, Shivam Medisoft Services Pvt Ltd says, “HIS & HMIS market in India is picking up beautifully. Off course it still has time to grow to its full potential. Most of the midsized and mega sized hospitals are using some or the other HMIS solutions as per their convenience and budget. With many hospitals opening every year the market is always there for the HIS vendors”. Dr Mallika Kapur, CEO, NEXTGEN eSolutions says, “A few years ago, hospitals demanded disparate solutions for different functions; today they want an integrated solution for their hospital, or chain of clinics, or mobile vans. The need for integration is higher, with customers demanding integration with SAP, Oracle based financial management systems, and equipment. With the quality of healthcare increasing by leaps and bounds, more and more customers are looking for integrated solutions which help them implement best practices at their centers”. A good HIS offers numerous benefits to a hospital including but not limited to the delivery of quality patient care and better financial management. The HIS should also be patient centric, medical staff centric, affordable and scalable. The technology changes quickly and if the system is not flexible it will not be able to accommodate hospital growth.
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tech trend
“HIS & HMIS in reducing trial and error” How do you perceive the market for HIS & HMIS in India? Today HIS is an essential part of any hospital in India that has more than 50 beds. It is widely accepted that it is not possible to manage large hospitals without an effective HIS system in place. As regards status of the HMIS market in India, we seem to be at an earlier stage of the adoption curve and only the thought leaders and quality focused hospitals have made a serious attempt at making the HMIS the central system around which the hospital functions. With much of the care documentation being paper based, the shift to HMIS has been slow. However there are a couple of recent trends that we have seen which can help increase HMIS adoption in the market. The first is that competition among hospitals is increasing as the number of hospitals increases. Some hospitals have recognised that the HMIS is a quality differentiator and something that enhances branding and can therefore pull in patients. Surprisingly this trend is more evident in the rural areas where hospitals with an HMIS in place perceive immediate branding benefits, leading to higher occupancy levels in the medium term. The second trend and perhaps a critical factor is that hospitals are slowly becoming aware of the requirements for an EMR as mandated in the Indian Government’s Clinical Establishments act of 2012. The realisation that this will become inevitable and an HMIS is required to meet this need, will result in a rapid increase in HMIS adoption.
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Wipro. The mid size deals are shared by the smaller healthcare IT companies such as Aavanor, 21CS, Napier, Akhil, Palash, Srishti, Instahealth, etc. The very small deals seem to go to local players active in their areas, who develop simple customised solutions for the smaller hospitals.
What are the unique HIS/HMIS solutions you have designed for Indian healthcare?
Vennimalai, CEO, Aavanor Systems Pvt Ltd feels cloud based HIS & HMIS solutions are making inroads in hospitals
What is the size of this market? Who are the top players in this field? The market is divided into large Governmental projects, large hospital chain implementations, mid size hospitals and finally the smaller hospitals. While a few large institutional deals take the total market size into the hundreds of crores, a majority of the deals are smaller value deals struck between the mid and small sized hospitals and the smaller Indian healthcare IT companies. By their very structure and requirements in terms of turnover and company size, most large deals go to the larger Indian IT companies such as TCS and
Indian healthcare systems have unique requirements in terms of billing and patient management. There are subtle but critical differences in the workflows followed by our hospitals in these areas and systems that are to service them need to address the realities of Indian hospitals. With multiple rate cards, multiple payers, complex ‘package’ treatments, and long collection cycles, the HIS’s abilities to handle the hospital’s finances is critical for a successful implementation. Our solutions offer a very comprehensive financial module that addresses the intricate requirements of the Indian market. The other critical success areas for an HIS are its ability to effectively handle the laboratory, store and pharmacy in the hospital. The various variants to the purchase and reimbursement practices that have evolved in the industry require tremendous breadth in the functionality required of the IT systems handling their operations. We have over the years refined the system to the point where operations of Indian hospitals are seamlessly handled by the system and hospitals are able to handle the multiple different types of transactions that take place on a routine basis.
tech trend
Improved Hospital Management
With HIS & HMIS
Sarath Anand Jupalli, Managing Director, Shivam Medisoft Services Pvt Ltd, shares his insights on the upcoming trends in HIS & HMIS in Indian healthcare How do you perceive the market for HIS & HMIS in India? HIS & HMIS market in India is picking up beautifully. Off course it still has time to grow to its full potential. Most of the midsized and mega-sized hospitals are using some or the other HMIS solutions as per their convenience and budget. With many hospitals opening every year the market is always there for the HIS vendors.
Server etc). The benefit with this technology is that our software works on LINUX (free Operating System), so none of our customers need to buy any costly licenses. We are completely on open source facility. We even have dashboards in form of apps for Anroid and iPhone (iOS). So that hospital owners can use their mobiles to monitor their hospital operation even when they are out of the hospitals.
What is the size of this market? Who are the top players of this field?
How much investment required to procure HIS/HMIS solution for a hospital infrastructure?
In Hyderabad/ Secunderabad alone about 800 plus hospitals are there and in Andhra Pradesh about 3500 plus hospitals are there, with this figure one can imagine the comprehensive picture of HIS market in India. In due course of time every hospital has to digitised for better management. There are many players in this industry. We have achieved our presence in Andhra Pradesh, Delhi NCR, West Bengal, and Punjab where we are one of the major players in HIS Market.
What are the unique HIS/HMIS solutions you have designed for Indian healthcare? Our HIS is unique because it has robust management capabilities. Our software is equipped with Objection Management System (OMS) which is specifically designed to control and improve the service quality of the hospital. Principally the concept is setting standards for each process of the hospital and allows the software to monitor it. Once the process is
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Sarath Anand Jupalli deviating from its standard then the OMS alerts the concerned authority that something is going wrong in the process for example if time taken for collecting a sample of a patient is more than 15 minuntes then system alerts the Assistant Medical Superintendent (AMS) about the delay immediately in form of SMS, mail, and pop up on screen. AMS then have to take action and report it to the system. A list of all objections rose in a day and action taken is mailed to CEO of the organisation automatically. This helps the hospital in setting right processes and monitoring is done by our OMS.
In technology front, what are the new developments have come up in this field? Various companies use various technologies. We at Shivam are completely on JAVA based technologies with independent back end (Oracle,MySql,SQL
Investment always depends on the requirements of the hospitals. It is purely on the modules that opt for and processes they are looking to stream line. Our range of software starts from `50 Thousand for a small hospital to `7080 lakh for a big hospital. Many hospitals opt for step by step implementations i.e placing multiple orders in a span of 1-2 years and going for full computerisation.
What are the advantages the solution offers to the hospital caregivers? HIS helps managing the hospital better. We can streamline every inch of hospital by putting in place the processes and linking them to OMS. We can control stocks (Auto Stocking System), Purchases (Auto PO System), Indenting (Auto Indenting with Auto Balancing System), Payments (Auto Journal and Auto Cheque System). If implemented properly then we can assure a complete stoppage of pilferages in hospital in form of money or stock and improved service quality.
