Ehealth june 2016

Asia’s first Monthly Magazine on the enterprise of healthcare Volume 11

Issue 06

June 2016

EDITOR-IN-CHIEF: Dr Ravi Gupta EDITORIAL TEAM - DELHI/NCR Senior Assistant Editor: Nirmal Anshu Ranjan Assistant Editor: Souvik Goswami, Gautam Debroy Senior Correspondent: Vishwas Dass, Arpit Gupta, Manish Arora BANGALORE BUREAU T Radha Krishna - Associate Editor JAIPUR BUREAU Kartik Sharma - Assistant Editor CHANDIGARH BUREAU Priya Yadav - Assistant Editor HYDERABAD Sudheer Goutham B - Senior Correspondent MUMBAI BUREAU Poulami Chakraborty - Correspondent SALES & MARKETING TEAM: eHealth Product Head: Fahim Haq Mobile: +91-8860651632 Senior Executive: Priyanka Singh Mobile: +91-8860651631 SUBSCRIPTION & CIRCULATION TEAM Manager Subscriptions: +91-8860635832; subscription@elets.in DESIGN TEAM Creative Head: Pramod Gupta, Anjan Dey Deputy Art Director: Om Prakash Thakur, Gopal Thakur, Shyam Kishore EveNt Team Manager: Gagandeep Kapani ADMINISTRATION Head Administration: Archana Jaiswal EDITORIAL & MARKETING CORRESPONDENCE

eHealth – Elets Technomedia Pvt Ltd: Stellar IT Park Office No: 7A/7B, 5th Floor, Annexe Building, C-25, Sector-62, Noida, Uttar Pradesh - 201301, Phone: +91-120-4812600, Fax: +91-120-4812660, Email: info@elets.in eHealth is published by Elets Technomedia Pvt Ltd in technical collaboration with the Centre for Science, Development and Media Studies (CSDMS).

Your pitch to Healthcare leaders goes here...

Visit ehealth.eletsonline.com

Owner, Publisher, Printer - Dr Ravi Gupta, Printed at Vinayak Print Media, D - 249, Sector-63, Noida 201 307. UP and published from 710, Vasto Mahagun Manor, F-30 Sector-50, Noida, Up

Editor in Chief: Dr Ravi Gupta

All rights reserved, No part of this publication may be reproduced or transmitted in any form or by any means, electronic and mechanical, including photocopy, or any information storage or retrieval system, without publisher’s permission.

ehealth.eletsonline.com egov.eletsonline.com digitallearning.eletsonline.com events.eletsonline.com bfsi.eletsonline.com smartcity.eletsonline.com Write in your reactions to news, interviews, features and articles. You can either comment on the individual webpage of a story, or drop us a mail at: editorial@elets.in

4

June / 2016 ehealth.eletsonline.com

Contents

JUNE 2016 | VOLUME - 11 | ISSUE - 06

10 Cardiology - Cover Story

Miles Covered,

Miles to be Covered Transformation of Non-Standard Procedures into Standard Practices Possible Via Structural Changes, Strategic Partnerships & CostEffective Innovations

14 Cardiology - Special Interview

Blend in Medical Expertise and Technology to Build Up‘Quality Care’ The government should be encouraged to create manufacturing and research ecosystems to give the best advantages to those interested.

38 Medical Tourism – Special Feature

Mere Vision or

Mission in Action?

Strengthen ‘Brand India ‘by Wrestling Away Self-Promoting Agencies

6

JUNE / 2016 ehealth.eletsonline.com

TECHNOLOGY AT THE HEART OF YOUR LABORATORY The most versatile range of clinical chemistry analysers in their class, the RX series combines robust hardware and intuitive software with the RX series dedicated test menu putting innovation, ease-of-use, and superior technology at the heart of your laboratory.

Tel: +91 80 2802 5000

A global market leader in the in vitro diagnostics industry for over 30 years

therxseries@randox.com therxseries.com

36

18 Cardiology – In Spotlight

Emerging Leader

Make Health Budget 5% of Annual GDP to Ensure Universal Care With India facing a heart disease epidemic and soon to acquire the title of the ‘Heart Disease Capital of the World’, there is an urgent need of a ‘National Cardiovascular Control’ programme

Complete Healthcare from the Comfort of One’s Home Hari Thalapalli CEO CallHealth

Medical Devices

54

56

Padma Shri Awardee Dr K K Aggarwal

Jibu Mathew Business Development Head - Life and Health Sciences, South Asia, UL

K Chandrasekhar Founder & CEO Forus Health Pvt Ltd

59

Corporate

62

46

Partha Dey Healthcare Leader IBM India/SA

48

50

Himanshu Baid Managing Director Poly Medicure Ltd

Gurmit Singh Chugh Managing Director Translumina Therapeutics

News

64 Government News 65 Company News Hiranjith G H Director, Corporate Planning and Marketing & Communications, MedGenome

8

JUNE / 2016 ehealth.eletsonline.com

Amol Naikawadi Joint Managing Director Indus Health Plus

Start-up

66

Lyfboat: Enabling Educated DecisionMaking Through One-Stop Experience

editorial

Technology Only a Means, Not the End – After All Mirroring the values & strategies of healthcare stakeholders, eHEALTH adorns the role of a ‘one-stop solution provider’ in this cardiology-special June issue.

Interestingly, the June issue of eHEALTH is nothing less than a platter full of thought-provoking insights & observations straight from the ‘thought leaders’ of till now isolated but steadily converging verticals of cardiology, medical tourism & medical device.

In this issue, we talk candidly not just about ‘flagship products’ but also ‘flagship ideas’ defining or about to define the course of action in Indian healthcare.

Here, the ‘gatekeepers of Indian healthcare’ discuss the latest trends, first-of-its-kind advancements & observations that can guide our policy-makers.

Well, I won’t hesitate to call this issue a ‘virtual symposium’, which makes one thumb through the magazine again and again, with new insights holding the attention of the reader every time. The reiteration of the role of technology as an absolutely necessary means, but definitely not the end becomes our key takeaway from this issue.

Away from bombastic and tall claims that fail to stand in the long run, leaders underline the USP of ‘partnerships’ and other practically engaging and fruitful solutions. There seems to be the ascent of ‘true innovation’ with ‘clear vision’ and ‘adequate understanding of responsibility towards ensuring larger benefits to a large number of people’.

We at eHEALTH feel extremely proud, like any watchdog, to witness such clear comprehension of problems in a country like India. We are excited about the well-researched strategies and approaches of doctors, start-ups, medical device manufacturers, etc. and their spirit to call spade a spade to ensure real changes spread their wings and unnecessary baggages of the past are done away with.

Like always, we look forward to more! Come and join us in this funfilled and adventurous journey of ‘yeh dil mange more’!

Dr Ravi Gupta ravi.gupta@elets.in

June / 2016 ehealth.eletsonline.com

9

Cardiology Cover Story

Transformation of Non-Standard Procedures into Standard Practices via Structural Changes, Partnerships & Cost-Effective Innovations

W

hen it comes to matters of ‘heart’, we all tend to undoubtedly become weak. In past, the mere mention of heart-related diseases subtly dropped a hint about an ‘inescapable death warrant’ lingering in the corner or ‘a message from the God’ capable of turning any person into nothing but a bundle of nerves’.

Unimaginably complicated procedures and exorbitant treatment costs made ‘cardiac diseases’ a horse of completely another colour. When we started working upon ‘cardiology, we aimed at ‘engaging’ ‘thought leaders’ to connect the missing dots to define till now largely unintelligible field of cardiology.

We bring together the renowned experts to reveal new dimensions and affirm or denounce “common observations’.

While many highlighted their concern over the emerging status of India as the ‘heart disease capital of the world’, the leaders talk more than what is visible to assist decision makers in understanding the key problem areas.

Cardiac diseases is definitely more

10

June / 2016 ehealth.eletsonline.com

than lifestyle disorder and rich man’s diseases, with 14 million heart patients in urban areas and 16 million in rural areas.

Nothing is more exciting than to hear the thought leaders of cardiology voicing in unison their support to creating an ecosystem for narrowing down the knowledge sharing gaps between medical device manufacturers, clinicians and medical experts. With so much clarity like never before, they even candidly share the strategies to be built in the system and to be adopted by each individual to reform Indian healthcare. Though pretty impressed with the start-ups, they leave no stone unturned in throwing light over hiccups still standing like roadblocks in the path of innovation. Rapid innovation in software-driven platforms, as highlighted by one and all, will definitely go a long way in ensuring ‘preventive care’, but dearth of innovations in hardware needed in super-specialised treatment becomes a key limiting factor.

M-health and e-health platforms will play a crucial role of preventing

cardiac disorders, but the lack of system-oriented support to indigenous manufacturing of high-end technologies that can enable cost-effective solutions remains a spoilsport in ensuring universal healthcare. With the cost involved, these technologies are able to target just 20 to 30 per cent of people.

With the occurrence of need-based structural changes, though quite delayed, leaders pin their hope on startups and policymakers who have shown support to structural changes required to build up a nation ready to meet the challenges of cardiac diseases.

We raised the following questions before the stakeholders to understand the key challenges of cardiology: • Do you think cardiac diseases are more than lifestyle disorders or a rich man’s disease? Please provide details.

• With the simplification of technologies, prevention of cardiac diseases is within reach. Have we seen any decrease in the number of cardiac diseases?

Here we present some of the excerpts:

Cardiology Cover Story

Dr Ajit Desai

Consultant Cardiologist, Jaslok Hospital & Research Centre • Cardiac diseases are more than lifestyle disorders. They depend on hereditary/genetic factors, age, sex, exercise status, smoking, diabetes, hypertension, obesity, stress factor, tobacco chewing and lipid metabolism of body. Lifestyle modifications can take care of smoking, stress, diet and tobacco chewing, but cannot modify the other factors. It is no longer be a rich man’s disease, particularly in India and other developing countries.

• There is no decrease in the number of cardiac diseases with the simplification of technologies.

Technological advances have made changes in the treatment of cardiac diseases, but not in the incidence of those diseases.

Although with better treatment and medications, we have reduced the morbidity and mortality of cardiac diseases.

Dr Subrata Lahiri

Senior Consultant Cardiologist, Delhi Heart and Lung Institute, New Delhi

• India is slowly moving towards becoming the heart disease capital of the world. While there are people who suffer from congenital heart defects, a condition due to lifestyle choices, majority of the population in our country suffers from acquired heart diseases due to unhealthy lifestyle. While heart disease can affect anyone, irrespective of age, gender or socioeconomic status, its incidence seems to be increasing among those between the age of 25 to 50.

• Despite path-breaking advancements, the disease incidence continues to grow. With a 9.2 per cent annual growth rate, the incidence of cardiac diseases has been increasing the fastest in comparison to all other chronic illnesses.

There is an urgent need to reverse this trend and focus on disease prevention, management and treatment together.

Dr M Lawrance Jesuraj

Consultant Cardiologist & Electrophysiologist, KMCH Heart Institute, Kovai Medical Center and Hospitals, Coimbatore • We cannot totally attribute all cardiac diseases as lifestyle disorders, but particularly ischaemic heart disease or block in blood vessels of the heart has significant relation with lifestyle, food habits and lack of exercise.

• Although technical advances made in the field of cardiology have improved success in managing heart disease patients, we are seeing an increasing trend in the incidence of these diseases due to stressful lifestyle, food habits, etc.

Dr Sourendra Sankar Das

Head of Critical Care & Cardiology, Mercy Hospital, Kolkata • If we go through the following risk factors for heart disease, such as hypertension, diabetes, dyslipidemia, alcohol, tobacco and positive family history, then it can be said that it is partly a lifestyle disease and certainly not only a rich man’s disease. Hypertension & diabetes have strong genetic predisposition along with lifestyle, and these can manifest in people of all socioeconomic strata. Dyslipidemia definitely has got relation with eating habits and also the amount of exercise/work out someone is doing. People with sedentary lifestyle are at more risk of developing dyslipidemia, which in turn can cause heart disease (ischaemic heart disease (IHD)/myocardial infarction (MI)). People hailing from lower socioeconomic or middle class are observed to be active and also their dietary habits are controlled.

Hence, the problem prevails more in the higher income group. Whereas consumption of alcohol and tobacco are prevalent in all socioeconomic groups and in the recent times, especially youngsters have developed a greater affinity towards this habit. So, the lifestyle is definitely a prime cause of cardiovascular disorders, and it is more risky if there is positive family history, such as parents suffering from such diseases or any other disorders like diabetes. In today’s fast-paced living, stress is a major factor which gives rise to common diseases, such as hypertension and diabetes. This trend also shows a steady rising graph of cardiac deaths, and it is witnessed that major deaths are happening due to non-communicable diseases (NCDs). So, it can be concluded that cardiac disease is more of a lifestyle disease than a rich man’s disease.

• I agree that simplification of technology has happened and a number of awareness programmes has been undertaken by various medical and social organisation, but it is yet to reach all the spheres of every community. Social awareness is still inadequate and needs more emphasis rather than interactions in the practice of cardiology. If proper precautions are not taken on time, then the situation will become more serious due to various socioeconomic issues. The alarming fact is that the young generation is affected the most and their health might be at a high risk. Youngsters are constantly working and hardly get time to exercise and follow proper diet. As a result, they easily contract hypertension. Diabetes is found commonly among youths in their 20s and 30s. A sedentary lifestyle only exacerbates the situation.

12

June / 2016 ehealth.eletsonline.com

Cover Story Cardiology

Dr Shrikant Parikh CEO & Director, A3 Remote Monitoring Technologies Pvt Ltd • ​Life expectancy is steadily rising, so is the incidence to cardiovascular disease (CVD). The incidence in case of CVD is rising at an ever accelerated rate in India. More people for more years of their lives need to be monitored for being inflicted with CVD. This is a serious burden on the medical infrastructure. In parallel, the healthcare costs in hospital and before and after hospitalisation - are steadily rising. It is consuming a greater percentage of global gross domestic product (GDP). This is reaching an unsustainable level. The combination of these two trends - each exacerbating the other - will lead to an unworkable and unsustainable situation, where the medical infrastructure may reach a breaking point. It is accepted that the clever use of technology, especially where the technology takes medical care in some forms right to the patient is the “way to go”. This can improve the effectiveness and efficiency of the existing infrastructure by a magnitude without any significant increase in infrastructure. A3 Remote Monitoring Technologies is precisely focused on this set of “remote medical technologies”, especially those that have a direct life-saving potential.A3 Remote Monitoring Technologies has developed a comprehensive set of technologies, power of which is amply proven by hundreds of lives it has managed to save (and counting!).

• ​Our technologies enable a cardiologist to remotely monitor at a “multiple levels of synchronicity”. Also, a local paramedic gets some instant indication of certain critical hearth conditions. The cardiologist, straight from his or her smartphone can manage cardiac emergencies anywhere in the world to a large extent, in a high speed, high precision and low turnaround manner. There are multiple live remote “monitoring and managing” technologies whereby the doctor is equipped and empowered to save a life in certain situations. Importantly, these technologies are designed for the tough Indian conditions. There are more technologies in pipeline and being tested. Our technologies enable a golden hour intervention by a cardiologist in a comprehensive manner.

Dr SK Agarwal Senior Interventional Cardiologist, Kailash Hospital and Heart Institute, Noida • Heart diseases may be present since birth or may be acquired during the course of one’s life. Innovations in cardiac treatment have reduced mortality rates in those with congenital/rheumatic or valvular heart disease, and conditions with limited or no lifestyle links. However, unhealthy lifestyle choices made by people in the 21st century continue to inch India closer to the title of the ‘heart disease capital of the world’. There has been a drastic increase in the incidence of coronary heart disease in our country over the past decade due to poor lifestyle. All these over time trigger conditions, such as hypertension, dyslipidemia and obesity, which are the direct causes of atherosclerosis or narrowing and/or blockage of the blood vessels that supply the heart. Atherosclerosis is one of the most common forms of heart disease and the leading cause of heart attacks and angina. Heart disease can happen to anyone, rich or poor, women and men. The recent studies reveal that out of the 30 million heart patients in India, 14 million reside in urban areas and 16 million in rural areas. Stress levels are high amongst the entire population at large and are not restricted to a particular geography. India is thus in need of a comprehensive strategy aimed at reducing it’s heart disease burden. This is only possible through a national-level programme based on a public-private partnership aimed at disease prevention, management and treatment. Living a healthy lifestyle is our best defence against heart disease. Lifestyle changes, I believe, are as simple as ABC; A- Avoid tobacco, B- Become more active and C- Choose nutritious food options. These can surely go a long way in preventing this life-threatening disease.

• Various efforts that have been made by organisations and bodies towards raising awareness about the increasing incidence of heart disease; however, there has been limited impact and we still have a long way to go. What we are in need of is a sustained national-level campaign. Stress levels are on an all time high and we are living in an age characterised by westernisation and urbanisation. People are more competitive and career oriented as ever before, making them ignore their health from an early age. Heart disease is now striking people as early as in their 20s, which is a factor of great worry for the medical fraternity. Technological development brings with it a massive scope of raising large-scale awareness about the implications of making unhealthy lifestyle choices in the long run and the need for the reversal of heart disease. Therefore, it is important that we make the most of it. The new developments in cardiac intervention have also made it possible for those with an existing heart disease to live longer and lead better quality of life. Statistics indicate that more than 200,000 open-heart surgeries are performed every year in our country, indicating an annual increase of 25 to 30 per cent in cardiac interventions. Better treatment options coupled with the right kind of preventive awareness programmes can go a long way in decreasing the disease incidence and increasing one’s lifespan.

June / 2016 ehealth.eletsonline.com

13

Cardiology Special Interview

Blend in Medical Expertise and Technology to Build Up ‘Quality Care’ The government should be encouraged to create manufacturing and research ecosystems to give the best advantages to those interested, shares Dr Ashok Seth, Chairman of Fortis Escorts Heart Institute, New Delhi and Head, Cardiology Council of Fortis Group of Hospitals in an exclusive interview with Kusum Kumari and Jaya Lakshmi of Elets News Network (ENN) Sir, with your wide experience as a super specialist, you have witnessed all kind of advancements. So, now that we are in the stage where gene therapy and robotic surgery are coming to India, what are your observations?

