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AUGUST 2017 | VOLUME 12 | ISSUE 08
10
COVER STOR
Smart Healthcare: A Game Changer
POLICYMAKER’S PERSPECTIVE 14 Transforming India’s Rural Healthcare Faggan Singh Kulaste Minister of State for Health and Family Welfare, Government of India 16 Electronic Medical Records Soon to Become a Reality in India Dr Ajay Kumar Additional Secretary, Ministry of Electronics and Information Technology, Government of India
INDUSTRY PERSPECTIVE 17 Elsevier: Delivering Best Possible Clinical Care to Save Lives Dr Lalit Singh Director, Clinical Solutions and Product Strategy, Elsevier Health 24 The Risks of Using Spurious Reagents to run Blood Analysers Dr Rajeev Gautam President, HORIBA Medical (India) Pvt Ltd 30 IVH: A Reliable Companion of Medical Travellers Gaurav Pandey Co-founder and Lead-Information Technology, India Virtual Hospital 32 Time to Think of Healthcare Beyond Hospitals O P Yadava CEO and Chief Cardiac Surgeon, National Heart Institute, New Delhi
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36 e-Governance in Indian Healthcare: Building a Stronger Nation Phanish Chandra Co-founder and CEO, Docplexus 38 A Novel Way to Combat Sedentary Lifestyle Ravi Krishnan Co-founder, Stepathlon Lifestyle Pvt Ltd
INDUSTRY INITIATIVE 20 Work Begins at Iconic Park for Medical Devices Following 11 months of groundwork and planning, construction activity at Andhra Pradesh MedTech Zone (AMTZ), the 270-acre state-of-the-art iconic park dedicated to medical device manufacturing, has been initiated.
ADVERTORIAL 28 The Curious Case of Two Beating Hearts A 45-year- old patient has two beating hearts in his chest after doctors at Kovai Medical Center And Hospital (KMCH), Coimbatore, successfully performed Asia’s first Heterotopic Heart plantation on a beating heart using the Direct Pulmonary Artery Anastomosis technique.
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Editorial Smart Healthcare Paving the Way for a New India Smart healthcare is gradually yet surely changing the way health services are delivered in India. From smart and connected Internet of Things (IoT) devices, sensing technology and real-time data analytics to mobile apps connecting patients with doctors and test laboratories, technology is propelling the country’s healthcare industry into the future. Innovations like telemedicine and teleradiology, too, have emerged as potent tools to deliver healthcare services in the country’s remote areas that lack human resources. The cover story of eHEALTH’s August issue, ‘Smart Healthcare: A Game Changer’, focuses on the role being played by smart technologies in transforming the Indian healthcare sector with useful insights offered by captains of the health industry. This issue of eHEALTH magazine also carries interviews of Faggan Singh Kulaste, Minister of State for Health and Family Welfare, Government of India and Dr Ajay Kumar, Additional Secretary, Ministry of Electronics and Information Technology, Government of India. The interviews present the perspective of the policy makers on digitalisation, e-medical records, IoT, among other ideas that are projected to change the delivery of health services in the future, even as the government continues its efforts to transform rural healthcare in the country through various schemes and initiatives. Elets Technomedia organised the 7th Healthcare Leaders Forum (HLF) - 2017 in New Delhi on June 30. This issue of eHEALTH magazine carries a detailed report of the conference that attempted to find ways to unlock the inherent potential of the health industry and help the country achieve its health goals. The conclave was graced by Dr Jitendra Singh, Minister of State (Independent Charge) for Development of North Eastern Region and Minister of State PMO; Dr K Rajeswara Rao, Joint Secretary, Ministry of Health and Family Welfare, Government of India; Peter Taksøe-Jensen, Ambassador Extraordinary and Plenipotentiary Royal Danish Embassy, Denmark; and Arun Singhal, Joint Secretary, Ministry of Health and Family Welfare, Government of India. Also healthcare industry leaders, experts, CEOs and other important industry stakeholders were part of this summit. In pursuance of its objective to bridge the existing knowledge gaps in the two most promising sector of the Indian economy -- Food and Pharmaceuticals -- eHEALTH magazine, in collaboration with Gujarat FDCA, will organise the ‘National Food and Pharma Summit’ in Ahmedabad on August 28. This conclave carries forward the vision of Gujarat Chief Minister Vijay Rupani and will be graced by Jayesh Radadiya, Minister of Food, Civil Supply and Consumer Affairs, Cottage Industry, Printing, Government of Gujarat and Shankarbhai Chaudhary, Minister of State for Health and Family Welfare, Medical Education, Environment and Urban Development, Government of Gujarat. This pioneering summit also brings a unique opportunity for key stakeholders of the two industries to build new synergies through collaboration with key decision makers, both in the government and industry. The 3rd Annual Healthcare Summit Rajasthan is also being organised by us in the month of September to bring together various stakeholders in the healthcare space on a single platform and take forward the agenda of our past conferences in creating a robust and quality healthcare system. We hope to see you at the National Food and Pharma Summit’ in Ahmedabad and the 3rd Annual Healthcare Summit Rajasthan!
Dr Ravi Gupta Editor - in - Chief eHealth & CEO Elets Technomedia Pvt Ltd ravi.gupta@elets.in
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CELEBRATING
COVER STORY
Smart Healthcare:
A Game Changer
Smart healthcare is changing the dynamics of health services delivery in India and increasingly addressing the deepening health divide among the urban and rural communities across the country. With India poised to spend much more on healthcare, smarter innovations using IoT devices, sensing technology and big data analytics are set to propel the healthcare industry into the future, writes Vivek Ratnakar of Elets News Network (ENN). AUGUST 2017 | ehealth.eletsonline.com
CELEBRATING
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Adoption of smart technologies will ensure significant improvement in access to quality care, providing effective health communication, information transfer across networks, improved patient outcomes, increased patient engagement and enhanced information flow. “Gradually, virtual patientdoctor consultations will become more common as patients can gain access to specialists and get treatment advice from home-based on digitised test reports. Combining telemedicine services and data from health apps will make this a possibility in the next few years. Devices will record health data and smart algorithms can analyze, support decision-making, prescribing personalised treatment and ensuring compliance,” says Col Chehal.
T
he Indian Healthcare sector is undergoing a fast paced transformation as information technology, smart and connected Internet of Things (IoT) devices, sensing technology and real-time data analytics are emerging as game changers. According to some recent reports, globally the smart healthcare segment is poised to grow at the rate of 25 per cent a year through 2020.
While this growth will be majorly driven by electronic health records, use of big data analytics to improve patient care and make it more efficient and accurate globally, India’s health system which lacks smarter content for patients and acute shortage of doctors and specialists (doctor-patient ratio of 1:1800) is set for a major overhaul. “Progress in medical technology, availability of improved diagnostic equipment, changing practices of specialists and growing awareness among patients has changed the way healthcare is being delivered today. Information technology is having a greater role in every aspect of healthcare ensuring faster diagnosis, reduction of service costs and provision of quality healthcare at affordable prices,” says Col HS Chehal, National Capital Region Chief Operating Officer of Fortis Healthcare Ltd. The private sector has been traditionally the main driving force behind technology adoption in the Indian healthcare sector. To optimise costs and effectively manage operations, IT solutions have already become an integral part of process management, patient care and the management of information system (MIS) in hospitals.
PROGRESS IN MEDICAL TECHNOLOGY, AVAILABILITY OF IMPROVED DIAGNOSTIC EQUIPMENT, CHANGING PRACTICES OF SPECIALISTS AND GROWING AWARENESS AMONG PATIENTS HAS CHANGED THE WAY HEALTHCARE IS BEING DELIVERED TODAY.
“With the health insurance sector poised for major growth in the coming decade, increasing demand for more efficient systems for storage and retrieval mechanisms will eventually lead to hospitals and healthcare providers to imbibe technology to modernise existing infrastructure. Cost-effective cloudbased solutions will drive HMIS and EMRs. More hospitals will seek automation digitalised infrastructure for workforce management, administration, finance, billing, patient records and pharmacies. The various benefits that can be derived, such as easy accessibility irrespective of geographical locations, fewer errors, faster response in times of emergencies, patient convenience, among others, will encourage increased adoption,” adds Col Chehal.
ehealth.eletsonline.com | AUGUST
COVER STORY
Smart Technologies Critical in Healthcare
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CELEBRATING
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COVER STORY
The Way Forward Integrate disruptive medical technology into medical education and training of health professionals so that they are open to and equipped to handle new technology in diagnosis and treatments. Virtual classrooms can enable experts to share information and practical lessons with students and allied health workers through live streaming of successful surgical skills to treat complex cases.
According to Sameer Bhalla, Founder, CEO at HealthIntel Services Private Limited, the global e-health market (currently at $23.8 billion) is predicted to reach $59.7 billion by 2018. Currently, there are over 97,000 mHealth apps and the top 10 mHealth applications generate up to four million free and 300,000 paid downloads per day.
THE GLOBAL E-HEALTH MARKET (CURRENTLY AT $23.8 BILLION) IS PREDICTED TO REACH $59.7 BILLION BY 2018. CURRENTLY, THERE ARE OVER 97,000 MHEALTH APPS AND THE TOP 10 MHEALTH APPLICATIONS GENERATE UP TO FOUR MILLION FREE AND 300,000 PAID DOWNLOADS PER DAY.
AUGUST 2017 | ehealth.eletsonline.com
The unprecedented explosion of mobile apps and mobile health technology amid escalating medical expenses is not a mere coincidence, says Bhalla. “We could say that the rising costs and inadequacies of the current healthcare industry have inspired its digitalisation.” Speaking about the challenges, Bhalla says, “One of the few prominent challenges is the adoption of technology in (Indian) healthcare sector, where doctors and patients are still hesitant with security poses as a frontline barrier. Additionally, poor integration also impedes uptake. The highly regulated nature of healthcare also hinders innovation.” However, Col Chehal is very optimistic the way smart healthcare is evolving in India. “Business models in healthcare are changing today. Companies are increasingly looking towards integrating the SMAC (Social, Mobile, Analysis and Cloud) model and a digital mindset, as this will enable them to uncover new value drivers. India is expected to become the largest consumer base for adopting digital innovations, with its population expected to expand from 1.3 billion
Comprehensive e-curriculums can be created and periodically updated for preparing medical students and health trainees on using the Internet, social media platforms, and digital technologies for their benefit. There is a need to develop a health infrastructure that supports this growing demand for technologically advanced services and a system that uses these resources effectively. There is a growing need for greater public-private partnerships, creating a sustained plan for equitable infrastructure for Tier 3 and 4 towns, bringing in digital technology and mobile healthcare services to remote locations, and building more cost-effective models with stakeholder collaborations and e-health services. in 2015 to 1.5 billion by 2026, making it the world’s most populous country, ahead even of China,” he says. His advice: “There must be efforts to not only digitise the system but also integrate it across systems, platforms and locations. This will enable health algorithms to analyse the data, help us spot health and disease trends and thereby make solutions and treatments possible.”
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CELEBRATING
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POLICYMAKER’S PERSPECTIVE
Transforming India’s Rural Healthcare In a bid to revive the Indian healthcare sector, the government has decided to upgrade at least 141 district hospitals in the country. The move will have a massive impact on the Indian healthcare sector as every rural area will be covered under this initiative, says Minister of State for Health and Family Welfare, Faggan Singh Kulaste, in conversation with Gautam Debroy of Elets News Network (ENN).