“HIS & HMIS
market continues to be lucrative”
Andy David, Senior Director-Healthcare (Asia Pacific & Japan - APJ), SAP, feels that the HIS & HMIS market continues to be lucrative How do you perceive the market for HIS & HMIS in India? Typically, hospitals implement these systems only to manage the basic functionalities. However, over the period when they realise the benefits of these offerings, the second and third choices are more towards a solution which is integrated and rich in functionality. This makes us a strong player in most of the matured countries. We have started to witness attraction for these solutions amongst Indian hospitals. However, the journey has just begun and we are confident that the early adopters in India will realise the benefit and look at the long term value and appreciate the right investment to deliver value throughout the journey.
What is the size of this market? Who are the top players of this field? With a significant contribution of private sector and with the public sector’s interest in leveraging technology, the market continues to be lucrative.
What are the unique HIS/HMIS Solutions you have designed for Indian healthcare? SAP is looking at leveraging the ‘Best Practices’ that have been developed by working with multiple hospitals across the world. Additionally, the capability of working in a single through to a cluster or even a state, offer us tremendous potential for the private hospitals that have growth plans and for the public hospitals who are looking for a single solution to run across a province.
In technology front, what are the new developments have come up?
What are the advantages the solution offers to the hospital caregivers?
SAP ERP is now powered by HANA, a flexible, multi-purpose, data source agnostic in-memory appliance that combines SAP software components optimised on hardware provided and delivered by SAP leading hardware partners. It helps in real time performance and delivers great speed in transaction. In addition, it also delivers a full business intelligence capability from the same source; there is no need to set a different reporting infrastructure. It can all be run from the same environment delivering huge savings. For business intelligence, SAP has a suite of tools which offers a unique advantage and the capability to drive change in clinical and operational functional areas. This solution can be supported by SAP HANA in memory solution that allow huge data to be analysed in seconds, thus have impact in research and ‘real time’ predictive capability offering individual focus delivering ‘Patient Analytics’. Mobility is empowering the doctor to be able to work by the bed side with the latest up to information on the patients’ situation. With SAP’s ‘Unwired EMR’ doctors are finally engaging with IT and delivering real patient satisfaction at the bed side. SAP Cloud Solutions for procurement ‘Ariba’ which have an immediately impact on savings thus a huge impact on the bottom line and for talent management with success factors which is key in a hospital where as service industry human resources and retaining top talent so critical.
From a caregiver’s perspective, the more accurate and more real time the information about the patient, the more accurate their diagnosis, therefore offering real benefits to improve patient outcomes. Through such solutions, the patients’ history can be reviewed and the current episode of care, with its results from the various departments, in a holistic view and with the mobile enabled capability can be done at the bedside. This allows a new level of engagement with the patient thereby increasing patient satisfaction.
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tech trend
HIS Ensures
Quality Care
Sadananda Reddy, Managing Director, Goldstar Healthcare Private Ltd, sheds light on the dynamics of HIS & HMIS market
How do you perceive the market for HIS & HMIS in India? Indian HIS market to grow at a Compound Annual Growth Rate (CAGR) of 15 percent over the period of 20102014. Key factors contributing to this market growth is the rapidly developing healthcare industry in India. The Indian HIS market has also been witnessing growth in medical tourism.
What are the unique HIS/HMIS Solutions you have designed for Indian healthcare? Goldstar Hospital Information Management System (GHIMS) Website is a comprehensive solution, which records transitions between patient, and service provider containing details about who did what to whom, when and where. GHIMS enables healthcare providers to improve the operational effectiveness, reduce costs, reduce medical errors and enhance delivery of quality care.
In technology front, what are the new development have come up in this field? Latest technologies like ASP.NET, J2EE, relational database management systems based on SQL or Oracle databases are required. There are open source technologies, being a service organisation need to focus on quick service and numerable features benefits to be taken from technologies. From client server to Web based or cloud based application/solution is the need of the hour.
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How much investment required procuring HIS/HMIS solution for a hospital infrastructure? It starts from `10 lakh and above depending on required modules, number of nodes and size of the hospital in terms of beds. Max Healthcare has an ITO with Perot Systems worth USD 20 million. That includes infrastructure upgrade, EMR implementation, application support and clinical transformation. It is a private cloud hosted on the Dell datacenter. Fortis Healthcare has an ITO with HCL worth USD 15 million. That includes infrastructure upgrade, new application implementation and support. It is on a private cloud hosted in HCL data center. Lower end of the spectrum is 20-50 bedded nursing homes. There are HIS products being sold for `5-10 lakh for licenses including support for one year.
What are the advantages the solution offers to the hospital caregivers? Implementing right IT solution will promote seamless and complete clinical data capture and improve billable charges, including medical supplies, drugs, procedures, and ancillaries. The system produce more granular information for all inpatient encounters, more accurately reflecting care intensity; and its automated charge capture enable earlier identification of encounters that are potentially billable. A consolidated real time HIMS report would provide complete health sta-
Sadananda Reddy
tus of the hospitals to top and middle management. With the advancement in business intelligence, application makes departmental heads / administrators / management to have pictorial representation of information readily available to analyse outcomes and take decisions accordingly to enhance hospital/ institute reputation. Information can be stored, retrieved and communicated very easily and high security of data can be provided by remote data storage server, which can be placed geographically in farther location to save data in unfortunate natural or manmade calamities with in the vicinity of hospital data storage location.
tech trends
Better Solutions for
More Mature Market Dr Mallika Kapur, CEO, NEXTGEN eSolutions believes the future for integrated HIS & HMIS solutions is hopeful in India, as the healthcare fraternity has matured and is looking to adopt better solutions. What are the solutions you have devised for Indian HIS/HMIS market? We have devised an ERP level HMIS, with a sophisticated EMR component – this is our flagship product, and is named Hospilogix. We have specialty specific EMRs as well, such as a cancer specific EMR Solution, and an EMR product for Women’sHealth too. We’ve rolled out our solution across 30 organisations (including some chain hospitals/ clinics), and have won over 150 orders for Hospilogix. We also have a one-of-a-kind Cath Lab Solution, Cardiologix, which is installed at all the major heart centers - Medanta, Max Devki Devi Hospital, Prime Hospitals, Sir Gangaram Hospital, etc. Heartened by our success in India, we recently started marketing Cardiologix to the overseas market, and have seen a lot of interest. We market our HIS products overseas as well, particularly the specialised Clinic Management Solution called Ambulogix, for which the Middle East and Africa are our target markets. We have recently developed Femilogix, which is a women health management solution with an IVF and aesthetics component. We have implemented it in a number of cancer hospitals across India. We have another multi location web based product called Vointilogix, which is targeted at price sensitive diagnostic customers – this has just come out of beta testing, and we already have orders for it.
this space over the last few years, has been the ability to survive.
What are the changes you have noticed in the market?