In the last 30 to 40 years, the science and technology advancements, especially in the medical field and more so in the cardiology field, have been massive. Science and technology has progressed like never before in the last 2,000 centuries, as in the 20th century.

Medical science has grown in the last 50 years. In brief, we have transformed ‘care’ in the last 30 years, offering ‘more treatment of disorders’; however, we have, of course, n o t

14

June / 2016 ehealth.eletsonline.com

found ‘cure for disorders, rather have found only palliations’. Overall, we have succeeded in ensuring ‘longer lives’.

However, we still have not found how to absolutely say that I have treated you and you will never have coronary heart disease or develop blockage again.

In another 1,000 years, we might conquer many of these challenges; in this century for certain we are not going to conquer many diseases, but only have better therapies. As such, ‘treatment’ has improved significantly, such as minimally invasive surgery, and we now have loads of equipment, which is phenomenal.

In the last 15 years, I have been the core part of numerous pioneering technologies, such as replacement of valve of the heart without cutting the heart open through catheters, which was for the first time ever done in Fortis Escorts Heart Institute in the world in 2014. It subsequently became an established procedure worldwide, with 150,000 implants conducted so far. Therefore, things that were unimaginable in 2000 have now become the standard care practice in 2016. The time span of innovation is reducing because people know that innovation actually helps to save lives. However, medical expertise still cannot be replaced, which is the vital

Cardiology Special Interview

aspect. Therefore, clinical acumen, compassion, ethics, expertise and focus of the medical profession combined with any of these advancements of technologies is what delivers the best for the patients. As such, technology will assist in improving the results, make procedures less painful (less of cuts, rapid recovery and more minimally invasive) and ensure costeffective quality care.

Quality care by the way relates to providing very cost-effective healthcare and not necessary high technology.

Gene therapy, which changes chromosomes and therefore transforms the disease process can have a great impact, but the cost involved is huge.

Any therapy besides being useful should also be cost-effective.

What are your key concerns and recommendations for the Indian healthcare?

The opportunities in India are phenomenal, as obviously we have got 1.2 billion people to treat. We cannot have innovations for the few who are rich and can pay for it. Every time a new technology comes to me or I pioneer a new technology which costs twice, supposing it’s a new stent, such as I was integral part of the creation and putting into research and practice of dissolvable stents, and my biggest concern was that if it is going to be available only to few rich people at the twice the cost of a normal stent, then I don’t think I have done justice to

healthcare, because at the end of the day it is only valuable if it is transferred down, not necessarily to all the people but at least to a significant portion of the people at a highly subsidised cost.

Therefore, everything which we have to think of in terms of healthcare has to be cost-effective. This is the reason I love the idea of start-ups. For me, the value of a start-up is that its offerings should be applicable and capable of altering the life of a large number of people.

My biggest problem is that we still have not built up ways to promote innovation in terms of funding. Research and science should start in the medical colleges. Our medical colleges have no curriculum about research and science.

That’s sad because minds should start working around healthcare delivery in an appropriate manner through innovation right from the beginning. It needs to be in-built in the system and encouraged. This will make people think much ahead. We should have more of innovation centres. It’s only in the last 5 years that we have seen innovation incubators. More number of people should be able to access these incubators. Innovation should become the agenda of the country and a habit. Youngsters should create and innovate not just for the sake of livelihood and financial rewards, but for the sake of ensuring benefits to a large number of people.

We see a lot of start-ups offering software-driven Internet platforms, as they overcome technical

Key Takeaways • Science and technology progressed like never before in the 20th century • Reduction in the time span of innovation • Medical expertise is irreplaceable • Technology to assist in improving results and making less-painful procedures • Ensure ‘cost-effective quality care’ • Innovation need to be the agenda of the country and a habit

16

June / 2016 ehealth.eletsonline.com

manufacturing issues.

However, innovations in hardware are less. But, remember it’s the hardware also that treat heart disease; therefore, it needs to be researched, created, developed and finally got to be implemented. A lot of hardware is required when we go for super specialised care, but when we go for preventive and commentary care a lot of m-health and e-health platforms are required.

Please throw light on the procedures initiated by you that have been institutionalised in the medical fraternity.

Two of the most recent procedures that I was talking about include percutaneous valve change through non-surgical route and the first implant ever done in the world was at Fortis Escorts Heart Institute, which we are doing so regularly. It’s the innovation which was of course started by a French surgeon, but the first implant was done by us. As they come at a cost, the growth of percutaneous valve replacement though needed by many people has not been at the same extent as in the developed countries where it has become standard procedures.

Same thing goes for the dissolvable stents, which has been the fourth revolution of angioplasty that goes beyond the medicated stents which we used to talk about. I have been integral part of the development of dissolvable for the last 8 years for research and science, trials and approvals in India.

I have helped numerous countries to learn it. I have written on it and in fact I was in the Food and Drug Administration (FDA) panel for its approval in the United States (US), where my experience was sought of, which has been never done by any Indian before. With the cost involved, these technologies are able to target just 20 to 30 per cent of people. Many of these technologies and advancements in science once approved are coming at a higher cost commercially, as the final cost does not take into account not the

Special Interview Cardiology

manufacturing cost but the amount spent on development, research science and trials. We need to promote the development of science, technology and research in India, only then we can hope to deliver solutions to the public at a lower cost. One such example in the context of India is the dissolvable stent, as currently I am researching on the Indian dissolvable stent, which is unique as there’s just one approved dissolvable stent across the world by an American multinational company which is good and bought up, and the another dissolvable stent that has seen the light of the day is made by an Indian company. Interestingly, we have finished the study and investigations, and we are now conducting follow-ups.

By the end of this year, we will have the results of follow-ups, and if the results are great, then hopefully we will have the second stent by an Indian company, which would be half the cost with indigenous technology. That’s the way we need to move forward.

The government should be encouraged to create manufacturing and research ecosystems to give the best advantages to those interested.

Luckily, things are improving in the last one and a half years, with Innovation Council and Industrial Council being set up. However, I still say that better may not be good enough, as we need to create single window clearance, an entrepreneur council, etc.

Sir, how do you rate our pace of innovation at the global level?

Our pace of software innovation is very high, but our pace of hardware innovation is poor. With regard to hardware, new innovation centres have come up by companies, such as GE, Philips, Tata, etc. They are looking into the potential of the Indian companies manufacturing stents and devices and other platforms. One of the innovations that we have come up using all these electronic and digital innovations is setting up electronic intensive care units (e-ICUs), which

Key Roadblocks • No built-in systems to promote innovation in terms of funding • No curriculum about research and science in medical colleges • Limited access to incubators • Creation and innovation should not be just for the sake of livelihood and financial rewards • Our pace of software innovation is very high, but our pace of hardware innovation is poor • No clear strategy & definition of ‘partnerships’ between different verticals • Indian approval system not robust enough in approving medical devices aim at delivering quality care using low-cost innovations. It ensures real time monitoring of critical care patients in faraway areas and hospitals, despite an absolute dearth of good critical care specialists. We have developed this platform along with GE and of course now with other vendors have worked according to it 3 years ago, we are now conducting real time monitoring of 400 beds from this site across numerous cities to right up to Bangladesh. We monitor their critical care units and vitals of each and every patient. We are able to advise and discuss vitals of each patient with nurses twice a day; we have saved lives and we have transformed antibiotics’ usage, which is a stumbling block across the world. We want this model to grow and it costs only $120,000 dollar to establish, but to a centre it costs less than $8, no more than Rs 500 per day per bed as an expense to have a patient. The other way it changes things that the patient does not need to be transported to bigger cities with relatives. It’s so defining for the moment that if this platform is being expanded to 500 beds and has been rewarded and written extensively. We have done it at the 1/8th cost of what GE would have been in the United States. We did it as part of healthcare

delivery with GE and Philips.

In the next 5 to 10 years, do you see a strong ecosystem emerging of med tech industries and medical experts for creating a single platform with all advanced technologies for customers and medical experts?

I do see that because that’s how it worked in the west. The west runs on that. Every technology that has come out has come out through partnerships between the medical device industries, clinicians and scientists. It has to be partnerships fueled all the time by the government.

Without such partnerships, no innovation will take place. Academic centres and government agencies should encourage such partnerships.

We can no longer afford to have these verticals functioning in an isolated manner. There should be collaboration among these verticals to ensure knowledge sharing, work efficiency, etc. This enables identification of the key areas. We need to have a team of brains in any part of the technology and delivery. However, this team should have an encouraging ecosystem. Unfortunately, the Indian approval system is not so robust in approving medical devices.

June / 2016 ehealth.eletsonline.com

17

Cardiology In Spotlight

Make Health Budget 5% of Annual GDP to Ensure Universal Care With India facing a heart disease epidemic and soon to acquire the title of the ‘Heart Disease Capital of the World’, there is an urgent need of a ‘National Cardiovascular Control’ programme, shares Padma Shri Awardee Dr K K Aggarwal, Hon’ble Secretary General, Indian Medical Association and President, Heart Care Foundation of India with Elets News Network (ENN) Sir, it’s quite interesting to see your involvement with different platforms and stakeholders of Indian healthcare. In the light of this, do you think enough measures and communication campaigns are being undertaken to address the growing demand of cardiac diseases.

The medical fraternity faces several issues and threats in today’s day and age and is often misunderstood. My role as the Honorary Secretary General of the Indian Medical Association, which is the largest representative organisation of doctors of modern scientific medicine, has b e e n

18

June / 2016 ehealth.eletsonline.com

to ensure that the voice of Indian doctors is heard both within the country and outside. We have been fighting tirelessly to safeguard the interests of the doctors with respect to the increasing incidence of violence against them, misrepresentation, especially in the National Council of Educational Research and Training (NCERT) books as being corrupt, inclusion in the consumer protection act and the unjust rules of the PreConception and Pre-Natal Diagnostic Techniques (PCPNDT) Act. As the president of Heart Care Foundation of India, a nongovernment organisation (NGO) I founded in 1987 with the sole aim of working towards a healthier India, I have been working towards the cause of preventive health and helping those who are in need of medical intervention, but are unable to afford treatment. A few activities, which are running successfully today, include: • Perfect Health Mela: A preventive health fair that has been taking place in the national capital for over 21 years in collaboration with the Government of India. The five-day event sees participation of over 5,000 school and college students, 4,000 nurses and medical students and is visited by 1 to 2 lakh people on a year-on-year basis. All competitions, activities

In Spotlight Cardiology

Sir, the average age of a person suffering with heart diseases has come down drastically and the rate of coronary heart disease in the Indian community is almost twice as high as their western counterpoints. What will be your recommendations for our youngsters to tackle this problem?

Indians are 17 times more prone to suffering from heart attacks than their western counterparts. I have developed an easy-to-learn formula of 80 to live up till the age of 80 without a heart attack: Dr KK formula of 80 for living up to 80 without a heart attack • Women must keep their abdominal circumference lower than 80 cm and men 90 cm • Keep your fasting sugar lower than 80 mg% • Keep your blood pressure lower than 80 mm Hg • Keep your heart rate lower than 80 per minute • Keep your bad low-density lipoprotein (LDL) cholesterol lower than 80 mg% • Do not consume more than 80 grams of caloric solid or liquid food at once • Observe a carbohydrate fast 80 days a year • Do not consume alcohol and if you do, restrict it to not more than 80 ml in a day or 80 grams in a week • Do not consume more than 80 ml of alcohol in less than 80 minutes • Restrict your soft drink consumption to 80 ml in one go.

The tip is to add soda and dilute it to make it 200 ml • Do not consume more than 80 eggs in a month • Consume at least 80 fruits and vegetables servings in a week • Do not consume tobacco otherwise you will end up with a surgery bill of Rs 80,000 • Do not consume more than 80 ml/gram of ghee, oil and butter in a week • People at high risk should consult

and events at the Perfect Health Mela are centred around health themes.

• Hands-Only Cardiopulmonary Resuscitation (CPR) 10 Training Campaign: In the past two years,

their doctor and consume 80 mg of aspirin for prevention of cardiac disease • People at high risk should consult their doctor and consume 80 mg of statins for prevention of cardiac disease • Ensure to sit out in the sun for at least 80 days in a year to fulfil the body’s requirement of vitamin D • Walk for 80 minutes in a day • Brisk walk for 80 minutes in a week • Brisk walking is defined as taking a minimum of 80 steps in a minute • Walk for 80 steps after every 80 minutes • Reach 80 per cent of your target heart rate when doing heartconditioning exercises • Do aerobic exercises for 80 minutes a week • Do stretching exercises for 80 minutes in a week • Keep noise pollution less than 80 db • Avoid areas where the particulate matter (PM) 2.5 and PM 10 levels are higher than 80 • Do not use your mobile phone for more than 80 minutes in a day • Whenever you clap, clap 80 times • Do yoga for 80 minutes in a week • Do 80 cycles of pranayama in a day • Spend 80 minutes in a week close to nature • Practice 80 minutes of non-violent communication every Monday • Call 80 people and practice

we have trained over 1.5 lakh people on the essential life-saving technique of hands-only CPR 10 for revival after sudden cardiac arrest. We also hold three Limca Book of World Records in this

80 seconds of free writing every Tuesday • Distribute non-materialistic gifts to 80 people every Wednesday • Think differently on 80 occasions every Thursday • Spend time in the natural environment for 80 minutes every Friday • Help 80 people every Saturday • Wash your hands fora minimum of 80 seconds • Get 80 per cent immunity to flu and pneumonia through vaccination • Article 80: You cannot be punished twice for the same offence • Ensure that your peak expiratory flow rate (PEFR) lung function is more than 80 per cent • Keep your epidermal growth factor receptor (EGFR), kidney function more than 80 • Learn hands-only CPR, since it can help revive 80 per cent of sudden cardiac arrest patients within 10 minutes of their death • Children should not watch more than 80 minutes of television in a day • Sleep for 8 hours a day to live up to 80 years • Spend 80 minutes reading everyday for an active and healthy brain • Plant 80 saplings every year • Learn 80 new words in a month • Meet 80 new people in a year • Make 80 people smile in a year

regard for the maximum number of people trained in one day, one location and one hour.

• Sameer Malik Heart Care Foundation Fund: Through this initiative, we provide technical

June / 2016 ehealth.eletsonline.com

19

Cardiology In Spotlight

and financial assistance to anyone belonging to economically weaker sections of the society in the need of cardiac intervention. We believe that no person should die of heart disease just because they cannot afford treatment.

With India facing a heart disease epidemic and soon to acquire the title of the ‘Heart Disease Capital of the World’, I believe that our country is in urgent need of a ‘National Cardiovascular Control’ programme. Presently, the focus of the government is only on the prevention and management of communicable diseases. A public-private partnership in this regard can go a long way.

As an advocator of preventive and universal healthcare, what measures do you think need to be undertaken to take care of critical areas, such as health financing, health infrastructure, skilled human resources, etc., particularly in cardiology segment where cost of treatment continues to be exorbitant and the incidence of cardiovascular diseases (CVDs) being higher in both rich and poor population.

The following steps will ensure

Universal Healthcare • Ensure primordial cardiac care • Public-private partnership • Increasing the share of healthcare in health budget • Cost-effective medical devices • Preventive cardiac care programme • Ensure wellness parameters

20

June / 2016 ehealth.eletsonline.com

Dr KK Aggarwal during one of the activities at ‘Perfect Health Mela’ universal healthcare in the long run: • Primordial cardiac care • Health budget should be 5 per cent of the annual gross domestic product (GDP) • Reducing the cardiac disease burden through a preventive cardiac care programme • Wellness parameters, such as more jogging tracks, reducing blood pressure of the community, and reducing salt and trans fat intake of the society

Please enumerate innovations that have taken place across the cardiac value chain and collaboration among various stakeholders, including the government, providers, pharmaceutical companies, medical technology firms and health insurers to enable cardiac care interventions.

• Now costly device are available on an equated monthly installment (EMI) • Leadless pace makers have come up • Beating bypass is a reality • After stenting, the patient can be discharged the same day • Cardiac transplant is becoming a routine • Aortic valve is now replaced without surgery • Stents have become affordable • Absorbable stents are now

available • Hybrid catha labs are now a routine • Congenital heart surgeries are saving lives

Most of the stakeholders in the Indian medical sector know that you have been the pioneer in the field of clotdissolving therapy for heart attacks and bringing the technique of colour Doppler echocardiography. Could you please highlight the infrastructural challenges that you have encountered as a cardiologist?

• In 1987, when I brought 2D colour Doppler echo technology to the country, there were no cardiac hospitals in Delhi. Now, we have advanced to three-dimensional (3D) echo.

• Today India is as developed in terms of healthcare technology and treatment as any other country in the world.

• I have been witness to patients dying due to the lack of angiography facilities in the past, which is not the case today and indicates how far we have come.

• Clot-dissolving therapy today has become the gold standard in situations where emergency stenting cannot be done in acute heart attack cases.

Cardiology Dr Vanita Arora

Advancements Come With a Cost, But Save Lives I believe future technologies will help us to take our success rate close to 100 per cent and to reduce procedure time to do more in less time, shares Dr Vanita Arora, Associate Director & Head Cardiac Electrophysiology lab & Arrhythmia Services, Sr. Consultant Cardiac Electrophysiologist & Interventional Cardiologist, Max Super Speciality Hospital, Saket & Patparganj, New Delhi to Elets News Network (ENN) How difficult it was for you to break into the till now believed to be male-dominated field of cardiology? What are your recommendations for women aspiring to enter this segment of healthcare?

In 1985, at the age of 17, I left home for MBBS to stay in a hostel at Dayanand Medical College (DMC), Ludhiana and after that there has been no looking back. I completed Doctor of Medicine (MD) (Internal Medicine) from DMC in an era when females only opted for ‘Gynaecology’ or ‘Eye’ or ‘Skin’.