Faggan Singh Kulaste
Minister of State for Health and Family Welfare
Q
What are the initiatives the government has taken in health sector to bridge the rural-urban divide?
will have a massive impact on the country’s health sector as every rural area will be covered under this initiative. Prime Minister Narendra Modi has been continuously putting in efforts to take this forward.
The government has implemented various schemes like National Rural Health Mission (NRHM) to address healthcare needs of the rural areas. The government has decided to work on it effectively.
Q
It has also been decided to upgrade the hospitals running in the rural areas of the country. In the first phase, 58 district hospitals will be upgraded, followed by 83 hospitals in the second phase. I think this
In order to promote generic medicines in the country, the government has taken all the necessary provisions. Stalls have been set up for the people to easily avail quality medicines at
AUGUST 2017 | ehealth.eletsonline.com
What steps the government has taken to promote sales of generic medicines in the country?
cheaper rates. Now, our focus is on establishing such stalls in all the regions of the country.
Q
The government has adopted a focused approach for the development of Northeast India. How is the government planning to boost health sector of the region?
For the benefit of the North-Eastern region, Prime Minister Narendra Modi on May 26 laid the foundation stone of AIIMS Guwahati, Assam. This is the first such institute to come up in the Northeast India. With the completion of the project, all the people of the North-Eastern region of the country can avail the benefits of a quality healthcare institution with facilities at par with top hospitals in the country.
Q
What is the role of FDI (Foreign Direct Investment) in the healthcare sector of India?
The required provisions are already in place and I think that the sector is already reaping necessary dividends from it.
CELEBRATING
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POLICYMAKER’S PERSPECTIVE
Electronic Medical
Records Soon to Become a Reality in India With the hospital management turning fully digital, Electronic Medical Records will soon become a reality in India, says Dr Ajay Kumar, Additional Secretary, Ministry of Electronics & Information Technology, Government of India, in conversation with Souvik Goswami of Elets News Network (ENN).
Dr Ajay Kumar
Additional Secretary, Ministry of Electronics & Information Technology, Government of India
Q
How is e-health changing the healthcare spectrum in India?
Healthcare in India is becoming IT-enabled in a big way. With the hospital management turning fully digital, e-Medical records (Electronic Medical Records) will soon become a reality. On the delivery side, more use of Internet of Things (IoT) and remote consultations for service delivery will be commonly practiced. On the patient side, I think, there will be digitisation of personal devices as well. Furthermore, the supply of digital devices like stethoscopes, blood sugar monitoring tool and thermometer in fitness and health sectors are going to increase at reduced cost.
AUGUST 2017 | ehealth.eletsonline.com
Q
Do you think that advancements in technology is transforming health scenario in India? The advancement in technology has had a great impact on e-governance. The best example is the ‘Cloud Service’ where both ‘post and scale’ of information can be done instantly at a reduced cost. It requires an account, for instance, to download the e-hospital system. Even common applications can be linked to cloud. This has helped in integrating all the departments, doing similar work, on the same platform. All India Institute of Medical Sciences (AIIMS) was
the first hospital to incorporate this service. This technology-based transformation is now changing the healthcare scenario in India.
Q
“Reaching out the unreached”, do you think that has been the biggest success of e-governance mission in India, especially in the health sector? This is an area where India is different from other countries. Globally, countries use e-governance to make their government more effective. But the focus of India, through e-governance, is to provide basic developmental needs to the deprived citizens in a traditional physical model.
CELEBRATING
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Delivering Best Possible Clinical Care to Save Lives Elsevier serves healthcare professionals by integrating its evidencebased content into the care process and help them improve patient outcomes, says Dr Lalit Singh, Director, Clinical Solutions and Product Strategy, Elsevier Health, in conversation with Elets News Network (ENN).
Dr Lalit Singh
Director, Clinical Solutions and Product Strategy, Elsevier Health
Q
Tell us about the clinical solutions offered by Elsevier. What are the key advantages they offer to doctors and patients? Elsevier clinical solutions provide information analytics solutions to academic institutions, hospitals and healthcare professionals to help them advance healthcare and improve clinical outcomes. These solutions help doctors and nurses deliver best possible clinical care and save lives by providing them evidence-based insights and clinical answers when required.
Elsevier suite of clinical solutions include clinical reference tools, clinical decision support solutions (Elsevier Order Sets and Elsevier Care Planning), diagnostic decision support solutions (STATdx and ExpertPath), and patient engagement solutions. As we know, all the stakeholders in healthcare delivery system have to work together through the various stages of a patient’s journey in order to positively impact quality of clinical care. Elsevier suite of clinical solutions is singularly focused on
helping healthcare professionals improve clinical outcomes through evidence-based care.
Q
How do your solutions integrate current evidence into clinical care?
At Elsevier, we serve healthcare professionals by integrating our evidence-based content into the care process and help them improve patient outcomes. For example, our clinical search engine – Clinical Key (CK) that is designed to suit the way healthcare
ehealth.eletsonline.com | AUGUST 2017
INDUSTRY PERSPECTIVE
ELSEVIER:
CELEBRATING
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INDUSTRY PERSPECTIVE
professionals think and search for clinical information. It is indexed daily and continues to be updated as new resources are published, ensuring that every decision made is based on the most current evidence. With its advanced search capabilities, CK helps physicians and healthcare professionals save time by recognising relevant clinical concepts as they type, and offering shortcuts to critical answers. It is also conveniently mobile and can be accessed on the go, making it easy to discover, share and apply content to support better clinical decisions. One such example is the adoption of CK for nursing in India’s Breach Candy Hospital. The nursing team at Breach Candy has significantly enhanced its practice with access to timely, accurate, and relevant information at the point of care. Nurses can retrieve answers to their questions directly from CK via their mobile phones and tablets without having to go to the library. It has helped to shorten the time nurses need to find information, which helps them make well-informed decisions in their practice. Nurses report that they have saved at least 15 minutes of their valuable time when treating a patient.
Q
What are the new and evolving trends in health information technology that can help improve patient outcomes? How does Elsevier use these new technologies to improve healthcare? Elsevier provides information analytics and decision support tools to healthcare organisations and health professionals to enable them to make better decisions, get better results and be more productive. We do this by leveraging a deep understanding of our customers to create innovative solutions, which combine content and data with
AUGUST 2017 | ehealth.eletsonline.com
analytics and technology in global platforms. There are several new and emerging technologies, which can help the healthcare organisations and health professionals, and Elsevier is at the forefront of combining advanced technology and evidencebased information for improving the healthcare quality and outcome. In my view, out of all these new and emerging technologies, Machine Learning (ML) and Artificial Intelligence (AI) will have the greatest contribution to healthcare in the coming years. These combined with big data, cloud computing and predictive analytics will increasingly help to create a more efficient and safe healthcare system. Also causing disruption in technology are wearable devices using sophisticated sensors, which when combined with big data analytics and artificial intelligence, will help deliver better and more effective care in a more efficient manner.
Q
What are the key components of a robust clinical decision support strategy for a healthcare organisation? It is very important for a healthcare organisation to have a well thought through Clinical Decision Support (CDS) strategy, which is aligned with the strategic, clinical and commercial goals of the organisation. The four key elements of a good CDS strategy include clearly defined CDS goals, the four pillars of CDS strategy, i.e., physicians, nurses, other clinicians (including pharmacists, therapists and other non-physician, nonnurse care providers) and patients (including, family, friends, and other social support). The other two elements include “push” and “pull” solutions and the four foundation layers of a CDS solution, i.e., access to reliable clinical information, meet information needs
of all four pillars, serve information across the care continuum and CDS solution that is minimally disruptive to the clinical workflow and should ideally be integrated into the provider’s workflow.
Q
How will evidence-based medicine bring down overall cost of healthcare delivery, especially in a country like India? One of the greatest challenges of healthcare reform worldwide is the reluctance of those paying for technology to invest in evidencebased medicine (EBM) and CDS solutions. Both the public and private sectors hold the responsibility of curbing costs, and developing tools that will help healthcare providers in tailoring smart care plans for diagnosis, treatment and management. At the moment, the Indian Government spends 1.15% of GDP on health. While the government works towards its goal of universal health coverage, and meeting the United Nations Sustainable Development Goals (SDGs), India needs to adopt a multipronged approach to address the complex issues around accessibility and affordability of quality healthcare. This would require the government to aid healthcare providers to practice evidence-based medicine delivered through smart CDS solutions, besides increasing the funding for healthcare and improving physical infrastructure in the country. Advocated as a method to improve clinical outcomes, the incorporation of EBM into powerful CDS solutions has the potential to transform healthcare safety, quality, and even reduce the cost of healthcare. This is due to the ability to eliminate the use of medications and treatments are not effective and focus on those that have been proven successful.
CELEBRATING
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INDUSTRY INITIATIVE
WORK BEGINS at Iconic Park for Medical Devices
Following 11 months of groundwork and planning, construction activities at Andhra Pradesh MedTech Zone (AMTZ), the 270-acre state-of-the-art iconic park dedicated to medical device manufacturing, has been initiated.
C
onsidered to be one of the most ambitious projects for achieving selfreliance in domestically manufactured medical devices under the ‘Make in India’ initiative, AMTZ will house several capital intensive scientific facilities like Gamma Irradiation, EMI/EMC and Electric Safety Testing, Biomaterials Testing, 3-D Design and Printing Labs in close proximity for mutual benefit of over 200 manufacturing units. A host of other common commercial facilities like Expo Hall, Convention Centre, Warehouse, etc, within the park will provide a holistic ecosystem for growth of the medical device manufacturing industry in India. The foundation stone for AMTZ was laid on August 19, 2016, by Chief Minister of Andhra Pradesh Chandra Babu Naidu. The contracts for all the scientific facilities have already been signed with the respective service providers. The first model factory is expected to be ready by October 15 this year. AMTZ on July 8 also signed a
AUGUST 2017 | ehealth.eletsonline.com
Memorandum of Understanding (MoU) with One97 Communications Limited, which owns and operates the Paytm online platform and the Paytm app. The MoU with Paytm will enable medical device manufacturing companies to do cashless transactions related to scientific tests and works, trading, payments for general and social services in the AMTZ zone. Meanwhile, the Kalam Institute of Health Technology (KIHT), India’s first institute dedicated to medical technology located at Andhra Pradesh MedTech Zone (AMTZ) in Visakhapatnam, has received official
approval for 100 per cent financial support from the Department of Biotechnology, Government of India. KIHT approval comes after the launch of ‘National Biopharma Mission’ – an industry-academia collaboration for accelerating discovery research to early development for biopharmaceuticals. The National Biopharma Mission includes an investment of $125 million from the Government of India and an equal contribution as a loan from the World Bank. It is anticipated to be a game changer for the Indian biopharmaceutical and medical devices industry.