Dr Mallika kapur The pricing in the HIS market is very variable. At the high end of the market, there are HIS projects, which call for extensive customisation – these are usually priced in excess of `1 Crore. The majority of HIS contracts fall in the `20-40 lakh range depending on the size of the hospital, the amount of customisation required, the number of satellite centres and the integration requirements etc. We’ve recently introduced a low end product for small standalone diagnostic centres, which is priced at under `1 lakh, and is sold exclusively through our dealer network. HIS- EMR is our major business and we find ourselves getting new orders increasingly through referrals from our satisfied customers. Our customers are happy on two counts – one that our solution works, and we support it round the clock, and two, that our company is still around. To my mind, the key differentiator in
A lot of small and medium sized hospitals, who were not ready to adopt Health IT have now started rapidly adopting HIS solutions. Earlier, it used to take forever to implement solutions in hospitals - at one location; it took us three long years to complete implementation. These challenges minimised, because both IT companies and customers have matured – our average implementation time is now under six months. In addition, we offer SAAS solutions targeted primarily at clinics. We find that many customers, particularly those with some experience with our product at a previous location, are willing to try hosted solutions. We have now implemented our SAAS based solutions at many locations, such as at Primus Hospitals, Chanakyapuri and their satellite clinics. SAAS based solutions are more suitable for outpatient wards and clinics. The need for integration is higher, with customers demanding integration with SAP, Oracle based financial management systems, and equipment. This is an interesting time to be working in this space - it is a time of transition. 6-7 years from now you will see a major consolidation, with a handful of ERP HIS/HMIS providers, and the others will be niche solution providers.
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Zoom In
Modern Dentistry Dental Cone Beam Computer Tomography g
By Himanshu Bhatt, Director, KS Biomed Healthcare Pvt Ltd
F
rom wooden chew stick to modern advanced tooth brushes, from powdered pumice stones and strong wine vinegar to tasty and healthy tooth pastes and from mere simple pain aided dental practice to today’s modern advanced dentistry our teeth demand with much better care and attention than what we give it. The best example of advantages of modern dentistry is today more and more number of youngsters is going to dentists then old aged patients for simple dentures compared to yester years. Merely from basic dental care, today this branch of healthcare has grown to cosmetic surgery, implant dentistry, root canal treatment, sedation dentistry, painless extractions, advance dentures, tooth colour filling or even dental jewelry. All above new advancement are predominantly supported by dental radiography.
Paradigm Shift Even dental radiography has seen paradigm shift from simple dental x-ray plates to modern time digital radiography, CT scan, CBCT (specialized dental CT) or even MRI in some dental analysis. In all above mentioned modern dental treatments, dental radiography from multiple angles is must. CBCT has revolutionized bone analysis and bone treatment planning to a great extent. It is the best technique today available for most effective pre-
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operative dental assessment. It also helps wonderfully in post-operative assessment for treatment planning which results in much faster and accurate patient recovery.
Modern Dentistry The US Food and Drug Administration (USFDA) describe cone-beam computed tomography systems or CBCT as a variation of traditional computed tomography (CT) systems and is used by dental professionals to rotate around the patient, capturing data using a cone-shaped X-ray beam. These data are used to reconstruct a three-dimensional (3D) image of the following regions of the patient’s anatomy: dental (teeth); oral and maxillofacial region (mouth, jaw,
Himanshu Bhatt
and neck); and ears, nose, and throat or ENT. X-ray imaging, including dental CBCT, provides a fast, noninvasive way of answering a number of clinical questions. Dental CBCT images provide three-dimensional (3-D) information, rather than the two-dimensional (2-D) information provided by a conventional X-ray image. This may help with the diagnosis, treatment planning and evaluation of certain conditions. One can reconstruct 3-D view of skull or any maxillo-facial region in all three planes i.e. sagital /axial and frontal. It’s a must technique for dental trauma patients, dental implant, orthodontic treatments, and also for diagnosis of any pathology or cyst in dental care. Its excellent quantitative and qualitative analysis tool for modern dentistry.
Promising Future With the help of all above modern advance radiography tools specialised in dental care, are the real future for advance radiology clinics in India. Also level of awareness is also growing at huge pace creating a assured promise of faster returns in digital OPG or CBCT by radiology set ups. The time has come that both this dental care modality should be part of all advanced radiology set ups which will help investor, referring dentists and patients to a great extent.
zoom in
Role of Virtual Slides in
Medical and Dental Education g
By Dr Mohit Chandra, Director, Digiscan
C
ertain aspects of medical education are particularly dependent upon teaching by microscope using glass slides. As medical education moves into the 21st century, new tools and methodologies have evolved into an innovative learning technique referred to as Virtual Microscopy (VM) and the image produced called Virtual Image. Virtual images are being used worldwide for e-teaching and e-learning of morphological sciences like histology and pathology. It is not a replacement of regular teaching methods; instead it is a great addition for quality enhancement of education. Its value lies in the ways it is utilized within the context of a well-designed, well-integrated and well-delivered medical curriculum. Though it is customary to introduce students to microscopes and glass slides at the beginning of medical and dental education, virtual slide laboratory will provide a better way of learning histology and pathology.
Medical Education VM is going to bring about a revolution in medical and dental education. Futuristic class rooms will be devoid of microscopes and equipped with PCs or laptops. Professors will be showing virtual images and students will be viewing the images on their laptops. Next few years are going to witness an improvement in quality of medical and dental education in India and bring it at par with global centers of excellence.
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Dr Mohit Chandra Virtual slides are playing an important role in e-medical and e-dental education and provide 24x7 online access and reduced infrastructure costs for institutions. Unlimited number of copies of images can be prepared for teaching and self study. Comparison of two images can be done at the same time. Virtual slides provide enhanced capacity for interactive learning among students and collaboration among institutions, universities and professional associations for advancement of knowledge and provide a tool for continuing professional education. Virtual slides are extremely helpful in institutes with high increased student - teacher ratio or inadequate staff. With virtual slides being used for teaching, infrastructure and hours and energy spent on preparing glass
slide sets for undergraduate teaching or for conducting slide seminars and examinations can be saved and these resources can be utilized for other activities to enhance education. Individual assistance is not required in practical classes as students have access to on line images without restraint of time and space. Revision by self study by the students will reduce the need for revision classes before exams. Institutes deficient of good teaching material will be extremely benefitted as teaching material can be shared with resourceful institutions. This will not only enrich education but will also bring uniformity in education with inter-institutional collaborations. Virtual slides are being used globally for slide seminars, quality assessment, practical examinations and presentations in conferences, seminars.
Telepathology A virtual slide is a useful tool for pathology diagnosis and second consultation. Virtual slides are transmitted online to the expert pathologist and report is received with minimal loss of time. Since virtual slide represents the whole section, it can be interpreted in totality with negligible chances of error. Digiscan a company with a focus on spreading e-medical and e-dental education in India, brings the technology of virtual microscopy at the doorstep of medical institutions. It provides annotated virtual slide sets in Histology, and Pathology for medical students and of Oral Histology, Dental Anatomy and Oral Pathology for Dental students which not only help teachers in teaching but also support an active learning in which students are enabled to explore a slide on their own and learning. For viewing virtual slides in action, visit www.digiscan.in, and to have a glimpse of the e-module on Cervical Cytology visit www.digiscan.co.in
9th india’s premier ICT Event
The 9th eINDIA (www.eINDIA.net.in), to be convened with the theme of ‘Building a Knowledge Society’ will be held on July 23 — 24, 2013 at Hyderabad International Convention Centre (HICC), Hyderabad, India and hosted by Government of Andhra Pradesh and Andhra Pradesh Technology Services Limited (APTS). The summit is being organised by Elets Technomedia Pvt Ltd. The two-day summit will serve as a platform for knowledge exchange between the key stakeholders who are active in the fields of Governance, Education and Health.
programme chair of eINDIA 2013
Leaders at eINDIA 2012
N Kiran Kumar Reddy Chief Minister Government of Andhra Pradesh
Sam Pitroda Advisor to the Prime Minister of India on Public Information Infrastructure & Innovations
Killi Kruparani Minister of State for Communication & IT, Government of India
Ponnala Lakshmaiah IT Minister, Andhra Pradesh
S S Mantha Chairman, All India Council for Technical Education (AICTE)
Prof H A Ranganath Director, NAAC
and more ...