Not many male peers had high hopes on my capabilities, but I surprised them with my hard work and intellect.

However, I was discriminated by my male colleagues, just because I was a hard working “Female” doctor with brains.

I became the first lady electrophysiologist of the country and am addressing with passion the heart failure and heat beat problems of the patients for more than 20 years. I joined Max Super Speciality Hospital in 2009 as the head of Department of

22

June / 2016 ehealth.eletsonline.com

Cardiac Electrophysiology. Now, I am the director of the same department.

However, the “Bias” against me as a headstrong female surviving in a man’s world of cardiology still persists.

I thank to God for giving me both troubles and strength to fight back.

This made me what I am today, i.e. independent and tough. I attribute my success to my sheer hard work and ‘never give up’ attitude in this man-dominated world. I have made the mountain from the stones thrown at me and that has made me scale towards the goal. I refuse to be deterred by these stones, instead choose to rise above them. My family and friends have been my backbone in this climb, and they have never let me down.

Young women who are aspiring to become electrophysiologists should adopt my attitude to rise above all to be victorious and achieve a good position in their career. Just remember “No one can make you feel inferior without your consent”.

It is quite interesting to note

that you run a blog to spread awareness on the key issues of cardiac diseases. Please describe in detail other platforms, workshops and activities through which you communicate on cardiac issues.

I conduct regular continuing medical education (CME) workshops, teaching courses, health camps and patient advocacy programmes to spread awareness regarding electrocardiogram (ECG) tests, arrhythmias (misbehaving heart beats), sudden cardiac death, heart failure, etc., some of the most dreadful and debilitating aspects of cardiac diseases in which physicians and patients lack awareness. I believe the most challenging aspect is developing awareness amongst physicians and patients about problems of heart beat and their treatment being available with a good success rate.

What kind of technological, both hardware and software, solutions are emerging to help cardiac care providers and

Dr Vanita Arora Cardiology

negotiate their way through a healthcare environment that’s increasingly competitive, costconscious and challenging?

I am constantly motivated to learn new developments on technology and research which benefit the patients.

I believe these future technologies will help us to take our success rate close to 100 per cent and to reduce procedure time to do more in less time.

I laid the inception of treating challenging complex arrhythmias (misbehaving heart beats) in the country by starting the threedimensional (3D) mapping programme at first in Fortis Escorts Heart Institute and then in Max Hospital. There are still very few operators of 3D mapping in our country. As such software advancement keeps happening every year, but 3D mapping system is the latest technological hardware advancement in the management of arrhythmias. Some of the challenging arrhythmias are the major cause of stroke (clot in the brain) in patients, and treating these arrhythmias using 3D mapping can prevent stroke. 3D mapping has given us the confidence to challenge life-threatening arrhythmias and save lives. We create the geometry of upper and lower chambers of the heart in real time and search the site of generations of electrical short circuits in the heart and then ablate them with a good success rate.

The advanced treatment for the heart failure patients in term of Device Therapy (COMBO Device) improves heart function and prevents ‘sudden cardiac death’. These implants are being successfully performed by me at Max Hospital, with hundreds of patients benefiting from it. Newer devices with latest algorithms and magnetic resonance imaging (MRI) compatibility have been the latest technological advancements.

These advancements come with a cost, but then they save lives. What is

a cost of Life? This question should be left to the individual patient to decide.

What I can insist on is that everyone should take health insurance. Paying for the premium of health insurance should be taken as part of package.

It makes life easy in case of any eventuality or urgent requirement.

Good work never goes unnoticed.

If you do your work well and give good outcomes to the patient, then the results travel by word of mouth and good will is spread by patients amongst the public. Competition doesn’t matter if your patient confidence is with you.

What are the key challenges in incorporating these new technologies in the Indian healthcare system? What kind of changes need to be undertaken by both cardiologists and medical facilities to adopt such technological innovations?

These new technologies are costly and require specific training. A corporate set-up is required to make these technologies available to the patients, but more than this proper training of the cardiologists is required prior to trying new technologies on the patients.

There is a lack of proper training institute in our country for ‘cardiac electrophysiology’, and there is a time period of at least 2 years required to get trained in this field.

Top Advancements • 3D mapping has given us the confidence to challenge lifethreatening arrhythmias and save lives • Newer devices with latest algorithms and MRI compatibility

The young generation tends to take short cuts for this training and wants to start practicing these procedures without getting properly trained.

These compromised skills result in poor outcome of the patients.

I insist on proper training of cardiologists in cardiac electrophysiology, so that there is growth of technology in our country. From past 3 years, I am running a Fellowship in Cardiac Electrophysiology programme, where we take one fellow every year to train them in electrophysiology for a period of 1 year. I know it is just the beginning, but then we have to start somewhere. I insist on initiation of more such programmes.

As a cardiac surgeon what kind of infrastructural and manpower challenges you witness in both urban and rural areas? Are enough training programmes being designed to upgrade the skills of the nursing staff and physician assistants?

If you need good outcome, you need good working hands. Infection is a big challenge in my field, as I implant expensive devices which play havoc with our patients in case there is even 1 per cent chance of infection. Rural areas are compromised in this aspect of maintenance of sterility.

Availability of trained nurses is a big challenge nowadays. It is a known fact that our good nursing skills are being drained to other countries, such as the United States (US), United Kingdom (UK), Saudi Arabia and South Africa, only because of the huge difference in the pay package. More depressing is the thought that we are not doing anything to stop this.

Same stands true for the trained assistants of physicians.

We should do good reforms in the pay package to stop India from losing the trained staff that forms the backbone of a good department.

June / 2016 ehealth.eletsonline.com

23

Cardiology Dr Manjinder Singh Sandhu

Restructured Training Programmes & Advanced Technologies to Redefine Medical Practice Simplification of technology will enable constant check on risk factors of cardiac diseases, suggests Dr Manjinder Singh Sandhu, Medical Director & Director, Cardiology, Artemis Hospitals with Elets News Network (ENN) Looking at your vast experience in teaching at Army College of Medical Sciences, please describe the key challenges that plague our medical education? Do you see any reforms being enunciated to encourage research and development at the educational institutional level?

Traditional merit-based seats of medical education are slowly ebbing and are replaced by paid (capitation fees) seats. There is a rise in fees in the medical education industry over the last decade and medical seats are sold to the highest bidder in the black market. Growth of private medical colleges has shifted the focus from providing high-quality education and is turning medical education into just another profit-generating industry.

Process of selection of students in the medical colleges is a challenging task, rather than assessing the general aptitude of the student.

The selection of students in most of the colleges is based on the score obtained in the entrance exam which test their theoretical knowledge rather than practical skills and humanistic attitude which are the basic foundation for doctors.

24

June / 2016 ehealth.eletsonline.com

Due to lack of trained medical faculty in colleges, there is a serious decline in the quality of education.

Research grants for faculties to do innovative research is non-existent and so are faculty development programmes. The majority of medical students lack any epidemiological or statistical knowledge about population-based research. Thus, training programmes during the medical course should be redesigned to stress on practical knowledge and communication skills, with focus on ethical issues and doctorpatient relationship.

Please discuss in detail the advanced cardiac technologies and procedures

Key Challenges • Dearth of domestic device medical safety testing infrastructure • Lack of any epidemiological or statistical knowledge about populationbased research

being practiced in developed countries, but are yet to see the light in the cardiology segment of Indian healthcare. Do you think we have been keeping pace in terms of technological advancement to meet challenges related to cardiac procedures?

• Transcatheter aortic valve replacement (TAVR) (Edwards SAPIEN 3 and Medtronic CoreValve): TAVR is the replacement of the aortic valve of the heart through the blood vessels (as opposed to valve replacement by open-heart surgery). The replacement valve is delivered via one of the several access methods that include transfemoral (in the upper leg), transapical (through the wall of the heart), subclavian (beneath the collar bone), direct aortic (through a minimally invasive surgical incision into the aorta) and transcaval (from a temporary hole in the aorta near the belly button through a vein in the upper leg).

• Transcatheter mitral valve repair (TMVR ) - CardiAQ valve- Edwards • CardioMEMS (St. Jude Medical (wireless pulmonary artery (PA) monitor for heart failure (HF)

Dr Manjinder Singh Sandhu Cardiology

patients): The CardioMEMS HF System measures and monitors the PA pressure and heart rate in certain HF patients. The system consists of an implantable PA sensor, delivery system and patient electronics system. The implantable sensor is permanently placed in the PA, the blood vessel that moves blood from the heart to the lungs. The sensor is implanted during a right heart catheterisation procedure. The PA sensor is about the size of a small paper clip and has a thin, curved wire at each end.

This sensor does not require any batteries or wires.

• Fractional Flow ReserveComputed Tomography (FFRCT): Like invasive coronary angiography (ICA) and FFR, FFRCT is coupled with coronary computed tomography angiogram (CTA), and thus represents a hybrid anatomical–physiological diagnostic strategy. Moreover, coronary CTA can assess plaque burden and composition comparable with intravascular ultrasound. Thus, added to noninvasive, semi-automated plaque assessment, potentially allowing for rapid and reproducible segmentation, non-invasive physiological assessment with FFRCT contributes with valuable diagnostic information.

• Wireless Pacemaker (Micra Transcatheter Pacing System (TPS) – Medtronic): The Micra TPS contains a one inch-long, self-contained pacemaker that is implanted directly in the right ventricle chamber of the heart.

Unlike other pacemakers, the Micra TPS does not have leads.

The Micra TPS is a single-chamber pacing system which paces only the right ventricle of the heart. The Micra TPS is implanted directly into the heart via the femoral vein (in the leg) using a catheter delivery system.

With healthcare largely funded out of pocket and cost of cardiac surgical procedures unbearably high, what costcontainment measures are being undertaken at Artemis Hospitals to ensure costeffective cardiac procedural solutions?

• Use of electronic medical records saves cost of repeat testing in case paper records are unavailable.

• Focus on cardiac rehab and drug compliance to prevent recurrence.

• Health packages for cardiac surgeries (angiography, angioplasty, valvuloplasty and coronary artery bypass grafting (CABG)) minimise the extra cost to the patient compared to the itemised billing.

• Group purchasing of equipment and supplies which cost less to the hospital and in turn less to the patients.

• Same day or next day discharge following angiography or angioplasty.

We lag behind developed countries in terms of testing centres to ensure adequate research and testing of advanced medical devices to contain any defect and malware. How do you meet such challenges? Do you have any partnership with med tech manufacturing companies?

Domestic device medical safety testing infrastructure is largely nonexistent in India. We use only the Food and Drug Administration (FDA) or CE approved devices.

With rise of start-ups, there has been a convergence of Internet, mobile phones and other platforms of healthcare service delivery. What ways do you think it can be used as a tool for spearheading movement against rising incidence of lifestyle disorder?

Benefits of Medical Devices • Monitoring of vitals and treatment • Continuous communication between patients and doctors Patients can monitor their own vitals, such as blood pressure (BP), heart rate (HR), respiratory rate (RR), temperature and blood sugar, through portable and inexpensive patient monitoring devises. An online database empowers the patient with day-to-day tracking of their health.

Patient feels in control of their health, as they can assess their vitals and in turn the treatment efficacy on a day-to-day basis. Additionally, these devices automatically send the daily readings (through a wireless connection) to the medical team.

The doctors and other staff receive alerts if a participant’s numbers are dangerously high, so they let the patient know and take whatever immediate action may be necessary.

A questionnaire on smartphone or tablet-based android application can be developed and can be used by patients to assess the risk of various diseases, such as stroke and depression. Patients can also monitor their physical activity and drug compliance.

Are enough training programmes being designed to upgrade the skills of the nursing staff and physician assistants to ensure adequate support to cardiac surgeons and avoid any medical negligence during cardiac surgery?

Yes, the nursing staff and physician assistants are trained at a regular interval to keep their knowledge up to date and prevent any medical negligence during cardiac surgery.

June / 2016 ehealth.eletsonline.com

25

Cardiology Dr Nidhi Rawal

Paediatric Heart Care: Ensure Confluence of High-End Technology, Sophisticated Infrastructure & Appropriate Training Paediatric cardiac surgeons find it compelling to spend a few years in busy centres overseas as only a handful of centres conduct paediatric cardiac surgeries, shares Dr Nidhi Rawal, Head Pediatric Cardiology, Artemis Hospitals with Elets News Network (ENN)

Has India as such succeeded in creating comprehensive paediatric heart centres with the capability for infant and newborn heart surgery?

What are the key challenges confronting Indian healthcare in this segment, as paediatric cardiology still remains a neglected arena?

Yes, to some extent, India has succeeded in creating comprehensive paediatric heart centres. Comprehensive paediatric heart care is very resource intensive and requires sophisticated infrastructure. It is challenging to develop a successful and effective programme in the government sector. We do have a handful of private institutions in India that have established good standards of paediatric heart care with rapidly increasing numbers. The total number of infant open-heart operations in India has almost

26

June / 2016 ehealth.eletsonline.com

doubled over the last five years.

There are limiting factors in the paediatric cardiology, which primarily include poor affordability, accessibility and acceptability.

Additionally, finances are the big issues. In most parts of India, very little or no government subsidy exists for congenital cardiac care, and most insurance companies also do not cover congenital heart lesions.

Therefore, families have to generate entire resources for surgery out of their pocket. Accessibility is another

Comprehensive paediatric heart care is very resource-intensive and requires sophisticated infrastructure

big problem, as paediatric cardiac care is very limited to metros. As a result, families have to travel long distances for treatment. Another factor is that cardiac surgery is not easily accepted, even if it is offered free of cost. There is a social stigma attached to post-surgery scars.

India has no national policy for the treatment of coronary heart disease (CHD). In 2008, out of the Rs 63 billion for integrated child development schemes, no allocation was made for CHD. There is a huge load of congenital heart disease patients requiring intervention. We need over 200 large-volume centres that can cater to at least 1,000 surgeries every year. This high demand makes any healthcare policy very challenging.

Although several new centres are opening up, the gap between the required number of centres and the number of patients who need treatment is very wide.

The key challenge is to establish

Cardiology Dr Nidhi Rawal

more centres that are capable of providing good quality care for patients with CHD, as it is the most sustainable approach over long term.

To date, India has almost 25 centres, of which 15 have been established in last 10 years. There are only three centres funded by the government and no new government-aided centre has been opened in the last 10 years.

It is important to note that, most of the new centres have been set up in the metros, with little or no facilities in some of the most populous and poor states, such as Uttar Pradesh, Bihar and Odisha. There is an urgent need to establish good quality paediatric cardiac care centres in these states.

Paediatric care has been closely linked to ‘infant mortality rate’ (IMR). Please describe in detail in which all regions you have seen more concrete changes in terms of paediatric care and which regions continue to be afflicted by this menace.

Paediatric care in terms of easy availability and access to a paediatrician has made things better, and information about nutrition and access to immunisation have resulted in reduced IMR. The advent of immunisation has resulted in the eradication of polio, and the next on target is measles.

Infections, such as diarrhoea and pneumonia, account for almost 50 per cent of infant mortality. Improved sanitation practices, Swachh Bharat Abhiyan, proper washrooms and proper use of antibiotics are some of the concrete steps in paediatric care.

A lot more needs to be done in the above-mentioned areas, especially in the rural belt. Additionally, government-funded accredited social health activists (ASHAs), who take care of pregnant mothers and infants up to six weeks of age, are also aiding in reducing the number of low

28

June / 2016 ehealth.eletsonline.com

birth weight babies.

The detection of congenital anomalies by the ultrasound scan in the antenatal period is a very important step in later neonatal care and management. Abuse of antibiotics resulting into resistance is a menace. Infection due to poor hygiene is a big menace in the rural area.

One of the critical elements of paediatric care is training paediatric heart surgeons.

Despite statistics suggesting that 70,000 to 100,000 infants and newborns need surgery, the number of paediatric surgeon remains very low.

Please explain the reasons and recommendations for improvement.

Currently, there are no structured training programmes for cardiac surgeons in India. The flawed training programme, long hours of work on high-risk patients, prolonged training requirements, modest remuneration (as compared to adult cardiac surgeons), late settlements and at times uncertain future are the keys factors amounting to the less number of trained paediatric cardiac surgeons.

With just a handful of centres conducting paediatric cardiac surgeries, most trainee cardiac surgeons completing their cardiac surgery programme have limited exposure to the sub-speciality.

Thus, most of the paediatric cardiac surgeons find it compelling to spend a few years in busy centres overseas to improve their skills and knowledge.

We urgently need formal, structured medical training programmes within India. Considering the high volume of patients and procedures that most centres have, this should not be a difficult proposition. Medical bodies, such as the Medical Council of India (MCI) and the National Board of Examination (NBE), have

to be engaged for initiating these programmes and fellowships.

What are the key technological and procedural gaps in the field of cardiology segment?

Please enumerate some of the latest advancements made in paediatric cardiology.

Paediatric cardiology is a long endearing programme. It requires high-end technology.

Paediatric surgeons need to be trained adequately in clinical and interventional skills. We need to have a trained paediatric cardiologist, paediatric cardiac surgeon, paediatric cardiac anaesthetist and intensivist to run a successful paediatric cardiac programme.

Key Challenges • No national policy for the treatment of CHD • No structured training programmes for cardiac surgeons • Wide gap between the number of centres and the number of patients • Only three centres funded by the government • No new governmentaided centre opened in the last 10 years • New centres mostly in the metros • Need to establish good quality paediatric care centres in Uttar Pradesh, Bihar and Odisha

Dr Nidhi Rawal Cardiology

There are a lot of devices, catheters and sutures that have been not yet manufactured in India. When these medical devices are imported, we encounter increased costs. A lot of technology/techniques have not yet come into India. A new technology has a lag period from western world of about 7 to 8 years. People have to be trained in the new technology, as they need to be updated. All these measures require investment.

Establishing new equipped advanced cardiac centres is a big challenge, due to huge investments necessary for technology, infrastructure and trained manpower. The latest development in paediatric cardiology is the establishment of several new centres that provide comprehensive paediatric cardiac care. Additionally, we have seen an increase in the number of trained manpower and development of newer cost-effective strategies and innovations. Threedimensional (3D) echo is emerging as a big help in complex surgeries.