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Ekansh
Tiwari Founder, Epilen
Epilen is a tech startup redesigning the way healthcare works by combining software, artificial intelligence, hardware and actual doctors – practicing all under one roof. Epilen was founded in January 2017 and led being by Ekansh Tiwari, a 25-year-old entrepreneur. Epilen is a self-funded company and backed by the support from government bodies. Transformational Here’s a new startup to keep an eye on – Epilen, which plans to digitise health information across the globe by working with some of the best hospitals and healthcare systems. It’s hard to say what that means
AUGUST 2017 | ehealth.eletsonline.com
exactly. For now, the Epilen Website is pretty much designed to provide the broader vision. Today’s healthcare experience has remained unchanged from decades. Doctors are still writing things down on ‘post-it’ notes. Every piece of software looks like it was built to be an elaborate form of punishment! At the same time, we are awash in data that is currently being underutilised even though it may represent a treasure trove of potential solutions to countless medical and public health problems.
records it in an organised digital format, and makes it available to the patient and their ‘care team’ round the clock. Furthermore, Epilen drives the business as a membership plan that pairs each patient with a world-class physician who uses new Epilen technology, real-time analytics, and the company’s software to build a personal “health view” for each patient, which offers a complete picture of their health along with a personalized plan for helping them to lead a healthier and happier life. Big Picture Speaking of the big picture, Epilen Founder, Ekansh Tiwari who is working in this field from past three years says, “Our long-term plan is to build a sustainable model of healthcare that improves medicine by digitising healthcare, increasing access, and opening the way for truly personalised care where it is needed most. We have a long way to go in making what we do affordable for everyone, but, fortunately, the same technologies that make the system smarter also make it cheaper over time.” Epilen can be reached at care@ epilen.com for any inquiries or if any hospital or doctor is interested to work with us!
Offering
Omana K Ajayan Chief Operational Officer E-mail: care@epilen.com Website: www.epilen.com (The views expressed in this write-up are
The first solution of Epilen is a software that collects people’s health data -
of the author-Omana K Ajayan, Chief Operating Officer, Epilen-and does not represent eHealth magazine’s opinion.)
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THE RISKS OF
Using Spurious Reagents to run Blood Analysers Studies have established beyond doubt that most of the breakdowns are found in the laboratories which are using spurious or locally manufactured duplicate reagents to run their hematology analysers, writes Dr Rajeev Gautam, President, HORIBA Medical (India) Pvt. Ltd.
Dr Rajeev Gautam
President, HORIBA Medical (India) Pvt. Ltd.
S
hould a doctor prescribe spurious medicines to his patient? Have you ever used duplicate fuel in your personal vehicle? Do you allow your child to go for local soft drink instead of Coke or Pepsi? And, last but not the least, will you ever use Koolgate instead of Colgate for your dental hygiene, that too just to reduce expenditure of running your personal life? Hopefully, all of us may give a unanimously same response, without our level of education or profession.
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Considering same intentions under similar grounds, this also applies when we are talking about hematology analyser. The consequences are more severe and long-term because it’s not just your vehicle, your single patient or your personal dental hygiene but it is about the entire population getting served by the results of that hematology analyser. All those generated reports will guide umpteen number of surgeries and treatment protocols based on the values it generate after consuming reagents
fed into its system. The quality of reagents will decide the quality and reliability of results. In turn, quality and reliability of results will decide the success of the treatment or surgery or avoiding the same. What are Original Reagents? Any chemical formula or solution prepared under strictly controlled standard conditions of temperature and pressure, utilising standardised and uncontaminated ingredients procured from standard and
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What are Spurious or Duplicate Reagents? Any chemical formula or solution prepared under non-standard conditions of temperature and pressure, utilising sub-standard or contaminated ingredients procured from non-standard or non-registered sources or vendors without following any standard GMP norms may be considered as a spurious or duplicate reagent. Research performed by team of expert internal engineers by various IVD companies clearly unearths that most of the breakdowns are found in the laboratories which are using spurious or locally manufactured duplicate reagents to run their hematology analysers. The various reasons cited by the laboratory authorities are cost saving, easy supply, workload, non-availability of original reagents or lack of manufacturing facility with the instrument manufacturer. We may consider any factor but the effect remains substandard results, unreliable outcomes and indirect implications on the instruments performance and life. So, what are the factors promoting usage of duplicate reagents? Cost Saving Saving cost is one of the commonly cited reasons by laboratory staff for using local or substandard or duplicate reagents. However, in the long-run these reagents negatively affect the
precision of the instrument results. To an extent, it also shortens the operational life of the analyser without even showing any visible symptomatic changes that are directly observable. Saving the cost at the cost of quality and life is not a rational choice for any scientifically-driven laboratory focused on patients’ health. Easy Supply Easy supply by local vendors is also one of the reasons for choosing spurious reagents by the laboratories. This reason, although not convincing, but somewhere needs to be looked upon by the IVD companies manufacturing the hematology analysers that the reagents that are available round-the-clock and are strategic logistic arrangements are made based on the local conditions and requirement of the reagents. Companies need to ensure that original reagents are made available in the territory where the installations are made on a regular basis and periodic forecasting of the requirement as per the local needs. Laboratory Workload Although, superficially, we may say that laboratories with heavy workload need constant and easy flow of reagents. Otherwise, to keep the work at pace, they may go for the local reagents. However, it can be easily analysed that for those laboratories where workload is heavy, needs better and more conscious usage of reagents. As these laboratories are more prone to get their analysers giving wrong results or contamination, chances are much higher in these laboratories. These laboratories are also more prone to human errors which can further complicate the matter, when it comes to patient health outcomes. Thus, it is suggested that these
RESEARCH PERFORMED BY TEAM OF EXPERT INTERNAL ENGINEERS BY VARIOUS IVD COMPANIES CLEARLY UNEARTHS THAT MOST OF THE BREAKDOWNS ARE FOUND IN THE LABORATORIES WHICH ARE USING SPURIOUS OR LOCALLY MANUFACTURED DUPLICATE REAGENTS TO RUN THEIR HEMATOLOGY ANALYSERS.
laboratories must ensure that they are using original and manufacturing company based reagents to bring the acceptable quality in their report. Lack of Manufacturing Facility with Analyser Company Most of the companies, especially in a country like India, are the second hand distributors of the hematology analysers. This further complicates the matter and creates more serious concern to the matter of spurious reagents. As these instruments are manufactured on Original Equipment Manufacturer (OEM) basis, the distributing company has less knowledge about the impact of spurious reagents. Just to increase the sales, they never keep their customers informed about the negative outcomes of using duplicate
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registered by authorised bodies or vendors following internationally acceptable standard GMP procedures and SOP norms is considered as an original reagent.
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reagents manufactured locally. Instrument manufactured in China under the assumptions based on Chinese environment and culture, but the reagents are made by local Indian manufacturers based on the Indian scenario and economic standards. This negatively impacts the market not just in terms of cost but also the overall perception of the customer about the performance of the analysers available in the Indian market. This is one of the critical factors to be considered by any medical laboratory owner that they must choose the hematology analyser more or less from the company which not only has good number of installations, but also manufactures the analyser in-house. It also has the capacity to manufacture reagents used in the analyser. This not only enhances the credibility of the manufacturing company in the
MERITS OF USING ORIGINAL REAGENTS Original reagents are strictly prepared on scientific basis and composition is kept constant as per the technology requirement. l Scientifically driven Hydraulics of the hematology analyser can be kept intact only by using original reagents. l Original reagents show minimum or negligible variation with change in reagent LOT whereas locally manufactured reagents may show damaging variation when change in reagent LOT occurs due to substandard protocols and SOPs used to manufacture them in a small unlicensed set-ups built locally. l Original reagents maintain pressure and vacuum requirements to be maintained by the O-rings and valves throughout analysis process inside the analyser. l Last but not the least, original reagents keep the warranty and accountability of the manufacturing company intact and build mutually better and trustworthy relationship with the customer.
Drawbacks Of Spurious Reagents Some of the baneful consequences of using duplicate reagents on your hematology analysers are:
SAVING COST IS ONE OF THE COMMONLY CITED REASONS BY LABORATORY STAFF FOR USING LOCAL OR SUBSTANDARD OR DUPLICATE REAGENTS. HOWEVER, IN A LONGRUN THESE REAGENTS NEGATIVELY AFFECT THE ACCURACY AND PRECISION OF THE INSTRUMENT RESULTS.
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market but also helps in winning the confidence of the pathologist. CRITICAL ANALYSIS How change in reagent affects blood analysis by hematology analyser? Hydraulics: Critical balance between engineering and chemistry blood cell analysis uses one of the universal principles of science, i.e., hydraulics, which is very sensitive to the changes in properties of liquid, liquid flow, temperature, pressure, chemistry or any other flow related factors. It is an applied science of engineering and chemistry. Whenever any of the two shows change, the effect on the other is seriously pronounced, anyhow. Most Hematology analysers consist
l l l
l
l
Lot to Lot variation of composition of reagents Unlicensed or non-standard manufacturing facility Non-compliance with GMP Guidelines for reagent manufacturing Affects Hydraulics parameters like pressure and vaccum creation in sample and reagent flow tubing Indirect breach of trust and confidence with Instrument manufacturer and loss of long-term support and service agreement
Best Practices l
l
l
l l
Always use original reagents manufactured or provided by the instrument manufacturer Design forecasting for your laboratory to avoid short notice supply and thus forced buy from local manufacturer Never cut cost on reagents to compromise quality and life of instrument performance Maintain trustworthy relationship with your instrument manufacturer Last but not the least, get registered on www.habx.in to know more about hematology research, important issues and concerns.
of special apparatus to maintain hydraulics, and thus, give accurate and balanced functioning of all its parts. This hydraulics apparatus consists of tubing, O-rings, aperture, valves, chambers which gives route of flow for reagent and sample consequently responding to any changes found in blood samples or in reagents. Any change in the chemical properties, composition or flow properties like viscosity or surface tension of the liquid will affect its flow through the tubing, its ability to cross the aperture and ability to analyse the cells etc. These will directly or indirectly impact the overall process of cell analysis and counting by the analyser.
Industry Perspective
MAY / 2017 ehealth.eletsonline.com
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The Curious Case of Two Beating Hearts A 45-year-old patient has two beating hearts in his chest after doctors at KMCH, Coimbatore, successfully performed Asia’s first Heterotopic Heart plantation on a beating heart using the Direct Pulmonary Artery Anastomosis technique.
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Kerala man’s heart functioning level was only 10% when he was admitted at KMCH, Coimbatore, for a surgery. His was the case of two beating hearts – a rare condition that might seem like science fiction to many. Following the surgery, the 45-year-old man became the first person in Asia to live with two beating hearts. While one was his own, the other was taken from a woman.
Dr Prasanth Vaijyanath, Consultant, Cardio Thorasic Surgeon; Dr Thomas Alexander, Dr Suresh Kumar and Dr Vivek Path team, successfully performed this surgery, which is Asia’s first Heterotopic Heart plantation on a beating heart using the Direct Pulmonary Artery Anastomosis technique. The patient, Vignesh (name changed), had to undergo transplantation because of the high lung pressure, which did not allow him to undergo a normal heart transplantation. Calling it a “hard and demanding surgery”, the doctors said the patient’s own heart (native heart) was only 10% operative. It was also by sheer chance that Vugnesh received the heart of a female donor, which was smaller in size and a perfect fit in the cavity.
Dr Prasanth Vaijyanath added that this operation was also genetically fascinating because, now, the man not only has the XY chromosome that all men have, but also the XX chromosome of a woman owing to the heart beating within him. Explaining the functioning of the two hearts, the doctor said, “There are five connections between the two hearts. Two of these connections are meant to take in pure blood, while three are meant to take the impure blood out. The two connections placed between the left atriums of the two hearts is what makes sure that blood can be shared. On the right-hand side, doctors have connected the Superior Vena Cava, Inferior Vena Cava and the Pulmonary Artery. Connecting them with the beating heart was
the hardest task and that makes this operation very challenging.” While most of the doctors abroad have connected the pulmonary arteries of the two hearts using an artificial connector, here at KMCH, in Vignesh’s case, the arteries were connected directly to the beating heart. The doctor also revealed that the weight, blood group and the age of the donor were similar to that of the recipient, stating that such details are often compared and analysed before any heart transplant is done. As a matter of fact, there are only four centres in the world which have the facilities and experts to perform such transplants and one of these is the Cardiac Department, KMCH, Coimbatore.