SMS
Sanjay Jaju Secretary, IT & Communications Department, Government of Andhra Pradesh It gives me immense pleasure to announce and welcome the 9th eINDIA Conference, Exhibition & awards. I am happy about the consistent and synergised endeavors of the organiser in engaging the government as well as the private sector in the development activities of the information and communication technology in conjunction with sectors like Education, Healthcare and Governance. We have taken good learning experiences from all the past eight chapters of eINDIA conference, orgainsed at dfifferent locations of the country. I am happy that Andhra Pradesh is hosting the 9th edition of eINDIA Conference, Exhibition and Awards
Who Should Attend? The Hon’ble Chief Minister of Andhra Pradesh is the Chief Guest The Hon’ble IT Secretary of Andhra Pradesh is the Programme Chair Dignitaries from Ministry of Communication and IT, Government of India Secretaries from various government departments in Andhra Pradesh and other states Administrative officers from foreign governments eIndia Health Summit will bring the crème-de- la- crème of the healthcare fraternity who will share their insights on crucial subjects like government initiatives in healthcare, multi specialty hospitals, telemedicine solution, health insurance and many more. It is the biggest platform for most eminent health experts, policy makers, researchers, solution developers and technocrats from across India and beyond, to meet & share the knowledge about the latest developments in Health Information Communication Technology (HICT) and interact with the stakeholders in the entire continuum of care about the challenges and opportunities in the healthcare sector.
Highlights · • • • • • • •
Leaders of private sector companies that are actively collaborating with the government in the area of e-Governance CEOs, CMOs, CFOs, CIOs, CTOs of healthcare organisations Health Secretaries and senior government officials Senior administrators, HODs and business managers of hospitals Investors from private equity and venture capital firms Vendors and suppliers of hospital materials, technologies, equipments and devices
Biggest networking event for leaders in health from around the country Health Secretary Conclave Hospital CEO/CIO Conclave and Health Leaders’ Conclave Convergence of who is who of the health sector Extensive media coverage for the Summit during and after the event Expo & Exhibition for showcasing best practices in healthcare domain eINDIA 2013 Award for innovation and excellence in healthcare Power Sessions on diagnostics industry, dominance of multi-specialty hospitals, health CIO conclave, health insurance etc. Special sessions on Health India Awards, business models in telemedicine, healthcare policy and exciting healthcare solutions available in India
Healthcare consultants and experts
Award Categories for eIndia Health Summit 2013 •
mHealth Project of the Year
• PPP Initiative of the Year in Healthcare • Civil Society/ Development Agency Initiative of the Year • Health Insurance Initiative of the Year • Hospital Information System Provider of the Year • Innovative use of Technology by a Hospital • Innovative Use of Technology by a Diagnostic Service Provider • Health Management Information System (HMIS) Provider of the Year • Telemedicine project of the year
Components
Conference Host Partners
Awards
Supporting Partner
Expo Organisers
For award nomination, paper submission or participation as a delegate Log on to eINDIA website http://eIndia.eletsonline.com For Registration Details: Aruna, aruna@elets.co.in For Programme Deatils: Sharmila, +91-8860651641, sharmila@elets.in
Department of Public Enterprises Ministry of Heavy Industries and Public Enterprises Government of India
For Sponsorship & Exhibition Details: Sunil Kumar, skumar@elets.in, +91-9910998067
eIndia.eletsonline.com
Cardiology
Angiography Is Gaining
Popularity in Cardiology Dr Anand Gnanaraj, Consultant Interventional Cardiologist, Madras Medical Mission Hospital says that these days heart diseases are more often being treated with angiography, and this is leading to an influx of medical tourists in the country. In conversation with Sharmila Das, ENN more than half of the patients with blocked arteries can be managed with angioplasty. This does not mean that this is a lesser form of treatment. It has been proven that it is as good as surgery and in some cases better. The reasons for growth in cardiology department are 1) Increase in the number of patients having the problem, 2) More affordability to healthcare 3) Better infrastructure in hospitals 4) Better awareness of treatment options 5) Better angioplasty techniques and the technology to back it up.
Who are the forerunners for this growth? How they have contributed to the growth?
Dr Anand Gnanaraj
Report says India is getting good number of medical tourists for heart treatment. What is your opinion on this? What factors are responsible for the growth of Indian cardiology? In fact heart disease numbers are increasing. It is just that they are being treated with angioplasty more instead of bypass surgery. With today’s technology and the scientific evidence,
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Certain people have been at the top positions at the right time doing smart procedures. Famous cardiologists like Dr Mathew Samuel and cardiac surgeons like Dr KM Cherian, Dr Devi Shetty have contributed to the field. I think the growth is more to do with the demand rather than someone promoting it as a commodity.
What factors have contributed to the growth story? Primarily it is the development of skills by the interventional cardiologists, better stents and better angioplasty hardware that has led to the advancement of this field. As we gather more and more evidence about the safety and efficacy of these procedures the growth of angioplasty is going to be tremen-
dous. The numbers of bypass surgery is going to decline more, simply because more and more patients will be effectively managed with angioplasty.
What is the number of medical tourist you get in your hospital for heart problems? The medical tourists we get today are mostly from less developed countries. I think we can consider this industry as growing if we start getting patients from developed countries, since there is a clear cost of advantage. Our hospital is equipped with the state of art technologies that can match any hospital. But I think it’s going to take some time for this to become a phenomenon.
What are the new technologies or modern equipment you have deployed in your cath lab? For starters we have the top end Philips cath lab with all its accessories. We also have the relevant software that can enhance its capabilities. There are some imaging modalities like Intravascular Ultrasound (IVUS) and Optical Coherence Tomography (OCT) that enhances the procedure outcomes that are used extensively in today’s angioplasty practice. The newer technique called Fractional Flow Reserve (FFR) is used to decide if a borderline lesions needs to be addressed or not. These techniques help us to optimise the procedure for the patient and ensure excellent results in the long term.