A lot of indigenous innovative interventions have come into action.

Holes are being closed in cath labs.

Valve replacement has been started in cath labs. Neonatal palliative procedures, such as patent ductus arteriosus (PDA) stenting, are being done in cath labs, which have reduced child morbidity and mortality. Neonatal surgeries are being done at most of the advanced centres with ease.

‘Paediatric cardiology’ has been conventionally considered a less lucrative career option due to uncertainties involved in growth. How far do you agree with this statement? Please provide details.

Personally, I don’t feel like that. If you have passion to treat cardiac patients, you can break yourself away from the rat race with adult

cardiologists and can get professional satisfaction early in life, paediatric cardiology is a lucrative option. In third world countries, such as ours where healthcare is self-financed, financial remuneration may not be high for all the sub-specialities of paediatric cardiac care.

I do agree with the fact that paediatric cardiology is a surgeondependent branch, because of which independent survival is difficult. This makes it little less lucrative.

Quite challenging to develop a successful and effective paediatric care programme in the government sector; a handful of private institutions have established good standards of paediatric heart care What kind of workshops and communication campaigns are being conducted in both public and private space to spread awareness regarding ‘paediatric cardiology’?

Are you part of any of these government-based and private activities?

The Government of India and several state governments are initiating health programmes for children. The national schemes, such as Janani Shishu Suraksha Karyakram and Rashtriya Bal Swasthya Karyakram, are designed to ensure care for the health of neonates, infants and children for multiple diseases, including congenital and rheumatic heart diseases. The government runs several programmes for poor

Indigenous Innovative Interventions • Valve replacement • Neonatal palliative procedures patients, those below the poverty line (BPL), or below poverty line cards are provided, and they can avail several facilities free of cost. Several states in India have similar programmes, e.g. Andhra Pradesh and Tamil Nadu have a special programme for conducting free congenital heart surgery for all children whose families cannot afford treatment. The National Rural Health Mission (NRHM) programme in Punjab has helped a lot of children in getting operated for paediatric cardiac surgeries.

Several regional charity organisations have established paediatric cardiac care facilities to help these children. The state of Karnataka has introduced a microfinance scheme for poor families.

Similarly, Saving a Child’s Heart initiative (SACHi) is a voluntary organisation dedicated to paediatric cardiac care and child heart surgery for the underprivileged. I am associated with campaigning and conducting non-profitable paediatric cardiac camps in Bhiwadi, Rewari and Dwarka. I am also helping underprivileged children to get operated with the help of nongovernment organizations (NGOs).

We conduct continuing medical education (CME) programmes to spread awareness and ensure early diagnosis and timely referral.

Additionally, we run school health schemes to screen the kids for cardiac problem. We, at Artemis Hospital, conduct a routine neonatal screening with the pulse oximeter in the neonatal intensivecare unit (NICU) and if needed, echocardiography is done.

June / 2016 ehealth.eletsonline.com

29

Cardiology Dr MG Pillai

Elevate Primordial Healthcare Models to Tackle Emerging Cardiac Challenges Holistically planned and executed treatment protocols laying thrust on prevention, early diagnosis and timely treatment will go a long way in reining in increasing heart disease cases, says Dr MG Pillai, Senior Interventional Cardiologist, Nanavati Super Speciality Hospital, Mumbai to Elets News Network (ENN) What kind of clinical excellence and infrastructure facilities are available at Nanavati Super Speciality Hospital that makes it one of the best centres of cardiac care?

Over the years, the Heart Institute at Nanavati Super Speciality Hospital has achieved a niche reputation as a unique and dedicated cardiac care unit with a dedicated team of highly experienced and qualified doctors equipped to provide a diverse array of 24x7 interventional cardiac services, such as radial and femoral coronary angiography, angioplasty, peripheral and neurological interventions and paediatric interventions, as well as electrophysiological evaluation and Radiofrequency Ablation (RFA). In order to provide a perfect amalgamation of clinical excellence and aesthetic ambience, the department undertakes on a routine basis complex cardiac procedures, such as mitral valvuloplasty, permanent pacemaker implantation, cardiac resynchronisation procedures, automatic implantable cardioverter defibrillator (AICD), implantation and procedures for congenital ailments, such as coarctation of the aorta, stenting and patent ductus arteriosus (PDA) closure, atrial septal defect (ASD)

30

June / 2016 ehealth.eletsonline.com

closure and ventricular septal defect (VSD) closure.

What places the Nanavati Super Speciality Hospital cardiac centre on par with global cardiac institutes of world-class standards is its advanced portfolio of non-invasive and advanced diagnostic services including ambulatory blood pressure monitoring (ABPM), head-up table tilt (HUTT) test and coronary computed tomography angiography (CCTA), as well as nuclear scans for cardiology. Additionally, Nanavati Super Speciality Hospital has a well-established cardiothoracic and vascular surgery division specialising in coronary bypass surgery (CABG), valve replacement, valve repair, aortic root and aneurysm surgeries. One of the few hospitals in the country offering minimally invasive bypass treatment, majority of c a r d i a c b y p a s s surgeries in the hospital a r e performed as off-pump surgeries with an emphasis

on total arterial revascularisation.

This is complemented with a range of diagnostic and therapeutic options, such as endovascular revascularisation, arteriovenous (AV) fistula construction, deep vein thrombosis (DVT) treatment, peripheral bypass procedures and peripheral angioplasty, stenting and

Dr MG Pillai Cardiology

use of drug eluting (long) balloons for below knee occlusions.

The hospital also has a fullyequipped catheterisation lab, equipped with Allura Xper FD 10 System, a first-of-its-kind installation in Mumbai. The machine boasts of excellent features, such as a big screen interface (LED 56”), swing camera and close reduction. The camera has a swing feature, wherein it captures one to six images automatically in various standard views on screen without a change in table position.

This catheterisation table has additional features, such as rotational angiography, stent boost and online fractional flow reserve (FFR). The hospital has in-house rotablation device and intravascular ultrasound (IVUS) evaluation set-up for complex angioplasties needing debulking using rotablation and strategising the complexity of coronary artery blocks and appropriate management strategies. There is a dedicated intensive cardiac care unit (ICCU) adjacent to the catheterisation lab and cardiac operation theatre (OT) which is fully capable of handling all kinds of cardiac emergencies.

Do you see increased penetration of advanced and next-generation cardiac and diagnostic devices in areas other than metropolitan cities, especially in the light of increased focus on tier-I and tier-II cities?

The need to provide housing to a large section of the population has led to the rise of tier–I and tier-II cities on the peripheries of big metropolitan cities, such as Mumbai and Delhi.

However, with rise in income levels, fast food culture compounded with lack of physical activity and lower awareness levels, people in smaller towns and cities are also becoming alarmingly susceptible to cardiac problems. Taking note of these rising exigencies, the government is

Key Takeaways - Nanavati Super Speciality Hospital, Mumbai • Advanced portfolio of non-invasive & diagnostic services • Well-established cardiothoracic & vascular surgery division • Offers minimally invasive bypass treatment • A fully equipped cath lab • In-house rotablation device & IVUS evaluation set-up for complex angioplasties • Dedicated ICCU fully capable of handling all kinds of cardiac emergencies introducing coronary intervention programmes in small towns with a thrust on research and cutting-edge technology parameters. Advanced coronary diagnostic techniques have been introduced in tier-I and tier-II cities and large private and public sector hospitals operating in metro cities are being encouraged to open cardiac units in these areas.

The private sector has also been roped in with healthcare solution providers, equipment manufacturers and pharma companies contributing to building new age cardiac facilities with state-of-the-art equipment aimed at providing affordable heart care treatment. Next-generation cardiac and diagnostic treatment protocols in small cities and semi-urban areas have undergone a paradigm shift and evolved to cater to a diverse section of the population inhabiting small towns and cities.

Looking at the growing menace of diseases due to lifestyle disorder, please throw light on what kind of cardiac diseases are frequently reported by Indians? How many cardiac procedures are conducted at Nanavati Super Speciality Hospital?

In the 70s and 80s, as a young resident doctor I observed that people

were increasingly diagnosed with rheumatic heart disease and valve problems. There were also many cases of congenital heart disease.

Over the years, there has been a gradual decrease in the number of patients diagnosed with congenital heart disease and a decline in rheumatic heart disease. This is on account of the aggressive rheumatic prophylaxis treatment implemented in tandem with the prescribed guidelines of the Cardiological Society of India and Association of Physicians of India. In the interceding years, improvements in environmental cleanliness, overall improvement in society and adherence to clean habits have reduced incidences of rheumatic heart disease. In contemporary times, there are increasing occurrences of coronary heart diseases and acquired muscular diseases, as we are becoming more susceptible to viral infections of the heart and resultant heart failure. However, the greatest challenge facing the modern cardiac fraternity is the growing onslaught of ischaemic heart diseases and sudden heart attacks, which were uncommon in the 60s, 70s and 80s and in those below the age of 45. In the decades of 70s and 80s, medical professionals would advise people to undergo a comprehensive health evaluation for heart disease prognosis in their mid-

June / 2016 ehealth.eletsonline.com

31

Cardiology Dr MG Pillai

40s. Today, we get patients as young as 20 to 25 years with chest pain and acute heart attack. Overstretched working hours, stress-laden lifestyles and corporate pressure to perform for deriving maximum results are exerting tremendous pressure on young professionals. This problem needs to be addressed immediately by the society and corporates.

Overindulgence of junk food, sedentary lifestyle, irregular sleeping habits, consumption of alcohol and tobacco abuse along with poor lifestyle habits can be cited as trigger points for increasing incidences of heart diseases.

Since many years, Nanavati Super Speciality Hospital has been one of the leading cardiac interventional centres in the city of Mumbai. On an average, we perform around 300 to 350 heart procedures every month. Out of these, around 100 cases are of angioplasty and 30 percent of the cases comprise acute heart attacks. We also undertake active paediatric interventional procedures for paediatric cases of any age from day one onwards which form about 8 to 10 per cent of the reported cases. The paediatric section of the hospital works in close association with the Department of Cardiology.

We also have an active arrhythmia treatment programme, which involves advanced pacemakers, defibrillations and resynchronised therapies for heart failure cases.

In 2015, a 24/7 accident and emergency (A&E) care centre was inaugurated at Nanavati Super Specialty Hospital.

Please explain in detail the key objectives and features of this centre. How far have you succeeded in meeting cardiac-related challenges during emergencies?

The Accident & Emergency Centre at Nanavati Super Speciality Hospital has been set up as a highly specialised unit to cater to diverse trauma cases

32

June / 2016 ehealth.eletsonline.com

in a real-time environment on a 24x7 basis. The thin line of survival between life and death is defined by the short span of three hours or less, known as “Golden Hour” in medical parlance, within which timely diagnosis and early start of medical treatment for trauma injuries can increase survival chances dramatically. The objective of the centre is to reduce the turnaround time for diagnosis and treatment for trauma patients, including emergency heart attack and cardiac arrest cases in which waste of critical seconds can be potentially fatal.

The unit is equipped with dedicated beds and qualified healthcare professionals endowed with the necessary prerequisites to deal with all kind of emergencies.

Spread over 3,000 sq. feet, the centre is strategically located on the ground floor of the hospital, facilitating the easy transfer of the patient from the ambulance to the unit. The centre operates a dedicated network of advanced life support (ALS) ambulances for transferring adult and paediatric patients within the “Golden Hour”.

Critical clinical services, such as computed tomography (CT) scan, ultrasound, magnetic resonance imaging (MRI), X-ray, blood bank, laboratories and emergency transportation services are located in proximity to the centre. The department is helmed round the clock by a team of super-speciality trauma personnel, cardiac units and rehabilitative groups manned by highly skilled technicians and nurses who are trained to provide quick time responses to reduce trauma and shock, diagnose the problem, start immediate treatment procedures and restore the patient to health.

What kind of workshops and communication campaigns are conducted to spread awareness on cardiac-related issues both in private and

public sector?

The hospital conducts regular workshops and educational programmes every fortnight involving local general practitioners to educate them on modern treatment methods and strategies. These sessions broadly train medical professionals how to tackle acute cardiac emergencies, and steps to be taken in case of a cardiac arrest and acute heart attack. Nanavati Super Speciality Hospital has initiated talks with public organisations that have signed up with the super-speciality player to start health education programmes for the layman and employees of corporate organisations.

Please recommend measures that need to be undertaken to close the gap between rural and urban spaces in terms of quality care, technology, clinical excellence and infrastructure.

Heart diseases, which were hitherto considered an urban phenomenon, have spurted into rural areas. Higher synergy and closer cooperation between different stakeholders in the treatment chain, such as pharmacology companies, government health departments and medical institutions, such as hospitals, are the need of the hour.

Modern clinical facilities and trained medical personnel should be deployed in remotely located rural health centres to tackle rising coronary exigencies. Greater emphasis needs to be placed on elevating the existing primordial healthcare model in rural areas to superior tertiary and quaternary treatment model to tackle emerging cardiac challenges. Rather than having a piecemeal overview of the existential threat of heart disease, holistically planned and executed treatment protocols laying thrust on prevention, early diagnosis and timely treatment will go a long way in reining in increasing heart disease cases.

11

REGENCY REGENCYHOSPITAL HOSPITALSARVODAYA SARVODAYANAGAR NAGAR

REGENCYRENAL RENALSCIENCES SCIENCESCENTRE CENTRE REGENCY

225 Bedded - Multi Super Speciality Hospital 225 Bedded - Multi Super Speciality Hospital

75Bedded Bedded- -Super SuperSpeciality SpecialityHospital Hospital 75

22

Renal RenalTransplant Transplant Management Managementofofchronic chronicKidney KidneyDisease Disease Reconstructive ReconstructiveUrology Urology BPH BPHManagement Management KidneyTransplant TransplantHospital Hospital Kidney Hemodialysis Hemodialysis

AllAll Departments && Services Under One Roof Departments Services Under One Roof Empanelled with allall leading insurance companies Empanelled with leading insurance companies CGHS, ECHS, ESI Factories Govt.

Institution CGHS, ECHS, ESI Factories Govt.

Institution

33

REGENCY REGENCYCITY CITYCLINIC CLINIC Wellness WellnessCenter Center OPD OPDConsultation Consultationby bySuper SuperSpecialist Specialist High High- -End EndDiagnostics Diagnostics Ultramodern UltramodernPathology Pathology Modern ModernPreventive PreventiveHealth HealthCenter Center

44

REGENCY REGENCYHCG HCGONCOLOGY ONCOLOGYHOSPITAL HOSPITAL

REGENCY REGENCYHOSPITAL HOSPITAL GOVIND GOVINDNAGAR NAGAR

100 100Bedded Bedded - Center - Center ofof Excellence Excellence forfor Oncology Oncology

100 100Bedded Bedded- -Multi MultiSpeciality SpecialityHospital Hospital

PET and “TruBeam” LINAC (Linear Accelerator), PET CTCT and “TruBeam” LINAC (Linear Accelerator), the latest technology Cancer treatment where forms advanced the latest technology in in Cancer treatment where allall forms ofof advanced external-beam radiotherapies are performed including IGRT, IMRT, external-beam radiotherapies are performed including IGRT, IMRT, 3D3D CRT, 2D, SRS, Rapid Arc, SRT, Palatine capabilities CRT, 2D, SRS, Rapid Arc, SRT, Palatine capabilities

55

ULTRA ULTRA- -MODERN MODERNHOSPITAL HOSPITAL especially especiallyfor forthe theresidents residentsofofSouth SouthKanpur Kanpur

Shortly coming up with Super Speciality Oncology & Renal Centers in Lucknow, Allahabad, Varanasi

Cardiology Dr Manoj Kumar

Partnerships & Indigenous Manufacturing: Answer to Increased CostEffective Cath Lab Demand To provide access to affordable cardiac care in tier-II and tier-III cities, use of mobile cath labs and introduction of entry-level cath labs manufactured in India would be a step in the right direction, shares Dr Manoj Kumar, Associate Director & Head - Cardiac Cath Lab, Max Super Specialty Hospital, Patparganj, New Delhi with Elets News Network (ENN) How important is the role of a cath lab in the entire cardiology segment? Is the data collected through cath lab utilised for improving the overall cardiac procedures?

The role of cath lab is immense in the current scenario. Nowadays a variety of diagnostic and interventional cardiology procedures for the treatment of coronary artery and peripheral vascular diseases are carried out in the cath lab. Procedures undertaken include diagnostic heart catheterisation, coronary angioplasty or percutaneous coronary intervention/percutaneous coronary intervention (PCI), closure of some congenital heart defects, treatment of stenotic heart valves, and permanent and temporary pacemaker implantations.

34

June / 2016 ehealth.eletsonline.com

Data is collected in the cath lab during the procedure and postprocedure until the patient is discharged, which include procedure results, any post-procedure complications and the patient’s disposition. These are used to improve the quality of cardiovascular patient care by providing information, knowledge and tools for implementing quality initiatives, as well as support research that improves patient care and outcomes. New analytical tools are being developed that analyse the performance of an interventional lab, providing hospitals with important data that can be used to identify the areas of improvement.

What are the major challenges of a cath lab? Are the emerging cath lab trends being addressed by the vendors

through innovations? Please provide details.

Major daily challenges include physician and staff demands, as well as patients who in many cases require higher acuity care. Also important are programme quality, patient safety, operational efficiency, including inventory management, prompt response and rectification of any breakdown, and customer service. Moreover, getting cath lab personnel, such as technicians & staff nurses, are difficult in peripheral centres, where the attrition rate is very high.

Nowadays procedures undertaken in the cath lab have become more complex and require longer imaging times, resulting in increased radiation exposure to both patients and operators.

Innovations in angiographic imaging

Dr Manoj Kumar Cardiology

system required include the need to reduce radiation dose, improve image quality and enable advanced procedural image guidance.