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IVH:
A Reliable Companion of Medical Travellers India Virtual Hospital’s technology backbone is designed in such a manner that it can handle thousands of patients’ queries with minimal manual intervention under pre-defined sets of quality parameters, says Gaurav Pandey, Co-founder and Lead-Information Technology, India Virtual Hospital (IVH), in conversation with Elets News Network (ENN).
Gaurav Pandey
Co-founder and Lead-Information Technology, India Virtual Hospital (IVH)
Q
What are the challenges faced by patients seeking tertiary care and how technology is solving them?
The patient treatment journey has many challenges - right diagnosis of medical problem, selection of best doctor, best line of treatment etc. At IVH, we strive to address all such challenges using technology as enabler and mapping all stakeholders in a cohesive manner. We have developed mobile apps which allow patients from any part of world to share their medical
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problems with us through one simple form or just a tap on the screen. The app talks to a web-based ERP solution which assists our doctors to follow standardised protocols to link patient queries with the best available medical expertise in India. Our technology as backbone is designed in such a manner that it can handle thousands of patient queries with minimal manual intervention under predefined sets of quality parameters.
In conjunction with our business theme – a total unbiased and neutral platform to facilitate medical travellers, our mobile app presents best suited doctors and hospitals to the patients and facilitate a personalised connect between doctor and patient which includes video or tele-consultation, email advise or scheduling an appointment as per mutual convenience.
Q
What are the additional features in the app which makes it more useful for a patient?
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Our app enables our hospital companions to mark all milestones during patient treatment journey and all regular updates get exchanged with patients and their family members and referring doctors to put their anxieties at rest. In a patient treatment cycle, the element of personal care is and will remain the most prudent component but with technology we can ensure better turnaround time, error free handing of patient queries, real-time knowledge exchange amongst all stakeholders, establishment of connect between patient and doctor and patient and another patient (patient like me), access to educational material, etc.
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How can you ensure the best user experience for your patients?
Our technology backbone is built on most advanced mobile and web platforms, which offers fast, secure and reliable interface to our patients. The interface has been developed in Hindi and English and soon we will offer more language options
to our patients. Data security and protection of patients’ medical records can cause serious threat. As a policy, we have very stringent data protection and confidentiality policies in place which are a ‘no compromise zone’ for all. Our mobile apps and ERP solution are developed under the best coding standards of the industry. In addition, our hosting platforms are secured under multi-tier firewalls with adequate measures of business continuity planning and disaster recovery protocols. We also use tele-medicine solutions to offer medical advice to our patients in various parts of India and abroad using real-time video and data exchange amongst patient and doctors in multiple geographical locations.
Q
WE HAVE VERY STRINGENT DATA PROTECTION AND CONFIDENTIALITY POLICIES IN PLACE WHICH ARE A ‘NO COMPROMISE ZONE’ FOR ALL. OUR MOBILE APPS AND ERP SOLUTION ARE DEVELOPED UNDER THE BEST CODING STANDARDS OF THE INDUSTRY.
Please provide a brief description about the Patient Care app.
At IVH, our technology offerings are designed and developed to ensure volume handling of patient queries and treatment bookings. Our apps also offer patient treatment journey mapping and informs all stakeholders involved in real time. Our dashboards gives a bird’s eye view with drill down data digging facilities to our patient care partners, who can track the status of all cases referred by them. We also maintain the secured repository of all communication for future references. Our modules are equipped with smart BI features to assist management to see the exceptions and areas which need interventions. The patient influx is on increase and with every passing day we are engaging new patient care partners in various geographies and to complement this, our digital marketing drive is also resulting in more patient queries.
The main essence of our apps and technology offerings to enable our patient query handling desk, Hospital Companion desk, IVH Concierge desk and recovery assistance desk to handle volume of such requests and collectively support each steps in harmony and to ensure smooth data flow in patient treatment journey. We aim to bring efficiencies, reduce TATs and equip our field operations with complete and correct piece of information. I wish to humbly submit that we have ambitious plans to reach out to patients in large numbers in vast geographies in India and abroad with SOPs to handle each of the patient query with personal touch and our technology offerings are being engineered to touch all said items in a cohesive manner.
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Our app has integrated features for patient education. This patient education section hosts series of video and text materials related to various medical issues and acts as myth buster. Our patients can refer to any topic of relevance using category wise listing and smart search options. The ‘Patient Likewise Me’ section facilitates connection with another patient who has undergone the treatment and has his own experience to share with the patient who is recommended to undergo similar surgery or treatment. A challenge faced by the patients and their family members and referring doctors is that they do not have access to the patient treatment journey and they have to rely on telephonic calls, which, at times, is not feasible.
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Time to Think
of Healthcare Beyond Hospitals OP
Yadava
CEO and Chief Cardiac Surgeon, National Heart Institute, New Delhi
T
he 21st century has seen us become a knowledgebased society and the world has shrunk into a global village with erudite, better informed and connected citizens -- all meriting a re-think in the way we govern ourselves. There has, therefore, been a clarion call and a felt need for a change from the archaic, bureaucratic and governmental control to a more user-friendly, simplified and single window systems. Over the last 70 years, physical governance has failed and is now slowly but surely witnessing a paradigm shift towards electronic (e) governance or e-Governance. Not only it offers the ease and convenience of delivery, but it also reaches out to the masses at their doorsteps in the remotest corners of the country with efficiency,
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rapidity, transparency and in a cost effective manner, besides providing a single window opportunity. One can seek services from the comforts of ones home and vice-e-versa deliver the same through smaller well kept offices rather than the conventional, shabby, dingy, dilapidated, ill-lit and unkept premises of a typical ‘Sarkari’ building. This assumes special significance in a vast country like India, which is seventh largest in the world with topography ranging from sprawling deserts to the high peaks of Himalayas, dense jungles and a huge ocean front. Moreover, India has developed strong capabilities in Information and Communication Technologies (ICT) and mobile telephones have reached and being
used by even the poorest of poor in the country. Though the first national e-Governance plan was launched in 2003, its actual growth started with the establishment of National Informatic Centre (NIC) in 1977 and the launch of NICNET in 1987. However, these disjointed standalone efforts needed to be integrated to provide an all encompassing model of e-Governance. Projects like Unique Identification Number and Aadhar Card and linking of these to the PAN card are important landmarks in this journey. E-Governance must encompass the entire society from the individual level to the collaborative bodies of corporates and the government. It is only then that this metamorphosis of the governance
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The proof of concept is already there in the form of initiatives like ‘Bhoomi Centres of Karanataka’ for land revenue records, building plan sanctions in Delhi and the ‘Gyan Doot’ project for the tribals in Madhya Pradesh. ‘Smart Government’ of Andhra Pradesh is another such glowing example of success of e-Governance. This can even take place at micro level as shown by the project SARI (Project Sustainable Access in Rural India) delivered through public access internet kiosks run and established by certain enterprising IT professionals in a small village near Madurai. This is one valid and effective way of addressing the issue of corruption, which has been the biggest bane for development in our country. It would also facilitate a push towards ‘Digital India’ and cashless economy. E-Governance in medical sciences is virtually in its infancy and could range from single window permission and sanction of licenses for medical institutions to monitoring of vital statistics like birth and death rates, and delivery of healthcare services through concepts like e-ICUs. According to EU, ‘E-Health can be described as the application of information and communication technologies across the whole range of function that affect the health sector, from the doctor to the hospital manager, via nurses, data processing specialists, social security of administrators and – of course – the patients’. It encompasses tools like web-based libraries, electronic medical records (EMR) and electronic health records (EHR), continuing medical education (CME) programmes, inventory control; hospital information system (HIS),
computerised prescriptions, medical and nursing audits, quality assurance tools, finance modules, image capture, storage and transmission tools like PACS and tools for doctor-patient communication. In a country like India, where nearly two-third of vulnerable population is based in rural areas, the concept of a village e-health centre via online video conferencing can be attractive and effective method of healthcare delivery. Personal health records can be made available on CD Roms and smart cards. Tele-health and medical informatics are new frontiers at present in India and are likely to see spiralling growth in near future. Medical transcription can even drive growth and economy. Some of the current examples of successful telehealth initiatives include the Wipro’s HIS system for Delhi Municipal Corporation, Tata Consultancy Services’ EMR system for Tamil Nadu and 21st Century Health NET in Goa. National Health Portal launched on 14th November 2014 too is a worthwhile single point initiative for authentic health information for general public, trainees, professionals and researchers. In fact, the next major disruptive change in health sector could well be the analysis of a huge amount of data available through various devices like ventilators, ICU monitors as well as wearable devices, which a large section of India’s population is using. While the data is being captured and stored effectively, it is not being analysed to improve health outcomes of an entire community. Remote sensing of health parameters and early institution of therapy to prevent hospitalisation will not only reduce morbidity and mortality of life threatening conditions but also would
become cost effective solution to the health problems of any nation. Most diseases today are lifestyle related and have behavioural factors as their root cause. E-Governance through mobile telephony and internet services can be used to bring about a paradigm shift in these behavioural parameters affecting health, thus contributing to primordial and primary prevention. People in far flung areas, with limited access to quality healthcare, can be given access to the best medical services anywhere through e-Governance. Tele-robotics can be used effectively to deliver therapeutic services. It’s time to think of healthcare beyond hospitals and to look at newer models like digital health. Health applications can be used to provide medical care and help prevent diseases. These can also help harness the power of artificial intelligence, point of care diagnostics, genetics and other affordable emerging technologies. Home health care, delivery of telemedicine and the use of healthcare analytics with medical grade wearables are going to bring, and are in fact they are already bringing, a paradigm shift in the way we deliver healthcare and look beyond hospitals. Patient data portability and laying down of the e-health standards, however, are certain issues that need to be addressed soon. To err is human but to reduce that ‘err’ is now the domain of e-health. It helps break the silobased outdated healthcare delivery systems and help integrate various legacy systems like the private sector with the government and the nongovernmental organisations; social care with hard core medicine; and acute hospital care with primary and primordial care. Even within the hospital, various departments can be integrated.
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would truly be called revolutionary and disruptive.