Cardiology
The Highs and Lows of
Indian Cardiology
Dr S K Parashar, President Elect and Chairman of the SC, Cardiology Society of India, shares his views on the developments that have taken place in Indian cardiology In conversation with Sharmila Das, ENN Why there has been a rise of medical tourist in our country seeking for heart treatments? The medical tourism is currently a booming multimillion dollar industry. In any medical condition the patient desires (a) an excellent professional skill ( b ) minimum waiting period for surgery / intervention (c) comprehensive medical care under one roof (d) excellent post operative care (e) cost -effective treatment (f) state of the art medical institutes and hospitals of international standard. (g) availability of interpreters (h) highlighting the medical facilities available through their respective embassies and medical tourism operators (h) availability of air ambulances. India is an important mainstream option providing solution to all the above needs. The professional skills of our cardiologists and surgeons can be matched with any Western counterpart. Our hospitals are extremely well equipped with all modern diagnostic and therapeutic facilities. Moreover our working system is such that any cross reference and investigations are completed within 24 – 48 hours, so that the waiting period for treatment is significantly reduced. Highest level of post operative care service is provided which includes physical, mental and emotional well being. One of the biggest advantages in our country is significantly reduced cost of all cardiac procedures. Most of the patients come from Middle East countries, but now patients from Western countries are also coming. As there is no separate registry available of foreign patients, hence number cannot be judged.
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Dr S K Parashar So in brief some of the attractions to draw foreign patients are: • Availability of latest medical technologies • Adherence to international quality standards • Reduced costs • No language barrier. Availability of interpreters • Excellent hospitality right from day of admission to discharge • Surgical and intervention results comparable with Western counterparts. • In some hospitals separate wing is reserved for foreign patients and their special dietary needs are catered for
How would you measure the growth of cardiology in India? There have been few important factors in the growth of cardiology. At first one of the main stimulating factors in the growth has been the rising cases of cardiovascular diseases. Moreover,
possibly due to genetic factors, the onset is almost a decade earlier than the Western population. Double and triple vessel coronary disease is more common among Indians. As such there was an increased awareness of this disease. This led to more diagnostic and therapeutic options being explored. Secondly there was an increasing emphasis on training and education of young cardiologists. This was significantly enhanced by interactions with invited international experts who gave practical demonstrations in their field of research. Thirdly the increasing demand and advancements in medical devices and instrumentation played an important role in growth. There has been a massive growth of Echocardiographic industry which greatly helped in earlier diagnosis, prognosis and management of cardiovascular disorders. Last, the mushrooming of high quality hospitals in private sector providing excellent healthcare cardiology services added to this growth.
According to you who are the forerunners of this growth story? One of the earliest cardiologists to have contributed to this growth is Dr S Padmavati who established cardiac services in 1950’s and early 1960. She had a lot of research work on rheumatic heart disease, coronary artery disease and hypertension. The credit of setting the first organised cardiac catheterisation laboratory in 1962 goes to Prof Sujoy B Roy of AIIMS which changed the face of cardiology in India and Delhi in particular. Prof
Raj Tandon and Savitri Shrivastava of AIIMS immensely contributed to the growth of pediatric cardiology which, due to their efforts, is now a recognised major specialty in India. Before the growth of interventional cardiology in India, some surgeons played a stellar role in revolutionising cardiology. Dr Naresh Trehan gets the credit of changing the face of cardiology in Delhi by making an excellent corporate hospital namely Escorts Heart Institute. However he brought world class medical services in India through Medanta Medicity. Dr MR Girnath deserves a special mention by initiating first cardiac surgery centre at Apollo Hospital in Chennai. Dr Ramakant Panda, Dr S Bhattacharya from Mumbai and many others were pioneers in cardiac surgery in India. A big breakthrough was initiation of interventional cardiology i.e. non sur-
gical management of various cardiovascular disorders. Initial leaders in this field have been Dr Ashok Seth and Dr Purshottam Lal from New Delhi who have had maximum experience in this field. Now, of course, there are numerous experienced interventional cardiologists in the country.
What are new areas of development in Indian cardiology? In every field of cardiology and cardiac surgery there has been notable progress in the last few years. In surgery, beating heart surgery, minimally invasive surgery, robotic and total endoscopic coronary bypass surgery, advances in valve repair, aortic surgeries, pediatric congenital cardiac corrective surgery, etc. are some of the advances. There has been significant progress in invasive and non invasive cardiology
which has made tremendous impact. In invasive cardiology, advances in devices, stent technology, mechanical support devices for heart failure, pace maker technology, CRT, ICD, radio frequency ablation, coronary / peripheral angioplasties, valvular and congenital interventions have made a lasting impact. Cardiac MRI, CT and echocardiography have shown progressive innovations and have replaced cardiac catheterisations in large number of cardiac disorders. Hand held echocardiography equipment, almost the size of the palm, had a big diagnostic impact in emergency units. There has been a progressive sophistication in cardiac catheterisation laboratory in the form of high resolution, low radiation, multiple view high frame rate systems, digital enhancing systems, 3-D imaging etc. We have a digital biplane cath lab system.
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Leaders’ Speak
‘We have rapidly
moved ahead’
Dr Ashok Seth has contributed extensively to the growth, development and scientific progress in India and across the world especially in Interventional Cardiology. So far he has performed 50,000 angiograms and 20,000 angioplasties and for that his name has been included in the Limca Book of Records. He shares his experience of building Indian Cardiology with Sharmila Das, ENN
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You have contributed a lot to the growth of Indian cardiology, how has been your journey so far? My journey as interventional cardiology in India spans 25 years and a few more years abroad before I came to India and it’s been very fascinating. Right from the very early times when we were only a handful of people, starting angioplasties in this country we had the belief, the skills and the abilities and luckily we had infrastructure 25 years ago also. Then we revolutionised not just healthcare and cardiac care in this country, but we were able to revolutionise cardiac care practically for the region. I would say the journey has been very fascinating because we were the pioneers for the whole Asia-Pacific region. We put India on the world map. Indians have always been very skilled. It was just a fact and we were already very intelligent. It was only the infrastructure which was missing because it used to be very expensive and available in few Government Hospitals. The private healthcare, should we say the corporatized healthcare, has consolidated in last 10 years. Apollo hospitals being the first followed rapidly by others and that brought revolution in this country with an ability to follow exactly those procedures which were happening abroad, happening in the West but with better skills, better care we were able to revolutionise and it’s been a fascinating journey. As we see, people were going abroad for angioplasties and surgeries at that time, and now 25 years later, I see people from abroad are actually coming for those surgeries and for angioplasties in this country. Cardiac care has been transformed hugely and I have been a witness to the advancements. Now, when I look at how we treat patients today to how we actually did Angioplasty or surgeries say 15 or 20 years ago, those techniques seem to be primitive in comparison to now. Also very fascinating is the fact that while Fortis Escorts Heart
Institute is the premier and the biggest free standing private heart care centre in Asia that has set the standard for Asia Pacific, now cath labs are being opened in cities like Ambala, Bareli, Muradabad, Hissar. All these cities are having cath labs so that patients can have procedures at the door steps and actually have those advancedprocedures which were happening in big cities. To have the procedures done 25 years ago people used to travel to London, New York and they are now being done at Muradabad, Agra, or Jabalpur. That I think is the biggest transition when high-end technology gets transferred to common
Awards, Recognition & Memberships Awarded the
PADMA SHRI by the President of India in 2003 Received recognition in the “Limca Book of Records” for performing 50,000
angiograms and 20,000 angioplasties Honoured by Banaras Hindu University with
Doctorate of Science (Honoris Causa) for his contribution to the field of Cardiology
man at his door steps. This has been a tremendous journey of literally 25 to 30 years in interventional cardiology and in this country where we have started from nothing and have progressed throughout the world.