Multimodality imaging in cardiac cath lab have been developed with advancements in the use of intracardiac echocardiography (ICE), 3D echocardiography (3DE), and multi-detector computed tomography (MDCT), with fluoroscopic overlay to produce 3D images of intracardiac structures. Operators can better visualise cardiac anatomy and provide real-time information to support a faster, more precise surgical workflow, optimise patient outcomes and minimise risk. New angiography systems have been introduced with dose-lowering technologies, which include new X-ray tubes and more sensitive detectors and software to help improve image quality at lower doses. We now have large-format displays which provide a larger field of view and better visualisation of procedures and lowers dose by not needing to image the anatomy several times.

Presently, cardiac cath labs are quite expensive and require considerable infrastructure. In the light of above, how do you plan to bring such facilities in

Key Takeaways • Data collected in the cath lab enable improvement in care and support research • Most government district hospitals still do not have cath labs • Cath labs per CHD case - 1/10th of developed countries • Locally manufactured cath labs 30% cheaper than imported labs rural areas and tier-II and tier-III cities.Please provide details.

High-end cath labs are indeed costly and not cost-effective for low-volume centres that exist in rural areas and tier-II and tier-III cities. To provide access to affordable cardiac care in tier-II and tier-III cities, use of mobile cath labs and introduction of entry-level cath labs manufactured in India would be a step in the right direction because they would be around 30 per cent cheaper than those imported.

Do you see the foray of indigenous manufacturers in the cath lab segment to address the infrastructural and cost-related challenges as witnessed in the context of India?

Constant growth in the number of patients suffering from cardiovascular diseases in India is resulting in an increase in the need for proper cardiac care services in the country. As a result the role of cath lab in the current scenario becomes paramount. If we compare the number of cath labs per coronary heart disease (CHD) cases, we are at 1/10th of developed countries, such as the United States (US). Most of the government district hospitals still do not have cath labs. Government support is essential to ensure that we provide universal access to a facility with cath labs. There is a huge opportunity for Indian manufacturers to build a state-ofthe-art cath lab with low cost, and public-private partnership (PPP) could be the answer to increase cath lab access in government set-ups, so that the facility can be available even in district towns.

Where do we stand in comparison to developed countries in the cath lab segment? What are recommendations for improvement and enhancement?

If we compare with the cath labs available in the developed countries, image quality and low-radiation dosage are two major concerns for the indigenous manufacturers in the cath lab segment. Image quality, cine as well as fluoro are lower for indigenous cath labs. New doselowering technologies which include new X-ray tubes and more sensitive detectors and software are required to help improve image quality at lower doses.

June / 2016 ehealth.eletsonline.com

35

Emerging Leader

Complete Healthcare from the Comfort of One’s Home To bring complete healthcare to the doorstep of the customers, CallHealth is building a new-age healthcare ecosystem and harnessing the collective knowledge and experience of its team, shares Hari Thalapalli, CEO, CallHealth with Elets News Network (ENN)

L

iving in a world ruled by technology, one that constantly values time more than anything, it comes as a whiff of fresh air that technology integration for healthcare needs are being prioritised too.

From food, groceries, gadgets, furniture, clothes, books to even movie tickets, we can easily order services online without having to move out of our comfort zone.

But strangely when we are sick, we still need to step out and wait for the longest time at a doctor’s clinic. Do we really need to aggravate our existing pain to get cured?

Not any more…

Hyderabad, a pharmaceutical hub and medical destination and also home to information technology innovations, now rolls out a technology-driven healthcare delivery start-up - CallHealth Services Pvt Ltd, which promises to put to rest all the hassles of access to one’s health needs.

CallHealth’s unique delivery model involves mobile health officers (MHOs), who visit the home of the patient and assist doctors remotely by conducting tests and enable virtual diagnosis for further prescriptions.

A one-stop integrated healthcare solution CallHealth’s unique virtual-and-mobility healthcare delivery platform enables customers to access all healthcare services from the convenience of their home, through voice, web or mobile. CallHealth provides doctor’s consultations (through a video conference), diagnostic tests, and professional home care services, such as nursing, physiotherapy and a family doctor at the patient’s home, besides home delivery of prescribed medicines, services to the cases which require a visit to hospitals or advanced tests at imaging centres they provide facilitation, and transportation services.

Going beyond the transactional and reactive approach of traditional healthcare management

36

June / 2016 ehealth.eletsonline.com

Emerging Leader

Over the last couple of years, people are becoming increasingly health conscious. There has been a steady rise in average healthcare spend by urban India. Despite this, there is a high incidence of communicable diseases in India.

CallHealth’s integrated healthcare delivery model goes beyond the traditional approach to healthcare and enables access across the healthcare spectrum through Prevention, Cure and Wellness. As a result, a one-stop solution for all your healthcare needs is now just a call or click away.

With a mission to bring complete healthcare to the doorstep of the customers, CallHealth is building a new age healthcare ecosystem and harnessing the collective knowledge and experience of its team of healthcare experts, technology evangelists and management professionals.

According to Hari Thalapalli, CEO, CallHealth, “In the last two decades, we have seen technology change the way we work, communicate, bank, buy, and consume media and entertainment.

Technology has

Key Takeaways • Hassle-free access to healthcare needs • Unique delivery model, including MHOs • One-stop integrated healthcare solution • Unique virtual-and-mobility healthcare delivery platform • 24x7 call centre • Menu-driven website • User-friendly mobile app • Has tie-ups with over 60 hospitals in and around Hyderabad • Has exhaustive symptomatology tools based on over 5,000 medical protocols • ‘2016 TiE50 Top Start-Up’ winner revolutionised the core of healthcare industry with the use of advanced medical equipment and tools, such as laser and robotics in surgery. However, delivery of healthcare services has not kept pace with technology. In line with the ‘Digital India’ initiative, CallHealth provides new age healthcare, which optimally leverages technology,” He describes CallHealth as the world’s first integrated virtual and mobility platform to give access to all healthcare products and services from the comfort of one’s home.

With a robust call centre that takes patients’ calls 24x7, an easy menudriven website and a user-friendly mobile app, CallHealth gives patients access to healthcare from home with just a call or click. CallHealth has tie-ups with over 60 hospitals in and around Hyderabad and has 28 points of presence (POP) centres, which are staffed by MHOs, nursing personnel, physiotherapists, delivery officers and facilitators.

Additionally, CallHealth was recently selected as the ‘2016 TiE50 Top Start-Up’ winner. TiE, Silicon Valley’s premier technology awards programme, is keenly contested by thousands of technology start-ups worldwide. This year, more than 2,000 companies were screened, and only the most innovative companies were

selected as ‘2016 TiE50 Top Start-Ups’.

“It has taken hundreds of engineers and medical professionals to create exhaustive symptomatology tools based on our over 5,000 medical protocols. Using these tools, and based on patients’ symptoms, our call centre officers (CCOs) connect a patient to the right specialist. Our system empowers doctors with the patient’s medical history, thousands of human anatomy images and videos as part of a patient tool kit to explain the problem to the patient and family,” says Sudhakar Nukala, President and Chief Operating Officer.

CallHealth’s organisational architecture comprises of a mission control centre which remotely monitors and proactively controls service processes across different interfaces within the company. This is achieved through system-level integration of multidisciplinary functions.

While the services are confined to modern medicine and are presently delivered in the twin cities of Hyderabad and Secunderabad, CallHealth aims to extend the services to other cities across India and globally in future.

For further information visit: www.callhealth.com

June / 2016 ehealth.eletsonline.com

37

Medical Tourism Special Feature

Vision or Mission in Action?

W Mere

Strengthen ‘Brand India’ by Wrestling Away Self-Promoting Agencies ith the identification of ‘Medical Tourism’ as one of the seven boosters, we do see both domestic and international medical tourism increasing in India. However, there are still many legal and quality hiccups that stop us from becoming a ‘medical tourism hub’. In brief, we need to pull up our socks and work upon strengthening the overall ‘Brand India’ through promotional campaigns at the international level and wrestle away self-promoting agencies.

During this entire vision and mission to become the best medical tourism destination, we must not forget the famous quote of the American writer Edward Abbey, “Growth for the

sake of growth is the ideology of the cancer cell.”We need to scale up our infrastructural facilities and amend laws to ensure safety, privacy and the best experience by transparency and right exchange of information with no involvement of middle men.

As mentioned before, we do see a ray of hope in terms of India strengthening its position as the medical tourism hub, despite fierce competition from the established medical tourism destinations, such as Thailand and Singapore.

In order to provide a lucid picture of the overall debate, we invited candid views from the real stakeholders. And, it was interesting to note that they had some real issues

to highlight to our decision makers.

We raised the following questions before the stakeholders to understand the challenges of medical tourism: • What will be the right ingredient to enable India to beat the established medical tourism destinations, such as Thailand and Singapore, and to attract medical tourists across Europe, the United States (US) and the United Kingdom (UK)?

• Where does India stand in terms of domestic medical tourism, particularly in the light of inequitable distribution of medical facilitates, high cost and other procedural glitches?

Here are some of the excerpts:

Sanjay Prasad Executive Director, President & CEO, Mercy Group • Globally, medical tourism is fast evolving. Established destinations, such as Thailand and Singapore, are being challenged by upcoming destinations, such as India and Turkey. As a medical tourism destination, India is known for high-class treatment at affordable costs. The country’s cost arbitrage gives it a definite edge over other countries like Singapore and Malaysia. Medical treatment in India enables savings of 30 to 70 per cent on total expenditure. The right ingredients for an active medical tourism programme are skilled doctors and state-of-the-art medical facilities capable of providing excellent medical care, especially in niche areas like transplants, joint replacements, cancer therapy, heart disease and bariatric surgery, for a fraction of the cost in one’s home countries, in a country that is well-connected, safe, and has good infrastructure. India has developed high reputation in advanced and life-saving treatments in the fields of cardiology, orthopaedics, nephrology, oncology and neurosurgery, which has a lot of potential, and by right promotional strategies, can turn the country into a leading player in medical tourism.

• With the advent of quality hospitals and the evolution of the industry, now the domestic medical tourism is equipped with world-class infrastructure, major accreditations (NABH & JCI) and capabilities to carry out the most complex surgeries. Also, government initiatives have propelled the sector and today the growth of medical tourism in India has not only generated value for the economy, but also led to the advancement of medical science, development of medical infrastructure and retention of skilled manpower.

38

june / 2016 ehealth.eletsonline.com

Special Feature Medical Tourism

Devendra Patel Founder and Director, Medisoft

Arnab Paul

Director, Patient Planet

Telemedicine Pvt Ltd & Founder and Managing Partner - The Meditour

• It is heartening to note that NITI Aayog’s roadmap to ensure annual 10 per cent growth lists medical tourism as one of the seven boosters. Issuance of medical visas that the government is planning for close to 150 countries is a step in the right direction. Hospitals that are successfully attracting foreign patients should enlarge their geographical footprints with representative offices or agencies in other countries. To attract medical tourists from Europe, the US and the UK, it is high time hospitals in India benchmark themselves up for international quality accreditation standards, such as the Joint Commission International (JCI), and ensure quick legal remedies.

• There is an urgent need for the availability of medical insurance and social security benefits to the vast number of the Indian population. It is time for the NITI Aayog or the other stakeholders in the healthcare ecosystem to come up with a policy of universal health coverage and put a robust mechanism in place to ensure people belonging to the underprivileged sections of the society and people from rural areas can access the medical facility closer to their homes.

• India is the third largest among all medical tourism destinations globally and is growing 27 per cent every year to reach $3.9 billion market in 2015. Our growth rate is highest among the top five most popular medical tourism destinations.

We lead in both quality and cost; we are most cost-effective and at par in terms of quality even in comparison to a developed country. There is a lot of potential to attract people from the US, Europe, etc. We need to do better branding of India as a destination. Make our visa and immigration more user-friendly and cost-effective. I suggest making a nodal public-private partnership (PPP) board to look after patient complaints and consider issuing an insurance policy.

• Approximately 80 per cent of people living in rural India have less than 20 per cent doctors. As a market, domestic tourism is the most neglected area in India. There is a high scope of marketing value of hospital and doctors using technology, such as e-health and telemedicine. We should allocate more funds to public healthcare facilities.

Abhishek Anand Director, Vibcure • A perfect mix of government and corporate efforts is required to change the existing perception of the country. Government efforts should come in the form of revision of the existing approach towards medical tourism, such as amending the existing medical visa policies to reduce the visa grant period and duration of stay.

The government should regulate the healthcare facilitation space to limit the entry of unorganised players bringing disrepute to the brand India. In addition to this, ensuring a safe stay to the attendants and family of medical tourists is of utmost importance

to emulate the environment of trust among the travellers at par with the competitive destinations, such as Thailand and Singapore.

Corporate stakeholders need to adhere to the standards of information and service accepted in the developed nations, as done

by Vibcure.

• Indian healthcare system is currently based on two cornerstones that include private and the government and trustsponsored hospitals and clinics.

Since the government hospitals and clinics have limited budgets, the quality is compromised, which ultimately leads to shift to private

facilities located in metro cities with higher treatment costs.

Currently, with only 210 million people being medically insured, the major population pays out of their pocket for the treatment. In such a scenario, regulating the prices and adhering to the standards is of utmost importance. Various state governments have identified the challenges and are taking various initiatives to promote private healthcare investments in their states by implementing a series of socioeconomic policies in the form of subsidies. Generally, these initiatives have a gestation period of 4 to 5 years.

JUNE / 2016 ehealth.eletsonline.com

39

Medical Tourism Nanavati Super Speciality Hospital

Trickle-Down Effect of Medical Tourism to Ensure Overall Improvement in Care There has to be streamlined management of facilitators referring medical tourists, states Dr Rajendra Patankar, Chief Operating Officer, Nanavati Super Speciality Hospital, Mumbai with Elets News Network (ENN) What should be the mantra to enable India as a competing destination in medical tourism sector to find its place in the league of best medical tourism destinations, such as Singapore, Thailand, etc.?

India is already a competitor destination in the medical tourism sector. In fact, it is at par or above in the league of best medical tourism destinations. India produces 50,000 doctors every year, which is a huge number. It is not the quantity vs. quality quotient here, as science advances so do the medical courses that are churning out good doctors. India is not only producing doctors, but also training doctors from all over the world, which makes it competitive already. However, we don’t intend to compete with other countries.

We wish to create monopolies in surgeries, such as advanced paediatric cardiac and cancer surgeries, which cannot be done anywhere, except here at the moderate pricing and high quality that the medical tourists are looking for.

They would automatically be left with no option but to travel to India.

What kind of technological

40

June / 2016 ehealth.eletsonline.com

innovations, infrastructural facilities and logistics support are provided to international patients at Nanavati Super Speciality Hospital? Do you have tie-ups with secondary service providers of medical tourism sector?

Please provide details.

Nanavati Super Speciality Hospital is one of the best-equipped facilities in Mumbai. With 10 completely equipped operating theatres (OTs), the hospital has an advanced imaging centre of over 10,000 sq. feet and houses 3 Tesla 32-channel wide bore magnetic resonance imaging (MRI) scanner with MR-guided focused ultrasound surgery (MRgFUS) and high-intensity focused ultrasound (HIFU) facilities and 64-slice positron emission tomography– computed tomography (PET-CT)

What Medical Tourists Want?

• Successful Treatment • Complete Transparency • Vicinity to Basic Needs

scanner with cardiac capability.

The catheterisation lab at Nanavati Heart Centre, which is the first of its kind in Mumbai, has a team of highly experienced and qualified doctors providing interventional cardiac services 24x7.

In addition to the above, the hospital has 350 beds, 55 speciality departments, 350 consultants, 100 resident doctors, 475 nursing staff members and 1,500 employees for running the hospital.

Moreover, the hospital has 88 dedicated intensive care units (ICUs), including an intensive cardiac-care unit (ICCU), medical intensive care unit (MICU), surgical intensive care unit (SICU), paediatric intensive care unit (PICU), neonatal intensive care unit (NICU) and coronary care unit (CCU), 24 dialysis units, a cath lab, and a dedicated 24X7 accident and emergency (A&E) centre.

For medical tourism, most of the business is generated by the referring doctors from other countries and some established medical facilitators in the country, such as High Beam Global, and Abercrombie and Kent.

Please throw light on the major concerns of medical tourists

Nanavati Super Speciality Hospital Medical Tourism

visiting India at pre-treatment, treatment and post-treatment stages? What measures should be initiated to overcome these roadblocks and gaps?

All medical tourists now look for one thing when they visit a country, which is “successful treatment”. The last thing they are looking for is “tourism”. As what they are travelling for is serious, they expect complete transparency even before deciding on travelling abroad, especially with regard to the cost of treatment, duration of stay and profile of the doctor. And, when these factors are taken care of, they are curious about the place of treatment, facilities available and vicinity to the basic needs during the stay, such as hotels, restaurants, prayer places, etc.

At Nanavati Super Speciality Hospital, we understand these needs of the patient; hence, everything is communicated to the patient before treatment. We even inform the patients that the costs may vary if there are unforeseen complications. However, what sets us apart from others is our post-operative care. Using our telemedicine facility, we follow-up the patients many months after their surgery to make sure they are alright and doing better after visiting us.

Inbound medical tourism is concentrated in Bengaluru, Chennai, Delhi and the National Capital Region (NCR), and Hyderabad, and Mumbai appears to attract domestic medical tourists from other states.

Has Nanavati Super Speciality Hospital got any plans to reverse this trend?

Medical tourists are not only coming to these states, but also to Pune, Bhopal, Nagpur, Chandigarh, Amritsar and Thrissur, which do not even have international airports. Therefore, it’s the quality of the doctors and the hospital infrastructure which attracts patients to a hospital. Mumbai already has been getting a huge chunk of patients

from the Middle East concentrated in a small area in South Mumbai. The only thing which needs improvement here is the management of facilitator. There has to be streamlined management of facilitators who are referring these patients. Mumbai is already on the world map.

Nanavati Super Speciality Hospital is not only a hospital, but also a centre of education and excellence.