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It helps reduce clinical errors, adverse drug reactions, implementation of evidence-based decisions and transparency of route to decision. One can identify the patient and community needs and, thus, help in efficient allocation of resources. It helps in acquisition of accurate and relevant data, its storage in a durable fashion, its retrieval and transmission at will and in its efficient analysis with a view to innovation. Even the productivity will go up as no time is wasted in standing in the queues. Besides contributing to such mundane parameters like the Gross Domestic Product (GDP), even more ephemeral parameters like the ‘Gross Happiness Index, Satisfaction, Peace of Mind of the general public will improve with such measures thereby reducing the stress levels and may even translate into reduction of man made diseases like hypertension, diabetes and metabolic syndrome. A paperless hospital will not only be cost effective but also efficient and environmentally friendly with less chances of inadvertent errors, besides improving patients’ satisfaction, all of which contributing to the productivity and acceptability of the institution. E-Governance also ensures accountability and outcomes analysis which should now become the buzz word in every field of service delivery, more so in medicine. Just as the benefits are humongous, there are countervailing panoply of challenges. These are related foremost to changing the mind-set of the bourgeois class and training the 50 years plus, who still have a morbid fear of these services; providing good connectivity to remote areas, specially the Himalayas – where physical barriers of mountains may affect satellite connectivity; and confidentiality and security of information and transactions. Rules
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concerning cyber frauds and hacking need to be made more stringent and e-policing too needs to have its ‘Is’ dotted and ‘Ts’ crossed. Challenges extend to creating an infrastructure to support the IT network in terms of power and physical creation of Internet kiosks etc which indeed is an Herculean task. The middle and upward classes may have their personal computers but for the people in the lower rung of the societal hierarchy, public access internet system would have to be created even though mobile telephony have percolated more than PC based services. Bridging this digital divide will require mobilization of resources. Also, besides Hindi and English, vernacular language applications too need to be developed as the dialect and language change in our country every 100 kilometers. It is heartening that the apex committee for the national e-Governance plan chaired by the cabinet secretary has approved the inclusion of health as a mission mode project. It will ensure easy access to public services and equitable distribution of economic growth. In health, it has been used effectively for monitoring the mother and the child health services and for management of the National Rural Health Mission Programme, but can also be used for HIS and for the supply chain management for drugs and vaccines. The challenges could be the maintenance of these services, in light of the past experiences of major equipments in hospitals remaining dysfunctional with a very long down time. Literacy of the users, their willingness to use and the mind-set and intent behind non-use of these services will all need to be addressed. The issues concerning security, privacy and confidentiality and the menace of spam and the fear of hyper-surveillance by an over-arching, all prevailing and
pervading watch dog – government and its bodies – are issues which may derail the e-Governance story unless addressed in the earnest. Even trust of the lay man needs to be built. Another limitation could be that medicine, as against other fields, is not a precise science and is highly subjective and therefore developing protocol based applications is not valid in all clinical scenarios. Therefore, some level of human interface with provisioning of override has to be built in e-Governance. There are certain protocols that are nearly mathematical and can be easily delivered, at least at the initial stages, through these e-Governance modules. Even diversity in food habit, life style and ethnicity of various population groups in our country as also the wide spectrum of health related issues ranging from communicable to noncommunicable lifestyle disorders pose a formidable challenge. The biggest barrier of e-Governance in medicine are the doctors, nurses and other healthcare professionals, who are hostile to new ICT applications, partially because of their mind set, but also at times, because of ulterior motives of loosing their control of the patient and the clientele. For these e-Governance initiatives to succeed, a high powered and enabled team headed by an intellectual and a kind of top-down approach should first give a thorough and meticulous look at the process engineering required prior to the actual launch of the services. Setting up of an over arching, high powered body with a secretary level officer and a minister in charge may indicate the seriousness with which these measures are meant to be implemented - a message to the public as well as to the bureaucracy.
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e-Governance in Indian Healthcare
Building a Stronger Nation
L
ike in most of the other economies, disruptive forces of digital technology are paving the way for a better governance in India. The e-governance movement holds potential to radically transform the way services are delivered to the populace. It promotes a collaborative approach to decision-making by allowing active participation of the common man in improving quality of public services through higher transparency and accountability.
The seeds of e-governance in India were sown back in 1987, with the launch of national satellite-based computer network -- NICNET. Since then, several e-governance projects have been initiated. Rapid computerisation in the 90s coupled with widespread tele-connectivity and internet proliferation in recent times has provided an impetus to various e-governance initiatives in India. Digital Health – A Crucial Area of e-governance If our country is to make great strides on the world stage, we must ensure that its populace enjoys abundant health. However the present public health machinery lies in dire straits, marred by multiple problems such as low budget, inaccessibility, high population density and lack of supportive infrastructure. India’s per capita spending on healthcare is less than one per cent.
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Phanish Chandra Co-founder and CEO Docplexus
Infrastructural growth in this sector severely lags behind its economic and sectorial growth. The ideal ratio of primary care centres is 74,150 per million people. However, the actual numbers are not even half of those. A majority of laboratories for testing drugs have inadequate facilities and are understaffed. Owing to the lack of access to basic healthcare services in remote regions, easily-curable diseases have turned into serious lifethreatening conditions. It is expected that e-governance would resolve most of these problems. Effective application of ICT in health can ensure higher productivity through more efficient use of equipment, support staff and critical drugs; better quality of care; optimised drug supply and improved patient satisfaction. It can successfully tackle the malice of red-
tapism, delays and chaos that currently prevail in large public hospitals across the country. In 2011, healthcare was added as a Mission Mode Project (MMP) in the National e-governance Plan (NeGP). It was also included in the government’s ambitious ‘Digital India’ Programme launched in 2015. e-Health – Fixing the Failings of Public Healthcare Digitisation has the prowess to bring about radical improvements in every area of public health in India. Telehealth and online video consultations can take previously inaccessible expert care right to patients in the remotest regions. Telemedicine and tele-referrals can link primary, secondary and tertiary health facilities to disseminate latest medical knowledge to all. Data analytics can improve capacity planning
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Digitisation is also empowering doctors for better information management, patient monitoring, medical education, and communication. Web-based libraries, online continuous medical education courses, KOL webinars, surgical videos, all equip the medical community to provide the best possible care. Online CME programmes and KOL interviews conducted by Docplexus, India’s largest online network of doctors, makes gaining latest medical knowledge highly convenient for its members. Electronic Medical Records and Electronic Health records are leading to easy exchange of patient data between primary care centres, specialists and pharmacists. Data mining on EMRs can further discovery of new treatments. Computerised prescriptions are reducing chances of errors. Challenges and Key Success Drivers Successful e-governance in health depends on India’s ability to overcome challenges and leverage opportunities. Following factors impact progress of e-Health: Technological Innovations Technological advances like mobile,
cloud computing and IoT will prove conducive to more effective delivery of e-Health. With rapid adoption of smartphones (over 300 million users and counting) it won’t be long before we see a mobile in every hand. Last year, the government launched four mobile health services, namely, M-Cessation, Kilkari, TB Missed Call initiative and Mobile Academy. Attitude of Medical Professionals The extent of success of digital health initiatives is related to their acceptance by doctors and medical staff. Currently, there is little awareness about the importance of electronic management of health data. Very few hospitals maintain EMRs as doctors consider it cumbersome to update the data in the system. The existing resistance to usage of technology can be dissipated through communication and training. Medical staff needs to be convinced that technology will assist and not replace them. Computer-aided teaching techniques should be adopted for medical and nursing courses. Public Awareness Experts cite lack of awareness and understanding of use of ICT in healthcare as a key hurdle in widespread adoption of e-health services. Despite online availability of diagnostic reports in certain hospitals, most people continue to collect the reports from the hospitals in person. Poor literacy levels, lack of regionally-relevant content, and low availability of appropriate access devices are some factors that hinder success of e-health initiatives. Interoperability, portability, integration e-Health requires joint effort of various government departments such as Department of Electronics and IT (DeitY), Department of Telecommunications (DoT) and
Law. It is necessary to put in place systems and interoperable standards that allow seamless integration across departments. Infrastructure, Internet and Data Speed Only when required infrastructure is in place, will healthcare technology be accessible to all. The government’s plan to connect 250,000 villages with the National Optical Fibre Network (NOFN) by 2016, has grossly failed to meet the deadline, with only one per cent of villages having been connected. Last-mile connectivity will continue to be a challenge in forthcoming years owing to its unaffordability for most Indians. Internet penetration in India is only close to 28 per cent. Affordability of broadband or mobile for low income group remains a question. Participation of Private Sector The private sector has a key role to play in the success of e-governance in healthcare Earlier this year, Glocal Healthcare announced its alliance with CSC e-governance Services India Ltd., the nodal autonomous agency of Ministry of IT, through which it is offering video consultation services to 84 crore people in remote areas. HP is working on automating 19 public hospitals and 14 medical colleges in Maharashtra. CMC is providing handheld mobile computing devices to PHCs. Docplexus recently tied up with the National Center for Disease Control and Indian Public Health Agency as their knowledge partners. Through this collaboration, NCDC and IPHA have connected to a community of over 2,25,000 doctors from 92 specialties and 1,500 cities for furthering their public health agenda. Participation of private players is crucial to provide last mile access, location specific access and cloud-based services relating to delivery of remote health.
ehealth.eletsonline.com | AUGUST 2017
INDUSTRY PERSPECTIVE
and resource management in hospitals. The e-hospital initiative of the Digital India programme has come up with an online registration system that connects hospitals based on Aadhaar. It facilitates services like online appointments, payments, access to diagnostic reports, etc. With six hospitals on board and over 48,000 registrations, e-hospital is fully functional. When all hospitals are interconnected, a master patient database would be created leading to a pan-India exchange of patient details. Local pharmacy databases would present an accurate picture of medicine stocks.
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CELEBRATING
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INDUSTRY PERSPECTIVE
A Novel Way to Combat Sedentary Lifestyle The wearable devices, apps or gym membership is not what makes one healthy. We are in the human behaviour business and, therefore, seek to change lives through a fun, non-prescriptive, community-based approach that leverages healthy competition with rewards and recognition, says Ravi Krishnan, co-founder of Stepathlon Lifestyle Pvt. Ltd. (SLPL), in conversation with Elets News Network (ENN).
Ravi
Krishnan
Co-founder of Stepathlon Lifestyle Pvt. Ltd. (SLPL)
Q
Please elaborate on the concept of virtual race, how was it conceptualised and what was the main idea behind it?
The human race has stopped moving. The idea behind Stepathlon is to combat the sedentary lifestyle through an ‘engage first, then make healthy’ approach. Lifestyle diseases are called as such because of the way people live. Through Stepathlon, we seek to modify people’s behaviour in a fun and sustainable manner.
AUGUST 2017 | ehealth.eletsonline.com
We use a combination of selfquantification, gamification, gratification and mass with the goal of creating a healthier, fitter, happier and more productive population. We have realised that we are in the human behaviour business. The wearable devices and gym membership do not make you fit. It is continuous, relevant engagement that catalyses positive, sustainable behavioural change. The fact that Stepathlon can be adopted by ‘anyone, anywhere, anytime’ makes it user-friendly
to both employees and their companies.
Q
Tell us about Stepisode 7, how is it different from earlier editions?
This year, we’re moving into a 75day race format to be conducted across three stages -- focused on WOW – Work or Workout (healthy weight management), Nutrition and MOM – Mind over Matter (Stress Management) – to facilitate greater engagement.
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INDUSTRY PERSPECTIVE
During Stepisode 7, the participants will also be armed with a new and improved Stepathlon app which features organisational and individual data analysis, and improved tools for greater engagement among participants and within the organisation like push notifications, a revamped Groups and Leagues section, and social sharing. The race gets even more exciting with contests, challenges, quizzes, tips, and rewards. Our platform is also integrated with apps like Google Fit as well as wearable’s including Fitbit, Jawbone, Garmin, and Goqii which makes it easier for the users of these technologies to sync their steps with the Stepathlon platform. All participants stand a chance to win from a prize pool worth Rs 20
Q
What role your partners like Google Fit, Fitbit, etc are set to play in making Stepisode 7 a success?
The wearable device/app/gym membership is not what makes you healthy. We are in the human behaviour business and, therefore, seek to change lives through a fun, non-prescriptive, communitybased approach that leverages healthy competition with rewards and recognition. We have, for the benefit of our participants, included the more popular apps and devices in the market to make participation as easy as possible.
Q
Do you have any mechanism to capture the health data of participants that can be further used to prepare better plans and activities?