Yes, reports also say that we are getting lot of medical tourists who come to India to treat their heart problems. What are the specific areas where the Indian cardiology has made its mark? There are two or three key areas. One of them is for heart disease like valve disease, coronary disease, heart attacks, angioplasties, medicated stents, bypass surgeries are far more advanced here. Actually we perform better than many centres in the West because we just not have good technologies but better skills available here. We have the latest devices and stents and we have tremendous nursing care. We actually are able to provide patient care completely. For example, beating heart surgery, which is rarely done abroad, is a very common procedure. Radial Angiographies and angioplasties or for that matter bio absorbable stents, the latest development of stents which dissolves are not available in many countries and we are leaders in that in the whole sphere of cardiology. We are not just providing expertise but providing advanced skills, technologies and patient care entirely. That is the first area of development. The second area is that we are costefficient. Cost-efficiency does not mean cheap, it means providing the best at a cost, which is right for the patient. All our care and services are cost-efficient to the patients and to get same level of services in West you would have to pay enormous amount of money. Thirdly is the fact that we are not just contributed to treating patients, we as leaders, have actually spent time for teaching and training whole of the region. For example, through the years not only have I
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Leaders’ Speak
trained over 350 interventional cardiologists in India alone, but actually, I have trained doctors from Malaysia, Singapore, China, Australia and Indonesia. 15 cardiologists in Bangladesh have been trained by me and that has helped Bangladesh to progress in Angioplasty over the last 15 years. We have doctors from Afghanistan and Iraq as well. We have a spectrum of training programmes through which doctors have come to us for training and gone back and therefore treated all patients there and knew what to give to the patients if advanced treatment is needed. I think, as a country we have not just attracted patients we have passed on expertise and education too.
Dr Ashok Seth
What is the role of technology in the growth of Indian cardiology? What are the advancements happened in our cath labs? Technology is very important because
Every medical college should lower their fee and put a mandate for compulsory medical service for two years in district and sub district hospitals” even a single advancement of science is technology dependant. 25 years ago, in 1988, I did the first angiogram or angioplasty of Escorts Heart Institute. Now when I look back, I realise, when we were doing Angioplasty at that time was crude. Then we had that metallic stents, stainless steel ring-like tubes in 1994. We had cutting devices, drilling devices, laser and nothing was working till these stents came. Then technology progressed to give us medicated or drug eluting stents and we were the first in Asia-Pacific to use medicated stents. In the last five years I have been involved in the development of the bio resorbable stents which goes into the artery, keeps the artery open and then dissolves over two to three years to leave the artery normal. We were personally involved in the large study with all my colleagues in India and this device is approved in India and in many other countries. The fas-
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cinating aspect of this technology has transformed everything to a situation that now we are able to treat blockages with dissolvable stents where the blockage is cleared and there is nothing left in the arteries after a couple of years. We have had major advancements in technologies in safe treatment of heart attacks. We have advancements and treatments of valves that we have started from here. We were one of the first people to replace a valve in a patient without cardiac surgery and without even opening of the heart in 2004. In 2000, if somebody would have asked me that how can a valve be changed without opening heart, I would have not considered it possible without surgery. I would have thought that it’s a fiction but now in an angioplasty like procedure done in our cath labs where we are able to change 85 year old patient’s valve, even when he is conscious. There
have been numerous advancements on the surgery side too. In fact, the surgeons and cardiologists are combining together to perform many complicated procedures in the areas where surgery theatres and the cath labs get together to combine the procedures. So, we have moved rapidly ahead. We are going to be treating high and uncontrollable blood pressures by a simple angioplasty like technique that cures high blood pressure. Again it is technology dependant but it is also mind that works along with technology. Now the biggest challenge of ours is how to make sure these technologies are cost-effective. Technology comes at a cost. New technologies are more expensive as we have seen it in every sphere. We are now even able to view arteries very clearly through little catheters. We are one of the first in Asia-Pacific to start doing OCT imaging of the heart arteries but the point is, these come at a cost. There should be a way so that we can transfer technology to smaller cities at a reasonable cost. Not everybody needs to get a Rolls Royce but if it’s not a Rolls Royce, it needs to be a very depend-
“In the last five years I was more involved in developing the dissolvable diluting stents so that it goes into the body, keeps the artery open and then dissolves over two to three years of blockage
able and durable car. Advancements are very technology driven but, we Indians are Jugaadu and that’s an asset for us. While in the West they only use technology presented to them and believe that technology is what saves patients. But we are able to modify that technology, downgrade it as per our need and apply it where and to which ever patient it is required and we have progressed well on those fronts.
Speaking about interventional cardiology, what are its benefits over other procedures? Interventional cardiology deals with every treatment of heart which is nonoperative. We can close holes in the heart, which 15 years ago were done only through surgery. Today 90percent of them are closed by catheters, little umbrellas which are put across the holes. For example, even procedures of valves like Mitral Stenosis required surgery all the time. Over the last 15 years it was transferred completely to ballooning of the valve and now, 80 percent of the patients are treated by ballooning of the valve. So there is a
huge shift from surgical methods to the minimally invasive methods and angioplasty. Say for example, stents were balloon angioplasty, which is a crude method of just ballooning, then those metal stainless steel stains came which were non- medicated, still have 20 percent of the recurrence and only 20 percent of the patients would do fine. Later we had medicated stems which revolutionised everything in 2002. When you got to that level, the whole lot of patients who are into surgery are now having angioplasty. So in a sense, angioplasty takes care of 75 percent of the patients having heart problems and 25 percent are taken care of by bypass surgery. If it comes to a situation where, for many reasons if one or two arteries get blocked, even if two or three stents are to be put in, patients can afford it. Angioplasty is more expensive and therefore one has to apply both surgery and angioplasty judiciously to look at the patient’s need, what sort of blockages he has, what is his financial status, where does he live so that we can tailor the treatment as per his circumstances. We look at all these aspects.