Most of the business is generated by the referring doctors from other countries and some established medical facilitators in the country Currently, most of our medical tourists are from Africa and Middle East for cardiac procedures, but we do see people from developed countries coming to India for cost-effective solutions.

How do you plan to diversify into new products and widen geographical reach?

The African, Middle East and South Asian Association for Regional Cooperation (SAARC) countries prefer coming to India for cardiac, orthopaedic, neurology and oncology procedures. There has also been a huge inflow of patients coming from developed countries for Ayurvedic and wellness treatments to Kerala for the longest time.

At Nanavati Super Speciality Hospital, we wish to promote cosmetic care and wellness, as these are increasingly becoming prerequisites to complete health.

What types of business strategies are being adopted by Nanavati Super Speciality Hospital to

maintain a balance between national healthcare demands and targeting new customers through medical tourism? What steps have been enunciated to ensure the development of Indian healthcare sector through medical tourism?

Many people think that if one builds a private hospital and promotes highquality high-cost healthcare, the masses will be affected. However, that is not the case. In fact, most people don’t realise that if a hospital adopts international standards in its treatment, it indirectly affects the quality of care given to its domestic patients. For example, if a hospital that was catering to its domestic patients installs central air conditioning to upgrade its quality, it would be a win-win situation for all. Our primary motive is to serve our nation’s healthcare needs. And, medical tourism can directly impact operations and processes of a hospital, which when upgraded indirectly serves the domestic needs.

‘Medical outsourcing’ from developed countries to Asian countries offering high-quality healthcare at low cost is on rise.

Please enumerate the reasons behind this shift.

‘Medical outsourcing’ has been happening for eons of years, in fact, since the time of the Greek God Asclepius when people used to come from all over the world to his temple for healing. In most cases, people from developed countries travel to developing countries for treatment because of expensive treatment or long waiting lines for insurance. The trend, as you asked before also, is inclining towards cosmetic surgery, spa and wellness.

At Nanavati Super Speciality Hospital, our services are at par with international hospitals, especially inpatient department (IPD) services and state-of-the-art wards for the patients’ stay.

June / 2016 ehealth.eletsonline.com

41

Medical Device Policy

AIMED: Correction of Inverted Duty Structure & Quality Assurance – Talisman to Boost Confidence in Local Manufacturers AIMED is hopeful that when the regulatory framework comes up it can utilise the ICMED certification as an alternative to Regulatory Factory Inspections, says Rajiv Nath, Forum Coordinator, AIMED in an exclusive interview to Elets News Network (ENN)

T

he Association of Indian Medical Device Industry (AIMED) has taken up a number of initiatives to encourage ‘domestic manufacturing’ in India.

The three most recent achievements of the AIMED are:

Tax & Duties Manufacturers will invest only if businesses they invest in can be viable. With the Department of Revenue, we have taken up the issue of ‘correction of inverted duty structure’ with the support of Indian Tariff Commission, DOP, Department of Industrial Policy & Promotion (DIPP) & the Ministry of Health & Family Welfare (MOHFW) whereby earlier the import duty on medical devices was mostly 5 per cent of the basic duty and in some case 0 per cent. There has been increase with effect from 19 January 2016 to 7.5 per cent of basic duty for 67 ITC Categories of Medical Devices and we are requesting similar imposition for the balance 19 Categories of Medical Devices. Similarly, the special additional duty of 4 per cent to enable balancing with sales tax (value-added tax (VAT)) has been re-imposed for the above stated 67 medical devices and we

42

June / 2016 ehealth.eletsonline.com

are requesting them to be extended for the balance medical devices.

Earlier the cost of manufacturing made Indian medical devices noncompetitive, as the peak rates of duty of 10 per cent of basic duty and 16 per cent of excise duty are usually applicable on raw materials.

From 19th January, the basic duty on inputs, such as raw materials and components to manufacture these 90.18, 90.19, 90.20, 90.21 & 90.22 Category of Medical Devices has been reduced to 2.5 per cent on the actual user condition. We are requesting this facility to be extended to medical devices covered under 30.06, 38.22 & 90.27, so that these could also be produced in India profitably.

We are requesting the medical

‘Incremental cost increase’ is a bitter pill in the short term to ensure long-term benefits for India to be self-dependent in the production of medical devices; local competition will bring down the prices Rajiv Nath Forum Coordinator, AIMED

community to bear with this incremental cost increase, as it’s a bitter pill in the short term to ensure longterm benefits for India to be self-dependent in the production of medical devices and local competition will bring down the prices.

Regulations There is a lack of regulations and an incorrect regulatory law of drugs is being applied to medical devices, which

For Campaign Queries Nilender Kumar; sales@elets.co.in; +91-8860635837

Find us on ehealth.eletsonline.com

Medical Device Policy

are discouraging investment in medical devices. We have been in a dialogue with MOHFW (with the support of Department of Commerce & Department of Pharmaceuticals) for a revised regulatory framework for medical devices by the Ministry of Health under a proposed IHPRA – Indian Healthcare Products Regulatory Authority – built around self-certification compliance according to the best international regulatory practice and independent of drugs.

We need minimum government and maximum governance, a separate law book, and a separate rule book than Drugs & Cosmetics (D&C) ACT with third-party certification. The ministry has now conceded and the drug rules are being amended to have a separate set of rules to regulate ‘notified medical devices’, and there is now an ongoing consultation with the stakeholders for ensuring these changes. Thereafter a New Medical Device Bill 2016 is under drafting by the MOHFW. The proposed regulatory framework will not only ensure patient safety, but also aim to inculcate confidence in Indian medical devices amongst the public.

For the short term, in order to ensure the ease of doing business, the following actions have been taken by the MOHFW and Central Drugs Standard Control Organization (CDSCO) for the 23 medical devices that were being regulated as drugs: On March 29, the draft notifications

Key Takeaways • Lack of regulations • Application of an incorrect regulatory law • Ensure minimum government & maximum governance • Need to have a separate law book

44

June / 2016 ehealth.eletsonline.com

to amend Rule 76 and Schedule MIII to delink medical devices from pharmaceutical-type regulation were issued to define the quality management system requirements.

This is based on the International Organization for Standardization (ISO) 13485 standard and will be a big relief to the existing manufacturers who had been arbitrarily inspected so far according to the Schedule M for pharmaceuticals.

A letter was issued by the Drug Controller General of India (DCGI) for doing away with No Objection Certificate (NOC) from Port ADC for export shipments destined to the Global Harmonization Task Force (GHTF) countries to avoid delays of exports, as these countries already have robust import regulations to protect their citizens.

A letter was issued by the DCGI for extending the validity of Free Sales Certificate (FSC) of ‘devices notified as drugs’ from two years till the validity of the manufacturing licence to help exporters.

Indian Certification of Medical Devices (ICMED) Scheme Meanwhile, in the absence of regulations, the Quality Council of India (QCI) has launched a voluntary certification scheme for the Indian medical device manufacturers.

The Indian Certification of Medical Devices (ICMED) Scheme is the first home-developed international class certification scheme for the medical devices in the country and is an initiative of the QCI in collaboration

with the AIMED and the National Accreditation Board for Certification Bodies (NABCB). ICMED is aimed at enhancing ‘patient safety’ to provide ‘enhanced consumer protection’, along with the much-needed ‘product credentials’, to manufacturers for instilling confidence among buyers and users.

The certification scheme was launched on 15th March 2016 and has presently two options for certification that include ‘ICMED 9000 Certification (ISO 9001 plus additional requirements)’ and ‘ICMED 13485 (ISO 13485 Plus additional requirements)’.

A third level, which would additionally prescribe medical device specifications developed by the National Health Systems Resource Centre (NHSRC) of the MOHFW is still under development and would be launched later.

Currently, there is no Indiaspecific official quality assurance system, due to which Indian medical device manufacturers encounter loss of competitiveness to foreign companies, while consumers end up paying extra premium with no concomitant benefits. In such a scenario, ICMED fills a big regulatory void. The certification under the ICMED scheme done by an independent third-party mechanism shall not only lend credibility to medical device manufacturing processes, but it will also help in ensuring quality of products. We are hopeful that when the regulatory framework comes up, it can utilise the ICMED certification as an alternative to Regulatory Factory Inspections.

6700+

Corporate Interview

IBM Analytics: Increased Adoption of Cognitive Solutions Underlines India’s Openness to Technology Healthcare providers and researchers can use social analytics to learn about the opinion of customers about their brand, service and the team of doctors, says Partha Dey, Healthcare Leader, IBM India/SA to Elets News Network (ENN) What types of healthcarespecific solutions are offered

by IBM Analytics to assist medical facilities in taking key transformative business decisions? Do you see a trend of increased adoption of such novel technological methodologies in India for making strategic decisions?

Across the globe, especially in India, majority of the healthcare data is unstructured and disparate, with most useful information recorded in papers or available in the form of prescriptions, unrecorded documents and so on.

IBM’s analytics capabilities address the challenge of inability to reference and action on such unstructured data. IBM’s cognitive solutions can create actionable insights from both structured and unstructured data and help take better decisions for better care management. IBM’s Watson for Oncology is one such step towards assisting the care providers to suggest the best course of treatment.

By applying IBM Watson’s cognitive technologies to the vast amount of data, medical practitioners can uncover patterns, opportunities and actionable hypotheses that would be virtually impossible to discover using traditional research or programmable systems alone.

These advanced and cognitive

46

June / 2016 ehealth.eletsonline.com

Corporate Interview

solutions have been adopted at the same rate as in the western world, which shows India’s openness to new technology in healthcare, as we have seen in telecom.

terminology management, userSolution defined assessment Sir, the averagetools, ageand of acomplex person suffering with heart diseases has • IBM’s Watson for privacy consent management. comeand down drastically and the rate of coronary heart disease

As every industry has its own challenges when it comes to developing business solutions, what kind of socioeconomic and political parameters play crucial role in the Indian healthcare sector? What all kind of expertise and steps are involved in identifying trends and gaps?

tools managing the With Indians social are 17platforms times more becoming prone to suffering from for heart attacks than their the western new counterparts. medium ofI have expression, developed an easy-to-learn formula of 80 to day-to-day activitieslive information up till the age and of 80 communication without a heartinattack: of public health today’s data cannot Dr KK world, formulasocial of 80 for living up to 80 without attack • IBM’sa heart Predictive be ignored. IBM’s Social Analytics Analytics: A tool practice brings some very useful and that help predict specific tools for healthcare players. probability and IBM’s landmark partnership with intensity of disease Twitter gives us an unprecedented outbreak in cities and access to social data, which when provinces coupled with other exogenous data, such as weather, events, etc., brings • IBM’s Social Analytics: forward useful trends, predictions Brings some very useful and actionable insights. Healthcare and specific tools for providers and researchers can use healthcare players social analytics to learn about the opinion of customers about their brand, service and the team of doctors; IBM is completely cognizant of customer treatment preferences; customers’ privacy rights and at opinions and experiences with various every step we respect and take care drugs; predicting disease outbreak in of patients’ private data. Analytics are specific geographical regions, etc. run on de-identified data provided by healthcare providers. All IBM tools are secure and trusted by every partner to With so much focus on ensuring get the best insights with any quantum privacy of data, how far has of structured or unstructured data.

IBM Analytics succeeded

IBM’s suite of solutions for public health, such as Panorama, provide public health professionals a powerful and comprehensive set of tools for managing the day-to-day activities of public health, and for less frequent but devastating occurrences, such as outbreaks or pandemics.

Additionally, IBM’s Predictive Analytics capabilities help predict probability and intensity of disease outbreak in cities and provinces. This new IBM solution is primarily designed for the use of provinces, states or country, as well as assists in the prevention, identification, treatment and management of communicable diseases and major outbreaks.

Its evolution has also resulted in pragmatic first-of-a-kind solutions to complex public policy and public health challenges, including medical

Oncology

in the Indian community is almost twice as high as their western • Panorama: for A our counterpoints. be your recommendations How is IBM usingWhat Socialwill Analytics comprehensive set of to tackle this problem? inyoungsters healthcare?

in aggregating trusted data available in the Indian market, particularly with the current status of market being still undefined to a large extent?

Key Takeaways • Enables reference and action on data to identify patterns, opportunities, etc.

• Actionable insights from both structured and unstructured data for decision-making • Unprecedented access to social data through IBM’s landmark partnership with Twitter • Ensures customers’privacy rights at every step • Secure tools trusted by every partner to get the best insights • Built a strong partner ecosystem across all functions and industries

Since ‘collaboration’ is one the key principles of IBM Analytics, what all types and levels of collaborations IBM Analytics has in the Indian healthcare sector? Do you also collaborate with medical institutions across India? If yes, please provide the details.

IBM has built a strong partner ecosystem across all functions and industries, with healthcare being one of them. We have various partnerships with leading institutes and hospitals across the world. Their industry expertise and our technological prowess bring together such tools and solutions that help us understand the events, customers and treatments, like never before.

June / 2016 ehealth.eletsonline.com

47

Corporate Interview

MedGenome: Genomics Solutions to Ensure Radical Clinical Practice Impacts Genomics-based diagnostics is now getting accepted as an effective tool for doctors in their routine clinical practice and ‘powerful screening tests’ for high-burden diseases, shares Hiranjith G H, Director, Corporate Planning and Marketing & Communications, MedGenome with Elets News Network (ENN) How far has MedGenome succeeded in ‘normalising’ the concept of ‘genomics-based diagnostics and research’ to deliver enhanced healthcare compared to other traditional approaches in the Indian market? Please explain in detail.

MedGenome has been successful in spreading the relevance of genomics in clinical practice for the last few years.

We have been engaging the medical fraternity, thought leaders, academic institutes, research centres, hospitals and policymakers at multiple levels and doctors now see how genomicsbased diagnostics can prove to be an effective tool in their routine clinical practice. In line with this is the fact that MedGenome currently works with more than 800 doctors and 500 hospitals across the country.

Our medical education programmes, symposiums and conference participation have allowed us to create awareness and educate the key gatekeepers in the healthcare system. Genomics-based diagnostics is expected to support the clinicians in better diagnosis, treatment, and management of chronic and acute diseases through targeted approaches.

They are also getting accepted as powerful screening tests for highburden diseases, e.g. the non-invasive

48

June / 2016 ehealth.eletsonline.com

prenatal screening that MedGenome offers in India exclusively.

Our genomic centres have been actively involved in creating an environment for genetic testing, as well as to engage genomicsbased research.

The adoption is slow given the various constraints, but by offering advanced tests at affordable prices and at global standards, MedGenome has been able to achieve a leadership position in the genomics-based diagnostics and research in India.

Last year the well-known geneticist and the principal leader of Human Genome Project Prof Eric S. Lander had cautioned against the hype around genomic research despite being promising?

Please comment.

Any new breakthrough discovery in science is bound to create attention and ‘Human Genome Project’ is no different. The fact of the matter is that it aroused lot of public interest and many believed that the course of healthcare would radically change in a very short frame of time. However, genomicsbased research is complicated and will take time to develop insights that are applicable in clinical practice.

Access to patients with rich archived data, and availability of baseline data,

advanced interpretation capabilities and scientific know-how to convert the genomics insights into a successful drug discovery and research programme is not a small task. But, we have been successful in some attempts and many more attempts are ongoing.

So, it is clear that the journey is not easy, but can provide promising results as eventual outcomes.

Which new segments and diseases are being targeted through ‘genomics-based diagnostics and research’ in the Indian healthcare?

It is estimated that India’s disease burden of diabetes and cardiovascular disease is bound to increase by 48

Corporate Interview

million and 69 million respectively by 2017. The cancer burden in the country is on the rise, so we can expect genetic markers to play a vital role in selecting the right drug for the right patient. Apart from oncology, metabolic diseases and cardiovascular diseases, genetics can play a major role in providing targeted drug choices for inherited disorders and rare disorders. With a high birth rate of 26 million in a year and approximately 5 per cent high-risk pregnancies, screening for chromosomal disorders in the paediatric population is also an area where genetics can play an impactful role.

In order to spread awareness about ‘genomics study’ and assist government in developing solutions against inherited diseases, do you have any partnerships with institutions, such as the National Institute of Biomedical Genomics (NIBMG), CSIR-Institute of Genomics & Integrative Biology (IGIB), etc.?

Please provide details.

Yes, we have collaborations with both government and private institutions to run research programmes in the key disease areas. In its effort to address the genetic problems prevailing in the Indian subcontinent, MedGenome has partnered with GenomeAsia 100K, a consortium aimed at sequencing 100,000 Asian genomes. The objective is to gain an understanding of the underlying

MedGenome - Key Achievements • Has succeeded in spreading awareness • Successful in enabling precision medicine in clinical practice • Has acquired leadership position

Genomics-Based Diagnostics - Key Benefits • Will ensure better diagnosis, treatment, and management of chronic & acute diseases through targeted approaches • Non-invasive prenatal test can change the way the pregnancies are managed in the country • Will enable screening for chromosomal disorders in the paediatric population population genotype in this region and thereby enable drug discovery and research to combat the diseases of high unmet need.

In 2015, MedGenome announced $20 million Series B investment from Sequoia Capital. What kind of scaling and enhancement measures were undertaken post this investment? Do you have more such investments in the pipeline?

MedGenome has increased its current laboratory capacity to be the largest throughput next-generation sequencing (NGS) lab in the region.

We have spread pan-India with a team size of more than 35 focusing on key disease areas. Our diagnostics test menu has more than tripled in the last 1 year, in line with the demands from our customers. Across oncology, neurology, ophthalmology, metabolic diseases, rare disease and paediatric disorders among others, MedGenome has forayed into expanding its offerings to customer bases in Southeast Asia and the Middle East and North Africa (MENA) region, where consanguinity levels are high and hence the burden of genetic disorders.

We have also launched various genomics solutions in cancer immunotherapy in the United States (US) in the past year, catering to the pharmaceutical and biotech industry.

We also have a Clinical Laboratory Improvement Amendments (CLIA)/ College of American Pathology

(CAP) certified lab in the US now, which will offer NGS services to our research customers.