DURING STEPISODE 7, THE PARTICIPANTS WILL ALSO BE ARMED WITH A NEW AND IMPROVED STEPATHLON APP WHICH FEATURES ORGANISATIONAL AND INDIVIDUAL DATA ANALYSIS, AND IMPROVED TOOLS FOR GREATER ENGAGEMENT AMONG PARTICIPANTS AND WITHIN THE ORGANISATION LIKE PUSH NOTIFICATIONS, A REVAMPED GROUPS AND LEAGUES SECTION, AND SOCIAL SHARING.
evaluate the impact of participating in Stepathlon. While over 10,000 people voluntarily took the Stepathlon mental health survey during Stepisode 4, our cardiovascular study was covered in over 200 publications across five continents, including the prestigious Journal of the American College of Cardiology.
lakhs, including daily prizes. The Stepisode 7 is also the foundation of a 12-month health and wellness programme, combined with 10 scientifically proven ‘Stepping Stones’, is designed to help individuals and organisations alike reach their health goals in a fun, engaging and simple manner.
AUGUST 2017 | ehealth.eletsonline.com
As part of our race events, individual participants complete a pre- and post-event survey questionnaire on our mobile and web-based platform. In the last few years, we have also enlisted the help of globallyrenowned experts, to release our very own mental health survey and cardiovascular study, to measure and
Moreover, our new and improved app is equipped with organisational and individual data analyses, providing accurate diabetes, sleep, wellness and cardiovascular scores. In addition, the Stepathlon platform with features such as newsfeeds, maps, leader boards and health reports, only incites the participants to take the requisite steps towards bettering their overall health.
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An EletsTechnomedia Initiative
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CONFERENCE REPORT
Creating Roadmap for Inclusive Healthcare in India
The Indian healthcare system is undergoing a major transformation with focus sharply shifting towards making delivery of health services more affordable, accessible and inclusive, taking quality healthcare to the doorsteps of the masses. To help achieve this target, efforts of the government and the healthcare industry are geared towards disruptive innovations and technological interventions to effect incremental changes in the entire healthcare ecosystem. As a key stakeholder of the Indian healthcare sector, Elets Technomedia organised the 7th Healthcare Leaders Forum (HLF) - 2017 in New Delhi on June 30, with clear objectives of helping the industry get rid of redundancies and bridging the existing information gaps
AUGUST 2017 | ehealth.eletsonline.com
across the country and health ecosystem to foster growth. The seventh edition of HLF, attempted to find ways to unlock the inherent potential of the health industry and help the country achieve its health goals. The conclave was graced by Dr Jitendra Singh, Minister of State (Independent Charge) for Development of North Eastern Region and Minister of State PMO; Dr K Rajeswara Rao , Joint Secretary, Ministry of Health & Family Welfare, Government of India; Peter TaksøeJensen, Ambassador Extraordinary and Plenipotentiary Royal Danish Embassy, Denmark; and Arun Singhal, Joint Secretary, Ministry of Health and Family Welfare, among others.
The 7th Healthcare Leaders Forum (HLF) special issue being released at the inaugural session by Dr Jitendra Singh, Union Minister of State (Independent Charge) for Development of North Eastern Region and Minister of State PMO and Poonam Malakondaiah, Principal Secretary (Health Medical & Family Welfare) & Mission Director (NHM), Government of Andhra Pradesh, on 30th June, in New Delhi.
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Healthcare for All – Taking Healthcare Services to the last Mile Dr Jitendra Singh
Union Minister of State (Independent Charge) for Development of North Eastern Region and Minister of State PMO “I think a great challenge before us is that on the one hand we have a huge mushrooming private sector in healthcare and on the other hand one-third of India’s population is still not having access to a decent hospital bed. This is because most of this mushrooming of private hospitals is happening in the cities, urban or semi-urban areas. The private sector has its own constraints as it has to thrive and sustain itself for which they may not find means in semi-urban or rural areas. As a result, the urban patient is overtreated, while the rural patient remains undertreated. Health is too serious an issue to be left to the government alone. In the context of patients in far-flung areas like in the Northeast India, if you have to make your services meaningful, you’ll have to reach out to those who have been left out.”
Dr K Rajeshwar Rao
Joint Secretary, Ministry of Health & Family Welfare, Government of India “In the last two-three years, there is a huge attention and great number of discussions on health sector reforms, culminating into the announcement of the National Health Policy. It has a very unique feature of increasing the budgets for the health, which will be substantial in the coming years and change the growth prospects for the entire health sector. Involvement of private sector, public private partnership (PPP), research and also the preventive healthcare will be the major focus areas under the new policy. Meanwhile, sustainable development goals of the UN significantly impact the healthcare sector indirectly, and also several states like Karnataka and Uttar Pradesh are developing their separate health strategy based on their needs and strengths. Couple of months back West Bengal also formulated a health policy. So, there is a macro national policy and also several state policies in place.”
Arun Singhal
Joint Secretary, Ministry of Health and Family Welfare “In Westen countries like the UK and Scandinavian countries, nurses and middle level professionals have played an important role in delivering healthcare. The question Indian healthcare industry faces today is do we need a model where every doctor is a post-graduate or we adopt a model where a family doctor, who is an MBBS, takes care of most of the health problems. The other question we need to ask ourselves is that if we adopt a post-graduate doctor model then should a post graduate doctor be sent to a remote village for screening tuberculosis patients. Today, a PG doctor is expected to stay and work in an area which is even smaller than the block level. The medical community has to think of what kind of physician assistants, nurse practitioners and other such service providers can be groomed in this country.”
ehealth.eletsonline.com | AUGUST 2017
CONFERENCE REPORT
Inaugural Session
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CONFERENCE REPORT
Dr Jagdish Prasad Director General (Health Services) Ministry of Health & Family Welfare
Abhishek Singh
Resident Commissioner, Government of Nagaland “We did a great experiment in Nagaland some time back when we used a commoditisation policy in involving the community for managment of healthcare. What we did was the administrative authority with regard to management of ANMs and sub-centres was delegated to the village health committee which was under the village development boards of village councils, which was the replacement of Panchayati Raj system in Nagaland. It was found that when the salary of the ANMs and doctors of the primary health centres was paid by the community, their attendance as well as their contribution in managing healthcare at the last mile was much better than when it was managed by the Health Department. The experiment was done in Nagaland not only in healthcare but also in education and other fields also. It resulted in remarkable improvement and that is the reason why Nagaland is much ahead in national averages of most health parameters.”
AUGUST 2017 | ehealth.eletsonline.com
“Few years ago, our fight against diseases was focused on malaria, filaria, kala azar, dengue and chikungunya, but now noncommunicable diseases are emerging as the leading cause of deaths in the country. Today, 57-58 per cent of deaths are caused by non-communicable diseases like cardiovascular diseases, diabetes, cancers, respiratory diseases and stroke. We tend to ignore the mental health problem in India. But this is leading to economic losses. In India, 7-10 per cent of the people are suffering from mental health issues, which is mostly neglected. The Government of India has passed an Act to take care of this issue. In most of the states like Bihar, Uttar Pradesh, Jharkhand and West Bengal, kala azar will be eliminated by the end of 2017. We will review the status of the disease in August-September. Except in Jharkhand, where it may take one or two months more, kala azar will be eliminated from the entire country.”
Peter Taksøe-Jensen
Ambassador Extraordinary and Plenipotentiary Royal Danish Embassy, Denmark “We (Denmark) are a small country with a population of 5.5 million, but we have managed to become a frontrunner in IT-based solutions in healthcare sector. Digitalisation has become a central part of the foundation on which the Dannish health system is based. We continue to develop new ways of optimising and innovating healthcare solutions by the use of ICT.” We have a tax-funded healthcare system. We spend about 9-10 per cent of our GDP on healthcare. This means that all the citizens have universal and free access to healthcare services in Denmark. But like many other Western countries, we are faced with financial pressure on our healthcare system. This is the consequence of an increasingly aging population also an increase in the overall dependency ratio. As the number of elders is increasing, healthcare expenditure is also increasing proportionally but the funding is staying the same or going down. Faced with this challenge, the Dannish healthcare sector, policy makers, researchers and other relevant stakeholders have been forced to rethink and innovate and here ICT solutions and digitalisation have really played a key role. While national challenges have incentivise the implementation of ICT in Denmark and healthcare sector, the ICT infrastructure and framework have been an important driver in the process of developing and implementing ICT solutions.”
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Panelists engaged in discussion at the session on ‘Smart Healthcare in the Era of Digital India’ during 7th Healthcare Leaders Forum.
Naveen Sharma Dr Rajiv K Jain
Additional Chief Medical Director (Health & Family Welfare), Ministry of Railways, Government of India “IT is as useful as physical infrastructure in the healthcare sector. Can we have IT functioning without the healthcare infrastructure on the ground? The answer is no, it can’t. In India, we have to scale up IT application in healthcare. We need to have an accessible, robust and affordable healthcare system existing on the ground. That’s a prerequisite. Without the foundation, you cannot build an IT infrastructure supporting the healthcare system. Similarly, in smart cities without a habitat you cannot have a smart city. So, it has to be synergically developed. Sometimes in order to push development of IT infrastructure, we forget that the basics of the healthcare systems are not available. We push IT too fast. That’s the word of caution we need to exercise. To build healthcare infrastructure, it takes years and years because of very nature of healthcare system that it requires diverse set of individuals, skills to deliver in a unified manner to an individual patient in a predictable fashion every time continuously. It is here the use of IT comes in to make the quality more predictable, more standardised and transparent. The use of IT in this manner needs to be embedded in the system. Here India has an advantage compared to the US.”
GM Operations & Head Business Development, Pushpawati Singhania Research Institute (PSRI Hospital), New Delhi “We are doing a lot of CSR
activities to ensure that a woman sitting in Gajraula, which is 100 kms from Delhi, can consult a super-specialist in PSRI Delhi through telemedicine. Technology and IT have been bridging the boundaries. There is an acute shortage of clinical practitioners. So, ehealth can be a viable solution to this challenge. The government should take this initiative to bring down the infrastructure cost and other healthcare costs as well.”
ehealth.eletsonline.com | AUGUST 2017
CONFERENCE REPORT
Smart Healthcare in the Era of Digital India
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Jay Prakash Dwivedi
Chief Information Officer, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi “We don’t do healthcare. All that we do is health repair and we start it at a point where it is mostly already irreparable. Smart healthcare would be, I enjoy the health and somebody else takes care of the care part. That somebody could be a technology, an agency, a person or a process. That is the smart way to deal with it. All that smartness can bring or technology can bring is a series of steps that can start taking care of the ‘care’ part. The first part is to monitor that how I am doing physically -- how much am I excercising, what am I eating and what is my sleeping habit while I am still healthy. It will help us to move from healthcare to wellness. The second part is information. Once something goes wrong, the technology informs me that you are going to encounter some problem. Also inform the nearby hospital that there is an incoming emergency case. The third comes the alerts and reminders. It tells me that you are due for a particular test or medicine. Then comes the subjects of accessibility, affordability, arranged telemedicine, tele consultancy, etc. There are a number of ways technology can help us move from health repair to wellness.”
Dr Deepak Agrawal Chairman of Computerisation, AIIMS, New Delhi
We needed solutions not only for healthcare professionals, but for the patient as well. IT is just a catalyst. It is not the answer to anything. When you start working..., you realise that there were lot of standard operating procedures or protocols and processes which have not been documented. IT just helps you initiate this process and put it up in a systematic way, so that quality of patient care, consistency of care can actually be put into action. The best example of how AIIMS leveraged IT to improve delivery of healthcare remains initiation of the appointment system of our institute. In the past three years, our institute used it so nicely and further developed it that it has taken a pan-India space. At AIIMS, we are booking more than 2 million appointments a year. The system’s biggest advantage is that it empowers the under privileged patients, who were earlier queuing up for hours or days to get an appointment. These small steps have improved the approach to healthcare and ensure the last mile connectivity.