Healthcare is not reaching rural India, what are your suggestions to improve the scenario? My suggestions about rural India are according to its needs. Rural India probably doesn’t need angioplasties and bypass surgeries. Luckily, rural India is healthier when it comes to these diseases. What affects it most is the infections, hygiene, sanitation, proper diet, nutrition; water, malaria and all such infectious disease are what we need to conquer. Now that is based upon infrastructure, education, and empowerment based. Cleaning hands, having clean water are all hygiene related and I think this whole infrastructure is needed for that. If we elevate health, clear water and hygiene sanitation we take away 80 percent of the disease process that at-
tacks Indian rural areas. Luckily, they have a healthier diet which comes out of agriculture, vegetables are fresh and they already exercise. Now when we look at the next step which is already more important is the intermediate level where people are in the lower middle class and middle class are being affected by disease processes, which actually needs therapy. At district levels we want to strengthen these. We need to strengthen care in district and sub-district levels whereby at least cardiac trained doctors that have an ability to do ECGs, diagnosis disorders are available, and they should be able to refer to a city hospital or regional hospital for further care. A system set up for that is possible. What saddens me is all that money allocated does not always go to downstream. It is truly a coordination and expense issue. Even there is a struggle of having large number of doctors to actually manage and while healthcare programmes are launched, I know that there is no doctor to take care of it. There are machines but there are no doctors for it. We need to increase the number of doctors, set up system whereby those doctors are put into those centres for a couple of years prior to do anything else so that is important. When we are talking about districts hospitals, we are not talking about putting doctors in extreme rural areas? Instead we need to put healthcare workers into these remote areas. Every medical college should lower their fee and put a mandate for compulsory medical service for two years in district and sub district hospitals. It can be done. We propagate private collages with heavy expenses, heavy infrastructure, and heavy fee so the doctor tries to earn back that heavy fee. Make education affordable, put a two year clause and then let the doctor do anything. I think we need to transform but, there has to be a will to transform, way to transform, it has to take all the stakeholders into discussions.
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policy
Peace and Prosperity Through IT “We want to develop IT industry in the state not only for creation of proper e-Governance framework, but also for creation of new jobs for the local youth,� says Feroz Ahmad Khan. In conversation with Anoop Verma, ENN Along with your studies, you were active in many extracurricular activities during your school and college life. Tell us about the period of your life when you were a student.
Feroz Ahmad Khan Minister of State (Independent Charge) Information Technology, Science & Technology; Additional charge of School Education, Medical Education, Youth Services and Sports, Government of Jammu & Kashmir
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While I was a student, I never thought of joining government service or politics. Even after completing my graduation, politics had not been my ambition. However, from the very beginning, I dreamed of working for social causes and providing help to the weaker sections of society, particularly to those who are residing in the Ladakh region, where I belong. I got involved in social activities while I was still in my teens. I was active in student union work and I made some contributions in battling orthodoxy and enriching the life of several individuals. During my college days I volunteered several times to provide assistance to people irrespective of their caste, creed, colour or religion. My college education had filled me with the idea that peaceful co-existence and communal harmony are most important. As spokesperson for the Student Association, I worked for strengthening the relationship between the executive body and student members. I coordinated and organised all kinds of fruitful activities for the students. I used to participate in the inter-state debate com-
petition. I was very much interested in cricket during my college days and several times I was nominated the man of the match. I was an active student, and I also developed an interest for swimming, yoga, volley ball, archery and trekking. I have won many tournaments in traditional archery. Drawing and painting were also of interest to me. I participated in several drawing and painting competitions during my school and college days.
2008, I filed for nomination from the Zanskar Constituency as a National Conference candidate and won the election. I was the MLA till 15th January 2013. After that I was inducted in the council of ministers and given the independent charge of Science and Technology, Information Technology Department, I was also given the independent charge of School Education, Medical Education, Youth Services and Sports.
How did you enter politics? Tell us about your political journey so far.
“In my opinion, the most burning issue for the state is unemployment”
Before entering into active politics, I was working as Project Officer in an International NGO called “Save the Children Fund,” which was active in Kargil district. I worked here for more than Seven Years. I was also associated with few other NGOs that are working for improving the state of education, human rights, rural development and for helping downtrodden people in general. During the course of my work for NGOs, I had to enter into confrontation with many powerful people and departments. While working towords the safeguarding the human rights of the people, I often faced threats from powerful people, but I continued to do my work. I advocated the cause of the people by writing for various papers, journals, magazines and by organising seminars and conferences. In 2001, panchayat elections were held in the state and I was elected unopposed as the sarpanch of the village Silmo in Kargil district. This is how my political career started. I served as sarpanch for close to two years. In 2003, I was elected unopposed as the Councillor for Ladakh Autonomous Hill Development Council. Then in 2008 I became affiliated with the National Conference and was once again elected unopposed for the same post. In October 2008, the assembly elections were declared, and the party high-command asked me to contest. So in December
As an MLA and a Minister in the State Government, what are the main issues that you would like to focus on? In your opinion what are the main problems and challenges that the people of this state are facing? In my opinion, the most burning issue for the state is unemployment. Once we are able to solve the problem of unemployment, the other problems will automatically get solved. The problem is that we have a very small private sector in the state. The youth are totally dependent on the government to get jobs. But there are only limited productive jobs that the government can provide. For tackling the unemployment problem, a large private sector is a must. The government has now started several programmes to help people who want to be self employed or start a small business. In our state, there is big scope in areas like animal husbandry, sheep husbandry and poultry farming. We are trying to promote such avenues for self-employment and small scale industries. IT industry can be a big source for jobs. But as of now we don’t have any major private sector IT players in the state. Now the government is
coming up with incentive schemes to encourage large IT companies to set up their development centres in the state. We are trying to encourage a closer interaction between the large IT companies of the country and the youth in the state, so that our young population becomes acquainted with the developments that are happening in the area of IT. In the times to come, the IT Department in the state will come up with a host of measures to encourage IT industry in the state. Tourism is already a well-developed industry in the state, but it needs to be promoted internationally for better outcomes.
Many states in the country have come up with IT Parks where large and small IT companies can set up their bases in a more convenient manner. Are you planning to develop IT Parks in the state? We are already working for the development of few IT Parks in Srinagar and in other parts of the state. As of now we are not having enough response from the major IT companies, but we are sure that eventually everyone will realise the great potential for IT that Jammu & Kashmir has. The state is now working to develop its IT policy. Once IT Policy is in place, the private sector will find it easier to set up its development centres in the state. Recently I had held discussions with the Commissioner IT about taking the IT Parks to other districts in the state so that everyone is able to equally benefit from the development that takes place.
Being an MLA and a social activist, you get the chance to meet a lot of people in the state. What kind of feedback are you receiving from the people about IT in general? Are the people in the state enthusiastic about IT? Nowadays most people realise the benefits that can be drawn from IT.
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policy
The youth in the state has definitely warmed up to IT. However, the state is yet to develop its own IT policy and that is why the bigger IT companies are unable to set up their bases here. There are hardly any private sector jobs in IT, so the youth is studying other subjects, which they think will lead them to good government jobs. The scenario can change once the private sector in IT gets developed, as it will lead to the creation of many new non-governmental jobs.
Some states are now coming up with policies to distribute free laptops and tablets. Do you think that we should have similar initiatives in Jammu & Kashmir? In my opinion, we should start distributing free laptops and tablets. But such a policy is yet to be drafted. We are also working for taking broadband to all corners of the state. In places like Kargil, which have a difficult terrain, we are trying to connect the schools with Block Headquarters. We have already provided broadband and computers to the schools from our (Constituency Development Fund) CDF. We will be providing free laptops to the students who can’t afford it.