With gene sequencing machines becoming more affordable and portable, do you think gene sequencing will soon move from government and high-end labs to regular medical centres in the corner?

Yes, with the cost of sequencing machines, as well as deoxyribonucleic acid (DNA) sequencing, reducing drastically in the past decade, sequencing can become a norm in clinical practice. However, it still needs to be seen that how many of them would want to invest in sequencing machines, since the analysis part is still very complex. The analysis will help in interpreting the genomic data for useful insights. This will require skilled bioinformatics capabilities, which will need to be developed over a period of time, which is what MedGenome has done so far.

However, very clearly, the application of genomics in the clinical practice is going to be very impactful.

Do you intend to target tier-I and tier-II cities where multi-specialty hospitals are spreading their reach?

Yes, we have a network of more than 500 hospitals across the country. Our team spans across all the regions and interact with the doctors in tier-I and tier-II cities supported by our panIndia logistics network.

June / 2016 ehealth.eletsonline.com

49

Corporate Interview

Indus Health Plus: One-Stop Solution for Cost-Effective Healthcare

Our motto is to make quality healthcare “Available, Accessible and Affordable” to masses, shares Amol Naikawadi, Joint Managing Director, Indus Health Plus with Elets News Network (ENN) What kind of business strategies, technical innovations and new partnerships are being undertaken by Indus Health Plus to bring preventive healthcare check-ups at door steps?

If we look at business strategy, we are expanding our business and partnerships. Our business model is such that we tie-up with the stateof-the-art hospitals and diagnostic chains to provide preventive

healthcare packages at an affordable rate. We are giving a one-stop solution to all clients across locations at same cost with no compromise on the quality of service. With turnaround time made smoother, meeting time requirement for reports generation, we are consistent towards giving quality service at minimal time. Our motto is to make quality healthcare available, accessible and affordable to masses and that’s how we plan our communication across markets to reach out to more.

Objectives • Adoption of new technologies for high-end preventive health check-ups • Focus on a geographical expansion in stages • Vision to serve tier-II and tier-III cities, as well as smaller towns Technology plays an integral part in the business. We have strong and integrated back-end processes and an in-house call centre that provides all the details regarding the checkups to the customers.

Electronic health records (EHRs) encompass and leverage digital progress and can transform the way care is delivered and compensated.

With EHRs, information is available whenever and wherever it is needed. It enhances privacy and security of patient data. It reduces costs through decreased paperwork, improves safety, and reduces duplication of testing We also have “Live Doctor Chat” service to enable the availability of consultation by a doctor. Hence, we are making the use of technology which helps grow our business better and provides good services.

50

June / 2016 ehealth.eletsonline.com

Corporate Interview

How far have you succeeded in realising your motto of making quality healthcare ‘Available, Accessible and Affordable’ each and every day? Please provide details.

The mission of Indus Health Plus is to make quality healthcare “Available, Accessible and Affordable” to masses every day. We want to educate people on the benefits of timely check-ups which not only save life of a person, but they also save their families from mental and physical trauma and financial distress. We are practicing our motto of making quality healthcare ‘Available, Accessible and Affordable’.

All hospitals and diagnostic centres have their own preventive health check-up packages, but this has been possible because they have always believed in our vision and that’s how they joined hands with us and hence we have been reaching out across the geographical spread in India and now also in the Gulf. We have partner hospitals and diagnostic centres in different cities across India that are using our affordable packages and making it possible to reach out to masses. We have reach in tier-I and tier-II cities, which is making healthcare available in remote areas.

So far we have reached 17 states, 121 centres across 78 cities with more than 5 lakh satisfied families. The services provided by Indus Health Plus are at a very nominal rate, which are substantially lesser than the medical tests conducted elsewhere,

Key Takeaways • One-stop solution • Strong & integrated back-end processes • Call centre • Live Doctor Chat” service • Tailor-made packages

at times close to 50 per cent less. With almost all the services under one roof and the entire testing, reports and counselling completed in a single day, this cost advantage is something that Indus Health Plus is proud to offer to its consumers.

It has been commonly observed that patients in India fail to complete their consultation due to prescription of lab tests.

Have you experienced this practice? What measures have been undertaken to spread awareness about the necessity of such tests as a preventive measure?

Each of our package has been tailormade according to the age group and the requirement of an individual, such as the number of tests, the duration of tests and the reports generated followed by counselling by a doctor.

So far we have not witnessed any problem because of this strategy.

With low penetration of insurance and big gap between urban and rural areas in terms of trained medical personnel, advanced diagnostic devices, etc., how

do you plan to create an indigenous healthcare system?

Indus Health Plus is not an insurance company. We are service providers for preventive healthcare check-ups.

As part of our expansion plans, we always look out for facilities that can give the best to the customers with well-equipped doctors and hospitals with high-end diagnostic equipment that can give quality results. We have partnered with various hospitals across 17 states in India and planning more by keeping in mind the rural and urban reach of it. Our strategy has made us frame a healthcare system in the country that has made the customers approach us easily to avail our services.

With a focus on the high-end preventive health check-ups, we are always trying to adopt new technologies for early detection mechanism. We are focusing on a geographical expansion in stages with a vision to serve not just tierII and tier-III cities, but also other smaller towns. With the edge in preventive healthcare that we are embarking on, even international bodies have started recognising us and in times to come, we look forward to extend our services in the international market also.

June / 2016 ehealth.eletsonline.com

51

Product Launch

Philips Intuis – Combines Technology & Affordability to Address Evolving Needs

I

n an effort to improve people’s lives through meaningful innovations in the area of healthcare, Royal Philips introduced Philips Intuis, which is a clinically versatile catheterisation lab (cath lab) with the state-of-theart live image guidance technology, as the latest innovation in image-guided therapy to ensure less invasive and more precise surgical procedures.

Intuis is an advanced, entrylevel cath lab designed, developed and manufactured at the Philips Healthcare Innovation Center (HIC) in Pune (India). It offers a full spectrum of capabilities ranging from innovation, design, research and development (R&D), and services to manufacturing of healthcare products.

52

June / 2016 ehealth.eletsonline.com

Intuis - An Important Milestone • Underlines HIC’s role as a healthcare innovation and manufacturing centre for India and other growth markets • Increases the scope of extending access to affordable cardiac care in tier-II and tier-III cities in India • Scope of extending Philips’s footprint beyond India to other growth geographies • Offers new possibilities in interventional procedures in India • Empowers interventional cardiologists and vascular specialists to decide, guide and confirm the right therapy for their patients in real time • Offers affordable care through its image quality and economic value

“We aim to deliver innovations to enhance existing image-guided minimally invasive therapies and to enable new ones,” Bert van Meurs, General Manager Image Guided Therapy at Philips

“Today interventional cardiologists need reliable systems that will help them perform a broad range of procedures,” Rekha Ranganathan, General Manager Mobile Surgery, Philips Image Guided Therapy Systems and Head of Philips HIC

Key Features • Follows Philips’ DoseWise X-ray dose management philosophy • Performs a wide range of diagnostic and interventional procedures, including cardiac, vascular and electrophysiology procedures, as well as an implantable cardioverter defibrillator (ICD) and non-vascular interventions • Enhances patient care by intelligent and intuitive integration of live imaging and real-time therapy guidance

For more news on Philips visit www.philips.com/newscenter

#elets_Ports

Host Partner

Conference Expo Awards

AUGUST

2016

P O R T- L E D D E V E L O P M E N T

OPPORTUNITIES FOR INFRASTRUCTURE & INDUSTRIAL GROWTH

For Details Contact: Fahim Haq, +91-8860651632, fahim@elets.in HEAD OFFICE

MIDDLE EAST OFFICE

Elets Technomedia (P) Ltd., Stellar It Park, Office No. : 7A/7B, 5th Floor, Annexe Building,

SAIF Desk Q1 - 05 - 130/A, P. O. Box: 124939, Sharjah, U.A.E

C-25, Sector 62, Noida, Uttar Pradesh - 201309, India, Ph: +91-120-4812600

ports.eletsonline.com

Elets Technomedia Pvt Ltd (FZE),

Medical Devices

UL: Indian Med-Tech Industry Promising, Despite Ambiguous Regulatory Framework Our primary goal is ensure medical devices comply with all regulatory and quality standards, shares Jibu Mathew, Business Development Head - Life and Health Sciences, South Asia, UL to T Radha Krishna of Elets News Network (ENN)

UL is a global independent safety science company with more than a century of expertise innovating safety solutions from the public adoption of electricity to new breakthroughs in sustainability, renewable energy and nanotechnology. What has been UL’s mandate in South Asia?

UL’s main mandate, especially in South Asia, is to work towards our corporate mission, i.e. create safer and healthier living environments in the areas we operate in. As a global leader in safety science, we want to provide our knowledge and expertise to our customers in navigating their manufacturing processes, supply chain and their products to be compliant. We also

• Large gap in understanding safety and regulatory framework, as well as the end-user framework

54

June / 2016 ehealth.eletsonline.com

want to enable our clients to address regulatory issues emerging from global market access. With 120 years of experience, through our testing, auditing, certification and advisory services, we would like to ensure that manufacturers, especially in the Indian market, succeed in their global market expansion plans.

What’s the support extended by UL to the medical device industry?

Currently, the medical device industry in India is dominated by multinational companies (MNCs) that manufacture and import products.

There are also small and medium businesses, mainly dealing with disposables, implants and medical electronics. The third segment is that of the start-up community.

These med-tech industries face numerous challenges. Firstly, they have to navigate the regulatory framework, especially when their products cater to the international markets. Some of these industries, particularly in the start-up domain, have a very good technological framework. However, there is a

larger gap in understanding safety and regulatory framework, as well as the end-user framework, in markets where the product has to be sold.

UL assists these manufacturers right from the concept stage, when they have an idea and a technology, to address a clinical need. We take them through the entire product lifecycle from defining user requirements, understanding safety challenges and the risk aspect of devices.

Key Highlights • Assists manufacturers through the entire product lifecycle • Helps manufacturers in navigating through the complex regulatory compliances • Ensures safety for healthcare professionals, doctors, etc.

• Works actively with the government

Medical Devices

Therefore, the end benefit to the manufacturers is that while they can focus on their technological and enduser frameworks, UL supports them in navigating through the complex regulatory compliances required for international market access.

What’s your perspective about the medical devices segment in the Indian context?

Despite its significant growth, the medical devices industry in India is still at a very nascent stage.

In terms of market size, the total medical device consumption in the country at present is to the tune of $5.8 billion. When corresponded with the 1.2 billion plus population, the penetration of medical devices into healthcare sector is very minimal, especially in comparison to similar economies, such as China, Korea or Japan.

However, the medical devices sector in India is specifically focused on two aspects that include penetration and affordability.

Keeping this in view, there is a lot of innovation, in pockets, that is contributing to the growth of this sector. This is specifically in the non-communicable diseases space, where screening devices for pointof-care testing are being created for diseases, such as cardiovascular diseases, diabetes, etc.

Additionally, the government’s support through ‘Make in India’ campaign to help India reach the $50 billion devices market by 2025 has laid the platform for the growth of the med-tech sector in India.

Highlight the major concerns of

• UL has been helping the government to build the regulatory framework around medical devices

life and health science industry in India from a regulatory standpoint.

Currently, the medical devices industry is faced with an ambiguous regulatory framework, wherein medical devices are treated as drugs under the Drugs and Cosmetics Act. As a result, the distinctive identity for medical devices has been absent for long. Nevertheless, there has been tremendous change over the last 12 to 18 months. A regulatory framework is currently developed by the Ministry of Health & Family Welfare and Central Drugs Standard Control Organization (CDSCO). And, we are witnessing a significant momentum in this area.

The medical devices industry is grappled within the ambiguous regulatory framework, wherein medical devices are treated as drugs under the Drugs and Cosmetics Act How significant is the India market for UL? And, whom does UL work with in India in life and health science domain?

India is an important market for UL across various industry segments.

Our primary goal is aligned to our mission to ensure medical devices and products, especially in life and sciences devices segment, comply with all regulatory and quality standards. UL also wants to ensure safety for healthcare professionals, doctors, patients, technicians or nurses using such devices.

For us, the life sciences industry is important, as medical device sector is not only evolving but has also seen tremendous growth,

• India aspires to grow to a $50 billion Medical Devices market by 2025 from the current $5.8 billion especially in the start-up domain.

Med-tech start-ups are emerging with new and innovative technologies to help address clinical needs for diseases, such as cardiovascular diseases, ophthalmology, diabetes management, etc. These start-ups are paving the growth of the medtech industry and addressing the healthcare needs of India.

Companies, such as Skanray, BPL and Forus, which began as start-ups now operate on a global scale and their products are sold across the world. Their products are accepted by bigger countries, such as the United States (US) and European countries, which have complex regulatory frameworks. Our solutions are highly customisable depending upon where the product is in the product lifecycle stage.

In the light of ‘Make in India’, ‘Digital India’, and similar campaigns and programmes initiated by the government, what are the focus areas and vision of UL? In the larger sense, UL has been very actively working with the government in the areas of smart cities, water quality, solar power, healthcare, energy and electricity.

We have been actively working with the Ministry of Health & Family Welfare and CDSCO in articulating how regulatory framework can work in India. We are also helping the government in identifying and developing standards for medical devices to bring harmonised standards that are accepted globally by various regulators, and how India can adopt them.

June / 2016 ehealth.eletsonline.com

55

Medical Devices

Forus Health: Creation and Deployment of Products Require Innovation Our strategy is to use emerging technologies offering scope for improvement and at the same time, keep it affordable, says K Chandrasekhar, Founder & CEO, Forus Health Pvt Ltd to Nilender Kumar and Kusum Kumari of Elets News Network (ENN)

What are the key objectives of Forus Health in the Indian market? Please describe in detail the infrastructure and research and development (R&D) facilities available?

Our mission is to play a role in eradicating preventable blindness. We did not want to build a medical device company, the idea was to solve the problem and the medical device is the consequence of that thought process.

Given that India has only 20,000 ophthalmologists for a 1.3 billion population, we felt the need

of bridging this ratio skew using technology. We came up with the mantra of “Innovate, Implement and Impact”.

Our products or solutions are result of our innovation. The Forus Health team, including optical engineers, hardware engineers, software engineers, quality engineers and manufacturing engineers, ensure we create worldclass products completely “Made in India”.

Our R&D lab is the Department of Scientific and Industrial Research (DSIR) registered and our in-house manufacturing is ISO 13485 approved

Key Takeaways • Designs, manufactures and sells products • Creates costeffective devices adequate for identifying a problem • Integrates multiple features in products with the state-of-the-art facilities. We have filed over 14 patents, of which four have already been granted. We also collaborate with leading clinical institutions to create world-class products.

Please highlight the parameters on which Forus Health products stand apart from those offered by the competing service providers?

The differentiating factor for Forus Health is that we create medical devices as a consequence of addressing the mission of ‘preventable blindness’. The way we approach our product is very different from other manufacturers.

We make affordable devices that are adequate and appropriate for identifying a problem. Our products are integrated, portable, rugged and affordable, which can be operated

56

June / 2016 ehealth.eletsonline.com

Medical Devices

by a minimally trained technician and has an integrated telemedicine module for remote screening. Most of the above features differentiate us from our competitors. However, these features have been built not to differentiate our products, but to actually solve the problem. These features enable devices to be operated even in tier-IV areas, wherein users can send the images to the doctors located in cities for screening.

There are some challenges specifically in the Indian market in terms of regulations and designing due to the climate as debated on different discussion forums. Please share your opinion?

Forus Health implies “healthcare for us; my community and I. As such, our key goal has always been to solve the problems of our community. Our solutions integrate many factors, such as ruggedness, portability and usage of less power to suite the Indian conditions. We make “world-class products” from India; hence, our products do have a global market.

Our company is ISO 13485 certified, and 3nethra Classic is CE marked and the United States (US) Food and Drug Administration (FDA) registered.

As a result of all these factors, we automatically build quality into the overall system. This combined with the fact our products have been created for the Indian market makes Forus Health and its services scalable.

How cost-effective are Forus Health ’ products to become an integrated part of medical facilities not just located in metropolitan cities, but also in tier-I and tier-II cities? Please provide details.

Our focus has been to make very affordable products that are appropriate and adequate for doctors to screen eye problems. We have been able to reach tier-II and tier-III

58

June / 2016 ehealth.eletsonline.com

Key Principles • Innovate, Implement &Impact • Create world-class products • Solve the problems of the community • Integration of emerging technologies • Modular designs to migrate to next-generation products seamlessly • Make products adoptable by people & doctors cities. In about 4 years, our installed base is more than 1,100 devices in over 25 countries. In India, out of the installed base of over 950 devices (which is the largest installed base in India), 60 per cent are in tier II and tier III cities. Therefore, we see a positive trend for our business in the Indian market. We have always got positive encouragement from Indian ophthalmologists in terms of adopting our products.

Has Forus Health got adequate labs for testing the devices, as we have faced the problem of devices not working in the real scenario?

As reiterated, our products have been designed keeping the Indian conditions in mind.

We have our own labs and we also use third-party labs to validate the reliability, safety and ruggedness of the product. We are an ISO 13485 certified company, which is the international standard for medical devices. The standard mandates that we verify and validate the products

Achievements • Sold 1,100 devices • Reached tier-II and tier-III cities • Raised two rounds of funding - almost $13 million

before releasing to the market.

We all know the fact that technology is getting smarter and simpler with time. In the light of the above, what measures are being undertaken by Forus Health to upgrade its offerings and staff?

I think two things are very important.

Firstly, we have to build a product, which will actually solve the problem.

Secondly, whatever solutions one makes, they have to be seamlessly integrated with the behaviour of the people and doctors adopting the devices.

We use emerging technologies, such as cloud computing, for remote diagnosis, which helps us to scale and also be cost-effective. We were one of the early adopters of complementary metal-oxide semiconductor (CMOS) sensors in our designs, which is also an emerging technology trend. Our designs are modular and hence can help us to migrate to next-generation products seamlessly.

What are the regulatory roadblocks in the Indian market?