AUGUST 2017 | ehealth.eletsonline.com
Inderjeet Davalur
Group Chief Information Officer, KIMS Hospital, Hyderabad “Essentially the way we are approaching IT or technology use in KIMS is taking the view that let me walk a mile in the patient’s shoes. We focus entirely on what the patient experiences in a hopsital. Instead of taking a postmortem approach, we are tracking patients in all departments in real-time and we are using thresholds to generate alerts to operations staff.” “We are also looking at other proactive measures that we take from our past experiences and build a system around that so that we can actually make it richer in terms of a better patient experience. We are trying to get away from all the buzz words that you keep on hearing like AI, deep learning, etc and instead think about some very basic things from a patient’s standpoint.”
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Dr Shankar Narang
COO, Paras Hospitals, Gurgaon “Healthcare is not only the delivery part. It is much bigger than this. It includes the life sciences part of it, where the pharmaceuticals, medical equipments, implants play a major role. It also includes the healthcare delivery right from the single doctor to polyclinics to primary, secondary, tertiary and quarter nary care. Then comes the payment part that includes TPAs, insurance companies and government agencies. I would call it a smart healthcare if all these parts of the healthcare ecosystem are integrated and connected to one platform where seamless exchange of data can take place, so that the customers or patients are not hassled. It’s not about making the solutions available but also implementation and adoption of that. To make sure that adoption of these solutions happen, I would recommend that we should take it to the level where the doctors and other service delivery personnel are trained right from the collegelevel or may be before that and have them integrated there itself, so that when they are ready to come on a platform they are ready to deliver the healthcare, they are more experienced and realise the advantages of these things. We should also be mindful of the e-waste we generate.”
Dr Lalit Singh
Director, Clinical Solutions & Product Strategy, Elsevier Health Speaking on how different stakeholders in the healthcare system are adopting technology and how the process of digitalisation will pan out in future, he said that technology adoption should be across the system and some progressive steps in that direction have been taken by the government as well -- first of which is giving some standards to follow -- and the next step will be initiatives like IHIP and health information exchange that will go a long way in helping the country achieve its health targets. He said that it was heartening to know that clinicians are finding technology adoption very useful. He added that the key thing is using the technology judicially and knowing exactly what we want to achieve, not withstanding whether it is public money or private money. Indian healthcare is fast moving from record management or financial module to clinical modules and connecting the dots to deliver quality healthcare in continuum.
Niranjan K Ramakrishnan
Chief Information Officer, Sir Ganga Ram Hospital, New Delhi “When we talk to media, we highlight the patient-centric approach. But within the organisation, it is always business, administration, doctors, nurses and then comes the patient. But with the adoption of technology, the focus becomes patientcentric. Everybody believes that the system should support the patient experience -- whether it is waiting time, reducing the number of bed days or discharging procedures. The technology can really improve the patient experience. Business assumes that technology has to improve, while technology assumes that business has to coordinate. I think there has to be a marriage between the two to make the things work.”
ehealth.eletsonline.com | AUGUST 2017
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CONFERENCE REPORT
Strengthening Public Health Delivery Challenges and Opportunities
A brainstorming session on ‘Strengthening Public Health Delivery - Challenges and Opportunities’ in progress at the 7th edition of Elets Healthcare Leaders Forum.
Prabin H Shingare
Director, Medical and Research, Government of Maharashtra “The main challenge in public health delivery system for the Government of India is that of manpower in rural India, especially in tribal and remote areas. If this challenge is overcome then I think there won’t be any major hurdles reaching to the last mile. In rural hospitals, the Maharashtra Government has completed filling up of 90 per cent posts of MBBS doctors. Now, we have a challenge on filling up of post-graduate vacancies at district, subdistrict, cottage and rural hospitals, having more than 50 beds. Notably, the Maharashtra Government has initiated a policy that doctors applying for renewal of their registration after five years have to mandatorily serve one year in the rural areas. If the doctors have served a year in the rural areas, the period will be treated as a ‘bond service’ to the government. This can be replicated by other states. Probably, this will help us get more and more doctors to work in rural areas.”
AUGUST 2017 | ehealth.eletsonline.com
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MPH, National Urban Health Mission, Government of Arunachal Pradesh Speaking of public health, the main problem we face in my state and other parts of the Northeast region is accessibility. We have problems in healthcare financing, manpower, infrastructure, medicines and equipment as well. In a way, PPP model has helped us in strengthening the state’s healthcare system. With the implementation of National Rural Health Mission in 2005, around 14 primary health centres are being run under PPP model in collaboration with Karuna Trust, a Karnataka-based NGO. These health centres are catering healthcare services really well in far-flung areas of our state.
Sanjay Deshmukh
Abhinav Agarwal
“The linkages between medical education and the public health system need more strengthening. At the level of medical colleges, we can introduce some necessary changes. In cities like Mumbai, non-communicable diseases have already crossed 10 per cent of the population. The issue needs to be addressed on priority. The average life expectancy has already reached 67.5 and we expect to take it up to 70 per cent by 2025. We’re exploring to provide supplementary knowledge of allopathic medical system to doctors to practice in rural areas. In the New Health Policy-2017, we’re hoping to increase the spending on health to 2.25 per cent of the GDP from the current 1.47 per cent. Probably, more spending and funding will arrive to strengthen the public healthcare system as well as the medical education system. In years to come, we should be able to achieve the policy goals of 2017.”
“In order to achieve any goals in public health, we need an active participation of one-and-all. We need to be well-informed on the latest trends. We can take a simple example on how we have used technology to impart information to the grassroots level. For instance, video conferencing can be used to inform all our 48,000 ASHAs in one instance, as the grassroots healthcare is very much dependant on them. There is a need of making the system more transparent and monitoring the data. Our biggest challenge is to make available the services to the grassroots levels in which ICT can play a major role.”
Secretary, Medical Education, Food & Drug Administration, Government of Maharashtra
Nodal Officer, Maternal Health, Government of Rajasthan
ehealth.eletsonline.com | AUGUST 2017
CONFERENCE REPORT
Dr Raja Dodum
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Dr R Harshvardhan
Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow “Let us look at the challenges and opportunities in public health delivery through a tri-elementary approach — input, process and output. The challenges that are available at the input level are manifold and primarily we look at infrastructure, manpower, equipment and supplies. The way the three-tier system has been designed in the public healthcare delivery, there is a topographical, geographical and heterogeneous distribution. We have to look at the challenges scientifically. In AIIMS, a study was conducted that revealed that 50 per cent of equipment in government hospitals are lying unused. If this is the state of hospitals in the country’s national capital, we can imagine the state of hospitals at district level across the length and breadth of the country. There is a need of capacity building through a long-term strategic plan: There is a great disparity in need and supply. Probably, the new National Health Policy, 2017 will look into it.”
Dr Supten Sarbadhikary
Project Director, Centre for Health Informatics of the National Health Portal
“Smart is basically safe and green. So, you need to keep safety in mind when you talk of smart healthcare. When we talk about public health delivery, it’s not just the hospitals or healthcare providers but it involves water, sanitation and other things as well. When we talk about challenges and opportunities, the challenges are not only in the health domain, but also in the other allied domains.”
AUGUST 2017 | ehealth.eletsonline.com
Dr Nitesh Shah Assistant Director (MA & RSBY), Rashtriya Swasthya Bima Yojna, Health and Family Welfare Department, Gujarat
“For any government, human resource (HR) is the major challenge in a public health delivery system. Through schemes like CM-SETU, Chiranjeevi Yojana and Bal Sakha Yojana, the Government of Gujarat has involved private sectors for addressing the HR issues. Infrastructure is another major challenge. To address this issue, Gujarat has initiated Mukhyamantri Amrutam Yojana and Rashtriya Sasta Bima Yojana. We’ve also initiated project implementation unit through which we’re developing infrastructure for the health.”
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Experts deliberate on ‘Medical Equipment & Devices: Building Capacity under Make in India’ during HLF-New Delhi.
Anjan Bose
Secretary-General , Healthcare Federation of India (NATHEALTH) “The moment inclusive healthcare is mentioned to me the following things come to my mind: universal health coverage, health for all, affordable, accessible and available across the country. India is a very diverse country. We have vast differences like European Union has from Yugoslavia to England and North Finland to South Italy. So, inclusivity is a tall order. Among the few prerequisites for Make in India include investment, innovation, skill and infrastructure.”
Rajiv Nath
Forum Coordinator, AIMED and Joint Managing Director, Hindustan Syringes and Medical Devices “Make in India is very interesting for medical devices because we don’t make most of devices in India. We import 70 per cent of the devices. Last year, the import bill was Rs 75,500 crore and electronics constituted 90 per cent of it. It is going up every year by Rs 2,500 crore or more. Even in percentage, it is not a falling figure and going up. So, definitely something is lacking in the ecosystem or policy framework, which is allowing this to happen. We want to make in India, but we need to look at why it is not being done. Is it the issue of competency, or competitiveness, or is it about the lack of capacity? Sometimes competitiveness can be created in very adverse environment and 700-800 odd manufacturers you find, who are making in India, are the ones who had the competency and the competitiveness to survive in a very adverse environment. They have to compete against imports coming in at a 0-7.5 per cent custom duty as compared to the automotive sector, which has 150 per cent to 200 per cent duty, or even bicycles at 20 per cent duty. So, anywhere there is a duty protection, it has definitely helped the industry.”
ehealth.eletsonline.com | AUGUST 2017
CONFERENCE REPORT
Medical Equipment & Devices: Building Capacity under Make in India
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Amit Bhatnagar
Managing Director, Accuster Technologies Pvt Ltd “Besides ‘Make in India’, it has to be ‘Make for India’ also. Not just from the market perspective but also from the design perspective. We need to design and build the medical devices according to India’s challenges and context. Challenges are different from other countries because they are not only environmental but also cultural and economical. We need to find out holistic answers, which try to meet the challenges of Indian market. We need to design products that are made for India and make in India. The challenge that I picked up is that 90 per cent of Indians are not getting quality diagnostics. I took four months to find out the reason behind it. The reason was very simple. The technology we are trying to bring in is not designed for Indian challenges. Delicate technology products are not fit to be transported to a remote location as there are challenges of availability of power and skilled manpower. Keeping all these challenges, we developed our own products. We developed a 600 gm analyser compared to 7-8 kg of heavy and delicate equipment. Further, we miniaturised the whole lab in a suitcase. We made such equipment that work from 2 degree Celsius to 50 degree Celsius, which consumes one-twentieth of the electricity of what conventional lab does.”
Dr Jitendar Sharma
Director and CEO, Andhra Pradesh Medtech Zone “Because of the positivity that our sector carries, we have not encountered any challenge that cannot be resolved. That is essentially because of the partners that we have. Andhra Pradesh is the only state in India that has achieved universal health coverage. We achieved it because of our focus on both poor as well as nonpoor population. Many states in India have schemes for the poor who are given some sort of coverage in both public and private hospitals. But the essential challenge for us was how to give healthcare coverage to non-poor. We launched a scheme on January 1 called Aarogya Raksha. Under this scheme, any person can pay Rs 100 per son irrespective of any secondary illness they have. Each individual can get Rs 2 lakh coverage per annum and is eligible for getting treatment in an air-conditioned semi-private ward in all government hospitals and almost 460 private hospitals. This was something which could not have been achieved without private sector engagement. Before the scheme was launched, we fixed up the reimbursement prices by agreeing to keep increasing it annually in accordance with the Consumer Inflation Index. So, if you sort out such business and transactional bottlenecks it is possible to get the existing private sector on board, cover poor -- which traditionally all governments have been doing -- and also cover non-poor. To cover non-poor, by taking just Rs 100 premium per individual per month, we are spending less than what we are earning even as a government.”