Is the IT Department in the state taking any initiative to ensure that the people in the state have easy access to the best possible trainings in IT? We are keenly focussed on the aspect of training our people in IT. We are encouraging the development of public and private institutions for imparting training to students and other sections of the population. The IT Department is closely monitoring the training of the employees in various government departments. In Srinagar and Jammu we have our institute where recently more than 100 KAS officers got their training in Information Technology. Currently we have sent a
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ESTABLISHMENT OF IT PARKS The Department has identified Land at Ompura, Budgam, Kashmir for establishment of IT-Park. The land is being transferred from the Industries and Commerce Department to Information Technology Department for the purpose. Further, the Department is also pursuing the matter for IT Intrastructure creation under various GoI Schemes like ASIDE and CBIS inSrinagar and Jammu Cities. The Department is expected to enter into an MoU with the Industries and Commerce Department
proposal to the Planning Department for creation of institutions where students can get trained in IT.
What is the situation of e-Governance in the state? What are the ways by which there can be an expansion in the scope of e-Governance? e-Governance will not be able to fully develop in the state until we make IT as a priority sector. We have to have in place a seamless system of connectivity between different government departments in all parts of the state. We will also have to make it easier for people to access the web based facilities from different government departments. For instance, sitting in Secretariat in Jammu or Srinagar, I should be able to interact with district or block level officials in Kargil and in other parts of the state. Once this kind of system has been developed, then we can proudly announce that we are now having e-Governance in Jammu & Kashmir. We need to develop lot of systems before a proper system of eGovernance can become a reality.
What is the situation of connectivity in Ladakh? In Ladakh the connectivity is not good. In few areas there is connectivity through BSNL’s network, but most-
ly Ladakh is not properly connected. Usually this area remains out of contact with the outer world. But we are hopeful that things will improve in near future.
Now the IT Department in the state has started working vigorously for implementation of lot of critical e-Governance systems. The State Data Centre (SDC) is ready. The implementation of the State Wide Area Network (SWAN) is underway. How do you see the developments in e-Governance happening in the times to come? I think that the IT sector is growing at a fairly fast pace. It is a good thing that it is growing like this. We are here to ensure that the growth does not falter due to any reason. The change that will come due to developments in IT and due to e-Governance can lead to huge benefits for the people. The SDC and the SWAN projects will contribute towards bringing the government closer to the people. I see lot of good things happening in the state with e-Governance becoming a reality. With proper deployment of IT, the people in the state will finally be able to enjoy the fruits of peace and prosperity.
Event Report
TiE Delhi-NCR Healthcare SIG
Presents Healthcare Insights Harkesh Dabas, Clinton Health Access Initiative, chairing his table
W
ith the aim of helping budding entrepreneurs to separate hype from reality, reveal strategic blind spots and pre-empt market movements, TiE Delhi-NCR has organised a mentoring group sessions at the Indian Habitat Centre, New Delhi on May 25th, 2013. Breakthrough insights are seldom found in research reports or consulting manuals; they come from a rare combination of hands on experience, intuition and vision. On 25th May, the Healthcare Insight has given an opportunity to connect with established entrepreneurs, investors and consultants in the healthcare space and gain insights through interactive, round table discussions.
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Pradeep Jaisingh, International Oncology, chairing the table The insight conference has five mentors namely: Vikas Kuthiala, Falck Group, Sameer Maheshwari, Healthkart, Harkesh Dabas, Clinton Health Access Initiative, Pradeep K Jaisingh_ CEO, International Oncology, Entrepreneur, Mentor and supporter & Sudhakar Mairpadi, Director-Quality & Regulatory, Philips. Sameer Maheshwari, Managing Director & Co-founder, HealthKart.com says, “We have been associated with TiE for years now and keep attending their events. So I think the power of the event is that it is a small group event where you can come and interact with the complete ecosystem of entrepreneurship that includes entrepreneurs, investors etc. People can very informally share ideas here in this platform. It’s a great event to get to know the trends and the industry and also share experiences”. Sudhakar Mairpadi, Director-Quality & Regulatory at Philips Electronics India Limited (Health Care sector) says, “First of all, this type of conference gives complete clarity on what is the regulation available in the country to start a venture. The group of excellence here can connect with people and thereby can reduce the unnecessary time and money one needs to invest in getting things done. They will get clarity on to do and not to do things. I feel this is a very good initiative and we should take it further in making and bringing the industry people, bring the hospital people, service providers under one roof. It’s a continuous process”.
ZOOM IN
Bridging Demand Supply Mismatch g
By KN Bhagat, Managing Trustee, OTTET
G
ood health is a state of complete wellbeing, which can be experienced when man becomes aware of that knowledge, which enable him to view himself as an integrated whole. Holistic healthcare has an important role to play in the maintenance of health, prevention and control of diseases and healing, even in most critical conditions. Providing healthcare services to all is the constitutional obligation. Community healthcare is seriously impaired not only in remote areas of the country, but also in urban due to absence of adequate number of doctors, health institutions & infrastructure. To show a way out, and to present a model, OTTET’s Telemedicine programmes have certain clear message. Technological advances are being utilised by OTTET Telemedicine not only in patient care but also in physician education and training. OTTET Telemedicine Network is a network of tele consulting and tele-education. The clinical component currently includes tele consulting for preliminary diagnosis, presurgical investigation and postsurgical follow-up, scheduling K N BHAGAT
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appointments for hospital visits, expert opinion, and patient counseling. The educational component involves participation in Continuing Medical Education (CME), training of students (physicians in residency training), and exchange of state-ofthe-art practices and expertise between participating institutions. This tele-health initiative would facilitate support for rural health initiatives by increasing access of rural population to ideal healthcare at their door steps. OTTET with the support of government of Odisha has successfully been implementing telemedicine project throughout the state to bridge the gap of demand supply mismatch, Doctor wise & facility wise. In order to give access to healthcare at the doorsteps to population living in far flung areas of 51,000 villages of Odisha using ICT platform, the Department of Health, Government of Odisha has taken initiative with OTTET, Bhubaneswar to implement the project in Public Private Partnership mode without any capital investment by the government. Pioneer institutes like AIIMS, SGPGIMS and super specialty hospitals of national and international repute like Narayana Hrudayalaya Group of Hospitals, Apollo Group of Hospitals, Global Hospitals Group, Asian Institute of Gastroenterology, etc have been connected with this network and poor patients of inaccessible areas are able to be diagnosed by eminent physicians through tele-
consultation. All Medical Colleges, DHHs, SDHs, AHs, CHCs, PHCs & Sub-Centers will be part of this Network. Besides nodes will be installed at each OPD and in selected village. Well equipped diagnostic facilities and innovative, easy-to-use and highly reliable biomedical devices available are installed at each node. Computer System equipped with multimedia components to undertake audio-video consultations. To act as a support system in the existing healthcare delivery system. To act as a cost-effective and efficient healthcare service system and ensuring accountability for every single patient. Treatment history of patients saved electronically in Patient Health Record (PHR). Vital parameters are measured with full autonomy, record in the personal clinical file of the patient and these medical data can be consulted by OTTET Telemedicine Programme Operative, and upon patient authorisation, by OTTET’s empanelled doctors, specialists & super specialists remotely. It helps the patients to avail the following healthcare services: Teleconsultation for preliminary diagnosis, pre surgical Investigation, post surgical follow-ups, scheduling appointments for hospital visits, expert opinion, patient counseling. This saves time & money of all patients with more benefits for the poor villagers.
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