When we create products for selling in India, we always keep the basic quality and hygiene factor as CE certification. Moreover, our devices are non-invasive. Our product is CE marked and US FDA registered.

Hence, we do not see any roadblocks in terms of regulatory for the Indian market.

Medical Devices

POLYMED Aims to Innovate, Invest, Upgrade Skills & Scale Up Products To Stay Ahead

With technical and product training, our staff is well capable to create high-quality and innovative solutions for the medical devices industry, says Himanshu Baid, MD, Poly Medicure Ltd to Elets News Network (ENN) Please describe in detail the infrastructure and research and development (R&D) facilities available at Poly Medicure Limited (POLYMED) to meet the ever-changing market requirements and other healthrelated challenges?

The following are the facilities available at POLYMED to meet constantly changing needs of the market: • Total five manufacturing facilities in India (two facilities in Faridabad, two in Jaipur and one in Haridwar) and two facilities overseas (one in China – wholly owned subsidiary and one joint venture in Egypt) • Over 400,000 square feet of manufacturing area with 100,000 + square feet of a clean room area and state-of-the-art facilities with capacity to expand rapidly • All manufacturing facilities are certified by the European Union (EU) (Conformité Européene (CE) Certification); one facility is the United States (US) Food and Drug Administration (USFDA) audited

• Manufacturing process capabilities include injection moulding, extrusion, insert moulding, compression moulding, blow moulding, ultrasonic welding, radio frequency (RF) & high frequency (HF) welding, ultraviolet (UV) bonding, laser welding, etc.

• Include Design for Six Sigma (DFSS), failure mode and effects analysis (FMEA), lean manufacturing and advanced product quality planning (APQP) • Rapid prototyping using a threedimensional (3-D) printer, process validation and customisation of products • R&D facility approved by the Ministry of Science & Technology, Government of India • 20 engineers in new product development/design • 15 engineers in value engineering, operational excellence and automation • Over 95 patents granted and over 300 patents filed internationally • New investment of Rs 60 crore in a new green field project at Institute

of Management & Technology (IMT) Faridabad in Haryana and is geared up to launch a slew of products in the third quarter of 2017 with all statutory approvals

What measures are being undertaken by POLYMED to ensure staff members stay technically competent and well trained to create high-quality and innovative solutions?

Do you think POLYMED’s manpower stands on par with those globally?

• Regular training programmes for our staff members • Best human resources (HR) practices focusing on continuous training, key result areas (KRAs), Kaizen, 5S, leadership skills, Six Sigma, etc. are being adopted • Training programmes led by the experts from the industry • End user – nurses and doctors are also involved and are getting valuable feedback • Constant interaction with the R&D team by visiting hospitals to

June / 2016 ehealth.eletsonline.com

59

Medical Devices

develop new products/technology and improve the existing products • In December 2015, we conducted a ‘Global Training Program’ for our business partners all over the world Yes, POLYMED’s manpower stands on par with those globally, as we have over 1,500 full-time employees working at different facilities. With technical and product training, they are well capable to create highquality and innovative solutions for the medical devices industry.

blow molding, ultrasonic welding, RF & HF welding, UV bonding, laser welding, etc.

POLYMED stands out because of its large range of product basket compared with competitors

60

June / 2016 ehealth.eletsonline.com

Is POLYMED looking forward to any new business strategies and partnerships to counter increasing competition in the medical device manufacturing and testing segment? If yes, please provide details.

• We are adding new products in gastrology and nephrology, including machines • Scheduled to add more diethylhexyl-phthalate (DEHP) & polyvinyl chloride (PVC) free range of products in the portfolio which will provide better patient care and safety • Created separate verticals and sales team for blood bags and diagnostics • Appointment of POLYMED’s representative in some hot spots and territories worldwide for more product intelligence

Where does POLYMED stand in the med tech ecosystem vis a vis its competitors? What are the key features that make POLYMED stand out from others. Please explain.

Please describe the measures undertaken by POLYMED to meet design-related challenges when it comes to manufacturing world-class medical devices, especially in a country like India.

• In-house R&D facility • Rapid prototyping using 3-D printer, process validation & customisation of products • In-house design, manufacture and maintenance of injection moulds and semi-automatic assembly lines using computer (or computerised) numerical control (CNC) machine tools • Manufacturing process capabilities include injection moulding, extrusion, insert moulding, compression moulding,

sterilisation facilities

• Highly experienced and trained manpower consisting of over 75 engineers • DFSS, FMEA, lean manufacturing and APQP • Equipment and machinery sourced from reputed suppliers worldwide • Semi-automatic and automatic assembly machines designed using the latest technology and developed in-house using wellequipped tooling facility • In-house ethylene oxide and steam

We stand out in the med tech system due to the following reasons: • Strong R&D facilities • Manufacturing facilities – 100,000 + square feet of clean room to meet high volume demand • A large range of product basket compared with competitors • Our core values – W I S E W – We care as we cure for our people, planet & prosperity of our stakeholder I – Innovation in everything we do S – Safety in Product & Processes E – Excellence in quality of

Leadership, People, Processes & Products

Medical Devices

Translumina Therapeutics: Strategic Partnership is Key to Business Growth

For us, it’s not about business, but about creating a movement that will empower patients of all economics strata to get quality treatment, states Gurmit Singh Chugh, Managing Director, Translumina Therapeutics exclusively to Elets News Network (ENN) Please provide details of the path-breaking technologies and projects that Translumina Therapeutics has been part of in the field of cardiac devices.

etc. What measures and partnerships are being undertaken by Translumina Therapeutics to ensure such facilities are available?

In the treatment of coronary blockage, it was evident that drug-eluting stents significantly reduced the incidence of restenosis compared with bare-metal stent, but by the late 2000s, the Data Encryption Standard (DES) emerged with its own set of problems with the usage of polymer - the drug-binding agent and the drug coating.

Translumina Therapeutics entered the field of interventional cardiology with the drug-eluting stents having microporous surface and one-fourth polymeric load that have safely reduced the late events. The efficacy of drug has also been improved by abluminal coating on the stent. This is the first patented technology from India for the world.

As a company, we strongly believe in innovations with quality at affordable pricing. Translumina Therapeutics has world-class state-of-the-art CEcertified manufacturing facility in Dehradun, India. We manufacture a wide range of quality products to treat cardiovascular aliments of patients. These products adhere to stringent quality controls at all levels of production to ensure highest

In order to ensure world-class innovations, one needs best infrastructural facilities/labs for clinical trials, compliance with international standards,

62

June / 2016 ehealth.eletsonline.com

Achievements • Drug-eluting stents is one of the most cutting-edge, nonsurgical techniques that save lives • Already in the preclinical phase of developing valves to treat structural heart diseases

standards. Our organisation has wellexperienced and trained personnel managing various key production and quality control departments.

In today’s global scenario, the key to growth is partnerships that enable synergy of competencies of each partner. Translumina Therapeutics has strategic partnership with Translumina GmbH, Germany for creating world-class products with the highest standard of quality and clinical significance. The research and development (R&D) is jointly carried at Translumina GmbH’s facility in Hechingen, Germany.

Translumina GmbH and Translumina Therapeutics co-manufacture Yukon Choice PC in their respective facilities.

Translumina Therapeutics also shares a partnership with the German Heart Centre Munich, Germany for conducting clinical evaluations of newer technologies. German Heart Centre has created some landmark research on various technologies and procedures in interventional cardiology to enable cardiologists around the world to optimise their clinical outcomes.

Medical Devices

Yukon Choice PC, our flagship product, as a technology has undergone the highest level of clinical evaluation at German Heart Centre and the data is published in the top international journals, such as Journal of American College of cardiology, European Heart Journal, Eurointervention, etc.

You have vast experience in the field of interventional cardiology, but now we are witnessing a major shift from invasive to noninvasive procedures. Please provide details of the newer technologies and solutions that Translumina Therapeutics has.

The field shift from invasive to minimally invasive procedures in coronary and peripheral vascular procedures is one of the significant innovations over the years that have revolutionised the field of interventional cardiology. Whether you were born with a structural heart defect, or develop a form of heart disease later in life, it can be treated without a major surgery.

Our drug-eluting stents is one of the most cutting-edge, non-surgical techniques that save lives. In addition to that, we are already in the preclinical phase of developing valves to treat structural heart diseases.

Do you think an ecosystem enabling effective confluence of all stakeholders is emerging in India?

Yes, with the advent of ‘Make in India’ campaign in healthcare and its alignment with the key government initiatives, technology has created a strong impact on public health.

Translumina Therapeutics was incorporated with an objective of creating technologies which help the physicians in enhancing their clinical outcomes whilst making it affordable for the patients. For the last few decades, most of the

Key Takeaways • World-class state-of-the-art CE-certified manufacturing facility in Dehradun, India • Products adhere to stringent quality controls at all levels of production • Strategic partnership with Translumina GmbH, Germany for creating world-class products • Joint R&D by Translumina GmbH and Translumina Therapeutics • Partnership with the German Heart Centre Munich for conducting clinical evaluations of newer technologies newer technologies in interventional cardiology were launched by the United States (US) multinationals, as they had the expertise and the funding needed to create such radical innovations. Most of these technologies have definitely improved the treatment of coronary artery diseases and have been very successful. However, there has been an inheriting limitation in terms of their affordability in developing countries where the insurance and state-run reimbursement schemes only cover a small population and most of the patients have to fund their treatment themselves. In addition, there is also a tremendous cost burden on the insurance and reimbursement sectors in developed countries to sustain such costly treatments. This resulted in search for cost-effective solutions which were met by either outdated technologies of these US multinationals or some smaller companies mushrooming out of Asia and Europe which started offering such complex technologies without the needed clinical evaluation of these products.

With our rich experience of working with various multinationals in healthcare for more than 16 years, we decided to start Translumina Therapeutics with an objective to manufacture world-class technologies with the highest level of quality and clinical evaluation at an affordable

price. For us, it’s not about business, but about creating movement that will empower patients of all economics strata to get quality treatment.

With cardiac and lifestyle diseases emerging as one the leading causes of casualties in India, do you see adoption of new-age machines and solution by both public and medical institutes?

The true test of technology and innovation is when it helps the society at large to live a better life and your peers think why they could not think of this idea. In the time to come, the world shall belong to people whose simple ideas backed by relentless execution shall change the way people live and that shall be the true progress of science. The adoption of new-age machines and technology is important for both the public and private entities for the better and cost-effective treatment in India.

The first and the foremost need of the hour is ‘patient awareness’. We are working relentlessly to ensure that the patient is aware about the disease which helps in early diagnosis.

We also distribute booklets and other information at the clinical and on our websites to ensure that the patient gets the correct information about the treatment and all his or her questions are answered.

June / 2016 ehealth.eletsonline.com

63

Government News

Health minister JP Nadda endorses ‘plain packaging’ for cigarettes – Draws flak from tobacco manufacturers Mission Indradhanush aims to include more vaccines in kitty – More than seven colours soon

I

n a recent announcement, the health ministry announced the plans to revamp its flagship immunisation programme ‘Mission Indradhanush’ to include four new vaccines.

The health minister Jagat Prakash Nadda aprised that the mission aims to fully immunise children against vaccinepreventable diseases. Currently, the programme provides coverage against seven life-threatening diseases, but it will soon also include vaccines for rotavirus, measles rubella, inactivated polio vaccine biavalent and Japanese encephalitis for adults.

Mission Indradhanush — depicting the seven colours of the rainbow — will also be rechristened accordingly.

It currently provides immunisation coverage against diphtheria, whooping cough, tetanus, polio, tuberculosis (TB), measles and hepatitis B.

64

June / 2016 ehealth.eletsonline.com

O

n the occasion of ‘World No Tobacco Day’(31 May), the health minister Jagat Prakash Nadda endorsed the decision of the World Health Organization (WHO) to implement ‘plain packaging’ for cigarettes and tobacco products globally. He has also hinted upon its implementation in India.

Understanding ‘Plain Packaging’ Plain, or standardised, packaging has a uniform colour across all brands, except for health warnings. Any brand names are in small, nondistinctive lettering.

Key Takeaways of Plain Packaging  Will make smoking comparatively less glamourous and attractive  Will significantly impact ‘public health’  Some of the influential countries, such as the United Kingdom (UK), France and Australia, have already implemented “plain packaging” Debates  Tobacco-manufacturing companies have derided the decision as mere “dogma” than a “fact”  Such an implementation will increase illegal market  Not likely to impact smoking trends  Impact the livelihood of people  Impact the intellectual property rights of legal manufacturers and promote the cause of smuggled foreign brands Anti-Smoking Measures Available  India has already adopted strict health warnings size rule by increasing the size of warnings from 40 per cent to 85 per cent

Company News

Barco to leverage technology to accelerate local growth under Rajiv Bhalla

B

arco, a global technology company that designs and develops networked visualisation products for the entertainment, enterprise and healthcare markets, announced on May 18 the appointment of Rajiv Bhalla as managing director for India.

With 22 years of senior leadership experience in leading technology organisations, such as Thomson Consumer Electronics, Microsoft, etc., his in-depth understanding of business-to-business (B2B) and business-to-consumer (B2C) aspects of the business will play a key role in enhancing Barco’s overall growth.

Rajiv will assist Barco in strategising business goals to expand local

business and accelerate growth.

Besides this, he will also be the legal representative of Barco India, fulfilling all legal, regulatory and statutory obligations, ensuring compliance with local legal, safety, environmental regulations, as well as company’s directives and guidelines.

Rajiv finds the Indian market quite exciting due to the current government’s focus on innovation and digitisation of services. He visions immense scope due to projects, such as Smart Cities, Digital India and Make in India. Interestingly, he aims to accelerate a new era of growth and innovation by leveraging technology and operational excellence of Barco.

Consure Medical secures funding from Accel Partners & others – Aims new markets and customers Consure Medical, a healthcare startup founded in 2012 that aims to become one of the most patientcentric medical device companies in the world, has received an undisclosed series-B funding.

Series-B funding is the second round of financing for a business by private equity investors or venture capitalists. Reportedly, the funding for Consure Medical was led by the venture capital firm Accel Partners, with participation from the earlier investors that include Indian Angel Network, India Innovation Fund and India Venture Partners.

Key Objectives  Penetration into new markets  Investment in further product development for critical

Nishith Chasmawala CEO, Consure Medical

care setting  Growing customer reach  Building sales in India and the United States (US)  Targeting Japan as the

next market destination Recent Achievements  Product platform — the Qora Stool Management Kit (SMK), which has received 510(k) US Food and Drug Administration (FDA) clearance for its Qora suite of devices  Added a short-term product, Qora Arida, and two long-term products, Qora Aeon and Qora AIM, which is MRI-compatible, which offer an expanded faecal management portfolio for complex critical care patients and long-term acute or nursing care patients june / 2016 ehealth.eletsonline.com

65

Start-Up Lyfboat

Lyfboat: Finding Trustworthy Healthcare Providers Has Never Been Easier Lyfboat aims to affect organisation and structure for all the stakeholders in the medical travel industry, says Anuj Gupta, CEO, Lyfboat to Elets News Network (ENN)

A

large global population underserved by their healthcare system at home, seek medical treatment abroad but struggle to get the right medical care due to unstructured healthcare information, lack of transparency and inflated treatment costs. This worldwide problem led to the advent of Lyfboat – a curated marketplace for the medical travel industry.

Lyfboat empowers patients from over 90 countries to make educated decisions on whom to trust with their healthcare.

Lyfboat.com is a curated medical travel platform that connects patients with trusted hospitals and surgeons worldwide, so that they can find the right medical treatment. It offers a onestop experience to find information on medical procedures, compare qualified hospitals, and get competitive cost estimates ahead of travel. Patients can also consult reputable doctors for free medical opinions to enable them to make educated decisions on the next course of action. Lyfboat’s proprietary cloud-based platform for patients, healthcare providers and medical facilitators is integrated into a single solution. With its firstto-market platform, Lyfboat aims to affect organisation and structure for

66

June / 2016 ehealth.eletsonline.com

all the stakeholders in the medical travel industry.

Key Takeaways of Lyfboat Medical providers associated with Lyfboat benefit with increased online visibility and discoverability while offering price transparency and expert opinions to patients.

Lyfboat is partnered with leading internationally accredited hospitals across India, Thailand, Malaysia and the United Arab Emirates (UAE) and is selectively expanding its provider network across the globe.

According to Anuj Gupta, CEO, Lyfboat, “Given the ease of travel around the world, healthcare is no longer limited by geography. Millions of patients travel abroad for medical treatment, but they often pay exorbitant prices. The right choice can help save anywhere from 30 to 80 per cent on the cost of medical treatment.” He further adds, “The medical travel landscape has undergone an unfortunate transformation; it has become tainted with unqualified middlemen overstating costs and misguiding patients. We want to solve this problem of inflated costs, patient misdirection and unqualified facilitation. We are transforming the industry by delivering quality medical treatment to patients in a transparent and structured manner.”

“We want to solve the problem of inflated costs, patient misdirection and unqualified facilitation globally” Anuj Gupta, CEO, Lyfboat

Overview Lyfboat, established in 2015 in New Delhi, was launched to consumers in March 2016. It was founded by three partners that include Anuj Gupta, CEO, who is a seasoned entrepreneur and the technical mastermind behind Lyfboat. Anuj drives the overall vision and strategy of the company. Dr Surbhi Suden, Chief Medical Officer, is a physician turned entrepreneur who has dedicated the last seven years to medical facilitation and patient care.

Mitika Gupta, Chief Product Officer, brings extensive knowledge in building intuitive online services and digital marketing based on years of experience working with market leaders, including Microsoft and Amazon in the United States (US). The company also has a solid advisory board of established technology entrepreneurs and surgeons from India and the US. Lyfboat has received tremendous response on the product quality and concept from healthcare partners. In the coming year, the Lyfboat team will be focused on driving market adoption while continuing to add value to consumers seeking medical care.

summit 30 June 2016, Le MĂŠridien, New Delhi th

Powered by:

Contact : Nilender Kumar | +91-8860635837 | hlf@eletsonline.net