AUGUST 2017 | ehealth.eletsonline.com
Chander Shekhar Sibal Executive VicePresident, Fujifilm India
“Fujifilm has survived because of innovation in crisis. We have adopted the changes; we brought new technologies and diversified ourselves into many businesses. Our 70-80 per cent business was in camera roll, which became obsolete after digital camera entered the market. But Fujifilm survived and thrived because we were present in many different fields like entering into medical equipment business -- one of the very important steps that the company had taken at that point in time. We are still making X-ray films, the analogue films and digital films and computer radiology systems. Healthcare IT is our backbone. As far as medical equipment industry is concerned, India has become a very importfriendly country whereas manufacturing medical equipment is full of red-tapism, thus not allowing anybody to manufacture here.”
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Mainstreaming AYUSH with Modern Healthcare
The 7th edition of HLF witnessed experts discussing ways for ‘Mainstreaming AYUSH with Modern Healthcare’ in order to help India deliver healthcare to the last mile.
Dr Lalit Kumar
Honorary Senior Vice-President, Sulabh International “There are about 50 diseases that are caused by lack of sanitation facilities. Now there are reports that stunting of growth is also happening because of lack of sanitation. We have constructed more than 1.5 million toilets and nine thousand toilets with biodigesters, which I think can use AYUSH material. For mainstreaming of AYUSH, we need to provide small e-booklets or some one-two page literature to help people understand the system. A lot of communities rely on AYUSH, so there has to be some studies done in synergy with other disciplines. The placebo tag attached to the AYUSH has to be removed. We also need to have quality control on AYUSH products.”
ehealth.eletsonline.com | AUGUST 2017
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Dr D C Katoch
Advisor-Ayurveda, Government of India “We have more than 7,70,000 registered institutionally qualified AYUSH practitioners in the country. There are 575 AYUSH teaching institutions, out of which 195 are imparting post-graduate education. For every system, we have research council just like ICMR. All these research councils have 85 field units across the country for doing validation studies, clinical studies and for product research, etc. For each system, we have a national post-graduate institution like National Institute of Ayurveda at Jaipur, National Institute of Unani Medicine at Bangalore, National Institute of Yoga in Delhi, National Institute of Naturopathy in Pune and National Institute of Siddha in Chennai. For the Northeastern region, we have Northeastern Institute of Homeopathy in Shillong. Last year, the All India Institute of Ayurveda was opened near the Apollo Hospital in Delhi. Earlier, the manpower and infrastructure was working on a standalone basis but after National Rural Health Mission and National Health Mission came into effect some sort of integration has started. Unlike China, where there is functional integration of infrastructure, we have started physical integration. We are also providing AYUSH facilities in Community Health Centres, Primary Health Centres and District Hospitals. More than 60 per cent district hospitals in the country have AYUSH facilities.”
Dr K S Sethi
Advisor-Homeopathy, Ministry of AYUSH
Padmapriya Balakrishnan
“Homeopathy is more popular in India than its source country Germany. India is a leader in propagating homeopathic education and treatment with more than 300,000 institutionally qualified practitioners across the country. We have more than 200 homeopathic colleges, 43 post-graduate colleges. With co-location, people are getting benefitted and the burden on the infrastructure has been greatly reduced by AYUSH intervention. We have launched projects for non-communicable diseases like diabetes, cancer, strike and cardio-vascular diseases. It is on record that Homeopathy has helped in reduction of 70 per cent mortality. In the areas of multi-drug resistant tuberculosis, leprosy and mental illness homeopathy interventions are very encouraging. Even nerve regeneration has been seen after homeopathic intervention. We are going to start a research project with ICMR and supported financially by AYUSH to study this. The National Institute of Homepathy has been started in Kotayam and we have one more national institute in Kolkata, where OPD witnesses more than 2,000 patients per day.”
“If you see the trend in many African, Asian and Latin American countries, more than 80 per cent of the people depend on traditional medicines, which are locally available. We use medicinal plants in everyday life as food. It is already in mainstream and we have to accept it. As far as medicinal plants are concerned, our country is very rich in it. India is the only country in the world which has got the codified system of traditional medicines. We have the Shahsutra which is used for reference to treat anorectal diseases. When you compare the Shahsutra with allopathic treatment, the former is considered to be more effective. The only challenge for traditional medicine in our country is that it is very complicated. Many medicinal plants involved Emerging trends in our medicinal system have to be harvested at a particular time for efficacy.”
AUGUST 2017 | ehealth.eletsonline.com
Deputy Chief Executive Officer, National Medicinal Plants Board, Ministry of AYUSH, Government of India
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Panelists discussing ‘Emerging Trends in Hospital Management & Administration’ at the 7th edition of Healthcare Leaders Forum (HLF) in New Delhi.
Prof Dr Sanjeev Bagai
Vice-Chairman and Director-Dean, Manipal Hospital, New Delhi “India has approximately two per cent of land area and
21 per cent of disease burden. Approximately, 25 to 30 per cent of global deaths happen in India and approximately 40 to 50 per cent of those global deaths happen among children below the age group of five years. The burden of non-communicable and lifestyle diseases is huge on adolescents and age groups beyond that. We see patients in hospitals, administrators running the hospitals and financiers funding the building of these hospitals. In certain large metros and expensive land areas, the cost of building a hospital is upwards of Rs 2 crore per bed. Very often, we say, private healthcare is expensive but actually it is not when compared to most hospitals in the Western part of the world, looking at the sheer volume of money spent on developing infrastructure and given the world-class level of care, equipment and healthcare delivery services.”
ehealth.eletsonline.com | AUGUST 2017
CONFERENCE REPORT
Emerging Trends in Hospital Management and Administration and Diagnostics & Point-of-Care Technologies & Chronic Diseases Management - The Untapped Market
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Prof Dr Nitin A Nagarkar
Director, AIIMS-Raipur “I think the health sector per se in the entire world -- whether in Western countries or any other country -- is going to become more and more expensive in coming times. The expectation of the public is bound to increase. However, technology has its own advantages. I think the best way to leveraging the technology is through networking. If we can have peripheral facilities networked through the ICT, we can have them linked with central institutions, or similar kind of systems, where peripheral systems are loose rather than relying only on certain large hospitals or facilities in larger cities and metros. I think that should definitely bring down the cost in future.”
Dr Sajan Nair
Group Chief Operating Officer, Zydus Hospital, Ahmedabad “There has to be differences between regulatory and accreditation in accrediting agencies. It can’t be made mandatory, though it’s up to the people to accept the quality of standards. Let’s understand why hospitals apply for accreditation. One of the reasons accreditation was started is to bring quality healthcare into the system. Ten years back we used to have one or two hospital chains across India. But now the situation has changed and now we have regional players. You don’t have one single hospital fixing the standards. As we moved on, accreditation came into the system and the first to start were the corporate hospitals. Almost all corporate hospitals obtained it. It started in 2008 and as of now there are 400 plus accredited hospitals. Accreditation standards are all objective and the people delivering them are subjects. They’ve their subjects to interpretation of the assessments. Although the standards are good, the implementation is not monitored. That’s the reason, accreditation can’t be made mandatory.”
AUGUST 2017 | ehealth.eletsonline.com
Ravi Bhandari
Chief Executive Officer, Shalby Hospital, Gujarat “Maintaining standards across different hospitals of the same chain is really bugging the industry or the chain of hospitals. We see a particular centre of excellence operating very well for a particular hospital at a particular place, but the same is not replicated at its branches. There is definitely a lot to be done in this area. Accreditation is very subjective, but at the same time, it does help us to lay down certain processes in systems — for people at other units or other hospitals of the same group — to refer to, and see, if the closest forms of replication are happening at those locations. It really remains subjective and person dependant. Hence there is bound to remain some kind of a difference between different locations of the same hospital for a particular procedure.”
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Dr Shuchin Bajaj
Founder Director Cygnus Hospitals, Gurgaon “We have 10 hospitals running in small towns. The industry is very capital-intensive and bigger corporate do not want to enter small towns because they feel that returns are not big enough. We run very lean hospitals. Our cost setting up of hospital is only Rs 10 lakh per bed having cath lab, neurosurgery, blood bank, intensive care and all of them are NABH accredited. When we were starting out, it was very feasible for us to outsource departments. Initially, radiology was outsourced because we couldn’t afford to buy CT Scans, MRI, Mammogram machine, high-end ultrasound, etc., and outsourcing was simple. The ophthalmology, IVF, physiotherapy units were outsourced because they’ve the expertise to do these works. They have doctors doing the same surgeries 100 times a day rather than us, general practitioners, who cannot get to know smallsmall things that are needed to make those processes very smooth and quick. Money that comes out is also not that much for us to invest. We initially used to outsource everything just because we didn’t have money to set it up. But as we grew and could arrange some funding for us, after setting up 4th or 5th hospitals — we realised, more you outsource, more you cut your returns back. You’re getting only a fixed percentage and you cannot really scale it up. While trying to set up hospitals at low cost, I think, it’s very good to follow shop-in-a-shop model and try to get as many people involved as possible.”
Neeraj Gupta
Director, Imperial Life Sciences Pvt Ltd “On one side, we have some of the most advanced hospitals which are epicenters of medical tourism in India but on the other side we have the highest number of deaths that are below the age of five. We have so many lifestyle diseases. One of the major reasons for all of this is the gap in terms of how we see diagnostics and how we see the treatment. If we are diagnosed with any kind of cancer, we are ready to spend any amount of money to treat that. But when it comes to diagnosis, we are very old school. We are trying to bring a preventive test, which not only takes care of basic biochemical testing but also provide a genetic makeup of each individual: what kind of disease he/she is having a predisposition for, or they’re subjected to have in future. These tests are becoming cost-effective these days. Later, as these tests get more prominent and keeps going up with the larger population accepting, the cost of the testing will further keep coming down.”
Vice President and Cluster Head, Rainbow Children’s Hospitals, Bangalore “In places like Hyderabad and Bangalore, more than 60 per cent of the business comes from health insurance and credit patient. So, insurance has developed over a period of years: PPN has gone, GIPSA has come and rate management is happening. Since the inception of cashless transactions in 2005, insurance has become more popular with so many new products launched. Earlier, about 70 per cent of the insurance was covered by companies managed by PSUs. But in the last few years, the private players have played a major role and most of the corporates have taken insurance for their employees. Most of the healthcare needs of Indians are being managed by health insurance companies. Gradually, private insurance will take major part of insurances. There are so many products that are patient-friendly. Less than 10 per cent people in India are covered under health insurance. Average plays an important role in determining the cost of insurance.”
ehealth.eletsonline.com | AUGUST 2017
CONFERENCE REPORT
Neeraj Lal
THANK YOU
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for your Immense Support and Participation in making
A Grand Success Heartiest thanks to all our speakers, participants, delegates and sponsors for their contribution in making the 7th Healthcare Leaders Forum a great success. It would not have been possible without each one of you.
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